Evaluation of the nutritional status of patients with liver cirrhosis

BACKGROUND Progressive malnutrition coexists with liver diseases,particularly in patients with cirrhosis.Early diagnosis of malnutrition in patients with advanced stages of chronic liver disease and the implementation of appropriate nutritional treatment for malnourished patients should be an integral part of the therapeutic process.AIM To evaluate the nutritional status of patients with various severities of advanced liver fibrosis,using various nutritional status parameters.METHODS This study involved 118 patients with liver cirrhosis who were classified into three groups according to their Child-Pugh score.The nutritional status of the patients in each group was assessed using different methods.The average values obtained from the measurements were calculated for each research group.The influence of disease stage on the examined parameters of nutritional status was determined using one-way analysis of variance.To investigate the relationship between the parameters determining nutritional status and the stage of disease advancement,a correlation analysis was performed.RESULTS The Child-Pugh A group had the highest mean body weight(76.42 kg),highest mean body mass index(BMI)(26.72 kg/m²),and largest mean arm circumference(27.64 cm).In the Child-Pugh B group,the mean scores of all examined variables were lower than those of the Child-Pugh A group,whereas the mean body weight and BMI of the Child-Pugh C group were higher than those of the Child-Pugh B group.There was a very strong correlation between the Child-Pugh classification and subjective global assessment score;a very strong correlation between the Child-Pugh classification and arm circumference;a strong correlation between the Child-Pugh classification and body weight,albumin concentration,fat-free mass index,muscle mass index,phase angle,and BMI;and an average correlation between Child-Pugh classification and fat mass index.Notably,these indicators deteriorated with disease progression.CONCLUSION Advanced liver fibrosis leads to the deterioration of many nutritional status parameters.The extent of malnutrition increases with the progression of liver fibrosis.The Child-Pugh score reflects the nutritional status.

Estimation of aboveground biomass of arboreal species in the semi-arid region of Brazil using SAR(synthetic aperture radar)images

The Caatinga biome is an important ecosystem in the semi-arid region of Brazil.It has significantly degraded due to human activities and is currently a region undergoing desertification.Thus,monitoring the variation in the Caatinga biome has become essential for its sustainable development.However,traditional methods for estimating aboveground biomass(AGB)are time-consuming and destructive.Remote sensing,such as optical and radar imaging,can estimate and correlate with vegetation.Nevertheless,radar imaging is still a novelty to be applied in estimating the AGB of this biome,which is an area with little research.Therefore,this study aimed to use Sentinel-1 images to estimate the AGB of the Caatinga biome in Sergipe State(northeastern Brazil)and to verify its influencing factors.Nineteen sample plots(30 m×30 m)were selected,and the stems of individuals with a circumference at breast height(1.3 m above the ground)equal to or greater than 6.0 cm were measured,and the AGB through an allometric equation was estimated.The Sentinel-1 images from 3 different periods(green,intermediate,and dry periods)were used to consider the phenological conditions of the Caatinga biome.All the pre-processing and extraction of attributes(co-polarized VV(vertical transmit and vertical receive),cross-polarized VH(vertical transmit and horizontal receive),and band ratio VH/VV backscatter,radar vegetation index,dual polarization synthetic aperture radar(SAR)vegetation index(DPSVI),entropy(H),and alpha angle(α))were performed with Sentinel’s Application Platform.These attributes were used to estimate the AGB through simple and multiple linear regressions and evaluated by the coefficients of determination(R2),correlation(r),and root mean squared error(RMSE).The results showed that the attributes individually had little ability to estimate the AGB of the Caatinga biome in the three periods.Combined with multiple regression,we found that the intermediate period presented the equation with the best results among the observed and estimated variables(R^(2)=0.73;r=0.85;RMSE=8.33 Mg/hm^(2)),followed by the greenness period(R2=0.72;r=0.85;RMSE=8.40 Mg/hm^(2)).The attributes contributing to these equations were VH/VV,DPSVI,H,α,and co-polarized VV for the green period and cross-polarized VH for the intermediate period.The study showed that the Sentinel-1 images could be used to estimate the AGB of the Caatinga biome in the green and intermediate phenological periods since the SAR attributes highly correlated with the estimated variable(i.e.,AGB)through multiple linear equations.

