Alcohol associated liver cirrhotics have higher mortality after index hospitalization: Long-term data of 5,138 patients

Background/Aims

Liver cirrhosis is an important cause of morbidity and mortality globally. Every episode of decompensation and hospitalization reduces survival. We studied the clinical profile and long-term outcomes comparing alcohol-related cirrhosis (ALC) and non-ALC.

Methods

Cirrhosis patients at index hospitalisation (from January 2010 to June 2017), with ≥1 year follow-up were included.

Results

Five thousand and one hundred thirty-eight cirrhosis patients (age, 49.8±14.6 years; male, 79.5%; alcohol, 39.5%; Child-A:B:C, 11.7%:41.6%:46.8%) from their index hospitalization were analysed. The median time from diagnosis of cirrhosis to index hospitalization was 2 years (0.2–10). One thousand and seven hundred seven patients (33.2%) died within a year; 1,248 (24.3%) during index hospitalization. 59.5% (2,316/3,890) of the survivors, required at least one readmission, with additional mortality of 19.8% (459/2,316). ALC compared to non-ALC were more often (P<0.001) male (97.7% vs. 67.7%), younger (40–50 group, 36.2% vs. 20.2%; P<0.001) with higher liver related complications at baseline, (P<0.001 for each), sepsis: 20.3% vs. 14.9%; ascites: 82.2% vs. 65.9%; spontaneous bacterial peritonitis: 21.8% vs. 15.7%; hepatic encephalopathy: 41.0% vs. 25.0%; acute variceal bleeding: 32.0% vs. 23.7%; and acute kidney injury 30.5% vs. 19.6%. ALC patients had higher Child-Pugh (10.6±2.0 vs. 9.0±2.3), model for end-stage liver-disease scores (21.49±8.47 vs. 16.85±7.79), and higher mortality (42.3% vs. 27.3%, P<0.001) compared to non-ALC.

Conclusions

One-third of cirrhosis patients die in index hospitalization. 60% of the survivors require at least one rehospitalization within a year. ALC patients present with higher morbidity and mortality and at a younger age.

Efficacy and safety of percutaneous microwave ablation for hepatocellular carcinomas <4 cm in difficult location

OBJECTIVE

Tumor location is a critical factor for determining technical success and local recurrence following percutaneous ablation of hepatocellular carcinomas (HCC). The purpose of this retrospective study was to evaluate the safety and outcome measures of percutaneous microwave ablation (pMWA) for HCCs <4 cm in difficult locations.

METHODS

Retrospective review included 81 patients who underwent pMWA for HCCs <4 cm. Fourty-three patients (30 males and 13 females; mean age, 61 years) with 53 HCCs located near the diaphragm, heart, gallbladder, kidney, gastrointestinal tract, large vessel and exophytic location were included under difficult location group. Thirty-eight patients (29 males and nine females; mean age, 60 years) with 48 HCCs in other locations were included under control group. Baseline demographics were recorded. Technical efficacy, local tumor progression (LTP), and complication rates were evaluated.

RESULTS

Mean follow-up period was 3.4 months (range 1-7). There was no major complication in both the groups; two patients had a mild perihepatic hemorrhage in the difficult location group which was managed conservatively. There was no difference between the groups in the overall technical efficacy rate (84.9% vs 91.7%, p = 0.294), LTP rate (4.4% vs 2.2%. p = 0.57) or complication rate (4.6% vs 0%, p = 0.177).

CONCLUSION

Our data suggest that there is no significant difference in technical efficacy, LTP or complication rates for MWA in both difficult and normal locations.

ADVANCES IN KNOWLEDGE

With proper patient selection, pre-procedural planning and appropriate technique, pMWA is feasible, safe, and effective for small HCCs in difficult location with an acceptable range of complications.

Influence of ion structure on thermal runaway behaviour of aprotic and protic ionic liquids

Accelerated rate calorimetric studies have been employed to study the exothermic and thermal runaway behaviour of some aprotic and protic ionic liquids based on several families of ions including the bis(flurorsulfonyl)imide anion ([FSI]^-); it was found that the protic salts are safer than aprotic salts of the [FSI]^- anion.

