241 research outputs found
Approach to perform the Safety Assessment of Cellulose and Nisin Biopolymers obtained from Bacterial Fermentation as Innovative Food Contact Materials Aimed to Extend Food Shelf Life
No full textIn the context of circular economy and the increasing demand for sustainable packaging solutions in the food industry, this study explores a possible approach to the safety assessment of innovative food contact materials (FCMs) that utilise agro industrial by-products for biopolymer production. The work focusses on biopolymers obtained from microbial fermentation, i.e. bacterial cellulose produced by Komagataeibacter xylinus, and the additive nisin produced from Lactococcus lactis subsp. lactis, in the formulation of active packaging. The approach used applies the EFSA principles that could be applicable to the safety assessment of the use of mixtures of natural origin to manufacture FCM (EFSA, 2023). A Literature Review was performed to identify potential substances of concern. Starting with the selection of natural carbon sources derived from agro-industrial waste, and continuing through the manufacturing of final materials and articles, each step is being scrutinised for the presence or production of hazardous substance, providing insights into the risks associated with the biobased FCMs throughout their manufacture. This work underscores the importance of a proper safety assessment approach for biopolymers derived from agro-industrial by-products
Reply to: Correspondence on "EASL Clinical Practice Guidelines on non-invasive tests for evaluation of liver disease severity and prognosis – 2021 update"
No full textin people with type‐2 diabetes in the community. Cost effectiveness of screening strategies
No full textBackground and Aims
As screening for the liver disease and risk-stratification pathways are not established in patients with type-2 diabetes mellitus (T2DM), we evaluated the diagnostic performance and the cost-utility of different screening strategies for MASLD in the community.
Methods
Consecutive patients with T2DM from primary care underwent screening for liver diseases, ultrasound, ELF score and transient elastography (TE). Five strategies were compared to the standard of care: ultrasound plus abnormal liver function tests (LFTs), Fibrosis score-4 (FIB-4), NAFLD fibrosis score, Enhanced liver fibrosis test (ELF) and TE. Standard of care was defined as abnormal LFTs prompting referral to hospital. A Markov model was built based on the fibrosis stage, defined by TE. We generated the cost per quality-adjusted life year (QALY) gained and calculated the incremental cost-effectiveness ratio (ICER) over a lifetime horizon.
Results
Of 300 patients, 287 were included: 64% (186) had MASLD and 10% (28) had other causes of liver disease. Patients with significant fibrosis, advanced fibrosis, and cirrhosis due to MASLD were 17% (50/287), 11% (31/287) and 3% (8/287), respectively. Among those with significant fibrosis classified by LSM≥8.1 kPa, false negatives were 54% from ELF and 38% from FIB-4. On multivariate analysis, waist circumference, BMI, AST levels and education rank were independent predictors of significant and advanced fibrosis. All the screening strategies were associated with QALY gains, with TE (148.73 years) having the most substantial gains, followed by FIB-4 (134.07 years), ELF (131.68 years) and NAFLD fibrosis score (121.25 years). In the cost-utility analysis, ICER was £2480/QALY for TE, £2541.24/QALY for ELF and £2059.98/QALY for FIB-4.
Conclusion
Screening for MASLD in the diabetic population in primary care is cost-effective and should become part of a holistic assessment. However, traditional screening strategies, including FIB-4 and ELF, underestimate the presence of significant liver disease in this setting
Royal Free Hospital-estimated glomerular filtration rate for prognostic stratification of first acute kidney injury in cirrhosis.
No full textBACKGROUND & AIMS
Renal function is a major determinant of prognosis in patients with cirrhosis. Current guidelines only contemplate serum creatinine (sCr) to assess kidney injury. However, there are formulas to estimate glomerular filtration rate (eGFR) which better measure renal function in patients listed for liver transplantation. There is no data available on whether these formulas predict prognosis in patients with acute kidney injury (AKI).
METHODS
In 143 patients presenting with a first episode of AKI, we compared the prognostic value of renal function estimated using sCr or eGFR assessed with Modification of Diet in Renal Disease (MDRD-6), chronic kidney disease epidemiology (CKD-EPI) and Royal Free Hospital (RFH) for renal replacement therapy (RRT) within 30 days of AKI, and 30- and 90-day transplant-free survival.
