Transient elastography (TE) has received increasing attention as a means to evaluate disease progression in patients with chronic liver disease.
To assess the value of TE for predicting the stage of ...fibrosis.
Liver biopsy and TE were performed in 150 consecutive patients with chronic hepatitis C-related hepatitis (92 men and 58 women, age 50.6 (SD 12.5) years on the same day. Necro-inflammatory activity and the degree of steatosis at biopsy were also evaluated.
The areas under the curve for the prediction of significant fibrosis (> or = F2), advanced fibrosis (> or = F3) or cirrhosis were 0.91, 0.99 and 0.98, respectively. Calculation of multilevel likelihood ratios showed that values of TE < 6 or > or = 12, < 9 or > or = 12, and < 12 or > or = 18, clearly indicated the absence or presence of significant fibrosis, advanced fibrosis, and cirrhosis, respectively. Intermediate values could not be reliably associated with the absence or presence of the target condition. The presence of inflammation significantly affected TE measurements in patients who did not have cirrhosis (p<0.0001), even after adjusting for the stage of fibrosis. Importantly, TE measurements were not influenced by the degree of steatosis.
TE is more suitable for the identification of patients with advanced fibrosis than of those with cirrhosis or significant fibrosis. In patients in whom likelihood ratios are not optimal and do not provide a reliable indication of the disease stage, liver biopsy should be considered when clinically indicated. Necro-inflammatory activity, but not steatosis, strongly and independently influences TE measurement in patients who do not have cirrhosis.
Visceral leishmaniasis is an uncommon disease in transplant recipients; however, if left untreated, the mortality can be high. If an organ donor or recipient is known to be an asymptomatic Leishmania ...spp. carrier, monitoring is advised. This study proposes to assess the prevalence of asymptomatic Leishmania spp. infection in liver transplant donors and recipients from an endemic area. A total of 50 liver recipients and 17 liver donors were evaluated by direct parasite search, indirect fluorescent antibody test (IFAT), anti‐Leishmania rK39 rapid test and Leishmania spp. DNA detection by polymerase chain reaction (PCR). Leishmania spp. amastigotes were not observed in liver or spleen tissues. Of the 67 serum samples, IFAT was reactive in 1.5% and indeterminate for 17.9%, and the anti‐Leishmania rK39 rapid test was negative for all samples. The PCR test was positive for 7.5%, 8.9%, and 5.9% of blood, liver and spleen samples, respectively (accounting for 23.5% of the donors and 8% of the recipients). Leishmania infantum‐specific PCR confirmed all positive samples. In conclusion, a high prevalence of asymptomatic L. infantum was observed in donors and recipients from an endemic area, and PCR was the most sensitive method for screening these individuals.
This study shows a high positivity of Leishmania DNA in blood and organs of liver donors and recipients from an endemic area of visceral leishmaniasis in Brazil, informing the risk of infection transmission and clinical disease development in organ recipients.
Long-term sequelae are frequent and often disabling after epidermal necrolysis (Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)). However, consensus on the modalities of ...management of these sequelae is lacking.
We conducted an international multicentric DELPHI exercise to establish a multidisciplinary expert consensus to standardize recommendations regarding management of SJS/TEN sequelae.
Participants were sent a survey via the online tool "Survey Monkey" consisting of 54 statements organized into 8 topics: general recommendations, professionals involved, skin, oral mucosa and teeth, eyes, genital area, mental health, and allergy workup. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). Results were analyzed according to the RAND/UCLA Appropriateness Method.
Fifty-two healthcare professionals participated. After the first round, a consensus was obtained for 100% of 54 initially proposed statements (disagreement index < 1). Among them, 50 statements were agreed upon as 'appropriate'; four statements were considered 'uncertain', and ultimately finally discarded.
Our DELPHI-based expert consensus should help guide physicians in conducting a prolonged multidisciplinary follow-up of sequelae in SJS-TEN.
Summary
Background
Supportive care is the cornerstone of management of adult and paediatric Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). However, consensus on the modalities ...of supportive care is lacking.
Objectives
Our aim in this international multicentric Delphi exercise was to establish a multidisciplinary expert consensus to standardize recommendations regarding supportive care in the acute phase of SJS/TEN.
Methods
Participants were sent a survey via the online tool SurveyMonkey, consisting of 103 statements organized into 11 topics: multidisciplinary team composition, suspect drug management, infection prevention, fluid resuscitation and prevention of hypothermia, nutritional support, pain and psychological distress management, management of acute respiratory failure, local skincare, ophthalmological management, management of other mucosa, and additional measures. Participants evaluated the level of appropriateness of each statement on a scale of 1 (extremely inappropriate) to 9 (extremely appropriate). The results were analysed according to the RAND/UCLA Appropriateness Method.
Results
Forty‐five participants from 13 countries (on three continents) participated. After the first round, a consensus was obtained for 82.5% of the 103 initially proposed statements. After the second round, a final consensus was obtained for 102 statements.
