Acute-on-chronic liver failure in cirrhosis

The definition of acute-on-chronic liver failure (ACLF) remains contested. In Europe and North America, the term is generally applied according to the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium guidelines, which defines this condition as a syndrome that develops in patients with cirrhosis and is characterized by acute decompensation, organ failure and high short-term mortality. One-third of patients who are hospitalized for acute decompensation present with ACLF at admission or develop the syndrome during hospitalization. ACLF frequently occurs in a closed temporal relationship to a precipitating event, such as bacterial infection or acute alcoholic, drug-induced or viral hepatitis. However, no precipitating event can be identified in approximately 40% of patients. The mechanisms of ACLF involve systemic inflammation due to infections, acute liver damage and, in cases without precipitating events, probably intestinal translocation of bacteria or bacterial products. ACLF is graded into three stages (ACLF grades 1–3) on the basis of the number of organ failures, with higher grades associated with increased mortality. Liver and renal failures are the most common organ failures, followed by coagulation, brain, circulatory and respiratory failure. The 28-day mortality rate associated with ACLF is 30%. Depending on the grade, ACLF can be reversed using standard therapy in only 16–51% of patients, leaving a considerable proportion of patients with ACLF that remains steady or progresses. Liver transplantation in selected patients with ACLF grade 2 and ACLF grade 3 increases the 6-month survival from 10% to 80%

INTERNAL SECURITY AS AN OBSTACLE TO MARITIME SECURITY: WHY PHILIPPINE NAVY AND COAST GUARD CAPABILITIES ARE UNDERDEVELOPED

As an archipelagic state, the Philippines has significant resource endowments that it must manage and protect. It recognized the importance of these resources when it adopted the National Marine Policy in 1994. It also has faced significant maritime security threats since China seized Mischief Reef in 1995. Since then, it has made progress on the management of the marine environment, but its efforts to enhance maritime security have lagged. This thesis explores why the Philippine Navy and Coast Guard capabilities are underdeveloped in comparison to the threats the country faces. It traces the roots of the problem to two main causes: the Army’s dominance within the security sector, and the government’s repeated perception of internal security threats as more important than external threats. To support these findings, the thesis examines evidence about the national budget allocations to each service, the background of top military leaders, major defense acquisitions, the content of each presidential administration’s operational plans, and the responses to major maritime conflicts in 1995 and 2012. The evidence confirms that Army dominance and the prioritization of internal security threats resulted in delayed development of Navy and Coast Guard capabilities that could be used to counter external threats.Distribution Statement A. Approved for public release: Distribution is unlimited.Commodore, Philippine Coast Guar

Acute-on-Chronic Liver Failure: Definition, Diagnosis, and Clinical Characteristics

Acute-on-chronic liver failure (ACLF) is a recently recognized syndrome in cirrhosis characterized by acute decompensation (AD), organ failure(s), and high short-term mortality. Organ failure(s) is defined by the Chronic Liver Failure-Sequential Organ Failure (CLIF-SOFA) score or by its simplified version Chronic Liver Failure-Organ Failure Assessment (CLIF-OF) score. They include six types of organ failure: liver, renal, coagulation, cerebral, respiratory, and circulatory. One third of patients hospitalized with AD present with ACLF at admission or develop ACLF during hospitalization. Acute-on-chronic liver failure frequently occurs in a closed relationship to a precipitating event. According to the number of organ failures, ACLF is graded into three stages: ACLF-1 = single renal failure or single nonrenal organ failure if associated with renal dysfunction and/or cerebral dysfunction; ACLF-2 = two organ failures; and ACLF-3 = three to six organ failures, with increasing 28-day mortality rate (from 23%–74%). Acute-on-chronic liver failure may develop at any phase during the clinical course of the disease. Patients without prior AD develop a severe form of ACLF

Central Pb+Pb Collisions at 158 A GeV/c Studied by Pion-Pion Interferometry

Two-particle correlations have been measured for identified negative pions from central 158 AGeV Pb+Pb collisions and fitted radii of about 7 fm in all dimensions have been obtained. A multi-dimensional study of the radii as a function of kT is presented, including a full correction for the resolution effects of the apparatus. The cross term Rout-long of the standard fit in the Longitudinally CoMoving System (LCMS) and the vl parameter of the generalised Yano-Koonin fit are compatible with 0, suggesting that the source undergoes a boost invariant expansion. The shapes of the correlation functions in Qinv and Qspace have been analyzed in detail. They are not Gaussian but better represented by exponentials. As a consequence, fitting Gaussians to these correlation functions may produce different radii depending on the acceptance of the experimental setup used for the measurement.Comment: 13 pages including 10 figure

Effects of water activity on the performance of potassium sorbate and natamycin as preservatives against cheese spoilage moulds

peer-reviewedThis work investigated the effects of the food preservatives potassium sorbate and natamycin, combined with different levels of ionic (sodium chloride) and non-ioinic (glycerol) water activity (aw), on growth of fungi involved in cheese spoilage. In general, the combined effect of water stress and presence of preservatives enhanced fungal inhibition. However, some doses of potassium sorbate (0.02%) and natamycin (1, 5 and 10 ppm) were able to stimulate growth of Aspergillus varians, Mucor racemosus, Penicillium chrysogenum and P. roqueforti at aw values in the range of 0.93–0.97. P. solitum was the only species whose growth was consistently reduced by any doses of preservative. The results also showed that sodium chloride and glycerol differentially affected the efficacy of preservatives. This study indicates that aw of cheese is a critical parameter to be considered in the formulation of preservative coatings used against fungal spoilage

Proximity effect at superconducting Sn-Bi2Se3 interface

We have investigated the conductance spectra of Sn-Bi2Se3 interface junctions down to 250 mK and in different magnetic fields. A number of conductance anomalies were observed below the superconducting transition temperature of Sn, including a small gap different from that of Sn, and a zero-bias conductance peak growing up at lower temperatures. We discussed the possible origins of the smaller gap and the zero-bias conductance peak. These phenomena support that a proximity-effect-induced chiral superconducting phase is formed at the interface between the superconducting Sn and the strong spin-orbit coupling material Bi2Se3.Comment: 7 pages, 8 figure

Suppression of High-p_T Neutral Pion Production in Central Pb+Pb Collisions at sqrt{s_NN} = 17.3 GeV Relative to p+C and p+Pb Collisions

Neutral pion transverse momentum spectra were measured in p+C and p+Pb collisions at sqrt{s_NN} = 17.4 GeV at mid-rapidity 2.3 < eta_lab < 3.0 over the range 0.7< p_T < 3.5 GeV/c. The spectra are compared to pi0 spectra measured in Pb+Pb collisions at sqrt{s_NN} = 17.3 GeV in the same experiment. For a wide range of Pb+Pb centralities (N_part < 300) the yield of pi0's with p_T > 2 GeV/c is larger than or consistent with the p+C or p+Pb yields scaled with the number of nucleon-nucleon collisions (N_coll), while for central Pb+Pb collisions with N_part > 350 the pi0 yield is suppressed.Comment: 5 pages, 4 figure

Characteristics, Diagnosis and Prognosis of Acute-on-Chronic Liver Failure in Cirrhosis Associated to Hepatitis B

The study was supported by National Natural Science Foundation of China (NSFC), grant number: 30770962, 30971333, 81170421, 81470869 and Chinese High Technology “863” programme, grant number: 2006AA02A411 (Hai.Li); The CLIF Consortium Data Management Center is supported by an unrestricted grant from Grifols