Paracentesis-Induced Circulatory Dysfunction With Modest-Volume Paracentesis Is Partly Ameliorated by Albumin Infusion in Acute-on-Chronic Liver Failure

BACKGROUND AND AIMS

Paracentesis-induced circulatory dysfunction (PICD) is a serious complication of large-volume (>5 L) paracentesis in cirrhosis and is reduced with albumin infusion. There is a lack of data on PICD in acute-on-chronic liver failure (ACLF). Because ACLF patients have greater hemodynamic derangements than patients with decompensated cirrhosis, we investigated whether PICD could develop with modest-volume paracentesis (MVP) and the role of albumin infusion.

APPROACH AND RESULTS

A total of 80 ACLF patients undergoing <5 L paracentesis were randomized to receive albumin (8 g/dL of ascitic fluid; n = 40) or no albumin (n = 40) and serially followed to detect PICD. Baseline characteristics were comparable between groups, including volume of ascitic tap (4.16 ± 0.23 versus 4.14 ± 0.27 L; P = 0.72) and plasma renin activity (PRA; 20.5 ± 7.03 versus 23.2 ± 8.24 ng/mL/hour; P = 0.12). PICD was more frequent in the no-albumin group than the albumin group (70% versus 30%; P = 0.001), with higher incidence of hepatic encephalopathy (50% versus 27.5%; P = 0.04), hyponatremia (67.5% versus 22.5%; P < 0.001), acute kidney injury (62.5% versus 30%; P = 0.001), and in-house mortality (62.5% versus 27.5%; P = 0.003). PRA of 25.15 ng/mL at day 3 had sensitivity and specificity of 71% and 68%, respectively, for development of PICD at day 6. Albumin infusion decreased the incidence of PICD at day 6 (odds ratio, 0.068; 95% confidence interval, 0.011-0.43; P = 0.005).

CONCLUSIONS

PICD is common and develops even with MVP in ACLF patients. Albumin infusion decreases the incidence of PICD and mortality in patients with ACLF. Clinical trial identifier: NCT02467348.

Insulin resistance and oxidative marker in women with PCOS

Polycystic Ovary Syndrome is a multifactorial reproductive problem and a leading cause of female infertility worldwide. Evidences have shown that Oxidative Stress and decreased antioxidant status are often linked with PCOS. Insulin Resistance in PCOS patients ranges from 50% to 70% and may encourage OS by production of reactive oxygen species.Objective: Our study determines serum MDA levels along with plasma glucose, serum insulin, and insulin resistance in obese and nonobese PCOS subjects.Materials and methods: A case control study was conducted on diagnosed 100 PCOS patients and 100 controls. Fasting plasma glucose was measured by enzymatic method. Insulin was estimated by chemiluminescent microparticle immunoassay using Abott Architect i 2000 SR analyser. Insulin resistance was calculated by HOMA-IR. Malonaldehyde is determined as Thiobarbituric acid reactive substances.Results: CRP and serum MDA levels were increased in women with PCOS irrespective of obesity compared to their respective controls with a p value of < .001. However, though fasting glucose, serum insulin, and IR were increased in both obese and nonobese women with PCOS compared to their BMI adjusted controls with p value of < .001, the values were within reference range in nonobese women.Conclusion: Our study suggests that women with PCOS have oxidative stress and elevated CRP irrespective of obesity. However, hyperinsulinemia and Insulin resistance are seen only in obese women with PCOS, indicating that these women are at high risk for developing low grade inflammation and cardiovascular diseases.

Extraction and crosslinking of bromelain aggregates for improved stability and reusability from pineapple processing waste

The present study is first of its kind that focuses upon the extraction of bromelain from pineapple core waste and stabilising it as insoluble cross-linked aggregates. The influence of process variables such as the choice of precipitant, type of cross-linker, concentration of cross-linker and the reaction time for cross-linking step was investigated upon the activity recovery of bromelain cross-linked aggregates. The optimization of this biocatalyst preparation specifically recovered 87% of the enzymatic activity available in pineapple core waste by ammonium sulphate (60%, w/v) precipitation followed by cross-linking for 4 h with 80 mM glutaraldehyde. Cross-linked bromelain aggregates were thermally more stable and exhibited higher pH stability in comparison to free bromelain. The cross-linked bromelain aggregates exhibited higher operational stability in different organic solvents at 4 °C. The highest operational stability (% stability given in parenthesis) was observed in acetone (100%) followed by hexane (53.6%), ethyl acetate (39.6%), ethanol (32.5%) and chloroform (14.9%). The kinetic studies revealed higher Km value (5.45 mM) after the formation of cross-linked bromelain aggregates as compared to free bromelain (5.04 mM) with almost similar Vmax values. Cross-linked bromelain aggregates also showed significant reusability characteristics with an activity retention of >85% after 5-time cycles. Such recyclability of bromelain cross-linked aggregates could lead to potential industrial applications in both food and non-food sector. In addition, the present extraction method avoids costs related to purification and expensive immobilization carriers.

