BaCKgRoUND aND aIMS: Early detection of perihilar cholangiocarcinoma (CCA) among patients with primary sclerosing cholangitis (PSC) is important to identify more people eligible for curative therapy. While many recommend CCA screening, there are divergent opinions and limited data regarding the use of ultrasound or magnetic resonance imaging (MRI) for early CCA detection, and it is unknown whether there is benefit in testing asymptomatic individuals. Our aims were to assess the diagnostic performances and prognostic implications of ultrasound and MRI-based CCA detection. appRoaCH aND ReSUltS: This is a multicenter review of 266 adults with PSC (CCA, n = 120) who underwent both an ultrasound and MRI within 3 months. Images were re-examined by radiologists who were blinded to the clinical information. Respectively, MRI had a higher area under the curve compared with ultrasound for CCA detection: 0.87 versus 0.70 for the entire cohort; 0.81 versus 0.59 for asymptomatic individuals; and 0.88 versus 0.71 for those listed for CCA transplant protocol. The absence of symptoms at CCA diagnosis was associated with improved 5-year outcomes including overall survival (82% vs. 46%, log-rank P < 0.01) and recurrence-free survival following liver transplant (89% vs. 65%, log-rank P = 0.04). Among those with asymptomatic CCA, MRI detection (compared with ultrasound) was associated with reduction in both mortality (hazard ratio, 0.10; 95% confidence interval, 0.01-0.96) and CCA progression after transplant listing (hazard ratio, 0.10; 95% confidence interval, 0.01-0.90). These benefits continued among patients who had annual monitoring and PSC for more than 1 year before CCA was diagnosed.CoNClUSIoNS: MRI is superior to ultrasound for the detection of early-stage CCA in patients with PSC. Identification of CCA before the onset of symptoms with MRI is associated with improved outcomes. (Hepatology 2021;73:1868-1881). C holangiocarcinoma (CCA) is prevalent among those with primary sclerosing cholangitis (PSC), and early detection is important. Indeed, 10%-15% of patients with PSC may develop CCA, typically the perihilar subtype. However, early-stage perihilar CCA is challenging to diagnose through noninvasive imaging, because a discrete mass can be absent, and distinguishing benign from malignant strictures is difficult. (1,2) CCA is the leading cause of death in this patient population. (3) In part, this is due to the delayed detection of CCA until advanced incurable stages. Neoadjuvant chemotherapy and radiation followed by liver transplantation
Biodegradation of phenol with pure culture of Pseudomonas putida was investigated. P. putida (PTCC 1694) was grown in facultative anaerobic condition at 27 degrees C and media pH value of 7. The effect of initial phenol concentration on the biodegradation rate was studied. The initial concentrations of phenol varied from 300 to 1000 mg/l. Experiments were performed for the duration of seven days while daily samples were withdrawn. The initial rate of biodegradation of phenol increased with initial concentration of 300-500 mg/l. Further increase in phenol concentration resulted in a slight decrease in the rate of biodegradation due to phenol inhibition. It was observed that by increasing the concentration of phenol, the lag phase was prolonged. Phenol is known to be an inhibitory substrate, thus Monod, Haldane and logistic kinetic models were applied to evaluate the growth kinetic parameters. The Monod model was unable to present the growth parameters over the defined concentration range. However, Haldane and logistic models perfectly fitted with the experimental data. The yield coefficients for the growth on phenol at concentrations of 300, 500, 700 and 1000 mg/l were 0.177, 0.062, 0.035 and 0.012 mg/mg, respectively.
Biodegradation of phenol with mixed consortia of bacterial was studied in an anaerobic batch reactor. The culture was acclimatized for a period of two months to grow in mineral salt medium contained phenol as the sole carbon source. Minimum and maximum concentrations of 50 and 1000 mg/l of phenol in the medium were used for the purpose of culture adaptation. The goals of these experiments were to determine the kinetics of biodegradation by determination of biomass growth rates and phenol concentrations with respect to incubation time. Substrate inhibition kinetics and specific growth rate were defined while data were fitted in Haldane model. The specific growth rate, half-saturation and inhibition coefficients for Haldane model were 0.067 hG , 25.32 and 200 mg/l, respectively. The biokinetic parameters were used to predict the biodegradation 1 profile, which was quite consistent with the obtained experimental data. The results were useful for the estimation of relations between growth rate and substrate utilization, which may be used to evaluate mass balance for a wastewater treatment plant contained phenol compound.
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