RESULTS
eGFR was calculated on values obtained before and at admission, at presentation of AKI (D0) and 48 hours after AKI (D2).15% of patients (more commonly in alcohol+metabolic etiology; p=0.049 vs. other) required RRT. Transplant-free survival at 30-and 90-day were 77% and 63%. Among sCr, MDRD-6, CKD-EPI and RFH-eGFR, the latter predicted best RRT (HR .937 95% CI .893-.982, p=0.007), 30-d (HR .936 95% CI .901-.972, p=0.001) and 90-d (HR .934 95% CI .908-.972, p<0.001) mortality/OLT.
CONCLUSIONS
Renal function estimated using the RFH-eGFR calculated at D2 after AKI diagnosis is a strong predictor of RRT and of 30-d and 90-d transplant-free survival. Results suggest that in cirrhosis, RFH-eGFR may be a better indicator of prognosis in AKI than sCr
Implications of vehicle automation for accessibility and social inclusion of people on low income, people with physical and sensory disabilities, and older people
No full textGreen Open Access added to TU Delft Institutional Repository ‘You share, we take care!’ – Taverne project https://www.openaccess.nl/en/you-share-we-take-care Otherwise as indicated in the copyright section: the publisher is the copyright holder of this work and the author uses the Dutch legislation to make this work public.Transport and Logistic
Derivation and validation of the BIMAST score for predicting the presence of fibrosis due to Metabolic dysfunction-associated steatotic liver disease among diabetic patients in the community
No full textBackground & aims
Current screening pathways, developed from tertiary care cohorts, underestimate the presence of Metabolic-dysfunction associated steatotic liver disease (MASLD) in patients with type 2 diabetes mellitus (T2DM) in the community. We developed, validated, and assessed cost-effectiveness of a new score for screening the presence of fibrosis due to MASLD in primary care.
Methods
Consecutive T2DM patients underwent screening for liver diseases with transient elastography (TE). Based on predictors of significant/advanced fibrosis, we generated the BIMAST score (based on aspartate aminotransferase (AST) and body mass index (BMI)) and validated it internally and externally (Royal Free Hospital, London and Palermo Hospital). For cost-effectiveness analysis, 6 screening strategies were compared against standard of care: BIMAST score, ultrasound plus abnormal liver function tests, FIB-4, NAFLD fibrosis score, ELF and transient elastography (TE). A Markov model was built based on fibrosis status. Cost per quality-adjusted life year (QALY) gained and the incremental cost-effectiveness ratio (ICER) were estimated over a lifetime.
Results
Among 300 patients enrolled, 64% (186) had MASLD and 10% (28) other causes of liver disease. In the whole population, patients with significant fibrosis, advanced fibrosis, and cirrhosis due to MASLD were 17% (50/287), 11% (31/287), and 3% (8/287), respectively. In primary care, BIMAST performed better than other non-invasive markers at predicting significant and advanced fibrosis. Moreover, BIMAST reduced false negatives from 54% (ELF) and 38% (FIB-4) to 10%. In both validation cohorts, BIMAST performance was as good as FIB-4. In the cost-utility analysis, ICER was £2,337.92/QALY for BIMAST.
Conclusion
The BIMAST predicts the presence of significant fibrosis in the community, reduces false negatives and is cost-effective. The BIMAST score should be included in the holistic assessment of diabetic patients
Case Study of Physiotherapy Treatment of a Patient with the Diagnosis Shoulder Luxation
No full textTitle: Case Study of Physiotherapy Treatment of a Patient with the Diagnosis Shoulder Luxation Název: Kazuistika fyzioterapeutické péče o pacienta s diagnózou luxace ramenního kloubu Author: Emmanouil Kassakis This bachelor thesis is divided into two parts, the general part and the special part. In the general part, it is included all the theoretical information about my patient's diagnosis. Specifically, the theoretical part is composed by the basic anatomy of the shoulder joint including muscles, joint, ligaments and bones. Then the biomechanical and kinesiological field. Furthermore, it is explained in details how the shoulder luxation injury is it possible to happen. Secondly, the special part which is the most important part of the bachelor thesis, it is composed by the whole information, examinations, therapy sessions and results of my patient. It is explained in details and in pictures of the patient during her therapy sessions as well. There were performed to the patient about 7 therapies sessions. Starting from Wednesday 5 February 2014 and ending on Friday 14 February 2014. Each therapy session is explained in details including the procedure and the results as well. Key words: shoulder, shoulder luxation, conservative treatment, shoulder girdle, range of motion, exercise. Powered by TCPDF..
