Posttransplant Metabolic Syndrome

Metabolic syndrome (MS) is a cluster of metabolic derangements associated with insulin resistance and an increased risk of cardiovascular mortality. MS has become a major health concern worldwide and is considered to be the etiology of the current epidemic of diabetes and cardiovascular disease. In addition to cardiovascular disease, the presence of MS is also closely associated with other comorbidities including nonalcoholic fatty liver disease (NAFLD). The prevalence of MS in patients with cirrhosis and end-stage liver disease is not well established and difficult to ascertain. Following liver transplant, the prevalence of MS is estimated to be 44–58%. The main factors associated with posttransplant MS are posttransplant diabetes, obesity, dyslipidemia, and hypertension. In addition to developing NAFLD, posttransplant MS is associated with increased cardiovascular mortality that is 2.5 times that of the age- and sex-matched individuals. Additionally, the presence of posttransplant MS has been associated with rapid progression to fibrosis in individuals transplanted for HCV cirrhosis. There is an urgent need for well-designed prospective studies to fully delineate the natural history and risk factors associated with posttransplant MS. Until then, early recognition, prevention, and treatment of its components are vital in improving outcomes in liver transplant recipients

Analysis of Thin Films Related to Flows in Cylindrical Geometries

Motivated by models for thin films coating cylinders in two physical cases proposed in [1] and [2], we analyze the dynamics of corresponding thin film models. The models are governed by nonlinear, fourth-order, degenerate, parabolic partial differential equations. We prove, given positive and suitably regular initial data, the existence of weak solutions in all length scales of the cylinder, where all solutions are only local in time. We also prove that given a length constraint on the cylinder, long-time and global in time weak solutions exist. This analytical result is motivated by numerical work on related models of Reed Ogrosky [3] in conjunction with the works [4, 5, 6, 7]. We also study traveling wave solutions and linear stability in these models, in collaboration with numerical work done by Ogrosky. This work is highly motivated by the numerical work done in [7] and the stability results of [8].Doctor of Philosoph

Analysis of the stresses and deflections of a LNG tanker.

http://archive.org/details/analysisofstress00twe

\u3ci\u3eBrachylicoa lui\u3c/i\u3e, a New Species of Parapseudid Tanaidacean (Crustacea: Peracarida: Apseudomorpha), From the Hawaiian Islands, With a Taxonomic Key

Brachylicoa lui sp. n. is described from the coastal waters of the Hawaiian island of O‘ahu. It is distinguished from the other four nominal members of Brachylicoa by a combination of characters including (1) an incised margin between base of rostrum and carapace, (2) mandible palp article-1 with cluster of 20–25 simple setae, (3) maxillule biarticulate palp ending in eight “cleaning’ setae, (4) maxilliped inner sub-distal margin with two stout spiniform seta, and (5) pereopod-6 with carpus having three plumose setae on mid-dorsal margin. Brachylicoa (=Apseudes) babelmandebensis sensu Guţu is tentatively transferred to the genus Saltipedis Guţu sensu lato. Brachylicoa lui is the only member of the genus known from the mid-Pacific Region and the Northern Hemisphere; the other species of the genus are known from the western Pacific and Indian Ocean in the Southern Hemisphere. A key to separate the four nominal species of Brachylicoa species is presented

Utility of Non-Invasive Testing for Fibrosis Assessment in Patients with End Stage Renal Disease

Background: Non-alcoholic fatty liver disease (NAFLD) risk factors including metabolic syndrome (MS) and its components obesity (BMI ≥ 30), diabetes mellitus (DM), hypertension (HTN), and dyslipidemia (DL), has an increased prevalence in end stage renal disease (ESRD). The goal of study was to assess utility of non-invasive testing (NIT) including transient elastography (TE) for liver stiffness (LS), controlled attenuated parameter (CAP) for steatosis, Fibrosis-4 (FIB-4), AST to platelet ratio (APRI) and NAFLD Fibrosis score (NFS), for assessment of NAFLD in patients with ESRD undergoing renal transplant (RT) evaluation. Methods: Demographic, clinical and laboratory data were collected within 12 weeks of TE. Primary outcomes were significant fibrosis (SF) and steatosis, defined by TE ≥ 9 kPa and CAP ≥ 263 dB/m, respectively. Univariate analysis was performed to identify factors associated with SF and steatosis. In those with available liver histology, utility of LS, FIB-4 and NFS to predict SF was assessed. Results: Total of 171 patients were evaluated. Mean age was 56 years, 65% male, 60% African American, 36% obese, 47% had DM, 96% had HTN, and 56% had DL. Median (IQR) LS was 6.5 kPa (4.7-8.9) with 21% having SF (\u3eF2). Mean CAP was 232 dB/m with 25% having steatosis. Those with SF were older (62 vs. 54 years; p=.005) and had higher NFS (0.138 vs. 0.560; p=0.021). Those with steatosis had obesity and DM without higher fibrosis. Those with liver histology (N=14), SF was associated with LS ≥ 9 kPa (p=.037) but not with APRI, FIB-4, or NFS. Conclusion: Amongst patients with ESRD being evaluated for RT, there was a high prevalence of LS. Normal liver enzymes, SF and steatosis were common, yet these were not detected by APRI or FIB-4. Patient’s who are at low risk for SF can be identified by NFS and TE with moderate negative predictive value and specificity