Distribution of 26 Metals in the Waters of the Aquatic Ecosystems of the Cotonou Channel and Lake Nokoué, Benin

Metallic elements have various origins: natural and anthropogenic sources as geochemical, marine and atmospheric sources resulting from the fallout of pollutants emitted or dust raised and which are transported by water and air currents. Thus marine, brackish and fresh continental waters may have high metal concentrations. In addition, some essential metals can become toxic above certain concentration values in aquatic environments. The aquatic ecosystems of Cotonou channel and lake Nokoué receive the pollutants charges from the town cities of Cotonou, Abomey-Calavi and town hall of So Ava. The aim of this study is to analyze waters from Eighteen (18) stations identified in the two ecosystems (nine by ecosystem). The concentrations of magnesium (Mg), calcium (Ca), vanadium (V), chromium (Cr), manganese (Mn), iron (Fe), cobalt (Co), nickel (Ni), copper (Cu), zinc (Zn), arsenic (As), selenium (Se), cadmium (Cd), beryllium (Be), aluminum (Al), strontium (Sr), molybdenum (Mo), silver (Ag), tin (Sn), barium (Ba), platinum (Pt), mercury (Hg), thallium (Tl), lead (Pb), thorium (Th) and uranium (U) were measured after acid digestion of the water samples using the inductively coupled plasma source mass spectrometer (ICP-MS). The results of the analyses indicate an unequal distribution of metals in the different ecosystems. However, atypical concentrations were observed at some stations of the lake and the channel. Magnesium, calcium and manganese have very high values in Lake Nokoué respectively at Ganvié market station GAN_M (2990 ± 105 mg/L), Ganvié center, station GAN_C (4991 ± 177 mg/L) and Lake middle station MLak4 (10662 ± 17.03 μg/L). On the other hand, iron, aluminum and strontium have very high concentrations in the Cotonou Channel respectively at Agbato station AGB (5236 ± 103 and 8289 ± 519 μg/L) and at the estuary station EST (6118 ± 68 μg/L). The concentrations were compared to wells and cborehole waters in sixth neighborhood of Cotonou. We have used statistical analyzers such as MANOVA which have made it possible to classify the waters and metals in the ecosystems studied compared to groundwater and Well water waters. We use hierarchical clustering on principal components to identify similarities between stations based on metal concentration with R software packages “FactoMineR” and “factoextra”. In general, we can conclude that most of the metals have an anthropogenic source except strontium and major elements (Ca and Mg) which could respectively provide from marine waters and geochemical sources.

Association of mineral and bone biomarkers with adverse cardiovascular outcomes and mortality in the German Chronic Kidney Disease(GCKD)cohort

Mineral and bone disorder(MBD)in chronic kidney disease(CKD)is tightly linked to cardiovascular disease(CVD).In this study,we aimed to compare the prognostic value of nine MBD biomarkers to determine those associated best with adverse cardiovascular(CV)outcomes and mortality.In 5217 participants of the German CKD(GCKD)study enrolled with an estimated glomerular filtration rate(eG FR)between 30–60 mL·min-1 per 1.73 m2 or overt proteinuria,serum osteoprotegerin(OPG),C-terminal fibroblast growth factor-23(FGF23),intact parathyroid hormone(iP TH),bone alkaline phosphatase(BAP),cross-linked C-telopeptide of type 1 collagen(CTX1),procollagen 1intact N-terminal propeptide(P1NP),phosphate,calcium,and 25-OH vitamin D were measured at baseline.Participants with missing values among these parameters(n=971)were excluded,leaving a total of 4246 participants for analysis.During a median follow-up of6.5 years,387 non-CV deaths,173 CV deaths,645 nonfatal major adverse CV events(MACEs)and 368 hospitalizations for congestive heart failure(CHF)were observed.OPG and FGF23 were associated with all outcomes,with the highest hazard ratios(HRs)for OPG.In the final Cox regression model,adjusted for CV risk factors,including kidney function and all other investigated biomarkers,each standard deviation increase in OPG was associated with non-CV death(HR 1.76,95%CI:1.35–2.30),CV death(HR 2.18,95%CI:1.50–3.16),MACE(HR 1.38,95%CI:1.12–1.71)and hospitalization for CHF(HR 2.05,95%CI:1.56–2.69).Out of the nine biomarkers examined,stratification based on serum OPG best identified the CKD patients who were at the highest risk for any adverse CV outcome and mortality.

