A current review of the diagnostic and treatment strategies of hepatic encephalopathy

Hepatic encephalopathy (HE) is a serious and potentially fatal complication in patients with cirrhotic liver disease. It is a spectrum ranging from minimal hepatic encephalopathy (MHE) without recognizable clinical symptoms or signs, to overt HE with risk of cerebral edema and death. HE results in diminished quality of life and survival. The broad range of neuropsychiatric manifestations reflects the range of pathophysiological mechanisms and impairment in neurotransmission that are purported to cause HE including hyperammonemia, astrocyte swelling, intra-astrocytic glutamine, upregulation of 18-kDa translocator protein (TSPO) (formerly known as peripheral benzodiazepine receptor or PBTR), and manganese. There is a myriad of diagnostic tools including simple bedside clinical assessment, and more complex neuropsychological batteries and neurophysiological tests available today. Current treatment strategies are directed at reducing ammonia, with newer agents showing some early promise. This paper describes the pathophysiology of the disease and summarises current diagnostic and treatment therapies available

Colorectal cancer screening

Estudo referente a duas noticias veiculadas na imprensa virtual, analisada com base em conceitos da Teoria da Comunicação e correlacionadas a alguns casos de infração ética aplicada pelo Conselho Regional de Enfermagem do Rio de Janeiro. As considerações finais apontaram para quatro eixos que visam colaborar com o aumento do cuidado seguro prestado à clientela

A Statistical Study of the Force Balance and Structure in the Flux Ropes in Mercury’s Magnetotail

This study presents a statistical investigation of the force balance and structures in the flux ropes in Mercury’s magnetotail plasma sheet by using the measurements of MErcury Surface, Space ENviroment, GEochemistry, and Ranging (MESSENGER). One hundred sixty-eight flux ropes were identified from the 14 hot seasons of MESSENGER from 11 March 2011 to 30 April 2015, and 143 of them show clear magnetic field enhancements with the core field being -20% higher than the background magnetic field. The investigation on the force balance of these 143 flux ropes shows that magnetic pressure gradient force cannot be solely balanced by magnetic tension force, implying that thermal plasma pressure gradient force cannot be neglected in the flux ropes. We employ a non-force-free model considering the contribution of thermal pressure to resolve the physical properties of flux ropes in Mercury’s magnetotail. Twenty-eight flux ropes are obtained through the fitting to the non-force-free model. The flux ropes are found to be consistent with the flattened structures, in which the mean semimajor is -851 km and semiminor is -333 km, both are several times the local proton inertial length. The average core field is estimated to be -57.5 nT, and flux content is -0.019 MWb, much larger than the previous results obtained from force-free flux rope model. The importance of thermal pressure gradient in the force balance of the flux ropes and the flattened structure indicates that the flux ropes in Mercury’s magnetotail plasma sheet are mostly in early stage of the evolution, and still contain enough plasma to affect their magnetic structures.Key PointsThermal pressure gradient is significant for the flux ropes in Mercury’s magnetotailNon-force-free modeling reveals the flatten structure and much higher magnetic flux of the flux ropes different from the previous studiesFlux ropes in this study should be in their early stage of evolution and could be strongly affected by thermal pressurePeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151305/1/jgra55044_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151305/2/jgra55044.pd

The Magnetic Field Structure of Mercury’s Magnetotail

In this study, we use the magnetic field data measured by MErcury Surface, Space ENvironment, GEochemistry, and Ranging from 2011 to 2015 to investigate the average magnetic field morphology of Mercury’s magnetotail in the down tail 0–3 RM (RM = 2,440 km, Mercury’s radius). It is found that Mercury has a terrestrial‐like magnetotail; the magnetic field structure beyond 1.5 RM down tail is stretched significantly with typical lobe field 50 nT. A cross‐tail current sheet separating the antiparallel field lines of lobes is present in the equatorial plane. The magnetotail width in north‐south direction is about 5 RM, while the transverse width is about 4 RM. Thus, the magnetotail shows elongation along the north‐south direction. At the cross‐tail current sheet center, the normal component of magnetic field (10–20 nT) is much larger than the cross‐tail component. The lobe‐field‐aligned component of magnetic field over current sheet can be well fitted by Harris sheet model. The curvature radius of field lines at sheet center usually reaches a minimum around midnight (100–200 km) with stronger current density (40–50 nA/m2), while the curvature radius increases toward both flanks (400–600 km) with the decreased current density (about 20 nA/m2). The half‐thickness of current sheet around midnight is about 0.25 RM or 600 km, and the inner edge of current sheet is located at the down tail about 1.5 RM. Our results about the field structure in the near Mercury’s tail show an evident dawn‐dusk asymmetry as that found in the Earth’s magnetotail, but reasons should be different. Possible reasons are discussed.Key PointsThe magnetic field distribution, configuration, and current density in Mercury’s magnetotail are quantitatively addressedMercury’s magnetotail is elongated along the south‐north direction, which is probably due to the effect of the dipole offset or the induction effect of coreThe magnetic structure of tail current sheet shows a clear dawn‐dusk asymmetry with smaller Bz and less flaring field on the dusksidePeer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/142544/1/jgra54041.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/142544/2/jgra54041_am.pd

