Background: Because the correlation between ammonia levels and the severity of hepatic encephalopathy remains controversial, we prospectively evaluated the correlation in 121 consecutive patients with cirrhosis. Methods: The diagno‐ sis of hepatic encephalopathy was based on clinical criteria, and the severity of hepatic encephalopathy was based on the West Haven Criteria for grading of mental status. Arterial and venous blood samples were obtained from each patient. Four types of ammonia measurements were analyzed: arterial and venous total ammonia, and arterial and venous partial pressure of ammonia. Spearman rank correlations (r s) were calculated. Results: Of the 121 patients, 30 (25%) had grade 0 encephalopathy (no signs or symptoms), 27 (22%) had grade 1, 23 (19%) had grade 2, 28 (23%) had grade 3, and 13 (11%) had grade 4 (the most severe signs and symptoms). Each of the four measures of ammonia increased with the severity of hepatic encephalopathy: arterial total ammonia (r s =0.61, p ≤ .001), venous total ammonia (r s =0.56, p ≤ .001), arterial partial pressure of ammonia (r s =0.55, p ≤ .001), and venous partial pressure of ammonia (r s =0.52, p≤ .001). Conclusions: Ammonia levels correlate with the severity of hepatic encephalopathy. Venous sampling is adequate for ammo‐ nia measurement. There appears to be no additional advantage of measuring the partial pressure of ammonia compared with total ammonia levels.

As survival after orthotopic liver transplantation (OLT) improves, cardiovascular (CV) disease has emerged as the leading cause of non-graft-related deaths. The aims of our study were to determine the cumulative risk of CV events after OLT and to analyze predictive risk factors for those experiencing a CV event after OLT. We identified all adult patients who underwent OLT at our institution for end-stage liver disease between October 1996 and July 2008. The cumulative risk of CV events after OLT was analyzed with the Kaplan-Meier method. Multivariate logistic regression analysis was used to identify factors independently associated with CV events after OLT. In all, 775 patients were included in our study cohort (mean age of 53.3 years, female proportion ¼ 44%, Caucasian proportion ¼ 84%, median follow-up ¼ 40 months). The most common indications for OLT were hepatitis C virus (33.2%), alcohol (14.5%), and cryptogenic cirrhosis (12.7%). Eighty-three patients suffered 1 or more CV events after OLT. Posttransplant metabolic syndrome was more prevalent in patients with CV events versus patients with no CV events (61.4% versus 34.1%, P < 0.001). According to a multivariate analysis, independent predictors of CV events were an older age at transplantation [odds ratio (OR) ¼ 1. Posttransplant cardiovascular (CV) complications are the leading cause of non-graft-related death for orthotopic liver transplantation (OLT) patients.1 Although the high incidence of posttransplant CV events is regarded as multifactorial, the increased prevalence of metabolic syndrome, which is attributed to immunosuppressant therapy and end-stage liver disease, likely plays a role. End-stage liver disease leads to metabolic disturbances that alter lipid, glucose, and blood pressure levels considerably; for instance, hepatitis C virus (HCV) has been associated with an elevated risk of diabetes.2 With a national shortage of donors, the selection of candidates who are likely to benefit the most and live the longest after receiving a

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Efficacy and safety of endoscopic dilation are similar between primary and anastomotic CD strictures. Intralesional steroid injection or use of biologics did not decrease the need for re-intervention or surgery for either primary or anastomotic strictures.