Serum adipokine levels in patients with chronic hepatitis
No full textAdipokines are recently discovered adipose tissue hormones with systemic effects. Leptin and adiponectin have been implicated in the pathogenesis and progression of non-alcoholic fatty liver disease and chronic hepatitis C, while little is known about the role of resistin in chronic liver diseases. The potential role of adipokines on patients with chronic hepatitis B is inadequately studied. In the present study, we investigated the above three serum adipokines levels in relation to the etiology of liver disease and determined their associations with various anthropometrical, epidemiological, metabolic host factors as well as with histological severity. We prospectively evaluated 146 patients who consecutively underwent liver biopsy. Of those 146 patients, 52 had HBeAg-negative chronic hepatitis B (CHB), 70 had chronic hepatitis C (CHC) and 24 non-alcoholic steatohepatitis (NASH). Detailed epidemiological, anthropometrical and laboratory data were recorded and insulin resistance was calculated using the HOMA index. All serum adipokines levels were determined in stored serum samples using immunoenzymometric assays. Serum samples were obtained after an overnight fasting on the liver biopsy day and were stored in aliquots at -200C until assayed. Histological lesions were evaluated blindly according to Ishak’s and Brunt’s classification for CHB/CHC and NASH, respectively. Serum adipokine levels were similar between CHB and CHC, while CHB/CHC compared to NASH patients had significantly lower leptin (8.3±7.3 vs. 17.6±16.6 ng/mL, P=0.012) and higher adiponectin (10.2±5.1 vs. 7.5±4 µg/mL, P=0.018) and resistin levels (7.1±2.5 vs. 5.7±2.8 ng/mL, P=0.016). In CHB/CHC, there was no significant association between steatosis or necroinflammation and adipokines levels, while presence of moderate/severe fibrosis (stage 4-6) was associated with higher leptin and adiponectin levels in male but not in female patients. Serum leptin and resistin levels were associated with severe fibrosis in NASH patients; however due to the small sample size this finding could not be verified in multivariate analysis. Lower resistin levels were independently associated with moderate/severe fibrosis in chronic viral hepatitis irrespective of gender or other factors (adjusted odds ratio=0.788, P=0.035). In conclusion, serum adipokines levels depended on the etiology of liver disease and differed between chronic viral hepatitis and NASH, but not between CHB and CHC. In CHB/CHC, resistin levels are independently associated with fibrosis severity, while it seems to be a gender effect in the association of leptin and adiponectin levels with fibrosis.Οι λιποκίνες αποτελούν πρόσφατα ανακαλυφθείσες ορμόνες του λιπώδους ιστού με συστηματικές δράσεις. Η λεπτίνη και η αδιπονεκτίνη πιθανόν να συμμετέχουν στην παθογένεια και εξέλιξη της μη-αλκοολικής λιπώδους νόσου του ήπατος και της χρόνιας ηπατίτιδας C, ενώ τα δεδομένα για τον ενδεχόμενο ρόλο της ρεζιστίνης στις χρόνιες ηπατοπάθειες είναι ελάχιστα. Στη χρόνια ηπατίτιδα Β οι ενδεχόμενες επιδράσεις των λιποκινών δεν έχουν μελετηθεί επαρκώς. Στην παρούσα ερευνητική εργασία, διερευνήθηκε η συσχέτιση των επιπέδων ορού των τριών λιποκινών σε συνάρτηση με την αιτιολογία της ηπατικής νόσου και με ποικίλες ανθρωπομετρικές, μεταβολικές, εργαστηριακές και ιστολογικές παραμέτρους. Στη μελέτη εντάχθηκαν προοπτικά 146 ασθενείς με χρόνια ηπατοπάθεια οι οποίοι υποβλήθηκαν σε βιοψία ήπατος. Εκ των 146 ασθενών, οι 52 έπασχαν από χρόνια ηπατίτιδα Β, οι 70 από χρόνια ηπατίτιδα C και οι 24 από μη-αλκοολική στεατοηπατίτιδα. Σε κάθε ασθενή καταγράφηκαν