Hepatocellular carcinoma in non-alcoholic steatohepatitis:Current knowledge and implications for management

With the prevalence of hepatitis C virus expected to decline, the proportion of hepatocellular carcinoma(HCC) related to non-alcoholic steatohepatitis(NASH) is anticipated to increase exponentially due to the growing epidemic of obesity and diabetes. The annual incidence rate of developing HCC in patients with NASH-related cirrhosis is not clearly understood with rates ranging from 2.6%-12.8%. While multiple new mechanisms have been implicated in the development of HCC in NASH; further prospective long-term studies are needed to validate these findings. Recent evidence has shown a significant proportion of patients with non-alcoholic fatty liver disease and NASH progress to HCC in the absence of cirrhosis. Liver resection and transplantation represent curative therapeutic options in select NASHrelated HCC patients but have placed a significant burden to our healthcare resources and utilization. Currently NASH-related HCC is the fastest growing indication for liver transplant in HCC candidates. Increased efforts to implement effective screening and preventative strategies, particularly in non-cirrhotic NASH patients, are needed to reduce the future impact imposed by NASH-related HCC.

Early anticoagulation in patients with stroke and atrial fibrillation is associated with fewer ischaemic lesions at 1 month: the ATTUNE study

Background The optimal time to commence anticoagulation in patients with atrial fibrillation(AF)after ischaemic stroke or transient ischaemic attack(TIA)is unclear,with guidelines differing in recommendations.A limitation of previous studies is the focus on clinically overt stroke,rather than radiologically obvious diffusion-weighted imaging ischaemic lesions.We aimed to quantify silent ischaemic lesions and haemorrhages on MRI at 1month in patients commenced on early(<4days)vs late(≥4days)anticoagulation.We hypothesised that there would be fewer ischaemic lesions and more haemorrhages in the early anticoagulant group at 1-month MRI.Methods A prospective multicentre,observational cohort study was performed at 11 Australian stroke centres.Clinical and MRI data were collected at baseline and follow-up,with blinded imaging assessment performed by two authors.Timing of commencement of anticoagulation was at the discretion of the treating stroke physician.Results We recruited 276 patients of whom 208 met the eligibility criteria.The average age was 74.2 years(SD±10.63),and 79(38%)patients were female.Median National Institute of Health Stroke Scale score was 5(IQR 1–12).Median baseline ischaemic lesion volume was 5mL(IQR 2–17).There were a greater number of new ischaemic lesions on follow-up MRI in patients commenced on anticoagulation≥4days after index event(17%vs 8%,p=0.04),but no difference in haemorrhage rates(22%vs 32%,p=0.10).Baseline ischaemic lesion volume of≤5mL was less likely to have a new haemorrhage at 1month(p=0.02).There was no difference in haemorrhage rates in patients with an initial ischaemic lesion volume of>5mL,regardless of anticoagulation timing.Conclusion Commencing anticoagulation<4days after stroke or TIA is associated with fewer ischaemic lesions at 1month in AF patients.There is no increased rate of haemorrhage with early anticoagulation.These results suggest that early anticoagulation after mild-to-moderate acute ischaemic stroke associated with AF might be safe,but randomised controlled studies are needed to inform clinical practice.WHAT IS ALREADY KNOWN ON THIS TOPIC⇒Early anticoagulation after ischaemic stroke associ-ated with atrial fibrillation(AF)may reduce the rate of recurrent diffusion-weighted imaging ischaemic lesions and increase the rate of new haemorrhage.⇒It is unknown whether early anticoagulation also re-duces the rate of new silent ischaemic lesions.WHAT THIS STUDY ADDS⇒Early anticoagulation(<4days)after ischaemic stroke due to AF reduces the rate of new silent isch-aemic lesions at 1month without increasing the rate of new haemorrhage.HOW THIS STUDY MIGHT AFFECT RESEARCH,PRACTICE OR POLICY⇒Early anticoagulation after mild-to-moderate acute ischaemic stroke due to AF might be safe,howev-er,the results require further validation with ran-domised trials.

Renewable hydrogen production from butanol:a review

Hydrogen production from butanol is a promising alternative when it is obtained from bio-butanol or bio-oil due to the higher hydrogen content compared to other oxygenates such as methanol,ethanol or propanol.Catalysts and operating conditions play a crucial role in hydrogen production.Ni and Rh are metals mainly used for butanol steam reforming,oxidative steam reforming and partial oxidation.Additives such as Cu can improve catalytic activity in many folds.Moreover,support-metal interaction and catalyst preparation technique also play a decisive role in the stability and hydrogen production capacity of catalyst.Steam reforming technique as an option is more frequently researched due to higher hydrogen production capability in comparison to other thermochemical techniques despite its endothermic nature.The use of the oxidative steam reforming and partial oxidation has the advantages of requiring less energy and longer stability of catalysts.However,the hydrogen yield is less.This article brings together and examines the latest research on hydrogen production from butanol via steam reforming,oxidative steam reforming and partial oxidation reactions.In addition,the review examines a few thermodynamic studies based on sorption-enhanced steam reforming and dry reforming where there is potential for hydrogen extraction.