3,050 research outputs found
The Assessment of Portal Hypertension
No full textPortal hypertension (PH) and the relative clinical manifestations represent major complications of advanced chronic liver disease (ACLD). PH is caused by a progressive increase in the resistance to portal blood flow into the liver due to substantial angio-architectural changes associated with liver tissue fibrosis, neo-angiogenesis and increased vascular tone within the hepatic microcirculation. The gold standard method for evaluating the severity of portal hypertension is the hepatic venous pressure gradient (HVPG). Liver stiffness measurement (LSM), mainly assessed by vibration-controlled transient elastography (VCTE), has been proposed as a non-invasive test able to provide important diagnostic and prognostic information in the setting of PH. However, the good correlation between LSM and PH is lost in clinically severe PH, i.e. HVPG >12 mmHg, mainly due to the inability of LSM to detect the extra-hepatic components of PH. Accordingly, the measurement of spleen stiffness (SSM), being a more accurate surrogate of HVPG, has been proposed as a non-invasive test able to predict the presence of PH and oesophageal varices (EV)
Management of hepatic encephalopathy: focus on antibiotic therapy
No full textAltered gut microecology is considered a key pathogenetic factor in the development of both inteststinal (irritable bowel disease, inflammatory bowel disease, ecc.)and systemic (hepatic encephalophaty, steatohepatitis, ecc.) diseases. Hepatic encephalopathy (HE) is a major neuropsychiatric complication of both acute and chronic liver failure. Symptoms of HE include attention deficits, alterations of sleep patterns and muscular incoordination progressing to stupor and coma. The pathogenesis of HE is still unknown, although ammonia-induced alterations of cerebral neurotransmitter balance, especially at the astrocyte-neurone interface, may play a major role. Treatment of HE is therefore directed at reducing the production and absorption of gut-derived neurotoxic substances, especially ammonia. The non-absorbable disaccharides lactulose and lactitol were long considered as a first-line pharmacological treatment of HE, but a recent systematic review questioned their efficacy, pointing out that there is insufficient high-quality evidence to support their use. Oral antibiotics are regarded as a suitable therapeutic alternative. However, the prolonged use of antimicrobials is precluded by the possible occurrence of adverse events. Rifaximin, a synthetic antibiotic structurally related to rifamycin, displays a wide spectrum of antibacterial activity against Gram-negative and Grampositive bacteria, both aerobic and anaerobic, and a very low rate of systemic absorption. Available evidence suggests that rifaximin - thanks to its efficacy and remarkable safety - has the highest benefit-risk ratio in the overall treatment of HE
Censorship and claims making regarding problem framing in 5 published RCT's on social anxiety (as identified by the author and Amanda Reiman, PhD).
No full text<p>Censorship and claims making regarding problem framing in 5 published
RCT's on social anxiety (as identified by the author and Amanda
Reiman, PhD).</p
Liver and Spleen Stiffness Measurements for Assessment of Portal Hypertension Severity in Patients with Budd Chiari Syndrome
No full textAims. Budd-Chiari Syndrome (BCS) is a rare vascular disease of the liver caused by the obstruction of the hepatic venous outflow located from the small hepatic venules up to the entrance of the inferior vena cava (IVC) into the right atrium. Current prognostic indexes are suboptimal for an individual prognostic assessment and subsequent management of patients with BCS. Liver (LSM) and spleen (SSM) stiffness measurements are widely validated prognostic tools in hepatology, but the evidence in patients with BCS is limited. This paper describes LSM and SSM in patients with BCS and their correlation with clinical, biochemical, and ultrasound findings from the same patients. Methods. We investigated a case series of seven patients with BCS diagnosis and available LSM and SSM evaluated by transient elastography (TE). Biochemical, imaging, and endoscopic findings nearest to the TE evaluation were recorded. Clinical outcomes and BCS evolution were described for each patient. When available, repeated TE assessments were also recorded. Results. Patients