EPI Info 2000在急性弛缓性麻痹病例监测系统中的应用研究

目的为解决计划免疫工作中急性弛缓性麻痹 (AFP)病例监测系统流行病学监测和实验室监测的数据库统一和完善变量设置 ,以便快速地进行AFP病例的录入、分析和统计。方法用EPI2000软件建立了计划免疫的急性弛缓性麻痹 (AFP)病例监测系统数据库 ,开发并完善了EPI2000软件在AFP监测系统中的应用研究。结果通过两年的应用和不断完善 ,解决了AFP监测中流行病学监测和实验室监测数据库统一并解决实际问题如麻痹部位、发病年龄、高危病例和聚集性高危病例在AFP监测系统数据库中的变量设置问题 ;完善了AFP监测系统的数据库及调查表视图中各种变量的分析统计及数据管理。结论EPI2000以其功能强大且容易与其他数据库进行数据转换 ,亲切的Windows界面和语言功能支持中文录入而方便中文信息的录入和分析应用 ,成功地应用于计划免疫急性弛缓性麻痹 (AFP)病例监测系统。

中文迁延悲伤量表修订版的效度和信度

目的:评价中文迁延悲伤量表修订版(PG-13-R)的效度和信度。方法:招募符合DSM-5-TR迁延悲伤障碍(PGD)诊断标准的患者200例为研究对象,进行迁延悲伤量表修订版评定,计算组内相关系数(ICC)评价评定者之间的一致性;计算Cronbachα系数评价量表的内部一致性,采取主成份方法计算条目的因子载荷考评量表的结构效度。通过计算PG-13-Revised量表的评分与社会适应量表(WSAS)评分和自评抑郁量表(SDS)的相关性来考察PG-R-13效标效度。以DSM-5-TR诊断标准为依据,计算受试者可接受曲线下面积(AUC)来判断量表的区分效度以及划定量表的划界分。结果:评定者一致性系数ICC为0.97;各个分条目之间的相关系数在0.85~0.99之间。量表总Cronbachα系数为0.85。在PG-13-R的13个条目中,采用主成分分析法算出1个主因子,贡献率达78.98%,高于结构效度检验的标准50%。以临床评估标准为参考,在区分轻度迁延悲伤障碍时划界分为≥25时灵敏度和特异度最好,分别为93.3%和78.2%,AUC为0.82,区分中度迁延悲伤障碍,划界分≥37时灵敏度和特异度最高,分别为92.5%、90.7%,AUC为0.92;在区分重度迁延悲伤障碍时,划界分≥46时灵敏度和特异度最高,分别为95.47%、92.18%,AUC为0.96。结论:中文迁延悲伤量表修订版(PG-13-R)有良好的效度和信度,能够早期测评迁延悲伤障碍的严重程度。

Combined TACE and PEI for palliative treatment of unresectable hepatocellular carcinoma

瞄准：估计是否 transarterial chemoembolization 的联合的有效性(不作声) 并且在 unresectable 肝细胞癌(HCC ) 的治疗的经皮的乙醇注射(PEI ) 是优异的独自不作声使随机化的控制试用是 performed.METHODS：长期的幸存率和住院的持续时间上的联合治疗的效果在 52 以前未经治疗的 HCC 被评估，随机分配了到 TACE-PEI (27 磅) 或独自不作声(25 磅) 。结果：TACE 组的累积幸存率在 6 瞬间是 75.8% ， 62.9% 在 12 瞬间，并且 18.0% 分别地在 24 瞬间并且 TACE-PEI 组织 76.9% ， 61.5% ，和 38.7% 。在两个组的全面幸存的比较统计上不出现了有效差量。关于有 HCC 的病人， Okuda 上演我(n = 26 ) ， TACE-PEI 组的中部的幸存显著地更长(】24 瞬间，还没在学习时期到达的 median ) 与 TACE 组相比(18.4 瞬间[范围 11.6-21.7 瞬间] ；P = 0.04 ) 。TACE-PEI 为死亡把相对风险归结为 0.4 (95%CI 0.15-0.96 ) 独自与接待了的病人相比不作声。在有 HCC Okuda 阶段 II 或 III 的病人的中部的幸存是在 TACE 组的 5.0 瞬间(1.7 瞬间不定义) 与 10.4 相比，在 TACE-PEI 的瞬间组织。结论：联合 TACE-PEI 改进了生存时间与相比独自不作声。我们的学习在 HCC Okuda 舞台揭示了统计上重要的改进幸存我。副作用是次要的，联合治疗没更加延长住院的持续时间。