Mutations in noncoding regions of GJB1 are a major cause of X-linked CMT

OBJECTIVE: To determine the prevalence and clinical and genetic characteristics of patients with X-linked Charcot-Marie-Tooth disease (CMT) due to mutations in noncoding regions of the gap junction β-1 gene (GJB1). METHODS: Mutations were identified by bidirectional Sanger sequence analysis of the 595 bases of the upstream promoter region, and 25 bases of the 3′ untranslated region (UTR) sequence in patients in whom mutations in the coding region had been excluded. Clinical and neurophysiologic data were retrospectively collected. RESULTS: Five mutations were detected in 25 individuals from 10 kindreds representing 11.4% of all cases of CMTX1 diagnosed in our neurogenetics laboratory between 1996 and 2016. Four pathogenic mutations, c.-17G>A, c.-17+1G>T, c.-103C>T, and c.-146-90_146-89insT were detected in the 5′UTR. A novel mutation, c.*15C>T, was detected in the 3′ UTR of GJB1 in 2 unrelated families with CMTX1 and is the first pathogenic mutation in the 3′UTR of any myelin-associated CMT gene. Mutations segregated with the phenotype, were at sites predicted to be pathogenic, and were not present in the normal population. CONCLUSIONS: Mutations in noncoding DNA are a major cause of CMTX1 and highlight the importance of mutations in noncoding DNA in human disease. Next-generation sequencing platforms for use in inherited neuropathy should therefore include coverage of these regions

IGF2BP2 alternative variants associated with glutamic acid decarboxylase antibodies negative diabetes in Malaysian subjects

Background: The association of Insulin-like growth factor 2 mRNA-binding protein 2 (IGF2BP2) common variants (rs4402960 and rs1470579) with type 2 diabetes (T2D) has been performed in different populations. The aim of this study was to evaluate the association of alternative variants of IGF2BP2; rs6777038, rs16860234 and rs7651090 with glutamic acid decarboxylase antibodies (GADA) negative diabetes in Malaysian Subjects. Methods/Principal Findings: IGF2BP2; rs6777038, rs16860234 and rs7651090 single nucleotide polymorphisms (SNPs) were genotyped in 1107 GADA negative diabetic patients and 620 control subjects of Asian from Malaysia. The additive genetic model adjusted for age, race, gender and BMI showed that alternative variants; rs6777038, rs16860234 and rs7651090 of IGF2BP2 associated with GADA negative diabetes (OR = 1.21; 1.36; 1.35, P = 0.03; 0.0004; 0.0002, respectively). In addition, the CCG haplotype and diplotype CCG-TCG increased the risk of diabetes (OR = 1.51, P = 0.01; OR = 2.36, P = 0.009, respectively). Conclusions/Significance: IGF2BP2 alternative variants were associated with GADA negative diabetes. The IGF2BP2 haplotypes and diplotypes increased the risk of diabetes in Malaysian subject

Stressful first impressions in job interviews

Stress can impact many aspects of our lives, such as the way we interact and work with others, or the first impressions that we make. In the past, stress has been most commonly assessed through self-reported questionnaires; however, advancements in wearable technology have enabled the measurement of physiological symptoms of stress in an unobtrusive manner. Using a dataset of job interviews, we investigate whether first impressions of stress (from annotations) are equivalent to physiological measurements of the electrodermal activity (EDA). We examine the use of automatically extracted nonverbal cues stemming from both the visual and audio modalities, as well EDA stress measurements for the inference of stress impressions obtained from manual annotations. Stress impressions were found to be significantly negatively correlated with hireability ratings i.e individuals who were perceived to be more stressed were more likely to obtained lower hireability scores. The analysis revealed a significant relationship between audio and visual features but low predictability and no significant effects were found for the EDA features. While some nonverbal cues were more clearly related to stress, the physiological cues were less reliable and warrant further investigation into the use of wearable sensors for stress detection

