Early identification of haemodynamic response to pharmacotherapy is essential for primary prophylaxis of variceal bleeding in patients with 'high-risk' varices

Background: A beta-blocker is recommended for primary prophylaxis of variceal bleeding; however, only one-third have hepatic venous pressure gradient (HVPG) response. The role of addition of isosorbide-5-mononitrate (ISMN) to beta-blocker and benefits of HVPG-guided 'a la carte' approach remain unclear. Aim: To determine the benefits of HVPG-guided pharmacotherapy in primary prophylaxis of variceal bleeding using beta-blocker and ISMN. Patients and methods: Consecutive patients of cirrhosis, with high-risk varices, with no previous variceal bleeding were included. After baseline HVPG, patients received incremental propranolol to achieve HR of 55/min. After one-month, HVPG was repeated to determine response (<12 mmHg or ≥20% reduction). ISMN was added in nonresponders and HVPG repeated. Patients were followed up for 24 months. Results: Of 56 patients (age 47 ± 13, males 79%) from 89 eligible patients, 21 (38%) responded to beta-blocker alone. Six additional patients responded to combination. Thus, overall 48% (27/56) patients responded. Variceal bleeding occurred in seven of 56 (13%) patients [one of 27 (4%) responder, five of 23 (22%) nonresponders and one of six (17%) with unknown response; P = N.S.]. The actuarial probability of variceal bleeding at median 24 months was 4% in responders and 22% in nonresponders (P < 0.05). Ten (18%) patients developed adverse effects to propranolol and six of 35 (17%) to nitrates requiring dose reduction. Risk factors of variceal bleed were grade IV varices and haemodynamic nonresponse. Conclusions: For primary prophylaxis, a beta-blocker is effective in 38% and addition of ISMN raises the response rate to about half of patients. The HVPG-guided 'a la carte' approach may be considered for these patients

Mergers of double neutron stars with one high-spin component: brighter kilonovae and fallback accretion, weaker gravitational waves

Neutron star mergers where both stars have negligible spins are commonly considered as the most likely, "standard" case. But based on observed systems, we estimate that actually a non-negligible fraction of all double neutron star mergers ($\sim$ 5 %) may contain one millisecond component. We use the Lagrangian Numerical Relativity code SPHINCS_BSSN to simulate mergers where one star has no spin and the other has a dimensionless spin parameter of $\chi=0.5$. These mergers exhibit several distinct signatures compared to irrotational cases. Morphologically, they are similar to unequal mass mergers and they form in particular only one, very pronounced spiral arm. Compared to the non-spinning cases, they dynamically eject an order of magnitude more mass of unshocked material at the original low electron fraction of the neutron stars and therefore produce particularly bright, red kilonovae and brighter kilonova afterglows months after the merger. We also find that the spinning cases have significantly more fallback accretion, with implications for late-time X-ray flares and the duration of the associated gamma-ray burst. Overall, the spinning case collisions are substantially less violent and they emit smaller amounts of shock-generated semi-relativistic material and therefore produce less pronounced blue/UV kilonova precursor signals. Their post-merger gravitational wave signal is weaker and, during the simulated time, substantially smaller amounts of energy and angular momentum are emitted. Therefore the central remnant contains a larger angular momentum reservoir and could remain an "active engine" for a longer time.Comment: 17 pages, 15 figures, submitte

Histological subclassification of cirrhosis based on histological-haemodynamic correlation

Background: Determining a relationship between specific histological parameters in cirrhosis and hepatic venous pressure gradient can be used to subclassify cirrhosis. Aim: To determine the relationship between hepatic venous pressure gradient and specific histological parameters in cirrhosis. Methods: Forty-seven patients (mean age: 46.2 ± 13.6 years; 36 male) with biopsy-proven cirrhosis and hepatic venous pressure gradient measurements within 1 month of biopsy were studied. The following histological parameters were scored semiquantitatively: nodule size, loss of portal tracts and central veins, portal inflammation, periportal inflammation, bile duct proliferation, lobular inflammation, ballooning, fatty change, cholestasis and septal thickness. Results: On multiple ordinal regression analysis, small nodule size (odds ratio: 21.0; 95% confidence interval: 2.1-208.2, P = 0.009) and thick septa (OR: 42.6; CI: 2.3-783.7, P = 0.011) were significantly associated with the presence of clinically significant portal hypertension. A score was assigned to each of the two parameters (nodule size: large = 1, medium = 2, small = 3 and septal thickness: thin = 1, medium = 2, thick = 3). Two subcategories were devised based on the composite score: category A (n = 12): score 1-3 and category B (n = 35): score 4-6. On ordinal regression, subcategory B (OR: 15.5; CI: 3.3-74.2, P = 0.001) was significantly associated with clinically significant portal hypertension. Conclusion: Small nodularity and thick septa are independent predictors of the presence of clinically significant portal hypertension

Analysis of cerebrospinal fluid adenosine deaminase level in tuberculous meningitis and validation of sensitivity and specificity