Pyrazolium Phase-Change Materials for Solar-Thermal Energy Storage

Thermal energy storage technology utilizing phase-change materials (PCMs) can be a promising solution for the intermittency of renewable energy sources. This work describes a novel family of PCMs based on the pyrazolium cation, that operate in the 100-200 °C temperature range, offering safe, inexpensive capacity and low supercooling. Thermal stability and extensive cycling tests of the most promising PCM candidate, pyrazolium mesylate (T_m =168±1 °C, ΔH_f =160 J g^-1 ±5 %, ΔH_total ^v =495 MJ m^-3 ±5 %) show potential for its use in thermal storage applications. Additionally, this work discusses the molecular origins of the high thermal energy storage capacity of these ionic materials based on their crystal structures, revealing the importance of hydrogen bonds in PCM performance.

Abstract 5187: Effect of histone deacetylase inhibitor on PD-L1 expression in lung cancer cells

Programmed Cell Death Ligand-1 (PD-L1) is frequently expressed on tumor cells and tumor-infiltrating immune cells. The expression of PD-L1 is indicative of immunosuppression and cause for poor prognosis in several cancers. The effects of PD-L1 are mediated through its binding to the Programmed Cell Death-1 (PD-1) receptor, which is a co-inhibitory surface molecule that is expressed on lymphoid and non-lymphoid derived cells. After PD-L1 binding the PD-1 receptor mediates the signals intracellularly to suppress peripheral T-cell responses. Therefore, determining the mechanisms of up-regulation or down-regulation of the PD-L1 is very crucial for the purpose of devising strategies to reactivate the T-cells that can lead to enhanced tumor attack. However, the cellular mechanisms that determine the levels of PD-L1 are not fully understood at this time. Hence, we analyzed different cancer cell lines for the expression levels of PD-L1 and confirmed the highest-level of expression in HCC827 lung cancer cells. In addition, H460, H1975 (Lung Cancer), SJSA1 (Osteosarcoma) and U-87 MG (Glioblastoma) cells were found to express PD-L1 in high levels. Relatively, lower level expression of PD-L1 was detected in H226 (Squamous Cell Carcinoma) PANC-1 (Pancreatic Cancer), CFPAC-1 (Pancreatic, Ductal Adenocarcinoma) and LNCaP (Prostate Cancer) cells compared to HCC827. Since, alterations in gene expressions are often regulated by epigenetic modifications, we conducted experiments to determine whether the expression of PD-L1 can also be altered by the HDAC inhibitor SAHA (Suberoylanilide hydroxamic acid). In our experiments, SAHA (7.5 μM) was able to reduce the expression of PD-L1 in a time and dose dependent manner and produced more than 50% decrease in the protein levels within 24 hrs. while the level of PD-L1 was significantly reduced, concomitant decreases in EGFR, phospho-EGFR levels were also observed in HCC827 cells following SAHA treatment. Furthermore, SAHA was able to increase the levels of acetyl-H2B, acetyl-H3 and acetyl-H4, which confirmed the impact of HDAC inhibition on the acetylation status of histones. Since de-acetylation mediated unwinding of the DNA is typically responsible for the increased expression of genes such as p21/CDKN1A, it is suspected that the decrease in the PD-L1 levels may be due to reduced transcription of the CD274 gene that is coding for PD-L1. However, it is not clear whether the decrease in PD-L1 expression observed is because of p21 mediated negative control on the transcription process or due to some other mechanism. Additional studies are required to fully understand the actual mechanisms that may be involved in the regulation of PD-L1 expression by HDACs and their inhibitors. (This research was supported by the Royal Dames of Cancer Research Inc., Fort Lauderdale, Florida).