Genetic and clinical characteristics of NEFL-related Charcot-Marie-Tooth disease

OBJECTIVES: To analyse and describe the clinical and genetic spectrum of Charcot-Marie-Tooth disease (CMT) caused by mutations in the neurofilament light polypeptide gene (NEFL). METHODS: Combined analysis of newly identified patients with NEFL-related CMT and all previously reported cases from the literature. RESULTS: Five new unrelated patients with CMT carrying the NEFL mutations P8R and N98S and the novel variant L311P were identified. Combined data from these cases and 62 kindreds from the literature revealed four common mutations (P8R, P22S, N98S and E396K) and three mutational hotspots accounting for 37 (55%) and 50 (75%) kindreds, respectively. Eight patients had de novo mutations. Loss of large-myelinated fibres was a uniform feature in a total of 21 sural nerve biopsies and 'onion bulb' formations and/or thin myelin sheaths were observed in 14 (67%) of them. The neurophysiological phenotype was broad but most patients with E90K and N98S had upper limb motor conduction velocities <38 m/s. Age of onset was ≤3 years in 25 cases. Pyramidal tract signs were described in 13 patients and 7 patients were initially diagnosed with or tested for inherited ataxia. Patients with E90K and N98S frequently presented before age 3 years and developed hearing loss or other neurological features including ataxia and/or cerebellar atrophy on brain MRI. CONCLUSIONS: NEFL-related CMT is clinically and genetically heterogeneous. Based on this study, however, we propose mutational hotspots and relevant clinical-genetic associations that may be helpful in the evaluation of NEFL sequence variants and the differential diagnosis with other forms of CMT

Current progress on removal of recalcitrance coloured particles from anaerobically treated effluent using coagulation–flocculation

The palm oil industry is the most important agro industries in Malaysia and most of the mills adopt anaerobic digestion as their primary treatment for palm oil mill effluent (POME). Due to the public concern, decolourisation of anaerobically treated POME (AnPOME) is becoming a great concern. Presence of recalcitrant-coloured particles hinders biological processes and coagulation–flocculation may able to remove these coloured particles. Several types of inorganic and polymers-based coagulant/flocculant aids for coagulation–flocculation of AnPOME have been reviewed. Researchers are currently interested in using natural coagulant and flocculant aids. Modification of the properties of natural coagulant and flocculant aids enhanced coagulation–flocculation performance. Modelling and optimization of the coagulation–flocculation process have also been reviewed. Chemical sludge has the potential for plant growth that can be evaluated through pot trials and phytotoxicity test

A comprehensive survey of genomic alterations in gastric cancer reveals systematic patterns of molecular exclusivity and co-occurrence among distinct therapeutic targets

Objective: Gastric cancer is a major gastrointestinal malignancy for which targeted therapies are emerging as treatment options. This study sought to identify the most prevalent molecular targets in gastric cancer and to elucidate systematic patterns of exclusivity and co-occurrence among these targets, through comprehensive genomic analysis of a large panel of gastric cancers. Design: Using high-resolution single nucleotide polymorphism arrays, copy number alterations were profiled in a panel of 233 gastric cancers (193 primary tumours, 40 cell lines) and 98 primary matched gastric non-malignant samples. For selected alterations, their impact on gene expression and clinical outcome were evaluated. Results: 22 recurrent focal alterations (13 amplifications and nine deletions) were identified. These included both known targets (FGFR2, ERBB2) and also novel genes in gastric cancer (KLF5, GATA6). Receptor tyrosine kinase (RTK)/RAS alterations were found to be frequent in gastric cancer. This study also demonstrates, for the first time, that these alterations occur in a mutually exclusive fashion, with KRAS gene amplifications highlighting a clinically relevant but previously underappreciated gastric cancer subgroup. FGFR2-amplified gastric cancers were also shown to be sensitive to dovitinib, an orally bioavailable FGFR/VEGFR targeting agent, potentially representing a subtype-specific therapy for FGFR2-amplified gastric cancers. Conclusion: The study demonstrates the existence of five distinct gastric cancer patient subgroups, defined by the signature genomic alterations FGFR2 (9% of tumours), KRAS (9%), EGFR (8%), ERBB2 (7%) and MET (4%). Collectively, these subgroups suggest that at least 37% of gastric cancer patients may be potentially treatable by RTK/RAS directed therapies