with acute nonfulminant manifestation of BCS presented near-the-upper-limit values (75 kPa) of LSM and SSM, which often persist until the placement of a transjugular intrahepatic portosystemic shunt (TIPS). On the other hand, TE values were markedly lower in patients with compensated BCS. In some patients with repeated TE measurement years after TIPS placement, LSM had decreased to values of <10 kPa years. SSM changes in these patients were, however, less evident. Conclusions. Extremely elevated values of LSM and SSM are suggestive of BCS. The evaluation of both LSM and SSM by TE could help clinicians in the initial evaluation, risk stratification, and therapy response monitoring of patients with BCS
Unveiling Melodies in Shadows: An Analysis of Swedish Female Composer Amanda Maier’s Sonata for Violin and Piano in B Minor
No full textAmanda Maier (1853−1894), a pioneering Swedish violinist and composer of the late nineteenth century, holds a unique place in music history as the first-ever female music director in Sweden. Despite her significant achievements, her compositions have remained relatively unknown. Therefore, the document aims to illuminate Amanda Maier's violin works, focusing on investigating her violin sonata in terms of violin performance and pedagogy. Specifically, the study offers insights into the performance techniques employed and provides other pertinent pedagogical suggestions for each movement. The document features an introductory chapter and a review of the historical context of Maier's life and the violin sonata. Subsequent chapters shift the focus to performance practice and pedagogical suggestions with theoretical analysis. One distinctive feature of the study is the inclusion of practice exercises composed originally by the author, tailored specifically to the techniques found in the sonata. These exercises aid practitioners in incorporating Maier's violin sonata into their program. The study assists violinists in diversifying their performance and teaching literature. It seeks to inspire renewed appreciation for Amanda Maier's artistic legacy because it is important to recognize the remarkable contributions of women in the classical music industry, and Amanda Maier, an underrepresented composer, exemplifies this. The document not only contributes to music research but also enhances pedagogical practices, fostering a more inclusive and equitable environment for female composers in the classical music world
Idiopathic chronic intestinal pseudo-obstruction syndrome is strongly associated with low serum levels of vitamin D
No full textIdiopathic chronic intestinal pseudo-obstruction (CIPO) is associated with intestinal inflammation and malabsorption and may cause serum vitamin D deficiency. We aimed to assess whether there is an association between idiopathic CIPO and serum levels of 25-hydroxy-vitamin D. Consecutive patients with confirmed diagnosis of idiopathic CIPO were prospectively enrolled and matched with healthy controls by gender, age, and BMI. Median serum level of 25-hydroxy-vitamin D of patients with CIPO was compared with that of healthy subjects using the Wilcoxon signed-rank test for matched samples. A total of 35 patients with CIPO and 35 matched healthy subjects were enrolled. All patients with CIPO had a 25-hydroxy-vitamin D deficiency with serum levels <12 ng/ml. The median serum level of vitamin D was significantly lower in patients with CIPO than in healthy controls (5.7 vs. 29.7 ng/ml, P < 0.0001). Serum level of vitamin D was not associated with gender ( P = 0.27), age ( P = 0.22), BMI ( P = 0.95), high (>10 000 × ml) WBC count ( P = 0.08), or high (>5 mg/l) C-reactive protein ( P = 0.87) among patients with CIPO. CIPO seems to be strongly associated with low serum levels of 25-hydroxy-vitamin D
Belonging: natural histories of place, identity and home
No full textCanongate's synopsis:
"Reflecting on family, identity and nature, Belonging is a personal memoir about what it is to have and make a home. It is a love letter to nature, especially the northern landscapes of Scotland and the Scots pinewoods of Abernethy – home to standing dead trees known as snags, which support the overall health of the forest.
Belonging is a book about how we are held in thrall to elements of our past. It speaks to the importance of attention and reflection, and will encourage us all to look and observe and ask questions of ourselves.