A Correction for Overestimation Bias in Estimates of Black-Tailed Prairie Dog Abundance Based on Aerial Surveys of Colony Sites in Colorado and Montana

Estimates of abundance of black-tailed prairie dogs (Cynomys ludovicianus) are obtained by estimating the area occupied by colonies. An approach for estimating this area used in Colorado and Montana was based on aerial survey transects that recorded the end points where transects intercepted and exited colony sites. Line intercept mathematical techniques were applied to these intercept data to obtain estimates of occupied area. We define a “colony site” as an aggregation of prairie dog burrows while a prairie dog “colony” is defined as the portion of a colony site that is occupied by living prairie dogs. Because of poisoning, plague and other factors, colony sites are commonly not completely occupied by colonies. In both Colorado and Montana, however, estimates obtained were estimates of the area occupied by colony sites that had some undetermined level of occupancy by colonies. We show for Colorado that the difference between estimates of area occupied by colonies was much less than the area occupied by colony sites. We provide an approach to correct estimates based on the extent of colony sites. This approach requires ground surveys of a sample of aerial intercepts of colony sites to document the proportion that is actually occupied by colonies of living black-tailed prairie dogs. Black-tailed prairie dogs were found as not-warranted for listing in 2004 in part because of inflated estimates of abundance obtained in Colorado that incorrectly equated the extent of colony-sites as equivalent to the extent of colonies in that state

Efficacy and optimal dosing interval of the long-acting beta2 agonist, vilanterol, in persistent asthma: A randomised trial

SummaryBackgroundVilanterol (VI) is a novel once-daily long-acting beta2 agonist with inherent 24-h activity. The aim of this study was to evaluate the efficacy of three once-daily doses and one twice-daily dose of VI used concurrently with ICS in adult patients (≥18 years) with persistent asthma. Safety was also assessed.MethodsMulticentre, randomised, double-blind, placebo-controlled, five-period crossover study consisting of 7-day treatment periods separated by 7-day wash-out periods. Seventy-five patients, maintained on ICS, received VI 6.25, 12.5 and 25 mcg once-daily (evening), VI 6.25 mcg twice-daily (morning/evening), and placebo. The primary endpoint was trough forced expiratory volume in 1 s (FEV1) (mean of 23 h and 24 h post evening dose) on Day 7; secondary endpoint was weighted mean 24-h serial FEV1 on Day 7.ResultsAll VI groups demonstrated statistically significant increases in trough FEV1 versus placebo (p < 0.001). There was a statistically significant increase in weighted mean 24-h FEV1 for each VI group versus placebo (p < 0.001). The effects of once-daily VI on trough FEV1 and weighted mean 24-h FEV1 were dose dependent. The incidence of adverse events (AEs) was low in each VI treatment group and was not dose dependent (5–9%; placebo = 18%); no drug-related AEs or serious AEs were reported.ConclusionOnce-daily treatment with VI was well tolerated and associated with improvements in lung function. The VI 6.25 mcg twice-daily dose showed the greatest change in trough FEV1, however, similar changes in weighted mean 24-h FEV1 with VI 12.5 mcg once-daily were observed. Although our study was not powered to demonstrate non-inferiority of once- versus twice-daily dosing of VI, the data suggest no advantage over a 24-h period of twice-daily over once-daily dosing for the same total daily dose.ClinicalTrials.gov: NCT00980200

Symptom Domain Groups of the Patient-Reported Outcomes Measurement Information System Tools Independently Predict Hospitalizations and Re-hospitalizations in Cirrhosis

Background Patient-Reported Outcomes Measurement Information System (PROMIS) tools can identify health-related quality of life (HRQOL) domains that could differentially affect disease progression. Cirrhotics are highly prone to hospitalizations and re-hospitalizations, but the current clinical prognostic models may be insufficient, and thus studying the contribution of individual HRQOL domains could improve prognostication. Aim Analyze the impact of individual HRQOL PROMIS domains in predicting time to all non-elective hospitalizations and re-hospitalizations in cirrhosis. Methods Outpatient cirrhotics were administered PROMIS computerized tools. The first non-elective hospitalization and subsequent re-hospitalizations after enrollment were recorded. Individual PROMIS domains significantly contributing toward these outcomes were generated using principal component analysis. Factor analysis revealed three major PROMIS domain groups: daily function (fatigue, physical function, social roles/activities and sleep issues), mood (anxiety, anger, and depression), and pain (pain behavior/impact) accounted for 77% of the variability. Cox proportional hazards regression modeling was used for these groups to evaluate time to first hospitalization and re-hospitalization. Results A total of 286 patients [57 years, MELD 13, 67% men, 40% hepatic encephalopathy (HE)] were enrolled. Patients were followed at 6-month (mth) intervals for a median of 38 mths (IQR 22–47), during which 31% were hospitalized [median IQR mths 12.5 (3–27)] and 12% were re-hospitalized [10.5 mths (3–28)]. Time to first hospitalization was predicted by HE, HR 1.5 (CI 1.01–2.5, p = 0.04) and daily function PROMIS group HR 1.4 (CI 1.1–1.8, p = 0.01), independently. In contrast, the pain PROMIS group were predictive of the time to re-hospitalization HR 1.6 (CI 1.1–2.3, p = 0.03) as was HE, HR 2.1 (CI 1.1–4.3, p = 0.03). Conclusions Daily function and pain HRQOL domain groups using PROMIS tools independently predict hospitalizations and re-hospitalizations in cirrhotic patients