Steam power station design criteria

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Palliative long-term abdominal drains in refractory ascites due to end-stage liver disease: a case series

Background: Ascites, the commonest complication of cirrhosis, leads to frequent hospitalisations. Refractory ascites (RA) confers a median survival of 6 months without liver transplantation (LT). In many the management remains palliative (large volume paracentesis, LVP). Despite calls for improvement, Palliative and End of Life (EoLC) is not yet integrated into end stage liver disease (ESLD). Long-term abdominal drains (LTAD) are a palliative strategy in malignant ascites, but not ESLD. Case presentation: A retrospective, single centre, case series review was performed of patients undergoing LTAD placement for RA secondary to ESLD at a large teaching hospital between August 2011 and March 2013. Case management: Patients with ESLD and RA, where LT was not an option, were considered for LTAD. Seven patients underwent successful LTAD insertion after multi-professional assessment. Case outcome: Following LTAD, mean hospital attendances reduced to 1 (0-4) from 9 (4-21); with none for ascites management. Median survival after LTAD insertion was 29 days (8-219). The complication rate was low and none life-threatening. Conclusions: Palliative and EoLC needs in ESLD remain under-addressed. Our data suggests LTAD may be a safe and effective palliative intervention in ESLD. Prospective randomised controlled trials comparing LVP versus LTAD in RA in ESLD are warranted

Modeling relationships between calving traits: a comparison between standard and recursive mixed models

<p>Abstract</p> <p>Background</p> <p>The use of structural equation models for the analysis of recursive and simultaneous relationships between phenotypes has become more popular recently. The aim of this paper is to illustrate how these models can be applied in animal breeding to achieve parameterizations of different levels of complexity and, more specifically, to model phenotypic recursion between three calving traits: gestation length (GL), calving difficulty (CD) and stillbirth (SB). All recursive models considered here postulate heterogeneous recursive relationships between GL and liabilities to CD and SB, and between liability to CD and liability to SB, depending on categories of GL phenotype.</p> <p>Methods</p> <p>Four models were compared in terms of goodness of fit and predictive ability: 1) standard mixed model (SMM), a model with unstructured (co)variance matrices; 2) recursive mixed model 1 (RMM1), assuming that residual correlations are due to the recursive relationships between phenotypes; 3) RMM2, assuming that correlations between residuals and contemporary groups are due to recursive relationships between phenotypes; and 4) RMM3, postulating that the correlations between genetic effects, contemporary groups and residuals are due to recursive relationships between phenotypes.</p> <p>Results</p> <p>For all the RMM considered, the estimates of the structural coefficients were similar. Results revealed a nonlinear relationship between GL and the liabilities both to CD and to SB, and a linear relationship between the liabilities to CD and SB.</p> <p>Differences in terms of goodness of fit and predictive ability of the models considered were negligible, suggesting that RMM3 is plausible.</p> <p>Conclusions</p> <p>The applications examined in this study suggest the plausibility of a nonlinear recursive effect from GL onto CD and SB. Also, the fact that the most restrictive model RMM3, which assumes that the only cause of correlation is phenotypic recursion, performs as well as the others indicates that the phenotypic recursion may be an important cause of the observed patterns of genetic and environmental correlations.</p

Current concepts in the diagnosis and management of autoimmune hepatitis

Autoimmune hepatitis (AIH) is a progressive necroinflammatory liver disease associated with significant morbidity and mortality. Mainly affecting females, AIH has a varied clinical presentation from minor symptomatology to acute liver failure. The diagnosis should be considered in anyone with abnormal liver function tests. Diagnostic features include biochemical evidence of transaminitis, elevated IgG and positive autoantibodies. Liver biopsy may show interface hepatitis with portal-based plasma cell infiltrates. A clinical and pathological spectrum of disease exists with other autoimmune liver disease in rare cases. AIH responds promptly to immunosuppression therapy, including corticosteroids (prednis(ol)one or budesonide) with azathioprine. Treatment failure can be addressed with several second-line immunosuppressive agents. Liver transplantation remains a successful salvage therapy for acute autoimmune liver failure or treatment failure in chronic AIH complicated by synthetic dysfunction, portal hypertension or hepatocellular carcinoma

Current concepts in the diagnosis and management of autoimmune hepatitis

Autoimmune hepatitis (AIH) is a progressive necroinflammatory liver disease associated with significant morbidity and mortality. Mainly affecting females, AIH has a varied clinical presentation from minor symptomatology to acute liver failure. The diagnosis should be considered in anyone with abnormal liver function tests. Diagnostic features include biochemical evidence of transaminitis, elevated IgG and positive autoantibodies. Liver biopsy may show interface hepatitis with portal-based plasma cell infiltrates. A clinical and pathological spectrum of disease exists with other autoimmune liver disease in rare cases. AIH responds promptly to immunosuppression therapy, including corticosteroids (prednis(ol)one or budesonide) with azathioprine. Treatment failure can be addressed with several second-line immunosuppressive agents. Liver transplantation remains a successful salvage therapy for acute autoimmune liver failure or treatment failure in chronic AIH complicated by synthetic dysfunction, portal hypertension or hepatocellular carcinoma