Conclusions
We have reached an international Delphi‐based consensus on best supportive care practice for SJS/TEN. Our expert consensus should help guide physicians in treating patients with SJS/TEN and thereby improve short‐term prognosis and the risk of sequelae.
What is already known about this topic?
Supportive care is the cornerstone of management of Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in the acute phase.
There is no consensus or guideline on the best supportive care.
What does this study add?
An international, multidisciplinary consensus on best supportive care practices for patients with SJS/TEN in the acute phase, along with practical guidance.
Linked Comment: C.-B. Chen and W.-H. Chung. Br J Dermatol 2021; 185:484–486.
Background & Aims: Proliferation and migration of hepatic stellate cells (HSCs) and expression of chemokines are involved in the pathogenesis of liver inflammation and fibrogenesis. Peroxisome ...proliferator–activated receptor (PPAR)-γ is a receptor transcription factor that controls growth and differentiation in different tissues. We explored the effects of PPAR-γ agonists on the biological actions of cultured human HSCs. Methods: HSCs were isolated from normal human liver tissue and used in their myofibroblast-like phenotype or immediately after isolation. Activation of PPAR-γ was induced with 15-deoxy-Δ12,14-prostaglandin J2 or with troglitazone. Results: PPAR-γ agonists dose-dependently inhibited HSC proliferation and chemotaxis induced by platelet-derived growth factor. This effect was independent of changes in postreceptor signaling or expression of c-fos and c-myc and was associated with inhibition of cell cycle progression beyond the G1 phase. Activation of PPAR-γ also resulted in a complete inhibition of the expression of monocyte chemotactic protein 1 at the gene and protein levels. Comparison of quiescent and culture-activated HSCs revealed a marked decrease in PPAR-γ expression in activated cells. Conclusions: Activation of PPAR-γ modulates profibrogenic and proinflammatory actions in HSCs. Reduced PPAR-γ expression may contribute to confer an activated phenotype to HSCs.
GASTROENTEROLOGY 2000;119:466-478
Gravitational waves enable tests of general relativity in the highly dynamical and strong-field regime. Using events detected by LIGO-Virgo up to 1 October 2019, we evaluate the consistency of the ...data with predictions from the theory. We first establish that residuals from the best-fit waveform are consistent with detector noise, and that the low- and high-frequency parts of the signals are in agreement. We then consider parametrized modifications to the waveform by varying post-Newtonian and phenomenological coefficients, improving past constraints by factors of ∼2; we also find consistency with Kerr black holes when we specifically target signatures of the spin-induced quadrupole moment. Looking for gravitational-wave dispersion, we tighten constraints on Lorentz-violating coefficients by a factor of ∼2.6 and bound the mass of the graviton to m(g)≤1.76 x 10^(-23) eV/sq. c with 90% credibility. We also analyze the properties of the merger remnants by measuring ringdown frequencies and damping times, constraining fractional deviations away from the Kerr frequency to δ{\hat {f}}(220)=0.03(+0.38,-0.35) for the fundamental quadrupolar mode, and δ{\hat {f}}(221)=0.04(+0.27,-0.32) for the first overtone; additionally, we find no evidence for postmerger echoes. Finally, we determine that our data are consistent with tensorial polarizations through a template-independent method. When possible, we assess the validity of general relativity based on collections of events analyzed jointly. We find no evidence for new physics beyond general relativity, for black hole mimickers, or for any unaccounted systematics.
We report results of a search for an isotropic gravitational-wave background (GWB) using data from Advanced LIGO's and Advanced Virgo's third observing run (O3) combined with upper limits from the ...earlier O1 and O2 runs. Unlike in previous observing runs in the advanced detector era, we include Virgo in the search for the GWB. The results of the search are consistent with uncorrelated noise, and therefore we place upper limits on the strength of the GWB. We find that the dimensionless energy density Ω(sub GW) ≤ 5.8 × 10(exp -9) at the 95% credible level for a at (frequency-independent) GWB, using a prior which is uniform in the log of the strength of the GWB, with 99% of the sensitivity coming from the band 20-76.6 Hz; Ω(sub GW)(f) ≤ 3.4 × 10(exp -9) at 25 Hz for a power-law GWB with a spectral index of 2/3 (consistent with expectations for compact binary coalescences), in the band 20-90.6 Hz; and Ω(sub GW)(f) ≤ 3.9 × 10(exp -10) at 25 Hz for a spectral index of 3, in the band 20-291.6 Hz. These upper limits improve over our previous results by a factor of 6.0 for a at GWB, 8.8 for a spectral index of 2/3, and 13.1 for a spectral index of 3. We also search for a GWB arising from scalar and vector modes, which are predicted by alternative theories of gravity; we do not find evidence of these, and place upper limits on the strength of GWBs with these polarizations. We demonstrate that there is no evidence of correlated noise of magnetic origin by performing a Bayesian analysis that allows for the presence of both a GWB and an effective magnetic background arising from geophysical Schumann resonances. We compare our upper limits to a fiducial model for the GWB from the merger of compact binaries, updating the model to use the most recent data-driven population inference from the systems detected during O3a. Finally, we combine our results with observations of individual mergers and show that, at design sensitivity, this joint approach may yield stronger constraints on the merger rate of binary black holes at z ≳ 2 than can be achieved with individually resolved mergers alone.