The vital threat of an upper gastrointestinal bleeding: Risk factor analysis of 121 consecutive patients

瞄准：在预言死亡的病人风险由于分析重要性上面胃肠(UGI ) 在今天的治疗学的政体下面流血。方法：从 1998 ～ 2001，有 UGI 流血的诊断的 121 个病人在我们的医院里被对待。基于病人的数据，一回顾多变量数据分析与开始，超过 270 个单个因素被执行。随后，下列潜在的风险因素经历了逻辑回归分析：年龄，性，起始的血红素， coumarines ，肝肝硬化，前凝血酶时间(磅)，胃溃疡(小弯曲)，十二指肠溃疡(灯泡我们背墙)，福雷斯特分类，脉管的树桩， variceal 流血， Mallory-Weiss 症候群， RBC 替换，周期性的流血，保守、外科的治疗。结果：七十男性(58%) 和 51 女性(42%) 有 70 的中部的年龄的病人(变化：21-96 ) 年被对待。他们的在里面医院死亡是 14% 。当(11/91 )12% 在保守治疗以后死于病人时，(6/30 )20% 在经历外科的治疗以后死了。流血的 UGI 由于十二指肠溃疡发生了(n = 36；30%) ，胃溃疡(n = 35；29%) ，食道的静脉曲张病(n = 12；10%) ， Mallory-Weiss 症候群(n = 8；7%) ，粘膜的腐蚀损害(n = 20；17%) ，癌症(n = 5；4%) ， coagulopathy (n = 4；3%) ，淋巴瘤(n = 2；2%) ，良性瘤(n = 2；2%) 并且未知理智(n = 1；1%) 。所有上述的因素的逻辑回归分析揭示了那肝肝硬化和十二指肠溃疡(灯泡我们背墙) 是为在 UGI 流血以后的一堂致命的功课的联系风险因素。在内视镜检查法以前，仅仅肝肝硬化是一个可估价的风险因素。此后，肝肝硬化，流血溃疡的地点(灯泡我们背墙) 并且病人的性(男性) 具有为有流血溃疡的病人的临床的结果(死亡) 的预示的重要性。结论：在今天的临床的常规使用的最预示的参数不在预言一个病人的重要威胁由流血的 UGI 摆姿势是足够可靠的。在另一方面，肝肝硬化更经常显著地与增加的风险被联系在在以后的十二指肠的墙定位的溃疡流血以后死。

Long-term follow-up after complete ablation of Barrett's esophagus with argon plasma coagulation

AIM: To report the long-term outcome of patients after complete ablation of non-neoplastic Barrett's esophagus (BE) with respect to BE relapse and development of intraepithelial neoplasia or esophageal adenocarcinoma.METHODS: In 70 patients with histologically proven nonneoplastic BE, complete BE ablation was achieved by argon plasma coagulation (APC) and high-dose proton pump inhibitor therapy (120 mg omeprazole daily). Sixty-six patients (94.4%) underwent further surveillance endoscopy. At each surveillance endoscopy four-quadrant biopsies were taken from the neo-squamous epithelium at 2 cm intervals depending on the pre-treatment length of BE mucosa beginning at the neo-Z-line, and from any endoscopically suspicious lesion.RESULTS: The median follow-up of 66 patients was 51 mo (range 9-85 mo) giving a total of 280.5 patient years.A mean of 6 biopsies were taken during surveillance endoscopies. In 13 patients (19.7%) tongues or islands suspicious for BE were found during endoscopy. In 8 of these patients (12.1%) non-neoplastic BE relapse was confirmed histologically giving a histological relapse rate of 3% per year. In none of the patients, intraepithelial neoplasia nor an esophageal adenocarcinoma was detected.Logistic regression analysis identified endoscopic detection of islands or tongues as the only positive predictor of BE relapse (P = 0.0004).CONCLUSION: The long-term relapse rate of nonneoplastic BE following complete ablation with high-power APC is low (3% per year).

