Optimal management for alcoholic liver disease: Conventional medications, natural therapy or combination?

© The Author(s) 2016. Alcohol consumption is the principal factor in the pathogenesis of chronic liver diseases. Alcoholic liver disease (ALD) is defined by histological lesions on the liver that can range from simple hepatic steatosis to more advanced stages such as alcoholic steatohepatitis, cirrhosis, hepatocellular carcinoma and liver failure. As one of the oldest forms of liver injury known to humans, ALD is still a leading cause of liver-related morbidity and mortality and the burden is exerting on medical systems with hospitalization and management costs rising constantly worldwide. Although the biological mechanisms, including increasing of acetaldehyde, oxidative stress with induction of cytochrome p450 2E1, inflammatory cytokine release, abnormal lipid metabolism and induction of hepatocyte apoptosis, by which chronic alcohol consumption triggers serious complex progression of ALD is well established, there is no universally accepted therapy to prevent or reverse. In this article, we have briefly reviewed the pathogenesis of ALD and the molecular targets for development of novel therapies. This review is focused on current therapeutic strategies for ALD, including lifestyle modification with nutrition supplements, available pharmacological drugs and new agents that are under development, liver transplantation, application of complementary medicines, and their combination. The relevant molecular mechanisms of each conventional medication and natural agent have been reviewed according to current available knowledge in the literature. We also summarized efficacy vs safety on conventional and herbal medicines which are specifically used for the prevention and treatment of ALD. Through a system review, this article highlighted that the combination of pharmaceutical drugs with naturally occurring agents may offer an optimal management for ALD and its complications. It is worthwhile to conduct large-scale, multiple centre clinical trials to further prove the safety and benefits for the integrative therapy on ALD

Optimization of admixture and three-layer particleboard made from oil palm empty fruit bunch and rubberwood clones

Empty fruit bunch (EFB) is a biomass that is widely available and has the potential to be used as industrial raw material especially in wood-based industries. This study focuses on producing a particleboard by incorporating EFB with two different rubberwood clones: Prang Besar (PB) 260 and RRIM 2002, respectively. PB 260 is a commercially planted clone and wood from matured (>25 year-old) trees are used by wood-based panel manufacturers. RRIM 2002 is a new clone planted at the Malaysian Rubber Board (MRB) research trial plots and consists of only 4-year-old trees. Two types of particleboards (admixture and three-layer) with different ratios were produced. The Japanese Industrial Standard (JIS-5908 2003 particleboard) was used to evaluate mechanical and dimensional stability properties of the particleboards. From the study, it was found that admixture particleboards showed superior properties compared to three-layer particleboards. Layering EFB and rubberwood significantly decreased board performance for all properties (except internal bonding). The optimum ratios of EFB and both rubberwood clones are found to be 1:1 (50% EFB: 50% rubberwood). Meanwhile, increasing the rubberwood clones ratio to 70% lowered board performance especially for EFB (30%):RRIM 2002 clone (70%) boards which showed the lowest values for all properties for both admixture and three-layer board

Institutional leadership—the historical case study of a religious organisation

In this chapter, I discuss institutional leadership vis-à-vis the value of poverty. To do so, I analyse how poverty has been conceptualised within a Catholic religious organisation, the Jesuits. The chapter shows that, in the Jesuit case, poverty is not strictly defined. Instead, poverty results from the constant dialogue between the individual Jesuit and their leader. This means that the understanding of what constitutes poverty is neither explicit nor implicit. The chapter contributes to our understanding of institutional leadership as the promotion and protection of values, as per Selznick’s classical definition. However, we discuss a less known part of Selznick’s work in which the ambiguous character of values is highlighted. In this sense, and after the Jesuit case, we advance the possibility that the promotion and protection of institutional values by institutional leaders does not necessarily imply the definition of what a value is. As values are not defined beforehand but the result of a constant dialogue between the leader and their followers, institutional leadership can be revisited and freed from the heroic view that has long characterised it

Using graphene nanoplatelets nanofluid in a closed-loop evacuated tube solar collector—energy and exergy analysis

Recently, nanofluid application as a heat transfer fluid for a closed-loop solar heat collector is receiving great attention among the scientific community due to better performance. The performance of solar systems can be assessed effectively with the exergy method. The present study deals with the thermodynamic performance of the second law analysis using graphene nanoplatelets nanofluids. Second law analysis is the main tool for explaining the exergy output of thermodynamic and energy systems. The performance of the closed-loop system in terms of energy and exergy was determined by analyzing the outcome of field tests in tropical weather conditions. Moreover, three parameters of entropy generation, pumping power and Bejan number were also determined. The flowrates of 0.5, 1 and 1.5 L/min and GNP mass percentage of 0.025, 0.5, 0.075 and 0.1 wt% were used for these tests. The results showed that in a flow rate of 1.5 L/min and a concentration of 0.1 wt%, exergy and thermal efficiencies were increased to about 85.5 and 90.7%, respectively. It also found that entropy generation reduced when increasing the nanofluid concentration. The Bejan number surges up when increasing the concentration, while this number decreases with the enhancement of the volumetric flow rate. The pumping power of the nanofluid-operated system for a 0.1 wt% particle concentration at 0.5 L/min indicated 5.8% more than when pure water was used as the heat transfer fluid. Finally, this investigation reveals the perfect conditions that operate closest to the reversible limit and helps the system make the best improvement

Risk-Based Screening Tools to Optimise HIV Testing Services: a Systematic Review.

