Performance of non-invasive tests and histology for the prediction of clinical outcomes in patients with non-alcoholic fatty liver disease: an individual participant data meta-analysis

BACKGROUND

Histologically assessed liver fibrosis stage has prognostic significance in patients with non-alcoholic fatty liver disease (NAFLD) and is accepted as a surrogate endpoint in clinical trials for non-cirrhotic NAFLD. Our aim was to compare the prognostic performance of non-invasive tests with liver histology in patients with NAFLD.

METHODS

This was an individual participant data meta-analysis of the prognostic performance of histologically assessed fibrosis stage (F0-4), liver stiffness measured by vibration-controlled transient elastography (LSM-VCTE), fibrosis-4 index (FIB-4), and NAFLD fibrosis score (NFS) in patients with NAFLD. The literature was searched for a previously published systematic review on the diagnostic accuracy of imaging and simple non-invasive tests and updated to Jan 12, 2022 for this study. Studies were identified through PubMed/MEDLINE, EMBASE, and CENTRAL, and authors were contacted for individual participant data, including outcome data, with a minimum of 12 months of follow-up. The primary outcome was a composite endpoint of all-cause mortality, hepatocellular carcinoma, liver transplantation, or cirrhosis complications (ie, ascites, variceal bleeding, hepatic encephalopathy, or progression to a MELD score ≥15). We calculated aggregated survival curves for trichotomised groups and compared them using stratified log-rank tests (histology: F0-2 vs F3 vs F4; LSM: <10 vs 10 to <20 vs ≥20 kPa; FIB-4: <1·3 vs 1·3 to ≤2·67 vs >2·67; NFS: <-1·455 vs -1·455 to ≤0·676 vs >0·676), calculated areas under the time-dependent receiver operating characteristic curves (tAUC), and performed Cox proportional-hazards regression to adjust for confounding. This study was registered with PROSPERO, CRD42022312226.

FINDINGS

Of 65 eligible studies, we included data on 2518 patients with biopsy-proven NAFLD from 25 studies (1126 [44·7%] were female, median age was 54 years [IQR 44-63), and 1161 [46·1%] had type 2 diabetes). After a median follow-up of 57 months [IQR 33-91], the composite endpoint was observed in 145 (5·8%) patients. Stratified log-rank tests showed significant differences between the trichotomised patient groups (p<0·0001 for all comparisons). The tAUC at 5 years were 0·72 (95% CI 0·62-0·81) for histology, 0·76 (0·70-0·83) for LSM-VCTE, 0·74 (0·64-0·82) for FIB-4, and 0·70 (0·63-0·80) for NFS. All index tests were significant predictors of the primary outcome after adjustment for confounders in the Cox regression.

INTERPRETATION

Simple non-invasive tests performed as well as histologically assessed fibrosis in predicting clinical outcomes in patients with NAFLD and could be considered as alternatives to liver biopsy in some cases.

FUNDING

Innovative Medicines Initiative 2.

Common musculoskeletal disorders in chronic liver disease patients

Chronic liver disease (CLD) is the commonest ailment affecting the hepatobiliary system. Six significant pathologies related to CLD include hepatic osteodystrophy (HO), increased infection susceptibility, sarcopenia, osteonecrosis of the femoral head (OFH), increased risk of periprosthetic complications and fracture. Hepatic osteodystrophy, which comprises osteopenia, osteoporosis, and osteomalacia, refers to alterations in bone mineral metabolism found in patients with CLD. The HO prevalence ranges from 13 to 95%. Low complement levels, poor opsonization capacity, portosystemic shunting, decreased albumin levels, and impaired reticuloendothelial system make the cirrhotic patients more susceptible to developing infectious diseases. Septic arthritis, osteomyelitis, prosthetic joint infection, and cellulitis were common types of CLD-associated infectious conditions. The incidence of septic arthritis is 1.5 to 2-fold higher in patients with cirrhosis. Sarcopenia, also known as muscle wasting, is one of the frequently overlooked manifestations of CLD. Sarcopenia has been shown to be independent predictor of longer mechanical ventilation, hospital stay, and 12-month mortality of post-transplantation. Alcohol and steroid abuse commonly associated with CLD are the two most important contributory factors for non-traumatic osteonecrosis. However, many studies have identified cirrhosis alone to be an independent cause of atraumatic osteonecrosis. The risk of developing OFH in cirrhosis patients increases by 2.4 folds and the need for total hip arthroplasty increases by 10 folds. Liver disease has been associated with worse outcomes and higher costs after arthroplasty. Cirrhosis is a risk factor for arthroplasty complications and is associated with a prolonged hospital stay, higher costs, readmission rates, and increased mortality after arthroplasty. Greater physician awareness of risk factors associated with musculoskeletal complications of CLD patients would yield earlier interventions, lower healthcare costs, and better overall clinical outcomes for this group of patients.

