Bile acid metabolism with special reference to the intravenous cholic acid tolerance test of liver function

1. Historical. The chemistry of the bile acids and their relationship to some other steroids is briefly reviewed. The nature of conjugation, the biological splitting of conjugated bile acids, and the action of bacteria on bile acids is discussed. The physiological importance of bile salts is briefly indicated, and it is suggested that the distribution of the different bile acids in the various animal species has an evolutionary significance. Animal experiments on bile acid metabolism and the effects of oral and intravenous administration of bile salts in animals and man are described. An account of the analytical methods which have been used in the determination of bile salts in body fluids is given.2. Experimental. The colour reaction used here in the estimation of bile salts is described in detail, with recovery of added cholates from blood and the accuracy to be expected. Blood cholate levels in subjects without liver disease, show little diurnal variation, but some alteration over a period of months. Significant differences are found both between the blood cholate levels in subjects with and without liver disease, and in different types of jaundice. There is, however, considerable scatter, so that the estimation is of little diagnostic value. The intravenous cholic acid tolerance test of liver function is compared with other liver function tests, the general biochemical findings, and the histological appearance of the liver. The results of the test in normal subjects, and in obstructive jaundice, active and latent cirrhosis, acute hepatitis, secondary malignant liver disease, and haemolytic jaundice are discussed. The intravenous cholic acid tolerance test has proved insensitive as a liver function test and unsuitable for routine clinical use, but interesting information about the metabolism of bile salts in liver disease has been obtained.<p

Unravelling the atomic and electronic structure of nanocrystals on superconducting Nb(110): Impact of the oxygen monolayer

The Niobium surface is almost always covered by a native oxide layer which greatly influences the performance of superconducting devices. Here we investigate the highly stable Niobium oxide overlayer of Nb(110), which is characterised by its distinctive nanocrystal structure as observed by scanning tunnelling microscopy (STM). Our ab-initio density functional theory (DFT) calculations show that a subtle reconstruction in the surface Niobium atoms gives rise to rows of 4-fold coordinated oxygen separated by regions of 3-fold coordinated oxygen. The 4-fold oxygen rows are determined to be the source of the nanocrystal pattern observed in STM, and the two chemical states of oxygen observed in core-level X-ray photoelectron spectroscopy (XPS) are ascribed to the 3-fold and 4-fold oxygens. Furthermore, we find excellent agreement between the DFT calculated electronic structure with scanning tunnelling spectroscopy and valence XPS measurements.Comment: 8 pages, 4 figures, plus 3 pages of Supporting Informatio

Oxidation of Nb(110): atomic structure of the NbO layer and its influence on further oxidation.

NbO terminated Nb(110) and its oxidation are examined by scanning tunneling microscopy and spectroscopy (STS). The oxide structures are strongly influenced by the structural and electronic properties of the underlying NbO substrate. The NbO is terminated by one-dimensional few-nanometer nanocrystals, which form an ordered pattern. High-resolution STS measurements reveal that the nanocrystals and the regions between the nanocrystals exhibit different electronic characters. Low-dosage oxidation, sufficient for sub-monolayer coverage of the NbO, with subsequent UHV annealing results in the formation of resolved sub-nanometer clusters, positioned in-between the nanocrystals. Higher dosage oxidation results in the formation of a closed Nb2O5-y layer, which is confirmed by X-ray photoelectron spectroscopy measurements. The pentoxide is amorphous at the atomic-scale. However, large scale (tens of nanometers) structures are observed with their symmetry matching that of the underlying nanocrystals

