Granulocyte colony-stimulating factor with or without stem or progenitor cell infusion for people with compensated or decompensated advanced chronic liver disease

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:. To assess the benefits and harms of granulocyte colony-stimulating factor with or without stem or progenitor cell infusion in people with compensated or decompensated advanced chronic liver disease

The Southern 2MASS AGN Survey: spectroscopic follow-up with 6dF

The Two Micron All-Sky Survey (2MASS) has provided a uniform photometric catalog to search for previously unknown red AGN and QSOs. We have extended the search to the southern equatorial sky by obtaining spectra for 1182 AGN candidates using the 6dF multifibre spectrograph on the UK Schmidt Telescope. These were scheduled as auxiliary targets for the 6dF Galaxy Redshift Survey. The candidates were selected using a single color cut of J - Ks > 2 to Ks ~ 15.5 and a galactic latitude of |b|>30 deg. 432 spectra were of sufficient quality to enable a reliable classification. 116 sources (or ~27%) were securely classified as type 1 AGN, 20 as probable type 1s, and 57 as probable type 2 AGN. Most of them span the redshift range 0.05<z<0.5 and only 8 (or ~6%) were previously identified as AGN or QSOs. Our selection leads to a significantly higher AGN identification rate amongst local galaxies (>20%) than in any previous galaxy survey. A small fraction of the type 1 AGN could have their optical colors reddened by optically thin dust with A_V<2 mag relative to optically selected QSOs. A handful show evidence for excess far-IR emission. The equivalent width (EW) and color distributions of the type 1 and 2 AGN are consistent with AGN unified models. In particular, the EW of the [OIII] emission line weakly correlates with optical--near-IR color in each class of AGN, suggesting anisotropic obscuration of the AGN continuum. Overall, the optical properties of the 2MASS red AGN are not dramatically different from those of optically-selected QSOs. Our near-IR selection appears to detect the most near-IR luminous QSOs in the local universe to z~0.6 and provides incentive to extend the search to deeper near-IR surveys.Comment: 57 pages, 12 figures, 4 tables, to appear in vol.27/4 of Publications of the Astronomical Society of Australia (PASA

Increased hormonal stress response of Apennine chamois induced by interspecific interactions and anthropogenic disturbance

Responses of animals to environmental changes and their interactions with other species play an important role in conservation. Sharing a common habitat may lead to interspecific competition for resources, but field assessment of these biological events is not always easily accomplished. By using a non-invasive method, we evaluated the physiological stress responses of Apennine chamois (Rupicapra pyrenaica ornata) to the presence of cattle, sheep and goat, red deer (Cervus elaphus), people (hikers), and predators to identify which factors may affect this endangered species. During September 2012, November 2012, and July 2013, a total of 318 faecal samples were collected in representative sites and analysed for faecal cortisol metabolites (FCM). FCM concentration was analysed through linear mixed-effect models. A significant increase in FCM values in Apennine chamois sharing their habitat with domestic animals was recorded during all study periods. On the contrary, stress responses to red deer and people were limited in time and emerged only during summer months, when hikers are more frequent and red deer extend their altitudinal range reaching chamois\u2019 habitat. The observed effects of domestic animals, red deer, and hikers should be considered in future Apennine chamois management plans, which should include the regulation of pastured domestic livestock, anthropogenic disturbances, and possible interferences with other wild species within parks

Non-steroid anti-inflammatory drugs for biliary colic

Cholelithiasis refers to the presence of gallstones, which are concretions that form in the biliary tract, usually in the gallbladder. Cholelithiasis is one of the most common surgical problems worldwide and is particularly prevalent in most Western countries.Biliary colic is the term used for gallbladder pain experienced by a person with gallstones and without overt infection around the gallbladder. It is the most common manifestation of cholelithiasis, observed in over one-third of people with gallstones over the course of 10 or more years. Non-steroid anti-inflammatory drugs (NSAIDs) have been widely used to relieve biliary colic pain, but their role needs further elucidation. They may decrease the frequency of short-term complications, such as mild form of acute cholecystitis, jaundice, cholangitis, and acute pancreatitis, but they may also increase the occurrence of more severe and possibly life-threatening adverse events such as gastrointestinal bleeding, renal function impairment, cardiovascular events, or milder events such as abdominal pain, drowsiness, headache, dizziness, or cutaneous manifestations

The Role of Spleen and Liver Elastography and Color-Doppler Ultrasound in the Assessment of Transjugular Intrahepatic Portosystemic Shunt Function