The postoperative chest in lung cancer

Most of the complications following lung cancer surgery occur in the early postoperative period and can result in significant morbidity and mortality. Delayed complications can also occur. Diagnosing these complications can be challenging because clinical manifestations are non-specific. Imaging plays an important role in detecting these complications in a timely manner and facilitates prompt interventions. Hence, it is important to have knowledge of the expected anatomical alterations following lung cancer surgeries, and the spectrum of post-surgical complications and their respective imaging findings to avoid misinterpretations or delay in diagnosis.

Analysis of trimodal and bimodal therapy in a selective-surgery paradigm for locally advanced oesophageal squamous cell carcinoma

BACKGROUND

Long-term survival outcomes of trimodal therapy (TMT; chemoradiation plus surgery) and bimodal therapy (BMT; chemoradiation) have seldom been analysed. In a selective-surgery paradigm, the benefit of TMT in patients with a complete clinical response is controversial. Factors associated with survival in patients with a clinical complete response to chemoradiation were evaluated.

METHODS

Patients with stage II-III oesophageal squamous cell carcinoma treated with TMT or BMT from 2002 to 2017 were evaluated. The BMT group consisted of patients who were otherwise eligible for surgery but underwent chemoradiation alone followed by observation. This group included patients who later had salvage oesophagectomy. Survival was evaluated and compared between TMT and BMT groups. Elastic net regularization was performed to select co-variables for Cox multivariable survival analysis in patients with a clinical complete response.

RESULTS

Of 143 patients, 60 (41.9 per cent) underwent TMT and 83 (58.0 per cent) BMT. Patients who underwent TMT had longer median overall survival than those who had BMT (77 versus 33 months; P = 0.019). For patients with a clinical complete response, TMT achieved longer median overall survival than BMT (123 versus 55 months; P = 0.04). BMT had a high locoregional recurrence rate (48 versus 6 per cent; P < 0.001); 26 of 29 patients with locoregional recurrence in the BMT groupunderwent salvage resection. Cox multivariable analysis demonstrated that upper-mid oesophageal tumour location (hazard ratio (HR) 2.04; P = 0.024) and tumour length (HR 1.18; P = 0.046) were associated with worse survival. Although TMT was not associated with survival, it was a predictor of reduced recurrence (HR 0.28; P = 0.028). The maximum standardized uptake value after chemoradiation also predicted recurrence (HR 1.33; P < 0.001).

CONCLUSION

In patients who achieve a clinical complete response, TMT reduces locoregional recurrence but may not prolong survival. The differences in survival outcomes may be due to patient selection; therefore, a selective-surgery strategy in oesophageal squamous cell carcinoma is a reasonable approach.

Photocatalytic activity of SnO2/Fe3O4 nanocomposites and the toxicity assessment of Vigna radiata, Artemia salina and Danio rerio in the photodegraded solution

The study was undertaken to design SnO₂/Fe₃O₄ nanocomposite by sonochemical method and to assess the photodegradation of organic dye. Textural, composition and structural features of the bare SnO₂ and SnO₂/Fe₃O₄ samples were characterized using scanning electron microscope (SEM), energy dispersive X-ray (EDX), X-ray diffraction (XRD), and Fourier transform infrared spectroscopy (FTIR). The X-ray diffraction of as-synthesized SnO₂/Fe₃O₄ nanocomposites confirms the presence of tetragonal and cubic structure. The results disclose that the incorporation of Fe₃O₄ in SnO₂ decrease the crystallite size and increase the surface area compared with bare SnO₂ nanoparticle. The as-prepared photocatalyst shows higher efficiency than the bare SnO₂ under sunlight irradiation. Vigna radiata seeds (VR), Artemia salina (AS) and Zebra fish (Danio rerio (DR) were used to check the toxicity level of the treated and untreated Rhodamine B (RhB) dye solution. These models displayed good consistency for examining the harmfulness of the solutions. The results suggests SnO₂/Fe₃O₄ nanocomposite exhibited a good efficacy in the dye wastewater treatment. Further, the degradation efficiency was confirmed by the toxicity examination.