λεπτομερή επιδημιολογικά, ανθρωπομετρικά και εργαστηριακά δεδομένα και υπολογίστηκε η αντίσταση στην ινσουλίνη με το δείκτη ΗΟΜΑ. Τα επίπεδα ορού των λιποκινών μετρήθηκαν με εμπορικά διαθέσιμες ανοσοενζυματικές μεθόδους σε δείγματα ορών των ασθενών από την ημέρα της βιοψίας. Η φύλαξη των δειγμάτων έγινε στους -200C. Η ιστολογική ταξινόμηση των βιοψιών έγινε κατά Ishak για τις χρόνιες ιογενείς ηπατίτιδες και κατά Brunt για τη μη-αλκοολική στεατοηπατίτιδα. Τα επίπεδα των λιποκινών δεν διέφεραν σημαντικά μεταξύ ασθενών με χρόνια ηπατίτιδα Β και C. Εντούτοις, ασθενείς με χρόνια ηπατίτιδα Β ή C εμφάνισαν σημαντικά χαμηλότερα επίπεδα λεπτίνης (8.3±7.3 έναντι 17.6±16.6 ng/mL, P=0.012) και υψηλότερα επίπεδα αδιπονεκτίνης (10.2±5.1 έναντι 7.5±4 µg/mL, P=0.018) και ρεζιστίνης (7.1±2.5 έναντι 5.7±2.8 ng/mL, P=0.016) σε σχέση με τους ασθενείς με μη-αλκοολική στεατοηπατίτιδα. Οι συσχετίσεις των επιπέδων λεπτίνης και αδιπονεκτίνης με την ηπατική ιστολογία στη χρόνια ιογενή ηπατίτιδα διέφεραν ανάλογα με το φύλο. Συγκεκριμένα, τα επίπεδα λεπτίνης συσχετίστηκαν ανεξάρτητα με την ίνωση μόνο στους άρρενες, ενώ αντίστοιχη συσχέτιση προέκυψε για την αδιπονεκτίνη στη μονοπαραγοντική ανάλυση. Τα επίπεδα λεπτίνης και ρεζιστίνης συσχετίστηκαν στη μονοπαραγοντική ανάλυση με τη βαρύτητα της ίνωσης στη NASH. Λόγω μικρού αριθμού ασθενών, το παραπάνω εύρημα δεν επαληθεύτηκε σε πολυπαραγοντική ανάλυση. Τέλος, τα επίπεδα ρεζιστίνης συσχετίστηκαν ανεξάρτητα με τη βαρύτητα της ίνωσης σε ασθενείς με χρόνια ιογενή ηπατίτιδα (σχετικός κίνδυνος=0.788, P=0.035). Συμπερασματικά, τα επίπεδα λιποκινών ορού εξαρτώνται από την αιτιολογία της υποκείμενης ηπατικής νόσου. Στη χρόνια ηπατίτιδα Β και C, τα επίπεδα ρεζιστίνης συσχετίζονται ανεξάρτητα με τη βαρύτητα της ίνωσης, ενώ η συσχέτιση των επιπέδων λεπτίνης και αδιπονεκτίνης με την ηπατική ιστολογία διαφέρει ανάλογα με το φύλο
Food Contact Materials: Migration and Analysis. Challenges and Limitations on Identification and Quantification
No full textFood contact materials (FCM) are defined as the objects and materials intended to come into direct or indirect contact with foodstuff, while food contact articles are defined as objects, being equipment, containers, packaging and various utensils which are clearly intended to be used for the manufacture, preparation, conservation, flow, transport or handling of foodstuffs [...
Case study of Physical Therapy approach of patient with Anterior. Cruciate Ligament rupture after traumatic injury in skiing
No full textTitle: Physical Therapy program in a patient with total rupture of Anterior Cruciate Ligament and partial rupture of Medial Collateral Ligament of the right knee joint after ski accident. Název bakalářské práce: Author: Emmanouil Tsichlakis The current Bachelor Thesis is divided into two parts, theoritical and practical one. In the theoritical part an overview of the general anatomy of the knee joint and the biomechanics of the knee ligaments are presented. Also the mechanisms of the injury of Anterior Cruciate Ligament, the clinical examination that follows, the symptomes that correspond in this injury and the conservative therapeutic approach are discused. The second part contains a detailed description of the case study of the patient, the examination tests and the rehabilitation program I perforfed to the patient and also the evaluation of the results of the therapy. Key worlds: Physical Therapy, knee joint, Anterior Cruciate Ligament, rupture, conservative, skiing Dates of practice: 16/1/2012 - 1/2/2012 Location of practice: Ústřední vojenská nemocnice Praha 1200/1, 162 00 Praha
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