Response evaluation of chemotherapy in metastatic colorectal cancer by contrast enhanced ultrasound

AIM:To evaluate whether contrast enhanced ultrasound(CEUS) might also be used for response prediction and early response evaluation in patients receiving bevacizumab based chemotherapy for metastasized colorectal cancer.METHODS:Thirty consecutive patients with non primary resectable liver metastases from colorectal cancer underwent CEUS before treatment(CEUS date 1) and before the second(CEUS date 2) and fourth(CEUS date 3) cycle of bevacizumab based chemotherapy.Three parameters [PEAK,Time to peak(TTP) and RISE RATE]were correlated with radiological response.RESULTS:For neoadjuvant purpose a reduction of tumour mass was required to assume clinical response.Based on these response criteria there was a significant(P < 0.001) correlation in TTP between metastases of responders(9.08 s) and non-responders(14.76 s) archived on CEUS date 1.By calculating a standardized quotient(metastases divided by normal liver tissue) we were able to define a cut off,predicting response with a sensitivity of 92.3 % and a specificity of 100 %.To reflect a palliative intention only those patients with progressive disease were classified as non-responders.In this stetting TTP was also significantly(P < 0.01) different between responders and non-responders.In contrast,Peak and Rise rate did not show any significant difference between responder and non-responder.CONCLUSION:CEUS might serve as a surrogate marker to predict treatment response in patients with metastasized colorectal cancer who receive antiangiogenic therapy.

Associating liver partition and portal vein ligation for staged hepatectomy: From technical evolution to oncological benefit

Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) is a novel approach in liver surgery that allows for extensive resection of liver parenchyma by inducing a rapid hypertrophy of the future remnant liver. However,recent reports indicate that not all patients eligible for ALPPS will benefit from this procedure. Therefore,careful patient selection will be necessary to fully exploit possible benefits of ALPPS. Here,we provide a comprehensive overview of the technical evolution of ALPPS with a special emphasis on safety and oncologic efficacy. Furthermore,we review the contemporary literature regarding indication and benefits,but also limitations of ALPPS.

Prevalence and risk factors of nonalcoholic fatty liver disease in patients with inflammatory bowel diseases:A cross-sectional and longitudinal analysis

BACKGROUND Nonalcoholic fatty liver disease(NAFLD)is common in the German population,with an even higher prevalence in inflammatory bowel disease patients.AIM To investigate the risk factors for NAFLD in inflammatory bowel disease patients.METHODS This monocentric retrospective study with a cross-sectional and a longitudinal part included 694 patients.Inclusion criteria were diagnosed inflammatory bowel disease,age≥18 years,availability of at least one abdominal ultrasound.Patients with infectious or suspected alcoholic fatty liver disease were excluded.NAFLD was defined by increased echogenicity at liver ultrasound.Demographic characteristics,disease activity and medications were analyzed as potential risk factors.Parameters influencing the course of NAFLD were identified by a generalized linear mixed model.RESULTS Forty-eight percent of Crohn’s disease(CD)patients and 44%of ulcerative colitis patients suffered from NAFLD.Its occurrence was associated with greater age,hypertension and body mass index(BMI)in both groups,and with higher disease activity and dyslipidemia in CD.2467 ultrasound results were included in the longitudinal analysis.Risk factors for NAFLD were age,BMI,higher disease activity,bowel resection(s),endoscopic activity and azathioprine use in CD;and BMI and endoscopic activity in ulcerative colitis.CONCLUSION NAFLD was highly prevalent in this cohort of German inflammatory bowel disease patients.Its risk increased mainly with rising age and BMI.This analysis provides a rationale for non-invasive liver screening in inflammatory bowel disease patients.

Evaluation of thermal water in patients with functional dyspepsia and irritable bowel syndrome accompanying constipation

瞄准：与机能性消化不良或伴随占优势的便秘的急躁的肠症候群(IBS ) 在病人评估水补充治疗的功效。方法：有机能性消化不良的 3872 个病人和有急躁的肠症候群的 3609 个病人的一个总数被 18 个 Italina 热中心在学习注册。病人们为 21 d 经历了热治疗的第一个周期。一年以后，病人们在一样的中心被重新估计并且收到了热治疗的另一个周期。在社会、职业的地位，家庭和病理学的病历，生活方式，临床的记录，福利的利用和健康结构和设备上收集个人数据的一张问询表在各热的治疗以后在基础时间和一年予每个病人被以。有机能性消化不良的六十个病人并且 20 由呼吸测试分析与 IBS 和 80 健康控制收到了胃的输出和 oro 盲肠的运输时间的评估。呼吸测试在基础时间并且在水补充治疗以后被执行。胃肠的症状同时被评估点。呼吸样品与集体 spectometer 和 gascromatograph 被分析。结果为呼吸测试的 octanoic 和 lactulose 呼吸测试的同样 oro 盲肠的运输时间被表示为 T (1/2 ) 和 T 落后。结果：症状的流行的重要减小在热治疗的第一和第二个周期的结束被观察在消化不良并且 IBS 病人。变化的分析出现了一真实并且在所有病人坚持症状的蚂蚁改进。在为 3 wk 的水补充以后，胃的输出的减小在 49 被观察(87.5%) 56 个消化不良的病人。T (1/2 ) 和 T 落后显著地与基础价值相比在治疗以后被减少[91 +/- 12 T (1/2 ) 和 53 +/- 11 (T 落后) ，搁置 1 和 2 ] 与类似于健康题目的 octanoic 呼吸测试的结果。在为 3 wk 的水补充以后， oro 盲肠的运输时间在学习的开始是比那短的。结论：为伴随 IBS 的机能性消化不良或便秘的矿水补充治疗能改进胃的酸输出和肠的运输时间。