Bioaccumulation of metals in mangroves and salt marshes collected from Tuticorin coast of Gulf of Mannar marine biosphere reserve, Southeastern India

Three species of mangroves and six species of salt marshes were collected from various locations along the Tuticorin coast for the estimation of metals like Cu, Cd, Pb, and Zn. The bioaccumulation of metals in mangroves is in the order of Cu > Pb > Zn > Cd, and the season-wise accumulation was higher in monsoon followed by summer, post-monsoon, and pre-monsoon seasons. The accumulation of metals in mangroves showed higher in Rhizophoraapiculata followed by Avicenniamarina, and Rhizophoramucronata. The concentration of metals in salt marshes is in the order of Pb > Zn > Cu > Cd, and the species-wise accumulation showed in the order of Suaeda maritime > Ipomoea sp. > Suaeda sp. > Spinifix littoreous > Sesuvium portacastrum > Ipomoea pes-capras. BAF in salt marhes and mangroves is as Cd < Pb < Cu < Zn and Cd < Cu < Pb < Zn, respectively.

Health risk assessment and bioaccumulation of toxic metals in commercially important finfish and shellfish resources collected from Tuticorin coast of Gulf of Mannar, Southeastern India

The present study was mainly focused on the distribution of metals (Cd, Cu, Pb, and Zn) in commercially important marine finfish and shellfish resources collected from the Tuticorin coast of the Gulf of Mannar, Southeastern India. Sixty-six species were collected in all four seasons for the analysis of metals. The order of bioaccumulation of metals in fishes is (Zn > Pb > Cu > Cd), in Crustaceans is (Zn > Pb > Cu > Cd), and in mollusks is (Pb > Zn > Cu > Cd). The human health risk assessment factors such as BCF, THQ, and HI were higher in most of the tested animals. The outcome of the present study will sound the alarm to the community about heavy metal contamination of sea foods. We conclude that continuous monitoring of the ecosystem is essential to the maintenance of the pristine ecosystem and quality of the seafood.

Assessment of Heavy Metals Pollution in Noyyal and Chinnar Rivers, Western Ghats of Tamil Nadu, India with Reference to Crabs (Gecarcinucidae)-A Baseline Study

In the present study, heavy metals (Cd, Cu, Pb, and Zn) level in the water, sediment, and crabs were analyzed from Noyyal and Chinnar Rivers of the Western Ghats in Tamil Nadu, India. Based on our results, Noyyal River is considered as polluted environment due to the discharge of contaminants by various anthropogenic activities, whereas, Chinnar River maintained as unpolluted one due to its tributary nature of Noyyal River located in Western Ghats hills. The results showed that the heavy metals in water and sediments were higher in Noyyal River. Also, the level of bioaccumulation of studied metals and biochemical constituents were higher in the crab Spiralothelphusa hydrodroma sampled from Noyyal River than Barytelphusa cunicularis collected from Chinnar River. The present findings revealed that the crab sampled from Noyyal River had elevated heavy metals which lead to a significant increase in biochemical constituents to overcome the stress.

Bioaccumulation of heavy metals, antioxidants, and metabolic enzymes in the crab Scylla serrata from different regions of Tuticorin, Southeast Coast of India

The present study was performed to analyze the bioaccumulation of heavy metals, biochemical constituents, antioxidants, and metabolic enzymes in the crab Scylla serrata from different regions of Tuticorin, Southeast Coast of India. The study area consists of Threspuram and Harbour Beach which were polluted environments due to the discharge of industrial effluents and domestic sewage into them. Punnakayal, which is a low-polluted environment where the in-situ culture of S. serrata is carried out by local fish farmers, was selected as well. The results revealed that the level of heavy metals, biochemical constituents, antioxidants, and metabolic enzymes were significantly high in the crabs collected from Threspuram and Harbour Beach compared to the crabs collected from Punnakayal. This study indicates that crabs from polluted environments have significant heavy metals bioaccumulation which leads to elevated antioxidants and metabolic enzyme levels. This implies that the crabs are under oxidative and metabolic stress.

