The Royal Free Hospital score: a calibrated prognostic model for patients with cirrhosis admitted to intensive care unit. Comparison with current models and CLIF-SOFA score

Prognosis for patients with cirrhosis admitted to intensive care unit (ICU) is poor. ICU prognostic models are more accurate than liver-specific models. We identified predictors of mortality, developed a novel prognostic score (Royal Free Hospital (RFH) score), and tested it against established prognostic models and the yet unvalidated Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) model

Elevated liver enzymes in inflammatory bowel disease: the role and safety of infliximab

BACKGROUND: Abnormal liver enzymes are frequently encountered in inflammatory bowel disease (IBD) patients. Infliximab has been implicated in inducing drug-induced liver injury, autoimmune hepatitis or reactivation of hepatitis B virus. We aimed to clarify the role of infliximab in liver impairment in an IBD cohort. STUDY: A total of 305 patients with IBD, without evidence of chronic liver disease, were included in the study and retrospectively evaluated. Laboratory and clinical data were retrieved from a prospectively acquired database. In all, 176 consecutive patients treated with infliximab during the last 5 years were compared with a matched population of 129 patients who did not receive any antitumour necrosis factor treatment. RESULTS: Elevation of alanine transaminase (ALT) was frequent in the entire population (36.4%) and it was not significantly associated with the use of infliximab (P=0.284). Elevations more than 3 upper limit of normal were observed in 7.9% and these resolved spontaneously in 83%. The use of immunomodulators was the only factor that was significantly associated with liver enzyme abnormalities in multivariate analysis [odds ratio (OR) 2.666, 95% confidence interval (CI) 1.576-4.511, P<0.005]. Overall, 39% of patients on infliximab had elevated liver enzymes and this was associated with increased ALT before starting infliximab (OR 3.854, 95% CI 1.800-8.251, P=0.001) and with longer duration of infliximab treatment (OR 1.030, 95% CI 1.013-1.047, P=0.001). CONCLUSION: Elevated liver enzymes are frequently found in IBD patients and they usually resolve spontaneously. The use of immunomodulators was independently associated with increased ALT. Infliximab is relatively safe in terms of liver impairment and discontinuation of treatment is rarely required in the setting of modest elevations of ALT

Development and validation of a mathematical equation to estimate glomerular filtration rate in cirrhosis: The rfh cirrhosis Gfr

Current expressions based on serum creatinine concentration overestimate kidney function in cirrhosis leading to significant differences between "true" and calculated glomerular filtration rate (GFR). We compared the performance of MDRD-4, MDRD-6 and CKD-EPI with "true" GFR and the impact of this difference on MELD calculation. We subsequently developed and validated a GFR equation specifically for cirrhosis and compared the performance of the new derived formula with existing GFR formulas. We included 469 consecutive patients who had a transplant assessment between 2011 and 2014. "True" GFR (mGFR) was measured using plasma isotope clearance according to a technique validated in patients with ascites. A corrected creatinine was derived from the mGFR after application of the MDRD formula. Subsequently, a corrected MELD was calculated and was compared with the conventionally calculated MELD. Stepwise multiple linear regression was used to derive a GFR equation. This was compared with the measured GFR in independent external and internal validation sets of 82 and 174 patients with cirrhosis respectively. A difference>20 ml/min/1.73m(2) between existing formulae and mGFR was observed in 226 (48.2%) patients. The corrected MELD score was ≥3 points higher in 177 (37.7%) patients. The predicted equation derived (R(2) =74·6%) was: GFR=45·9x(creatinine(-0) ·(836) )x(urea(-0) ·(229) )x(INR(-0) ·(113) )x(age(0) ·(129) )x(sodium(0) ·(972) )x1·236(if male)x0·92(if moderate/severe ascites). The model was a good fit and showed the greatest accuracy compared to that of existing formulae. CONCLUSION: We developed and validated a new accurate model for GFR assessment in cirrhosis, the RFH cirrhosis GFR, using readily available variables. This remains to be tested and incorporated in prognostic scores in patients with cirrhosis

Sol–Gel Synthesis and Characterization of YSZ Nanofillers for Dental Cements at Different Temperatures