Background: Tuberculous meningitis is an important cause of morbidity and mortality in developing countries especially in India. The mortality associated with tuberculous meningitis is very high if not detected early and meticulous treatment is not given. CSF analysis and imaging are the most commonly used tools for diagnosis of meningitis. But these are often inadequate in making a definitive diagnosis. CSF Adenosine Deaminase estimation (ADA) is useful in differentiation of tuberculous meningitis from non-tuberculous meningitis. Though few studies have proved efficacy of Adenosine Deaminase level for the diagnosis, studies to assess the sensitivity and specificity of ADA levels were limited. This study was conducted to assess its usefulness and to validate the sensitivity and specificity of ADA level in tuberculous meningitis (TBM).Methods: This was a prospective study conducted at Academy of Medical Sciences, Pariyaram for a period of 18 months from December 2013 to June 2015, Adenosine deaminase level was studied in the cerebrospinal fluid of 50 patients who got admitted with symptoms and signs of meningitis in the medical wards and intensive care units who fulfilled the inclusion criteria.Results: In this study 50 patients were diagnosed clinically and with CSF analysis as meningitis. The mean cerebrospinal fluid adenosine deaminase activity was 23.08+17.5in Tuberculous meningitis 3.8 +1.92U/l in Bacterial meningitis and 4.8+2.3U/l in Viral meningitis. The adenosine deaminase activity in Tuberculous meningitis cases were significantly higher than non-tuberculous meningitis. The sensitivity and specificity of this test for diagnosis of tuberculous meningitis was 90% and 100% respectively with ADA value of more than 10U/L.Conclusions: This study found out that estimation of CSF Adenosine level is a very useful test for the diagnosis of tuberculous meningitis. The sensitivity and specificity attained in this study were comparable to other studies. This study also found out that ADA estimation is very useful in distinguishing tuberculous and viral meningitis

Fertilizer use in semi-srid tropical India: The case of high-yielding varieties of sorghum and pearl millet

Sorghum and pearl millet are the two most important cereals grown on drylands in semi-arid tropical (SAT) areas of india. These have traditionally formed part of a highly unstable, low-cost, low-output farminq system and are evaluated in the market as relatively inferior foodgrains (Jodha 1973)..

The Development of Chemically Vapor Deposited Mullite Coatings for the Corrosion Protection of SiC

Crystalline mullite coatings have been chemically vapor deposited onto SiC substrates to enhance the corrosion and oxidation resistance of the substrate. Current research has been divided into three distinct areas: (1) Development of the deposition processing conditions for increased control over coating`s growth rate, microstructure, and morphology; (2) Analysis of the coating`s crystal structure and stability; (3) The corrosion resistance of the CVD mullite coating on SiC

A COMPREHENSIVE METRIC FOR COMPARING TIME HISTORIES IN VALIDATION OF SIMULATION MODELS WITH EMPHASIS ON VEHICLE SAFETY APPLICATIONS

ABSTRACT Computer modeling and simulation are the cornerstones of product design and development in the automotive industry. Computer-aided engineering tools have improved to the extent that virtual testing may lead to significant reduction in prototype building and testing of vehicle designs. In order to make this a reality, we need to assess our confidence in the predictive capabilities of simulation models. As a first step in this direction, this paper deals with developing a metric to compare time histories that are outputs of simulation models to time histories from experimental tests with emphasis on vehicle safety applications. We focus on quantifying discrepancy between time histories as the latter constitute the predominant form of responses of interest in vehicle safety considerations. First we evaluate popular measures used to quantify discrepancy between time histories in fields such as statistics, computational mechanics, signal processing, and data mining. Then we propose a structured combination of some of these measures and define a comprehensive metric that encapsulates the important aspects of time history comparison. The new metric classifies error components associated with three physically meaningful characteristics (phase, magnitude and topology), and utilizes norms, cross-correlation measures and algorithms such as dynamic time warping to quantify discrepancies. Two case studies demonstrate that the proposed metric seems to be more consistent than existing metrics. It is also shown how the metric can be used in conjunction with ratings from subject matter experts to build regression-based val- * Corresponding author, Phone/Fax: (734) 615-8991/647-8403 idation models

Pseudorapidity and centrality dependence of the collective flow of charged particles in Au+Au collisions at sqrt{s_NN} = 130 GeV

This paper describes the measurement of collective flow for charged particles in Au+Au collisions at sqrt{s_NN}} = 130 GeV using the PHOBOS detector at the Relativistic Heavy Ion Collider (RHIC). An azimuthal anisotropy is observed in the charged particle hit distribution in the PHOBOS multiplicity detector. This anisotropy is presented over a wide range of pseudorapidity (eta) for the first time at this energy. The size of the anisotropy (v_{2}) is thought to probe the degree of equilibration achieved in these collisions. The result here,averaged over momenta and particle species, is observed to reach 7% for peripheral collisions at mid-rapidity, falling off with centrality and increasing |eta|. Data are presented as a function of centrality for |eta|<1.0 and as a function of eta, averaged over centrality, in the angular region -5.0<eta<5.3. These results call into question the common assumption of longitudinal boost invariance over a large region of rapidity in RHIC collisions.Comment: 5 pages, 4 figures, submitted to Physical Review Letter