Objective: Hospital readmission rates following a transjugular intrahepatic portosystemic shunt (TIPS) insertion after an episode of esophageal variceal bleeding (EVB) has not been well studied. We aimed to address this gap in knowledge on a population level. Methods: The Nationwide Readmission Database (NRD) was used to study the readmission rates for patients with decompensated cirrhosis who had a TIPS insertion performed for EVB. The NRD is a national database that tracks patients longitudinally for hospital readmissions. A propensity score matching model was created to match patients who received TIPS with those who did not. Results: A total of 42,679,001 hospital admissions from the 2012 to 2014 NRD sample were analyzed. There were 33,934 patients with EVB who met inclusion criteria for the study, of whom, 1527 (4.5%) received TIPS after EVB and were matched with 1527 patients with EVB who did not undergo TIPS. With a uniform follow-up of 3 months, patients with TIPS were less likely to be readmitted to hospital with a recurrent EVB [odds ratio (OR): 0.33, 95% confidence interval (CI): 0.24-0.47, P<0.01], although were more likely to be readmitted with hepatic encephalopathy (OR: 1.66; 95% CI: 1.31-2.11, P<0.01). At 3 months, there was no difference in all cause hospital readmission rate between the 2 groups (OR: 38.8%; 95% CI: 38.1-44.9 TIPS vs. OR: 41.5%; 95% CI: 34.1-43.3 non-TIPS: P=0.17). Conclusions: In this large nationally representative study, TIPS insertion after an episode of EVB was associated with a significantly lower risk of 3-month readmission for recurrent EVB compared with patients who did not receive TIPS. Although those receiving TIPS had a higher rate of hepatic encephalopathy the overall readmission remained unchanged.
Background: Crohn's disease (CD) is a chronic idiopathic disease characterized by transmural inflammation of the gastrointestinal tract. Aims: To evaluate the efficacy and safety of infliximab (IFX) for induction of remission in CD. Methods: MEDLINE, EMBASE, the Cochrane Library were searched from database inception to August 2016. Randomized controlled trials (RCTs) comparing IFX to placebo or an active treatment for induction of remission in CD were eligible for inclusion. Data were analyzed on an intention-to-treat basis. The risk ratio (RR) and corresponding 95% confidence interval (CI) were calculated for dichotomous outcomes. The primary outcome was failure to enter clinical remission. Methodological quality was assessed using the Cochrane risk of bias tool. GRADE was used to assess the overall quality of the evidence for the primary outcome. Results: Five RCTs (total 956 patients) were included. All of the studies were judged to be at low risk of bias. Targan
Combinations of different concentrations of substrate (0.025M, 0.05M, 0.1M, 0.15M, 0.20M and 0.25M KNO3) with different pH of buffer (0.1M, KH2PO4 of the pH 6.5, 6.6, 6.7, 6.8, 6.9, 7.0, 7.5, 7.6, 7.7, 7.8) solutions were tried for the nitrate reductase activity of Erythrina blakei leaves. Maximum nitrate reductase activity was observed in the combination of buffer solution of 0.1M having pH 6.8 and substrate solution of the concentration 0.15M. NR activity and moisture content in single leaf blades of Erythrina blakei leaves of different branches from different levels of tree have different concentration of activity and Moisture percentage. In single leaf blades maximum NR activity was recorded in leaf number 10, Branch number 3. And maximum moisture percentage observed in leaf number 12, Branch number 3.
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