PURPOSE OF REVIEW: Effective ways to diagnose the remaining people living with HIV who do not know their status are a global priority. We reviewed the use of risk-based tools, a set of criteria to identify individuals who would not otherwise be tested (screen in) or excluded people from testing (screen out). RECENT FINDINGS: Recent studies suggest that there may be value in risk-based tools to improve testing efficiency (i.e. identifying those who need to be tested). However, there has not been any systematic reviews to synthesize these studies. We identified 18,238 citations, and 71 were included. The risk-based tools identified were most commonly from high-income (51%) and low HIV (<5%) prevalence countries (73%). The majority were for "screening in" (70%), with the highest performance tools related to identifying MSM with acute HIV. Screening in tools may be helpful in settings where it is not feasible or recommended to offer testing routinely. Caution is needed for screening out tools, where there is a trade-off between reducing costs of testing with missing cases of people living with HIV

Combined Laparoscopic and Thoracoscopic Repair of A Large Traumatic Diaphragmatic Hernia: A Case Report

SUMMARY Traumatic diaphragmatic hernia is a well known complication of blunt trauma to the abdomen and thorax. In the acute setting, laparotomy is mandatory. In this current era, this condition can be managed with minimally invasive surgery. We hereby report a case of delayed large left diaphragmatic hernia that was repaired with a combination of laparoscopic and thoracoscopic approach. KEY WORDS: Diaphragmatic hernia, laparoscopic, thoracoscopic, trauma INTRODUCTION Mechanisms of traumatic diaphragmatic hernia have been well described after blunt injury to the chest and abdominal cavity. Diaphragmatic ruptures can occur from 0.8% to 7.0% of blunt abdominal trauma, with left hemi diaphragm involvement the commonest; a ratio of 9:1. 1, 2 Conventionally, laparotomy is indicated in all patients with other associated injuries in the acute setting. However, when the diagnosis is missed during early post trauma period, thoracotomy and repair were recommended. In this present era of minimally invasive surgery, laparoscopy is a useful means to treat diaphragmatic rupture even during the acute phase. 1, 2 Here, we report a case with a delayed large left diaphragmatic hernia that was repaired with a combination of laparoscopy and thoracoscopic approach. CASE REPORT A 30 year old gentleman presented to the emergency department with sudden onset breathlessness on exertion. He had a history of left rib fracture due to motor vehicle accident four years ago, but otherwise asymptomatic prior to current complaint. On examination, the left chest had reduced breath sounds and his abdomen was scaphoid but non tender. Plain chest x-ray showed loops of bowel in the left thorax. Computerized tomography of the thorax and abdomen revealed large left diaphragmatic hernia with bowel occupying almost all the left thorax (figure 1). Elective laparoscopic and thoracoscopic repair of incarcerated diaphragmatic hernia with mesh was performed. He was put in supine position with slightly left sided up. Five trocars were placed; 1x12mm (camera port at infra umbilicus) and 4x5mm (two ports at right upper quadrant, one port at left 4th intercostal space anterior axillary line and another port at the lateral aspect of left upper quadrant). The omentum, small bowel and transverse colon were found densely adhered into the left hemithorax through the left anterolateral diaphragmatic hernia that measured 10x5 cm (figure 2). A combination of blunt and sharp dissection was used to reduce the hernia content to the abdominal cavity. Thoracoscopic approach was used to release the dense adhesion at the upper lobe of the lung to the left lateral thoracic wall. Upon reduction, the hernia defect was then closed with ethibon 2/0. Before placing the mesh, the anaesthetist increased the tidal volume to expand the collapsed left lower lobe of the lung and a chest drain size 28F was placed in the left pleural space. Composite mesh 10x15cm was reinforced with secure strap tackers. Portex drain size 27F was placed at left sub diaphragmatic space. The patient was then transferred to the intensive care unit (ICU) postoperatively. He was extubated on day one in ICU and on postoperative day two, he was transferred out to the general ward. Chest x-ray immediate post-operative showed expansion of the left lung with minimal pleural effusion. He was discharged on post-operative day six. He recovered well and during clinic follow up to six months, there was no evidence of recurrence or infection. DISCUSSION Chronic traumatic diaphragmatic hernia is conventionally repaired using the thoracotomy approach, reduction of intraabdominal content and closure of the defect primarily. Where else in acute cases, a laparotomy is performed to reduce and repair the diaphragmatic hernia defect. In 1976, thoracoscopy was used to evaluate diaphragmatic injuries. Laparoscopy was used in a case series of suspected diaphragmatic injury in 1984