Health risk assessment and potentiality of green seaweeds on bioaccumulation of trace elements along the Palk Bay coast, Southeastern India

Bioaccumulation of metals in ten species of green seaweeds collected along the Palk Bay was assessed in the present study. The accumulation of metals in all the ten species were in the order of Pb > Cu > Zn > Cd. Cd was recorded above the permissible level, and Pb, Cu and Zn were below the permissible level of CEQG. The metal concentration in seaweeds was above the WHO standards. The permissible levels of metals were compared with the standards of human health risk assessment, which shows that the exposure of metals from seaweeds has moderate hazard risk to humans. The result of trace element accumulation in four seasons was in the order of summer >monsoon>pre-monsoon>post monsoon. One-way ANOVA revealed that Cd and Pb show significant differences (p˂0.01) in all the species. Cu showed significant variation (p˂0.01) in all the four seasons. Zn also showed significant difference (p˂0.01) during pre-monsoon season.

Bioaccumulation of trace metals in the coastal Borneo (Malaysia) and health risk assessment

The concentration of nine trace elements were analyzed in the different tissue organs of commonly available crabs (Portunus sanguinolentus, Portunus pelagicus and Scylla serrate) and bivalve (Polymesoda erosa) species collected from the Miri coast, Borneo in order to evaluate the potential health risk by consumption of these aquatic organisms. Among the analyzed organs, metal accumulation was higher in the gill tissues. The essential (Cu and Zn) and non-essential (Pb and Cd) elements showed the highest (i.e. Zn) and lowest concentrations (i.e. Cd) in their tissue organs, respectively. The estimated daily intake and hazard indices of all metals in the muscle indicate that the measured values were below the provisional tolerable daily intake suggested by the joint FAO/WHO Expert Committee on Food Additives. Compared to Malaysian and international seafood guideline values the results obtained from the present study are lower than the permissible limits and safe for consumption.

Morphological variations in marine pufferfish and porcupinefish (Teleostei: Tetraodontiformes) from Tamil Nadu, southeastern coast of India

In the present study, morphological variations in 14 species of two families, Tetraodontidae and Diodontidae, were examined for individuals collected from five different centres in Tamil Nadu in the southeastern coast of India.  Twenty-seven morphological measurements and four meristic characters were taken and used for multivariate analyses such as discriminant function analysis (DFA) & MANOVA.  DFA revealed that the first two functions accounted for more than 75% variation between the species.  Negative allometric values were observed on head length (HL), orbital length (OL), pupil diameter (PD), interorbital length (IOL), pectoral-fin length (PEL), caudal peduncle depth (CPD), dorsal to pectoral fin distance (DPFD), caudal peduncle length (CPL) and post-pectoral-fin length (POPFL) measurements.  Also, MANOVA supported the DFA results.  Additions, allometric relationships, and meristic variations were observed for most of these species.   Moreover, this is the first attempt to describe a greater number of morphological features of the species belonging to the order Tetraodontiformes.

Isatin based macrocyclic Schiff base ligands as novel candidates for antimicrobial and antioxidant drug design: In vitro DNA binding and biological studies

In the present work, five macrocyclic compounds, C₁₈H₁₂N₂O₄ (1), C₃₈H₂₄N₈O₆ (1a), C₃₈H₂₄N₈O₄S₂ (1b), C₄₀H₃₂N₈O₄ (2a) and C₄₈H₃₂N₈O₄ (2b) have been synthesized and thoroughly characterized by elemental analysis, FT-IR, 1D & 2D NMR and electron spray ionization mass spectral analysis. The DNA binding ability of these compounds were investigated in vitro by UV-Visible, fluorescence, circular dichroism (CD) spectroscopy and viscosity measurements. The results indicate that these compounds possess strong DNA binding affinity via intercalation, while the order of binding strength followed the trend 2b (1.52 ± 0.06 × 10⁵ M^-1) > 2a (1.12 ± 0.11 × 10⁵ M^-1) > 1b (1.05 ± 0.04 × 10⁵ M^-1) > 1a (0.97 ± 0.14 × 10⁴ M^-1) > 1 (0.75 ± 0.21 × 10⁴ M^-1). The radical scavenging potencies of the compounds were explored by employing DPPH, OH and NO assays, in which 1a exhibited highest inhibitory effect on the radicals (IC₅₀ = 23.59 μM (DPPH), 26.14 μM (OH), 28.41 μM (NO)). The in vitro antibacterial studies showed that these compounds have the potential to arrest the growth of bacteria, among which, 1a was found to be vulnerable against the bacterial stains. In addition, in silico molecular docking stimulations were also performed to position these compounds into the active sites of bacterial membrane proteins. The results of in vitro and in silico investigations reveal that the compounds apprehend the bacterial growth significantly. The data obtained from this piece of work would be helpful to design antibacterial drugs incorporating isatin based macrocyclic frameworks.