From MDPI via Jisc Publications RouterHistory: accepted 2021-10-26, pub-electronic 2021-10-29Publication status: PublishedFunder: The project is co-financed by Greece and the EuropeanUnion (European Social Fund-ESF) by the Operational Program Human Resources Development,Education and Lifelong Learning 2014–2020.; Grant(s): MIS5047876Background: Yttria-stabilized zirconia nanoparticles can be applied as fillers to improve the mechanical and antibacterial properties of luting cement. The aim of this study was to synthesize yttria-stabilized zirconia nanoparticles by the sol–gel method and to investigate their composition, structure, morphology and biological properties. Methods: Nanopowders of ZrO2 7 wt% Y2O3 (nY-ZrO) were synthesized by the sol–gel method and were sintered at three different temperatures: 800, 1000 and 1200 °C, and their composition, size and morphology were investigated. The biocompatibility was investigated with human gingival fibroblasts (hGFs), while reactive oxygen species (ROS) production was evaluated through fluorescence analysis. Results: All synthesized materials were composed of tetragonal zirconia, while nanopowders sintered at 800 °C and 1000 °C additionally contained 5 and 20 wt% of the cubic phase. By increasing the calcination temperature, the crystalline size of the nanoparticles increased from 12.1 nm for nY-ZrO800 to 47.2 nm for nY-ZrO1200. Nano-sized particles with good dispersion and low agglomeration were received. Cell culture studies with human gingival fibroblasts verified the nanopowders’ biocompatibility and their ROS scavenging activity. Conclusions: the obtained sol–gel derived nanopowders showed suitable properties to be potentially used as nanofillers for dental luting cement

Recommendations for National Risk Assessment for Disaster Risk Management in EU

Decision No 1313/2013/EU on a Union Civil Protection Mechanism (UCPM) calls Participating States to develop risk assessments periodically and make the summary of their National Risk Assessment (NRA) available to the European Commission as a way to prevent disaster risk in Europe. In order to facilitate countries on this task, the European Commission developed the Guidelines on risk assessment and mapping. In spite of these, the summaries received have revealed several challenges related to the process and the content of the assessments. The current report aims to provide scientific support to the UCPM participant countries in their development of NRA, explaining why and how a risk assessment could be carried out, how the results of this could be used for Disaster Risk Management planning and in general, how science can help civil protection authorities and staff from ministries and agencies engaged in NRA activities. The report is the result of the collaborative effort of the Disaster Risk Management Knowledge Centre team and nine Joint Research Centre expert groups which provided their insight on tools and methods for specific risk assessment related to certain hazards and assets: drought, earthquakes, floods, terrorist attacks, biological disasters, critical infrastructures, chemical accidents, nuclear accidents and Natech accidents. The current document would be improved by a next version that would include scientific guidance on other risks and the collaboration of potential users.JRC.E.1-Disaster Risk Managemen

Everolimus with or without mycophenolate mofetil in a liver transplantation setting: A single-center experience

Background This study evaluated the efficacy, safety, and impact on renal function of everolimus in patients after liver transplantation (LT) with or without mycophenolate mofetil (MMF). Methods We evaluated LT recipients with calcineurin inhibitor (CNI)-related renal dysfunction after everolimus initiation. Laboratory data, including evaluation of renal function based on glomerular filtration rate (GFR) at baseline (i.e., everolimus initiation) and at the end of follow up, were analyzed. Results Fifty consecutive patients started taking everolimus at 30 months post-LT (range: 1-240), 6 as monotherapy and 44 in combination with MMF. After 30.5 months (range: 6-112), all patients were alive, without any biochemical evidence of a rejection episode or recurrence of hepatocellular carcinoma. The mean GFR, based on the Modification of Diet in Renal Disease equation, was 53±13 mL/min at baseline and 59±12 mL/min at the end of follow up (P=0.031). Eleven (22%) of the patients had GFR &lt;60 mL/min at baseline but returned to GFR &gt;60 mL/min by the end of follow up. In multivariate analysis, the time between the development of renal dysfunction and everolimus initiation was the only factor independently associated with GFR improvement (odds ratio [OR] 0.85, 95% confidence interval [95%CI] 0.76-0.96; P=0.007). Everolimus was stopped in 11 patients (22%) at the end of follow up because of adverse events. Conclusion A CNI-free everolimus-based regimen was effective in LT recipients with renal dysfunction and was associated with an improvement in GFR. © 2018 Hellenic Society of Gastroenterology