The reference standard for assessing transjugular intrahepatic portosystemic shunt (TIPS) function is venography with portosystemic pressure gradient (PPG) measurement. This procedure is invasive and expensive; thus, we assessed the feasibility, reproducibility and diagnostic accuracy of color-Doppler ultrasound (CDUS) and spleen and liver stiffness (LS) measurements for identifying TIPS dysfunction. Twenty-four patients (15 undergoing TIPS placement and nine undergoing TIPS revision) consecutively underwent CDUS examination and LS and spleen stiffness (SS) determination by transient elastography (TE) and point shear-wave elastography (pSWE). All parameters were taken before TIPS placement/revision (1\u201315 d before) and 24 h after, just before revision by venography. pSWE inter-observer agreement was assessed by intra-class correlation coefficient (ICC). CDUS and elastographic data were correlated (Pearson coefficient) with pressure gradients (hepatic venous pressure gradient [HVPG], PPG). Main determinants of TIPS dysfunction were investigated by linear regression. Forty-nine paired examinations were performed in total: 49 (100%) SS reliable measurements by pSWE and 38 (88%) by TE. The ICC for pSWE values was 0.90 (95% confidence interval [CI] 0.81\u20120.94). SS values significantly correlated with HVPG and PPG (R = 0.51, p = 0.01). The area under the Receiver-Operating Characteristic (AUROC) curve of SS for diagnosing TIPS dysfunction was 0.86 (95% CI 0.70\u20120.96) using a 25 kPa cutoff. At multivariate analysis, the flow direction of the intrahepatic portal vein branches and SS values were independently associated to TIPS dysfunction. The intrahepatic portal vein branches flow direction and SS value are two simple, highly sensitive parameters accurately excluding TIPS dysfunction. SS measurement by pSWE is feasible, reproducible and both positively and significantly correlates with HVPG and PPG values

Ultrasound elastographic techniques in focal liver lesions

Elastographic techniques are new ultrasound-based imaging techniques developed to estimate tissue deformability/stiffness. Several ultrasound elastographic approaches have been developed, such as static elastography, transient elastography and acoustic radiation force imaging methods, which include point shear wave and shear wave imaging elastography. The application of these methods in clinical practice aims at estimating the mechanical tissues properties. One of the main settings for the application of these tools has been liver stiffness assessment in chronic liver disease, which has been studied mainly using transient elastography. Another field of application for these techniques is the assessment of focal lesions, detected by ultrasound in organs such as pancreas, prostate, breast, thyroid, lymph nodes. Considering the frequency and importance of the detection of focal liver lesions through routine ultrasound, some studies have also aimed to assess the role that elestography can play in studying the stiffness of different types of liver lesions, in order to predict their nature and thus offer valuable non-invasive methods for the diagnosis of liver masses

Size and Properties of the NLR in the Seyfert-2 Galaxy NGC 1386

We study the narrow-line region (NLR) of the Seyfert-2 galaxy NGC 1386 by means of long-slit spectroscopy obtained with FORS1 at the VLT. We use the galaxy itself for subtracting the stellar template, applying reddening corrections to fit the stellar template to the spectra of the NLR. The continuum gets steadily redder towards the nucleus. The spatial distribution of the reddening derived from the Balmer decrement differs from the continuum reddening, indicating dust within the NLR with a varying column density along the line of sight. Using spatially resolved spectral diagnostics, we find a transition between central line ratios falling into the AGN regime and outer ones in the HII-region regime, occuring at a radius of ~6 arcsec (310 pc) in all three diagnostic diagrams. Applying CLOUDY photoionisation models, we show that the observed distinction between HII-like and AGN-like ratios in NGC 1386 represents a true difference in ionisation source and cannot be explained by variations of physical parameters such as ionisation parameter, electron density or metallicity. We interpret it as a real border between the NLR, i.e. the central AGN-photoionised region and surrounding HII regions. We derive surface brightness, electron density, and ionisation parameter as a function of distance from the nucleus. Both the electron density and the ionisation parameter decrease with radius. We discuss the consequences of these observations for the interpretation of the empirical NLR size-luminosity relation. In the outer part of the NLR, we find evidence for shocks, resulting in a secondary peak of the electron-density and ionisation-parameter distribution north of the nucleus. We compare the NLR velocity curve with the stellar one and discuss the differences.Comment: 14 pages, 20 figures, accepted for publication in A&