Citation Format: Umamaheswari Natarajan, Thiagarajan Venkatesan, R Vijayaraghavan, Shila Samuel, Appu Rathinavelu. Effect of histone deacetylase inhibitor on PD-L1 expression in lung cancer cells [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 5187.

New insights into odontological exploration of drowning using rat model - A pilot study

Dental forensics for the resolution of unnatural death remains an underdeveloped field. Accordingly, an experimental study was conducted with six to seven months old Wistar rats that were drowned in order to identify key postmortem features and pattern of dental decomposition. The visual, structural and elemental changes were assessed periodically. Based on mode of death, they were designated as SB (euthanized and soil buried), FWD (fresh water drowned) and SWD (sea water drowned). Postmortem features as well as the structural and elemental patterns of decomposition of teeth were analyzed with Field Emission Scanning Electron Microscopy (FE-SEM) and Energy Dispersive Spectroscopy (EDAX) periodically for two months. The periodic observation of elemental changes in the teeth of SB, FWD and SWD rats allowed us to derive an equation using linear regression analysis to relate the degree of dental decomposition with the time since death. The difference in pattern of surface deterioration was also observed. The present findings could provide a better knowledge in resolving unnatural deaths and supporting evidence for legal prosecution.

A double-blind randomized controlled trial to assess efficacy of bromocriptine in cirrhotic patients with hepatic parkinsonism

BACKGROUND

Parkinsonism like features can be seen in cirrhotics, possibly related to alterations in brain dopamine metabolism, transport and receptor integrity at basal ganglia. Hepatic parkinsonism is often not suspected and only ammonia-reducing therapies are given to such patients. We investigated the efficacy and safety of bromocriptine, a dopaminergic agent, in patients with hepatic parkinsonism.

PATIENTS AND METHODS

Cirrhotics were screened for the presence of extrapyramidal symptoms and were diagnosed as hepatic parkinsonism if any two of tremor, bradykinesia and/or rigidity were present, supported by MRI brain showing T1 hyperintensities in basal ganglia and substantia nigra. Patients were randomized to receive placebo (Gr A, n = 22) or bromocriptine (Gr B, n = 24) for 12 weeks. Complete, partial and non-response were defined as 30%, 10%-30% and <10% reduction,respectively, in Unified Parkinson's Disease Rating Scale motor score.

RESULTS

Of 1016 cirrhotics, 50 (4.9%) had hepatic parkinsonism. Patients in two treatment groups were comparable for MELD score, arterial NH3 and frequency of portosystemic shunts. Bromocriptine therapy for 12 weeks resulted in improvement in rigidity, tremors, bradykinesia and gait compared to placebo with complete and partial response in seven vs none (29.1%, 0%, P < 0.01) and 12 vs one (50%, 4.5%, P < 0.01) patients. Prolonged and more severe motor symptoms were associated with non-response to bromocriptine therapy. There were no major side effects in either treatment group.

CONCLUSIONS

Hepatic parkinsonism is seen in ~5% cirrhotics. Bromocriptine is a safe and effective therapy for these patients and is more effective in mild to moderate hepatic parkinsonism.

New dimensions in salt-solvent mixtures: a 4th evolution of ionic liquids

In the field of ionic liquids (ILs) it has long been of fundamental interest to examine the transition from salt-in-solvent behaviour to pure liquid-salt behaviour, in terms of structures and properties. At the same time, a variety of applications have beneficially employed IL-solvent mixtures as media that offer an optimal set of properties. Their properties in many cases can be other than as expected on the basis of simple mixing concepts. Instead, they can reflect the distinct structural and interaction changes that occur as the mixture passes through the various stages from pure coulombic medium, to "plasticised" coulombic medium, into a meso-region where distinct molecular and ionic domains can co-exist. Such domains can persist to quite a high dilution into the salt-in-solvent regime and their presence manifests itself in a number of important synergistic interaction effects in diverse areas such as membrane transport and corrosion protection. Similarly, the use of ionic liquids in synthetic processes where there is a significant volume fraction of molecular species present can produce a variety of distinct and unexpected effects. The range of these salt-solvent mixtures is considerably broader than just those based on ionic liquids, since there is only minor value in the pure salt being a liquid at the outset. In other words, the extensive families of organic and metal salts become candidates for study and use. Our perspective then is of an evolution of ionic liquids into a broader field of fundamental phenomena and applications. This can draw on an even larger family of tuneable salts that exhibit an exciting combination of properties when mixed with molecular liquids.

