Development and validation of a prognostic score for long-term transplant-free survival in autoimmune hepatitis type 1

Background No prognostic score is currently available for long-term survival in autoimmune hepatitis (AIH) patients. Objective The aim of this study was to develop and validate such a prognostic score for AIH patients at diagnosis. Methods The prognostic score was developed using uni- & multivariate Cox regression in a 4-center Dutch cohort and validated in an independent 6-center Belgian cohort. Results In the derivation cohort of 396 patients 19 liver transplantations (LTs) and 51 deaths occurred (median follow-up 118 months; interquartile range 60-202 months). In multivariate analysis age (hazard ratio [HR] 1.045; p < 0.001), non-caucasian ethnicity (HR 1.897; p = 0.045), cirrhosis (HR 3.266; p < 0.001) and alanine aminotransferase level (HR 0.725; p = 0.003) were significant independent predictors for mortality or LT (C-statistic 0.827; 95% CI 0.790-0.864). In the validation cohort of 408 patients death or LT occurred in 78 patients during a median follow-up of 74 months (interquartile range: 25-142 months). Predicted 5-year event rate did not differ from observed event rate (high risk group 21.5% vs. 15.7% (95% CI: 6.3%-24.2%); moderate risk group 5.8% versus 4.3% (95% CI: 0.0%-9.1%); low risk group 1.9% versus 5.4% (95% CI: 0.0%-11.4%); C-statistic 0.744 [95% CI 0.644-0.844]). Conclusions A Dutch-Belgian prognostic score for long-term transplant-free survival in AIH patients at diagnosis was developed and validated

Globalisation, the practice of devotional songs and poems and the linguistic repertoires of young British Muslims

This article provides empirical data from transnational religious contexts which highlight the complexity, fluidity and indexicality of language and religious practices in globalising settings. Through an examination of the role of devotional song and poetry in the Islamic world, and in particular, among young multilingual and multivarietal British Muslims, an attempt is made to show how globalising processes of the present age contribute to, on the one hand, novel forms of language resources and innovative religious practices and, on the other, co-existing traditional approaches to faith and language practices. It also shows how young people deploy their linguistic repertoires and language resources in order to re-construct their religious and linguistic identities. A conclusion is presented that such practices, whilst drawing on old and traditional roots, become transformed when enacted in these newer settings, both linguistically and religiously

Colorectal liver metastases: Surgery versus thermal ablation (COLLISION) - a phase III single-blind prospective randomized controlled trial

Background: Radiofrequency ablation (RFA) and microwave ablation (MWA) are widely accepted techniques to eliminate small unresectable colorectal liver metastases (CRLM). Although previous studies labelled thermal ablation inferior to surgical resection, the apparent selection bias when comparing patients with unresectable disease to surgical candidates, the superior safety profile, and the competitive overall survival results for the more recent reports mandate the setup of a randomized controlled trial. The objective of the COLLISION trial is to prove non-inferiority of thermal ablation compared to hepatic resection in patients with at least one resectable and ablatable CRLM and no extrahepatic disease. Methods: In this two-arm, single-blind multi-center phase-III clinical trial, six hundred and eighteen patients with at least one CRLM (≤3cm) will be included to undergo either surgical resection or thermal ablation of appointed target lesion(s) (≤3cm). Primary endpoint is OS (overall survival, intention-to-treat analysis). Main secondary endpoints are overall disease-free survival (DFS), time to progression (TTP), time to local progression (TTLP), primary and assisted technique efficacy (PTE, ATE), procedural morbidity and mortality, length of hospital stay, assessment of pain and quality of life (QoL), cost-effectiveness ratio (ICER) and quality-adjusted life years (QALY). Discussion: If thermal ablation proves to be non-inferior in treating lesions ≤3cm, a switch in treatment-method may lead to a reduction of the post-procedural morbidity and mortality, length of hospital stay and incremental costs without compromising oncological outcome for patients with CRLM. Trial registration:NCT03088150 , January 11th 2017

'Repentant' artists in Egypt: debating gender, performing arts and religion

Contains fulltext : 68454.pdf (publisher's version ) (Open Access)20 p

Diagnose en behandeling van auto-immune hepatitis.

Autoimmune hepatitis (AIH) is a progressive, chronic form of hepatitis of unknown cause that occurs in people of all ages. The diagnosis is based on characteristic clinical and biochemical abnormalities, absence of other causes of hepatitis and histopathological characteristics. The variety of symptoms that AIH patients may have and the importance of considering the disease is illustrated in three case studies. The first was a 22-year-old woman with fulminant hepatitis and jaundice. Corticosteroid and azathioprine treatment resulted in prolonged remission. The second patient, a 48-year-old woman, had hepatocellular carcinoma in a cirrhotic liver, based on AIH. Radiofrequency ablation was planned, after which the patient would be put on the waiting list for transplantation. The third patient was an 81-year-old man with impaired liver function and cirrhosis. His treatment was the same as in the first patient and resulted in remission as well. No curative therapy for AIH is yet available, but appropriate management of the disease can prolong survival, improve the quality of life, and avoid the need for liver transplantation

Popularizing Islam or Islamizing Popular Music : New developments in Egypt's wedding scene

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Increased osteoclast formation and activity by peripheral blood mononuclear cells in chronic liver disease patients with osteopenia

Osteoporosis is a common complication of chronic liver disease, and the underlying mechanisms are not understood. We aimed to determine if osteoclasts develop from osteoclast precursors in peripheral blood mononuclear cells (PBMCs) of chronic liver disease patients with osteopenia compared with controls. PBMCs were isolated and fluorescence-activated cell sorting was performed to quantify the activated T lymphocyte population and receptor activator of nuclear factor kappabeta ligand (RANKL) expression. The activated T lymphocyte populations were comparable for all 3 groups, and RANKL was not detectable. The percentage of CD14+CD11b+ cells containing osteoclast precursors was comparable between the 3 groups. To assess the formation and functional activity of osteoclasts formed from circulating mononuclear cells, PBMCs were cultured (1) without addition of cytokines, (2) with macrophage colony-stimulating factor (M-CSF), (3) with M-CSF and osteoprotegerin, and (4) with M-CSF and RANKL. The number of tartrate-resistant acid phosphatase-positive multinucleated cells and bone resorption was assessed. PBMCs from chronic liver disease patients with osteopenia formed more osteoclast-like cells, which, when cultured in the presence of M-CSF and RANKL resorbed more bone than controls. The number of osteoclast-like cells and the amount of bone resorption correlated with lumbar bone densities. Addition of M-CSF increased numbers of osteoclast-like cells formed in healthy controls; however, this was not observed in either of the chronic liver disease groups. Plasma levels of M-CSF were elevated in both patient groups compared with healthy controls. CONCLUSION: Circulating mononuclear cells from chronic liver disease patients with osteopenia have a higher capacity to become osteoclasts than healthy controls or chronic liver disease patients without osteopenia. This could partially be due to priming with higher levels of M-CSF in the circulatio