Enhanced antimicrobial, antioxidant and anticancer activity of Rhizophora apiculata: An experimental report

The present study is designed to evaluate the antimicrobial, antioxidant and anticancer activities of Rhizophora apiculata. Initially, the phenolic and flavonoid content was quantified in solvent extracts, and gallic acid and rutin were used as a control, respectively. Further, antimicrobial and minimal inhibitory activities of different solvent extracts were assessed against human clinical pathogenic bacteria, and the results showed that butanol and methanol extract has potential antimicrobial activity. FTIR analysis of solvent extracts showed the presence of phenolic compounds at 3409-3430 cm^-1 that actively involved in various applications including antioxidant and anticancer activities. The in vitro antioxidant activity of solvent extracts showed excellent antioxidant potential, about 84% of DPPH free-radical scavenging, 76% of hydrogen peroxide, 82% of hydroxyl radical scavenging, and 80% of reducing power. Two-way ANOVA analysis showed that the highly significant effect of antioxidant activity depends on the concentration of extracts. The DNA protection efficiency of extracts against oxidative damage was confirmed by DNA nicking assay using bacterial DNA. The methanol extract effectively inhibited the growth and induces the apoptosis through ROS generation and sensitizes the mitochondrial membrane potential of A549 lung cancer cells. Taken together, the results showed that the solvent extracts of R. apiculata could be potential antioxidant and anticancer agents.

Mesenchymal stem cell therapy for advanced liver cirrhosis: A case report

Mesenchymal stem cell (MSC) transplant may offer an alternative to liver transplantation in patients with end‐stage liver disease. However, its efficacy remains uncertain. MSC was performed on a 50‐year‐old male with decompensated (Child‐Turcotte‐Pugh grade C) alcoholic liver cirrhosis due to an absence of donors for adult‐deceased and living‐related liver transplantation. Autologous bone marrow‐derived MSCs were harvested from the patient and cultured using standard protocols. The MSCs were subsequently re‐administrated into the liver via hepatic intra‐arterial infusion on two separate occasions. After infusion, there was an improvement in biochemical parameters (serum total bilirubin, serum albumin), and a reduction of diuretic use for ascites for up to 8 weeks. However, all biochemical and clinical parameters deteriorated on long‐term follow‐up without any further infusions. The patient eventually succumbed to his disease. MSC transplantation may have a clinical benefit on adult patients with end‐stage liver cirrhosis, but this appears to be transitory.

Biogenic gold nanoparticles induce cell cycle arrest through oxidative stress and sensitize mitochondrial membranes in A549 lung cancer cells

Schematic representation of biogenic synthesized AuNPs have been proven to have excellent anticancer activity against A549 human lung cancer cells.

Antioxidant activity of 1-hydroxy-1-norresistomycin derived from Streptomyces variabilis KP149559 and evaluation of its toxicity against zebra fish Danio rerio

Extraction of bioactive compounds from marine actinomycetes and its antimicrobial activity.

Correction: Development of glycolipid biosurfactant for inducing apoptosis in HeLa cells

Correction for ‘Development of glycolipid biosurfactant for inducing apoptosis in HeLa cells’ by V. Ramalingam et al., RSC Adv., 2016, 6, 64087–64096.

Development of glycolipid biosurfactant for inducing apoptosis in HeLa cells

A novel glycolipid biosurfactant produced fromStaphylococcus aureuswas used to induce apoptosis in HeLa cells.