Self-assembled structure and dynamics of imidazolium-based protic salts in water solution

Protic ionic liquids containing cations with long alkyl chains can form self-assembled micelles, vesicles, microemulsions, and lyotropic liquid crystal structures in water, acid water or tetrahydrofuran, etc. As a result of this unique property, they are regarded as a novel category of amphiphiles, and are gaining importance in the field of colloid and interface chemistry. The critical micelle concentration (CMC) of protic salts, e.g., alkyl-ammonium nitrates in water, was found to increase with decreasing chain length. It is generally believed that a long alkyl chain length is essential for the formation of self-assembled structures. So far, no self-assembled structure has been reported for protic ionic liquids with an alkyl chain length of n < 4. This paper reports on the structure and dynamics of two imidazolium based protic organic salts with no alkyl chain or a methyl group (n = 1) attached to the cation in water solution, determined through a detailed analysis of NMR spectra and pulsed-field gradient NMR data. We demonstrate that these imidazolium cations with no or a short alkyl chain (n = 1) can form a self-assembled clustering structure in water solution, which has a strong influence on the diffusion behavior of imidazolium molecular ions. It is speculated that this self-assembled structure is likely to be present in other similar solutions of ionic liquids with short alkyl chains.

Protein loosing enteropathy after Fontan procedure

Fontan and Baudet described the procedure in 1971 and was very useful to improve the quality of life in many complex cyanotic heart diseases. It has gone through various modifications since then to improve the outcome. The mortality was reported as 2.1% and survival rate of at 5 years, 10 years, 15 years and 20 years were 91%, 80%, 73%and 69% respectively. Though it was a useful palliative procedure to improve the quality of life, it has complications which may affect the morbidity and mortality like Protein loosing enteropathy ,reduced exercise capacity thromboembolism. The patients with protein losing enteropathy present with Pleural effusion, ascites, and edema and they need periodic replacement of Albumin and frequent reviews and close follow up in the management to reduce the mortality and to improve the quality of life .These complications we come across and they need our support in the management at district level hospitals.

Targeted methylation sequencing of plasma cell-free DNA for cancer detection and classification

Background

Targeted methylation sequencing of plasma cell-free DNA (cfDNA) has a potential to expand liquid biopsies to patients with tumors without detectable oncogenic alterations, which can be potentially useful in early diagnosis.

Patients and methods

We developed a comprehensive methylation sequencing assay targeting 9223 CpG sites consistently hypermethylated according to The Cancer Genome Atlas. Next, we carried out a clinical validation of our method using plasma cfDNA samples from 78 patients with advanced colorectal cancer, non-small-cell lung cancer (NSCLC), breast cancer or melanoma and compared results with patients' outcomes.

Results

Median methylation scores in plasma cfDNA samples from patients on therapy were lower than from patients off therapy (4.74 versus 85.29; P = 0.001). Of 68 plasma samples from patients off therapy, methylation scores detected the presence of cancer in 57 (83.8%), and methylation-based signatures accurately classified the underlying cancer type in 45 (78.9%) of these. Methylation scores were most accurate in detecting colorectal cancer (96.3%), followed by breast cancer (91.7%), melanoma (81.8%) and NSCLC (61.1%), and most accurate in classifying the underlying cancer type in colorectal cancer (88.5%), followed by NSCLC (81.8%), breast cancer (72.7%) and melanoma (55.6%). Low methylation scores versus high were associated with longer survival (10.4 versus 4.4 months, P < 0.001) and longer time-to-treatment failure (2.8 versus 1.6 months, P = 0.016).

Conclusions

Comprehensive targeted methylation sequencing of 9223 CpG sites in plasma cfDNA from patients with common advanced cancers detects the presence of cancer and underlying cancer type with high accuracy. Methylation scores in plasma cfDNA correspond with treatment outcomes.

High CO2 absorption by diamino protic ionic liquids using azolide anions

Highly efficient low-viscosity protic ionic liquids with enhanced CO₂ absorption capacities exhibiting more than 20% w/w uptake.

The influence of anion chemistry on the ionic conductivity and molecular dynamics in protic organic ionic plastic crystals

Protic organic ionic plastic crystals based on different anions exhibit more than two orders of magnitude difference in conductivity.