Planet Hunters: Assessing the Kepler Inventory of Short Period Planets

We present the results from a search of data from the first 33.5 days of the Kepler science mission (Quarter 1) for exoplanet transits by the Planet Hunters citizen science project. Planet Hunters enlists members of the general public to visually identify transits in the publicly released Kepler light curves via the World Wide Web. Over 24,000 volunteers reviewed the Kepler Quarter 1 data set. We examine the abundance of \geq 2 R\oplus planets on short period (< 15 days) orbits based on Planet Hunters detections. We present these results along with an analysis of the detection efficiency of human classifiers to identify planetary transits including a comparison to the Kepler inventory of planet candidates. Although performance drops rapidly for smaller radii, \geq 4 R\oplus Planet Hunters \geq 85% efficient at identifying transit signals for planets with periods less than 15 days for the Kepler sample of target stars. Our high efficiency rate for simulated transits along with recovery of the majority of Kepler \geq 4 R\oplus planets suggest suggests the Kepler inventory of \geq 4 R\oplus short period planets is nearly complete.Comment: 41 pages,13 figures, 8 tables, accepted to Ap

Definition of Healthy Ranges for Alanine Aminotransferase Levels: A 2021 Update

The changing epidemiology of liver disease, and modifications in the recommended analytical methodology call for a re-evaluation of the upper reference limits (URLs) of alanine aminotransferase (ALT) levels. Using the same ap- proach consolidated 20 years ago to define the healthy population, we defined the URL for the newly recommended International Federation of Clinical Chemistry (IFCC) standardized test. In a cross-sectional study, we examined 21,296 apparently healthy blood donors (age 18-65 years) and calculated the sex-specific URL by the 95th percentile in indi- viduals without risk factors for liver disease. These were tested for the ability to predict liver damage in a subset of 745 participants with dysmetabolism, in an independent cohort of 977 unselected donors, and in 899 patients with chronic liver disease. ALT levels were measured by the IFCC test. Male sex, body mass index, glucose, lipids, ferritin, hyper- tension, and younger age were independent ALT predictors (P < 0.001). Updated URLs were identified at 42/30 U/L in males/females, approximately 30% lower than those currently recommended by the IFCC. Due to improved sensitiv- ity, they conferred the ability to detect steatosis and significant fibrosis in individuals with dysmetabolism (odds ratio [OR] = 2.31, range 1.40-3.80, P = 0.001; and OR = 3.35, range 1.19-9.42, P = 0.021; respectively), although with a limited accuracy, and significant fibrosis in unselected donors (OR = 2.32, 1.02-5.31, P = 0.045). Updated URLs had a moderate to high accuracy to discriminate liver conditions (area under the receiver operating characteristic curve = 0.81, range 0.78-0.91). Conclusion: Updated URLs by the IFCC method were lower than those calculated in initial studies, but higher than those in use with the recommended old, nonstandardized method, and were able to better predict liver disease. The limited awareness that different techniques are still in use should be regarded as a possible source of medical errors

Diagnosis of hepatocellular carcinoma in cirrhosis by dynamic contrast imaging: The importance of tumor cell differentiation

Dynamic contrast imaging techniques are considered the standard of care for the radiological diagnosis of hepatocellular carcinoma (HCC) in cirrhosis. However, the accuracy of radiological diagnosis depends largely on the degree of arterial hypervascularization, which increases with tumor size. Owing to the interplay and prognostic relevance of tumor vascularization and cell differentation, we asked ourselves whether tumor grade also affects the outcome of radiological diagnosis. Sixty-two HCCs (47 of which measured 1-2 cm) were consecutively detected in 59 patients with compensated cirrhosis under surveillance with ultrasound and confirmed by way of echo-guided biopsy and concurrent investigations with contrast-enhanced ultrasound (CE-US), computed tomography (CT), and gadolinium magnetic resonance imaging (MRI). Tumor cell differentiation was evaluated using Edmondson-Steiner criteria in liver cores of 0.9-5.0 cm (median 1.6 cm). Eighteen (29%) HCCs were grade I (1.5 cm), 28 (45%) were grade II (1.5 cm), 16 (26%) were grade III (1.8 cm), and none were grade IV. Contrast wash-in and wash-out were concurrently demonstrated in 21 (34%) tumors by way of CE-US, including three (16%) grade I and 18 (41%) grade II-III (P = 0.08); in 32 (52%) tumors by way of CT, including three (16%) grade I and 29 (66%) grade II-III (P = 0.0006); and 28 (47%) tumors by way of MRI, including three grade I (16%) and 25 (57%) grade II-III (P = 0.01). Among 1- to 2-cm tumors, the radiological diagnosis was achieved in two of 16 grade I and 17of 31 grade II-III tumors (P = 0.006). Conclusion: Tumor grade, a relevant predictor of disease severity, influences the accuracy of dynamic contrast techniques in the diagnosis of HCC