Cryoablation of malignant liver tumors: results of a single center study

BACKGROUND: Local ablative procedures such as cryo-surgery and thermo-ablation are increasingly employed as a supplement to liver resection for the therapy of primary and secondary liver tumors. It is still unclear if the survival time can be extended through local ablative procedures. This prospective study shows operative actions, complications and long-term follow-up of 19 patients undergoing cryotherapy. METHODS: Between 1997 and 1998, 19 patients underwent cryotherapy due to a non-resectable malignant liver tumor (17 patients with metastases of a colon carcinoma, 2 patients with a hepatocellular carcinoma). Twelve patients (63.2%) received cryotherapy only and seven patients (36.8%) received a combination of resection and cryotherapy. The median follow-up period was 23 months. RESULTS: In a total of 59 liver tumors (18 were resected and 41 received cryotherapy), 12 had cryotherapy only, and 7 had a combination of cryotherapy and resection. The 30-day lethality was 0%, and the rate of major complications was 21%. After one year, 27.3% of the patients were still recurrence- free. The recurrence rate for all tumors treated was 58.8%. The median survival time for all patients was 21 months. The one- and three-year survival rates were 62. 5% and 15.8%, respectively. CONCLUSIONS: The mortality for cryotherapy is low, but there is a high rate of complications and long-term tumor control is not sufficient. If local ablative procedures of hepatic lesions are to be performed, not laparotomy but percutaneous, percutaneous thermoablation should be discussed as an alternative therapeutic measure.

Increased liver stiffness in alcoholic liver disease:Differentiating fibrosis from steatohepatitis

AIM:To test if inflammation also interferes with liver stiffness (LS) assessment in alcoholic liver disease (ALD) and to provide a clinical algorithm for reliable fibrosis assessment in ALD by FibroScan (FS).METHODS:We first performed sequential LS analysis before and after normalization of serum transaminases in a learning cohort of 50 patients with ALD admitted for alcohol detoxification. LS decreased in almost all patients within a mean observation interval of 5.3 d. Six patients (12%) would have been misdiagnosed with F3and F4 fibrosis but LS decreased below critical cut-off values of 8 and 12.5 kPa after normalization of trans-aminases. RESULTS:Of the serum transaminases,the decrease in LS correlated best with the decrease in glutamic oxaloacetic transaminase (GOT). No significant chang-es in LS were observed below GOT levels of 100 U/L. After establishing the association between LS and GOT levels,we applied the rule of GOT < 100 U/L for reliable LS assessment in a second validation cohort of 101 patients with histologically confi rmed ALD. By ex-cluding those patients with GOT > 100 U/L at the time of LS assessment from this cohort,the area under the receiver operating characteristic (AUROC) for cirrhosis detection by FS improved from 0.921 to 0.945 while specificity increased from 80% to 90% at a sensitivity of 96%. A similar AUROC could be obtained for lower F3 fibrosis stage if LS measurements were restricted to patients with GOT < 50 U/L. Histological grading of inflammation did not further improve the diagnostic accuracy of LS.CONCLUSION:Coexisting steatohepatitis markedly increases LS in patients with ALD independent of fibrosis stage. Postponing cirrhosis assessment by FS during alcohol withdrawal until GOT decreases to < 100 U/mL signif icantly improves the diagnostic accuracy.