Beautifully written and featuring Amanda Thomson’s artwork and photography throughout, it explores how place, language and family shape us and make us who we are."
Longlisted for the Highland Book Prize, 2023
Some of the reviews...
Outstanding - ROBERT MACFARLANE
Amanda Thomson’s new book manages to carve out a distinctive niche for itself . . . This is a passionate book and infused with a sense of rootedness - STUART KELLY, The Scotsman
In recent years rural landscapes have turned into battlegrounds, and nature writing has become increasingly polemical. Belonging is a quiet book of questions in a genre full of answers, but it is all the more powerful and beautiful for this - PATRICK GALBRAITH, TLS
One of the best things I have read in ages . . . Quiet and beautiful and powerful - ALYS FOWLER
Thomson writes of the natural in a way I have yet to encounter before. There is no real hoo-haa, no flowery description of which to speak yet somehow, I came away with that ache inside me — that renewed obsession with the world that is only borne of a very particular kind of writing — poetic, loving, raw . . . Like no other - KERRI Ní DOCHARTAIGH, Caught by the River
In strikingly original takes on Scottish history, environmentalism, Black feminist theory, artmaking, list-making, memory, and memoir, Thomson crafts a cadence that is as wise as it is vitally alive. - MARGOT DOUAIHY, author of Scorched Grac
Interview with Amanda Huron, author, Carving Out the Commons: Tenant Organizing and Housing Cooperatives in Washington, D.C.
No full textIs modern capitalism too far advanced in the U.S. to create common property regimes? Are there models for what an Urban Commons might look like? Join us as we speak with Amanda Huron, author of Carving Out the Commons: Tenant Organizing and Housing Cooperatives in Washington, D.C. (University of Minnesota Press, 2018). She’ll help us understand the theory and practice of Limited Equity Housing Cooperatives and the affordability, control, stability, and community they can provide to low-income communities and the people who live in them
Effect of a symbiotic preparation on the clinical manifestations of irritable bowel syndrome, constipation variant. Result of an open, uncontrolled , multicenter trial.
No full textCan Liver Ultrasound Elastography Predict the Risk of Hepatocellular Carcinoma Recurrence After Radiofrequency Ablation? A Systematic Review and Meta-Analysis
No full textPurpose: The role of liver stiffness (LS) on ultrasound elastography in the prediction of hepatocellular carcinoma (HCC) recurrence after treatment with radiofrequency ablation (RFA) is still unclear. Our aim was to perform a systematic review and meta-analysis to assess whether LS can predict the recurrence of HCC after RFA.
Materials and methods: Medline via PubMed, Embase, Scopus, and Cochrane Library databases, and abstracts of international conference proceedings were searched up to June 30, 2020. Cohort studies were included if they assessed the association between LS values measured by ultrasound elastography before RFA and HCC recurrence.
Results: 9 studies including 1373 patients with HCC treated by RFA, 643 of whom developed HCC recurrence, were identified. The mean value of LS before RFA was significantly higher in patients who developed HCC recurrence than in those who did not (weighted mean difference=11.98 kPa, 95%CI: 7.60-16.35, I2=63.8%). There was a significant positive association between LS value and HCC recurrence both at univariate (unadjusted HR=1.03, 95%CI: 1.00-1.07, I2=72.7%) and multivariate analysis (adjusted HR=1.03, 95%CI: 1.02-1.04, I2=0). Patients with LS value ≥13-14 kPa or >1.5 m/s have a higher risk of both HCC recurrence (unadjusted HR=2.18, 95%CI: 1.46-3.25, I2=49.7%; adjusted HR=2.41, 95%CI: 1.53-3.79, I2=0) and overall mortality (adjusted HR=4.38; 95%CI: 2.33-8.25, I2=0) in comparison with those with LS below these cutoffs.
Conclusion: Liver ultrasound elastography appears to be a reliable tool to predict HCC recurrence and overall survival after RFA. This technique may be useful for the management of patients with HCC treated by RFA
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