Liver transplantation after paracetamol overdose.

Abstract

made in table VII (that is, 13 surgeons by three types of operations and all operations together). Thirdly, no data are given to show whether or not survival is improved when surgery is done by specialists because, as the authors say, none of the surgeons specialised in this type of surgery. Furthermore, the postoperative mortality and complication rates for the four consultants with over 40% oftheir operations performed by surgeons in training were no worse than those for the other surgeons. Fourthly, comparing the hazard rates in the 10 years after surgery ignores the possibility that factors influencing postoperative mortality may well differ from those influencing longer term mortality. For example, postoperative mortality may be related to the technical skill of the surgeon, but longer term mortality might be related more to the surgeon's choice of procedure influenced by the patients' likely prognosis. Reporting large variability based on relatively small numbers resembles the situation on referral rates of general practitioners some time ago. Such studies had reported 20-fold variation in rates. Concern about this forms part of the government's justification for NHS reforms.' These studies were, however, based on small numbers of referrals and much of the variability could be attributed to random variation.4 Later studies involving larger numbers of referrals found significant but much smaller variations in referral rates.4 The paper by Messrs McArdle and Hole raises the important issue of significant variation in patients' outcome among surgeons. In our opinion there is insufficient adequate data and statistical back up to justify their conclusions. Further studies involving many more patients are required.

The Beneficial Roles of SIRT1 in Drug-Induced Liver Injury

“…The frequent etiology of DILI is linked with herbal products, antibiotics, chemotherapeutics, and immunomodulatory agents [3]. In recent decades, research has mainly focused on finding potential agents such as antitubercular [4], acetaminophen (APAP) [5], and inorganic heavy metals [6] that cause DILI. DILI gained much attention due to its importance in drug development along with its roles in failure or withdrawal of drug development [7].…”