Adjuvant chemotherapy for gastric cancer:Current evidence and future challenges

Gastric cancer still represents one of the major causes of cancer mortality worldwide.Patients survival is mainly related to stage,with a high proportion of patients with metastatic disease at presentation.Thus,the cure rate largely depend upon surgical resection.Despite the additional,albeit small,benefit of adjuvant chemotherapy has been clearly demonstrated,no general consensus has been reached on the best treatment option.Moreover,the narrow therapeutic index of adjuvant chemotherapy(i.e.,limited survival benefit with considerable toxicity)requires a careful assessment of expected risks and benefits for individual patients.Treatment choices vary widely based on the different geographic areas,with chemotherapy alone more often preferred in Europe or Asia and chemoradiotherapy in the United States.In the present review we discuss the current evidence and future challenges regarding adjuvant chemotherapy in curatively resected gastric cancer with particular emphasis on the recently completed landmark studies and meta-analyses.The most recent patient-level meta-analysis demonstrated the benefit of adjuvant chemotherapy over curative surgery;the same Authors also showed that disease free survival may be used as a surrogate end-point for overall survival.We finally discuss future research issues such as the need of economic evaluations,development of prognostic or predictive biomarkers,and the unmet clinical need of trials comparing perioperative chemotherapy with adjuvant treatment.

Cyclosporine versus tacrolimus in patients with HCV infection after liver transplantation:Effects on virus replication and recurrent hepatitis

瞄准：决定 calcineurin 禁止者， cyclosporine 和 tacrolimus 的效果，在丙肝上，在病人的周期性的丙肝的病毒(HCV ) 复制和活动张贴肝移植。方法：在我们的中心为在 1999 和 2003 之间的联系 HCV 的肝肝硬化收到了肝移植的 107 个病人的一个队的数据回顾地被分析。浆液 HCV-RNA 的水平和周期性的肝炎的活动在作为主要抑制免疫力的代理人和没在移植以后在开始的 12 瞬间以内导致胆汁的复杂并发症的不那样类似的抑制免疫力的政体收到了 cyclosporine 或 tacrolimus 的 47 个病人之间被比较。结果：HCV-RNA 在移植以后在 3 瞬间以内增加了，但是 cyclosporine 组和 tacrolimus 组之间的差别是不足道的(在 12 瞬间的 P=0.49 ) 。另外，由浆液 transaminases 决定了的周期性的肝炎并且门发炎和纤维变性的组织学的分级没在 12 瞬间(P=0.34 ) 以后显示出有效差量。结论：一个主要抑制免疫力的代理人不在肝移植以后在感染 HCV 的病人影响周期性的肝炎的正式就职或严厉的 Cyclosporine 或 tacrolimus。

Performance of tacrolimus in hospitalized patients with steroid-refractory acute severe ulcerative colitis

BACKGROUND Acute severe ulcerative colitis unresponsive to systemic steroid treatment is a lifethreatening medical condition requiring hospitalization and often colectomy.Despite the increasing choice of medical therapy options for ulcerative colitis, the condition remains a great challenge in the field of inflammatory bowel diseases(IBD). The performance of the calcineurin inhibitor tacrolimus in this clinical setting is insufficiently elucidated.AIM To evaluate the short and long-term outcomes of tacrolimus therapy in adult inpatients with steroid-refractory acute severe ulcerative colitis.METHODS We conducted a retrospective monocentric study enrolling 22 patients at a tertiary care center for the treatment of IBD. All patients who were admitted to one of the wards of the Department of Gastroenterology and Hepatology of the Heidelberg University Hospital with acute severe ulcerative colitis between 2007 and 2018, and who received oral or intravenous tacrolimus for steroid-refractory disease were included. Baseline characteristics and data on the disease courses were retrieved from entirely computerized patient charts. The primary study endpoint was clinical response to tacrolimus therapy, resulting in discharge from the hospital. Secondary study endpoints were colectomy rate and time to colectomy, achievement of clinical remission under tacrolimus therapy, and the occurrence of side effects.RESULTSIn the majority of the 22 included patients(68.2%), tacrolimus therapy was initiated intravenously and subsequently converted to oral administration. The treatment duration was 128 ± 28.5 d(mean ± SEM), and the patients were followed up for 705 ± 110 d after treatment initiation. Among all patients, 86.4%were discharged from the hospital under continued oral tacrolimus therapy. In36.4% of the patients, the administration of tacrolimus resulted in clinical remission at some point during the treatment. Thirty-two percent of the patients underwent colectomy between 5 and 194 d after the initiation of tacrolimus treatment(mean: 97.4 ± 20.8 d). Colectomy-free survival rates at 1, 3, 6 and 12 mo after the initiation of tacrolimus therapy were 90.9%, 86.4%, 77.3% and 68.2%,respectively. The safety profile of tacrolimus was overall favorable. Only two patients discontinued the treatment due to side effects.CONCLUSION The short-term outcome of tacrolimus in steroid-refractory acute severe ulcerative colitis was beneficial, and side effects were rare. In all, tacrolimus therapy appears to be a viable option for short-term treatment of steroidrefractory acute severe ulcerative colitis besides ciclosporin and anti-tumor necrosis factor α treatment.