Antimitotic drugs are chemotherapeutic agents that bind tubulin and microtubules. Resistance to these drugs is a major clinical problem. One hypothesis is that the cellular composition of tubulin isotypes may predict the sensitivity of a tumor to antimitotics. Reliable and sensitive methods for measuring tubulin isotype levels in cells and tissues are needed to address this hypothesis. Quantitative measurements of tubulin isotypes have frequently relied upon inferring protein amounts from mRNA levels. To determine whether this approach is justified, protein and mRNA levels of beta-tubulin isotypes from 12 human cancer cell lines were measured. This work focused on only beta-tubulin isotypes because we had readily available monoclonal antibodies for quantitative immunoblots. The percentage of beta-tubulin isotype classes I, II, III, and IVa + IVb mRNA and protein were compared. For beta-tubulin class I that comprises >50% of the beta-tubulin protein in 10 of the 12 cell lines, there was good agreement between mRNA and protein percentages. Agreement between mRNA and protein was also found for beta-tubulin class III. For beta-tubulin classes IVa + IVb, we observed higher protein levels compared to mRNA levels.Beta-tubulin class II protein was found in only four cell lines and in very low abundance. We conclude that quantitative Western blotting is a reliable method for measuring tubulin isotype levels in human cancer cell lines. Inferring protein amounts from mRNA levels should be done with caution, since the correspondence is not one-to-one for all tubulin isotypes.

With increasing numbers of people with HIV/AIDS receiving oral dental care, dentists should have sufficient knowledge of the disease, and their attitude should meet professional expectations. HIV and AIDS–related knowledge among dental students provides a crucial foundation for efforts aimed at developing appropriate education on these topics. Accordingly, the aim of this study was to assess the HIV/AIDS–related knowledge and attitudes amongst the 460 dental students of the Institute of Dental Sciences, Bareilly (UP), India. A self–administered survey consisting of fifty–three structured questions was conducted with the students. Overall, the response rate was 79.7 percent. The total mean knowledge and attitudes scores were 78.8 percent (excellent) and 77.7 percent (positive). There was no statistically significant difference between the knowledge and attitude scores of males and females. Regarding oral manifestations, Kaposi's sarcoma and candidiasis were the most identified. The results indicated that the students’ knowledge on HIV/AIDS generally increased as they progressed through the curriculum, but their utilization of all barrier techniques for infection control and clinical protocol lacked consistency and compliance. Hence, there is a need to address, more clearly, the students’ misconceptions and attitudes towards the disease.

The shape of the thyroid gland, its extension as the pyramidal lobe (PL) and attachments of the levator glandulae thyroideae (LGT) were studied in 410 male and 160 female adults from the Chandigarh zone in northwest India during medicolegal autopsies performed in the department. Whereas the measurements of the gland were recorded in 210 subjects, the weights were taken only in 160 instances. The shapes of the glands were: lateral lobes (LL) with isthmus (50.2%), horseshoe-shaped gland (36.8%), gland with separate lobes (7.9%) and irregularly shaped gland (5.1%). No sexual dimorphism was seen in the incidence of various shapes of the gland. The incidence of the PL and LGT was 28.9% and 19.5%, respectively. Neither a PL nor LGT was present in irregularly shaped glands. The mean weight of the gland was 15.01+/-7.69 g in males and 13.16+/-5.64 g in females. Sexual and age-wise differences in weights were found to be statistically insignificant. A survey involving 152 subjects in 2 villages in Chandigarh showed that it is an iodine sufficient zone. The size and weight of thyroid glands in adults of the two genders were found to be smaller than in western Caucasian and Japanese subjects.

Colorectal cancer screening dates to the discovery of pre-cancerous adenomatous tissue. Screening modalities and guidelines directed at prevention and early detection have evolved and resulted in a significant decrease in the prevalence and mortality of colorectal cancer via direct visualization or using specific markers. Despite continued efforts and an overall reduction in deaths attributed to colorectal cancer over the last 25 years, colorectal cancer remains one of the most common causes of malignancy-associated deaths. In attempt to further reduce the prevalence of colorectal cancer and associated deaths, continued improvement in screening quality and adherence remains key. Noninvasive screening modalities are actively being explored. Identification of specific genetic alterations in the adenoma-cancer sequence allow for the study and development of noninvasive screening modalities beyond guaiac-based fecal occult blood testing which target specific alterations or a panel of alterations. The stool DNA test is the first noninvasive screening tool that targets both human hemoglobin and specific genetic alterations. In this review we discuss stool DNA and other commercially available noninvasive colorectal cancer screening modalities in addition to other targets which previously have been or are currently under study.