Ocjena radne sposobnosti pacijenta s Wilsonovom bolesti - prikaz bolesnika

Wilson’s disease (WD) is a rare, progressive autosomal recessive disorder characterised by impaired transport and excessive accumulation of copper in the liver, brain, and other tissues. The disease is diagnosed based on clinical manifestations and screening tests results. Work ability assessment of patients with WD is based on the analysis of liver, kidney, neurological, and cognitive impairments, and takes into account patient’s level of education. This article presents a case with a 48-year-old male patient, who was admitted for work ability assessment due to polymorphic symptoms. The patient had been working as a salesman for 28 years. A detailed interview and examination by occupational health and other medical specialists revealed that the patient had been suffering from Wilson’s disease from the age of 13, and had now developed hepatic manifestations (compensated liver cirrhosis with portal hypertension), neurological manifestations (dystonia, dysarthria, muscle weakness, vertigo), and psychiatric manifestations (depression, insomnia, cognitive impairment) of the disease, including problems partially caused by long-lasting treatment with copper chelating agents (neurological and haematological manifestations). There were no ocular manifestations of Wilson’s disease (Kayser-Fleischer rings or sunflower cataract). The patient was assessed as having drastically diminished general work ability, dominantly due to neurological and psychiatric impairments caused by Wilson’s disease.Wilsonova je bolest rijetka, progresivna autosomno recesivna bolest karakterizirana poremećajem transporta bakra i posljedičnim prekomjernim nakupljanjem bakra u jetri, mozgu i drugim tkivima i organima. Dijagnoza bolesti postavlja se na osnovi kliničkih manifestacija bolesti i nalaza laboratorijskih ispitivanja. Ocjena radne sposobnosti pacijenata s Wilsonovom bolesti zasniva se na analizi postojanja oštećenja i stupnja oštećenja hepatičkih, neuroloških, bubrežnih i kognitivnih funkcija, kao i na analizi stupnja obrazovanja pacijenata. Prikazan je slučaj D. M., 48-godišnjeg pacijenta, koji je primljen zbog polimorfnih tegoba na bolničko ispitivanje radi ocjene radne sposobnosti. Pacijent je radio kao prodavač posljednjih 28 godina. Nakon detaljne anamneze i pregleda koje su obavili specijalisti medicine rada i drugi specijalisti utvrđeno je da pacijent boluje od Wilsonove bolesti od 13. godine života i da u ovom trenutku ima izražene hepatične manifestacije (kompenzirana ciroza jetre s portalnom hipertenzijom), neurološke manifestacije (distonija, dizartrija, mišićna slabost, vrtoglavica) i psihijatrijske manifestacije (depresija, nesanica, kognitivno oštećenje) Wilsonove bolesti, kao i da su prisutne tegobe djelomično uzrokovane dugotrajnom upotrebom kelatne terapije (neurološki i hematološki poremećaji). Nisu uočene karakteristične očne promjene Wilsonove bolesti (Kayser-Fleischerov prsten, katarakta u obliku suncokreta). Ocjenom radne sposobnosti utvrđeno je da pacijent ima drastično smanjenu radnu sposobnost pretežno zbog neuroloških i psihičkih poremećaja u sklopu Wilsonove bolesti

White Paper by the European Society for Swallowing Disorders: screening and non-instrumental assessment for dysphagia in adults

This White Paper by the European Society for Swallowing Disorders (ESSD) reports on the current state of screening and non-instrumental assessment for dysphagia in adults. An overview is provided on the measures that are available, and how to select screening tools and assessments. Emphasis is placed on different types of screening, patient-reported measures, assessment of anatomy and physiology of the swallowing act, and clinical swallowing evaluation. Many screening and non-instrumental assessments are available for evaluating dysphagia in adults; however, their use may not be warranted due to poor diagnostic performance or lacking robust psychometric properties. This white paper provides recommendations on how to select best evidence-based screening tools and non-instrumental assessments for use in clinical practice targeting different constructs, target populations and respondents, based on criteria for diagnostic performance, psychometric properties (reliability, validity, and responsiveness), and feasibility. In addition, gaps in research that need to be addressed in future studies are discussed. The following recommendations are made: (1) discontinue the use of non-validated dysphagia screening tools and assessments; (2) implement screening using tools that have optimal diagnostic performance in selected populations that are at risk of dysphagia, such as stroke patients, frail older persons, patients with progressive neurological diseases, persons with cerebral palsy, and patients with head and neck cancer; (3) implement measures that demonstrate robust psychometric properties; and (4) provide quality training in dysphagia screening and assessment to all clinicians involved in the care and management of persons with dysphagia.Otorhinolaryngolog

Insights from Amphioxus into the Evolution of Vertebrate Cartilage

Central to the story of vertebrate evolution is the origin of the vertebrate head, a problem difficult to approach using paleontology and comparative morphology due to a lack of unambiguous intermediate forms. Embryologically, much of the vertebrate head is derived from two ectodermal tissues, the neural crest and cranial placodes. Recent work in protochordates suggests the first chordates possessed migratory neural tube cells with some features of neural crest cells. However, it is unclear how and when these cells acquired the ability to form cellular cartilage, a cell type unique to vertebrates. It has been variously proposed that the neural crest acquired chondrogenic ability by recruiting proto-chondrogenic gene programs deployed in the neural tube, pharynx, and notochord. To test these hypotheses we examined the expression of 11 amphioxus orthologs of genes involved in neural crest chondrogenesis. Consistent with cellular cartilage as a vertebrate novelty, we find that no single amphioxus tissue co-expresses all or most of these genes. However, most are variously co-expressed in mesodermal derivatives. Our results suggest that neural crest-derived cartilage evolved by serial cooption of genes which functioned primitively in mesoderm

Experimental study of high-lying states in ²⁸Mg using the resonant elastic scattering of α particles

International audienceThe excitation function of Mg28 above the α-decay threshold has been measured for the first time using the resonant scattering of α particles with the technique of a thick target in inverse kinematics. Thirteen new states are reported between Ex=15.5 and Ex=20.5 MeV, and suggestions for spin-parity assignments are given for two of these. Calculations of the branching ratio to α decay for these states as well as comparison of the measured cross sections to calculations suggest that α+Neg.s.24 clustering is not dominant in this energy regime