Elective percutaneous liver biopsy and use of aspirin.

OBJECTIVES Percutaneous liver biopsy is an essential diagnostic investigation in hepatology. Among complications, which are rare, bleeding is the most feared. Many patients scheduled for a liver biopsy are taking aspirin. Surprisingly no information is available in the literature on this frequent clinical situation. The American Association for the Study of Liver Diseases (AASLD) position paper on percutaneous liver biopsy does not specifically recommend stopping low dose aspirin prior to an elective percutaneous liver biopsy. The European Association for the Study of the Liver also remains unspecific without giving clear recommendation on stopping or not low dose aspirin before the procedure. The aim of this study is to document current practice concerning the management of patients scheduled for an elective percutaneous biopsy and taking low dose aspirin. DESIGN An online questionnaire was designed to gather data on current practice on the perioperative management of percutaneous liver biopsy and use of aspirin. SETTINGS The questionnaire was emailed to AASLD members in September 2018. PARTICIPANTS Four hundred sixty six responses were collected. RESULTS Seventy eight percent postpone elective percutaneous liver biopsy if International Normalised Ratio is ≥1.5 or Quick ≤50%. Ninety five percent postpone biopsy if platelet count is ≤50,000 × 106 /L. Seventy five percent stop low dose aspirin, on average, 6 days prior to the percutaneous liver biopsy. This choice of management does not seem to be related to previous complications since 86% report not having experienced any bleeding in patients taking low dose aspirin. Nevertheless, this practice has logistic consequences since 61% of the respondents postponed a liver biopsy due to intake of low dose aspirin. CONCLUSIONS Despite the lack of clear statement in guidelines and evidence supporting this practice, three quarters of physicians practicing in hepatology stop low dose aspirin before elective percutaneous liver biopsy

Correlates of at-risk gambling behaviors of homeless youth

Objective: This exploratory study aims to describe the gambling behaviors of 419 homeless youth. Methods: Participants were divided into two groups: 1) those whose gambling behaviors did not present a risk (n=366); and 2) those whose gambling behaviors presented a risk (n=53). Results: In this homeless youth cohort, 12.6% exhibited gambling behaviors that could be considered at-risk. Compared to youth not having at-risk gambling behavior, youth with at-risk gambling behaviors were more likely to be male and be born outside of Canada. The at-risk participants were three times more likely to have a diagnosis of mental health disorder and two times more likely to report criminal activities as their main source of income. Conclusions: These findings underline the importance of addressing all at-risk behaviors engaged in by homeless youth

PPAR-Targeted Therapies in the Treatment of Non-Alcoholic Fatty Liver Disease in Diabetic Patients.

Peroxisome proliferator-activated receptors (PPAR), ligand-activated transcription factors of the nuclear hormone receptor superfamily, have been identified as key metabolic regulators in the liver, skeletal muscle, and adipose tissue, among others. As a leading cause of liver disease worldwide, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) cause a significant burden worldwide and therapeutic strategies are needed. This review provides an overview of the evidence on PPAR-targeted treatment of NAFLD and NASH in individuals with type 2 diabetes mellitus. We considered current evidence from clinical trials and observational studies as well as the impact of treatment on comorbid metabolic conditions such as obesity, dyslipidemia, and cardiovascular disease. Future areas of research, such as possible sexually dimorphic effects of PPAR-targeted therapies, are briefly reviewed

Herpes simplex virus hepatitis 4 years after liver transplantation

If not promptly recognized and treated, herpes simplex virus (HSV) hepatitis is associated with a high mortality. A patient transplanted for primary sclerosing cholangitis required, 4 years later, a colectomy for a steroid-resistant flare of ulcerative colitis. He subsequently developed fever, with genital and oral ulcerations. He was hospitalized for diabetic decompensation with massive elevation of serum aminotransferases. Examination revealed vesicles on the hands. Liver biopsy showed Cowdry type B inclusions. Therapy with acyclovir was immediately initiated and the patient recovered. This case illustrates the diagnostic importance of mucocutaneous lesions in the assessment of complications after liver transplantatio

Biochar as a catalyst for hydrogen production from methane conversion

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In-Plane Forces Prediction and Analysis in High-Speed Conditions on a Contra-Rotating Open Roto

Due to the growing interest from engine and aircraft manufacturers for contra-rotating open rotors (CROR), much effort is presently devoted to the development of reliable computational fluid dynamics (CFD) methodologies for the prediction of performance, aerodynamic loads, and acoustics. Forces transverse to the rotation axis of the propellers, commonly called in-plane forces (or sometimes 1P forces), are a major concern for the structural sizing of the aircraft and for vibrations. In-plane forces impact strongly the stability and the balancing of the aircraft and, consequently, the horizontal tail plane (HTP) and the vertical tail plane (VTP) sizing. Also, in-plane forces can initiate a flutter phe- nomenon on the blades or on the whole engine system. Finally, these forces are unsteady and may lead to vibrations on the whole aircraft, which may degrade the comfort of the passengers and lead to structural fatigue. These forces can be predicted by numerical methods and wind tunnel measurements. However, a reliable estimation of in-plane forces requires validated prediction approaches. To reach this objective, comparisons between several numerical methods and wind tunnel data campaigns are necessary. The primary objective of the paper is to provide a physical analysis of the aerodynamics of in-plane forces for a CROR in high speed at nonzero angle of attack using unsteady simulations. Confidence in the numerical results is built through a code-to-code comparison, which is a first step in the verification process of in-plane forces prediction. Thus, two computa- tional processes for unsteady Reynolds-averaged Navier–Stokes (URANS) simulations of an isolated open rotor at nonzero angle of attack are compared: computational strategy, open rotor meshing, aerodynamic results (rotor forces, blades thrust, and pressure distributions). In a second step, the paper focuses on the understanding of the key aerodynamic mechanisms behind the physics of in-plane forces. For the front rotor, two effects are predominant: the first is due to the orientation of the freestream velocity, and the second is due to the distribution of the induced velocity. For the rear rotor, the freestream velocity effect is reduced but is still dominant. The swirl generated by the front rotor also plays a major role in the modulus and the direction of the in-plane force. Finally, aerodynamic interactions are found to have a minor effect

Endoplasmic Reticulum and Mitochondria Contacts Correlate with the Presence and Severity of NASH in Humans.

The interaction between the mitochondria and the endoplasmic reticulum (ER) is essential for hepatocyte function. An increase in ER-mitochondria contacts (ERMCs) is associated with various metabolic diseases. Non-alcoholic fatty liver disease (NAFLD) is associated with obesity and type 2 diabetes, and its progressive form non-alcoholic steatohepatitis (NASH) can lead to cirrhosis and hepatocellular carcinoma. However, the role of ERMCs in the progression of NAFL to NASH is still unclear. We assessed whether ERMCs could correlate with NAFLD severity. We used a proximity ligation assay to measure the abundance of ERMCs in liver biopsies from patients with biopsy-proven NAFLD (n = 48) and correlated the results with histological and metabolic syndrome (MetS) features. NAFLD patients were included according to inclusion and exclusion criteria, and then assigned to NAFL (n = 9) and NASH (n = 39) groups. ERMCs density could discriminate NASH from NAFL (sensitivity 61.5%, specificity 100%). ERMCs abundance correlated with hepatocellular ballooning. Moreover, the density of ERMCs increased with an increase in the number of MetS features. In conclusion, ERMCs increased from NAFL to NASH, in parallel with the number of MetS features, supporting a role for this interaction in the pathophysiology of NASH