Abstract PL-1: Hormones and the Breast: Local and Environmental Interactions

A woman's reproductive history affects her risk to get breast cancer. In particular, the number of menstrual cycles she experiences correlates with risk. We use tissue recombination experiments and different mouse mutant models to discern the roles of the ovarian hormones estrogens and progesterone act in the mammary gland. While estrogens drive pubertal development, progesterone is the major driver of proliferation in the adult mammary epithelium. Both steroids rely strongly on paracrine signaling to elicit cell proliferation and other biological effects.

Perinatal exposure to environmentally relevant concentrations of a high production volume chemical, bisphenol A, that is detected in human due to exposure through consumer products, results in persistent changes in the mammary gland. The cell number is increased in in adult females as is the response to progesterone.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr PL-1.

Development of polyvinyl chloride biofilms for succession of selected marine bacterial populations

Present investigation was made to bring out the pattern of biofilm formation by heterotrophic bacteria on nontoxic material, polyvinyl chloride (PVC) sheet fitted wooden rack that was immersed in seawater and the study was conducted in Tuticorin coast. Samplings were made over a period of 7 days with the following time period intervals: 30 min, 1, 2, 4, 24, 48, 72, 96, 120 and 144 hr. Bacterial enumeration was made by spread plate method on nutrient agar medium and characterization of bacterial isolates up to generic level was done. Gram-negative bacteria like Pseudomonas sp., Enterobacter sp., Aeromonas sp., Cytophaga sp. and Flavobacterium sp. were found to be the pioneer in colonizing the surface within 30 min and seven genera were represented in the biofilm. Among them two genera were found belonging to Gram-positive groups which included Micrococcus and Bacillus sp. The early stage biofilm i.e. up to 24th hr was wholly constituted by Gram-negative groups. However, the population density of Pseudomonas sp. was found to be higher (315 CFU) when compared to other Gram-negative forms. Occurrence of Gram-positive group was noted only at 48th hr old biofilm (28 to 150 CFU). The period between 48 and 96th hr was the transition where both the Gram-negative and Gram-positive groups co- existed. After 96th hr, the biofilm was found constituted only by Gram-positive groups. The isolates of early stage biofilm were found to produce allelopathic substance like bacteriocin.

A dynamic micro-CT scanner based on a carbon nanotube field emission x-ray source

Current commercial micro-CT scanners have the capability of imaging objects ex vivo with high spatial resolution, but performing in vivo micro-CT on free-breathing small animals is still challenging because their physiological motions are non-periodic and much faster than those of humans. In this paper, we present a prototype physiologically gated micro-computed tomography (micro-CT) scanner based on a carbon nanotube field emission micro-focus x-ray source. The novel x-ray source allows x-ray pulses and imaging sequences to be readily synchronized and gated to non-periodic physiological signals from small animals. The system performance is evaluated using phantoms and sacrificed and anesthetized mice. Prospective respiratory-gated micro-CT images of anesthetized free-breathing mice were collected using this scanner at 50 ms temporal resolution and 6.2 lp mm(-1) at 10% system MTF. The high spatial and temporal resolutions of the micro-CT scanner make it well suited for high-resolution imaging of free-breathing small animals.

An unusual finding in the follow-up of a transabdominal pre-peritoneal (TAPP) implanted mesh for inguinal hernia

BACKGROUND

Abnormalities around titanium stapled sites are not well described in the literature. Existence of staple granulomas or neoplasms on titanium stapled sites used in TAPP procedures is unknown.

CASE

We report a case in which differentiation of suspected staple granuloma or neoplasm around a titanium staple, used to secure the mesh in a TAPP procedure, could not be made other than by pathologic examination.

CONCLUSION

This case emphasises that although the appearance of the lesion may be suspected for staple granuloma, the possibility of a malignant neoplasm should always be considered.

Classification Methods in the Detection of New Suspicious Emails

Email has become one of the fastest and most economical forms of communication. However, the increase of email users has resulted in the dramatic increase of suspicious emails during the past few years. This paper proposes to apply classification data mining for the task of suspicious email detection based on deception theory. In this paper, email data was classified using four different classifiers (Neural Network, SVM, Naïve Bayesian and Decision Tree). The experiment was performed using weka on the basis of different data size by which the suspicious emails are detected from the email corpus. Experimental results show that simple ID3 classifier which make a binary tree, will give a promising detection rates.