Multifrequency Strategies for the Identification of Gamma-Ray Sources

More than half the sources in the Third EGRET (3EG) catalog have no firmly established counterparts at other wavelengths and are unidentified. Some of these unidentified sources have remained a mystery since the first surveys of the gamma-ray sky with the COS-B satellite. The unidentified sources generally have large error circles, and finding counterparts has often been a challenging job. A multiwavelength approach, using X-ray, optical, and radio data, is often needed to understand the nature of these sources. This chapter reviews the technique of identification of EGRET sources using multiwavelength studies of the gamma-ray fields.Comment: 35 pages, 22 figures. Chapter prepared for the book "Cosmic Gamma-ray Sources", edited by K.S. Cheng and G.E. Romero, to be published by Kluwer Academic Press, 2004. For complete article and higher resolution figures, go to: http://www.astro.columbia.edu/~muk/mukherjee_multiwave.pd

Determining Possible Shared Genetic Architecture Between Myopia and Primary Open-Angle Glaucoma

PURPOSE: To determine genetic correlations between common myopia and primary open-angle glaucoma (POAG). // METHODS: We tested the association of myopia polygenic risk scores (PRSs) with POAG and POAG endophenotypes using two studies: the Australian & New Zealand Registry of Advanced Glaucoma (ANZRAG) study comprising 798 POAG cases with 1992 controls, and the Rotterdam Study (RS), a population-based study with 11,097 participants, in which intraocular pressure (IOP) and optic disc parameter measurements were catalogued. PRSs were derived from genome-wide association study meta-analyses conducted by the Consortium for Refractive Error and Myopia (CREAM) and 23andMe. In total, 12 PRSs were constructed and tested. Further, we explored the genetic correlation between myopia, POAG, and POAG endophenotypes by using the linkage disequilibrium score regression (LDSC) method. // RESULTS: We did not find significant evidence for an association between PRS of myopia with POAG (P = 0.81), IOP (P = 0.07), vertical cup-disc ratio (P = 0.42), or cup area (P = 0.25). We observed a nominal association with retinal nerve fiber layer (P = 7.7 × 10-3) and a significant association between PRS for myopia and disc area (P = 1.59 × 10-9). Using the LDSC method, we found a genetic correlation only between myopia and disc area (genetic correlation [RhoG] = -0.12, P = 1.8 × 10-3), supporting the findings of the PRS approach. // CONCLUSIONS: Using two complementary approaches we found no evidence to support a genetic overlap between myopia and POAG; our results suggest that the comorbidity of these diseases is not influenced by common variants. The association between myopia and optic disc size is well known and validates this methodology

Progress on Modified Calcium Oxide Derived Waste-Shell Catalysts for Biodiesel Production

The dwindling of global petroleum deposits and worsening environmental issues have triggered researchers to find an alternative energy such as biodiesel. Biodiesel can be produced via transesterification of vegetable oil or animal fat with alcohol in the presence of a catalyst. A heterogeneous catalyst at an economical price has been studied widely for biodiesel production. It was noted that various types of natural waste shell are a potential calcium resource for generation of bio-based CaO, with comparable chemical characteristics, that greatly enhance the transesterification activity. However, CaO catalyzed transesterification is limited in its stability and studies have shown deterioration of catalytic reactivity when the catalyst is reused for several cycles. For this reason, different approaches are reviewed in the present study, which focuses on modification of waste-shell derived CaO based catalyst with the aim of better transesterification reactivity and high reusability of the catalyst for biodiesel production. The catalyst stability and leaching profile of the modified waste shell derived CaO is discussed. In addition, a critical discussion of the structure, composition of the waste shell, mechanism of CaO catalyzed reaction, recent progress in biodiesel reactor systems and challenges in the industrial sector are also included in this review

SILAC-based proteomic quantification of chemoattractant-induced cytoskeleton dynamics on a second to minute timescale

Cytoskeletal dynamics during cell behaviours ranging from endocytosis and exocytosis to cell division and movement is controlled by a complex network of signalling pathways, the full details of which are as yet unresolved. Here we show that SILAC-based proteomic methods can be used to characterize the rapid chemoattractant-induced dynamic changes in the actin–myosin cytoskeleton and regulatory elements on a proteome-wide scale with a second to minute timescale resolution. This approach provides novel insights in the ensemble kinetics of key cytoskeletal constituents and association of known and novel identified binding proteins. We validate the proteomic data by detailed microscopy-based analysis of in vivo translocation dynamics for key signalling factors. This rapid large-scale proteomic approach may be applied to other situations where highly dynamic changes in complex cellular compartments are expected to play a key role