The third Gravitational-Wave Transient Catalog (GWTC-3) describes signals detected with Advanced LIGO and Advanced Virgo up to the end of their third observing run. Updating the previous GWTC-2.1, we ...present candidate gravitational waves from compact binary coalescences during the second half of the third observing run (O3b) between 1 November 2019, 15∶00 Coordinated Universal Time (UTC) and 27 March 2020, 17∶00 UTC. There are 35 compact binary coalescence candidates identified by at least one of our search algorithms with a probability of astrophysical origin pastro>0.5. Of these, 18 were previously reported as low-latency public alerts, and 17 are reported here for the first time. Based upon estimates for the component masses, our O3b candidates with pastro>0.5 are consistent with gravitational-wave signals from binary black holes or neutron-star-black-hole binaries, and we identify none from binary neutron stars. However, from the gravitational-wave data alone, we are not able to measure matter effects that distinguish whether the binary components are neutron stars or black holes. The range of inferred component masses is similar to that found with previous catalogs, but the O3b candidates include the first confident observations of neutron-star-black-hole binaries. Including the 35 candidates from O3b in addition to those from GWTC-2.1, GWTC-3 contains 90 candidates found by our analysis with pastro>0.5 across the first three observing runs. These observations of compact binary coalescences present an unprecedented view of the properties of black holes and neutron stars.
We report on the population properties of 76 compact binary mergers detected with gravitational waves below a false alarm rate of 1 per year through GWTC-3. The catalog contains three classes of ...binary mergers: BBH, BNS, and NSBH mergers. We infer the BNS merger rate to be between 10 $\rm{Gpc^{-3} yr^{-1}}$ and 1700 $\rm{Gpc^{-3} yr^{-1}}$ and the NSBH merger rate to be between 7.8 $\rm{Gpc^{-3}\, yr^{-1}}$ and 140 $\rm{Gpc^{-3} yr^{-1}}$ , assuming a constant rate density versus comoving volume and taking the union of 90% credible intervals for methods used in this work. Accounting for the BBH merger rate to evolve with redshift, we find the BBH merger rate to be between 17.9 $\rm{Gpc^{-3}\, yr^{-1}}$ and 44 $\rm{Gpc^{-3}\, yr^{-1}}$ at a fiducial redshift (z=0.2). We obtain a broad neutron star mass distribution extending from $1.2^{+0.1}_{-0.2} M_\odot$ to $2.0^{+0.3}_{-0.3} M_\odot$. We can confidently identify a rapid decrease in merger rate versus component mass between neutron star-like masses and black-hole-like masses, but there is no evidence that the merger rate increases again before 10 $M_\odot$. We also find the BBH mass distribution has localized over- and under-densities relative to a power law distribution. While we continue to find the mass distribution of a binary's more massive component strongly decreases as a function of primary mass, we observe no evidence of a strongly suppressed merger rate above $\sim 60 M_\odot$. The rate of BBH mergers is observed to increase with redshift at a rate proportional to $(1+z)^{\kappa}$ with $\kappa = 2.9^{+1.7}_{-1.8}$ for $z\lesssim 1$. Observed black hole spins are small, with half of spin magnitudes below $\chi_i \simeq 0.25$. We observe evidence of negative aligned spins in the population, and an increase in spin magnitude for systems with more unequal mass ratio.
The detection of gravitational waves by Advanced LIGO and Advanced Virgo provides an opportunity to test general relativity in a regime that is inaccessible to traditional astronomical observations ...and laboratory tests. We present four tests of the consistency of the data with binary black hole gravitational waveforms predicted by general relativity. One test subtracts the best-fit waveform from the data and checks the consistency of the residual with detector noise. The second test checks the consistency of the low- and high-frequency parts of the observed signals. The third test checks that phenomenological deviations introduced in the waveform model (including in the post-Newtonian coefficients) are consistent with 0. The fourth test constrains modifications to the propagation of gravitational waves due to a modified dispersion relation, including that from a massive graviton. We present results both for individual events and also results obtained by combining together particularly strong events from the first and second observing runs of Advanced LIGO and Advanced Virgo, as collected in the catalog GWTC-1. We do not find any inconsistency of the data with the predictions of general relativity and improve our previously presented combined constraints by factors of 1.1 to 2.5. In particular, we bound the mass of the graviton to be mg≤4.7×10−23 eV/c2 (90% credible level), an improvement of a factor of 1.6 over our previously presented results. Additionally, we check that the four gravitational-wave events published for the first time in GWTC-1 do not lead to stronger constraints on alternative polarizations than those published previously.
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