Structural characterization of monoterpene indole alkaloids in ethanolic extracts of Rauwolfia species by liquid chromatography with quadrupole time-of-flight mass spectrometry

Rauwolfia species(Apocynaceae) are medicinal plants well known worldwide due to its potent bioactive monoterpene indole alkaloids(MIAs) such as reserpine,ajmalicine,ajmaline,serpentine and yohimbine.Reserpine,ajmalicine and ajmaline are powerful antihypertensive,tranquilizing agents used in hypertension.Yohimbine is an aphrodisiac used in dietary supplements.As there is no report on the comparative and comprehensive phytochemical investigation of the roots of Rauwolfia species,we have developed an efficient and reliable liquid chromatography-tandem mass spectrometry(LC–MS/MS) method for ethanolic root extract of Rauwolfia species to elucidate the fragmentation pathways for dereplication of bioactive MIAs using highperformance liquid chromatography coupled with electrospray ionization quadrupole time-of-flight tandem mass spectrometry(HPLC–ESI–QTOF–MS/MS) in positive ion mode.We identified and established diagnostic fragment ions and fragmentation pathways using reserpine,ajmalicine,ajmaline,serpentine and yohimbine.The MS/MS spectra of reserpine,ajmalicine,and ajmaline showed C-ring-cleavage whereas E-ring cleavage was observed in serpentine via Retro Diels Alder(RDA).A total of 47 bioactive MIAs were identified and characterized on the basis of their molecular formula,exact mass measurements and MS/MS analysis.Reserpine,ajmalicine,ajmaline,serpentine and yohimbine were unambiguously identified by comparison with their authentic standards and other 42 MIAs were tentatively identified and characterized from the roots of Rauwolfia hookeri,Rauwolfia micrantha,Rauwolfia serpentina,Rauwolfia verticillata,Rauwolfia tetraphylla and Rauwolfia vomitoria.Application of LC–MS followed by principal component analysis(PCA) has been successfully used to discriminate among six Rauwolfia species.

Growth and form of Quercus robur and Fraxinus excelsior respond distinctly different to initial growing space: results from 24-year-old Nelder experiments

Initial growing space is of critical importance to growth and quality development of individual trees. We investigated how mortality, growth （diameter at breast height, total height）, natural pruning （height to first dead and first live branch and branchiness） and stem and crown form of 24-year-old pedunculate oak （Quercus robur [L.]） and European ash （Fraxinus excelsior [L.]） were affected by initial spacing. Data were recorded from two replicate single-species Nelder wheels located in southern Germany with eight initial stocking regimes varying from 1,020 to 30,780 seedlings·ha？1. Mortality substantially decreased with increasing initial growing space but significantly differed among the two species, averaging 59% and 15% for oak and ash plots, respectively. In contrast to oak, the low self-thinning rate found in the ash plots over the investigated study period resulted in a high number of smaller intermediate or suppressed trees, eventually retarding individual tree as well as overall stand development. As a result, oak gained greater stem dimensions throughout all initial spacing regimes and the average height of ash significantly increased with initial growing space. The survival of lower crown class ashes also appeared to accelerate self-pruning dynamics. In comparison to oak, we observed less dead and live primary branches as well as a smaller number of epicormic shoots along the first 6 m of the lower stem of dominant and co-dominant ashes in all spacing regimes. Whereas stem form of both species was hardly affected by initial growing space, the percentage of brushy crowns significantly increased with initial spacing in oak and ash. Our findings suggest that initial stockings of ca. 12,000 seedlings per hectare in oak and 2,500 seedlings per hectare in ash will guarantee a sufficient number of at least 300 potential crop trees per hectare in pure oak and ash plantations at the end of the self-thinning phase, respectively. If the problem of epicormic shoots and inadequate self-pruning can be controlled with trainer species, the initial stocking may be reduced significantly in oak.