Summary Lifestyle intervention can be useful across all the spectrum of NAFLD patients. Losing weight decreases cardiovascular / diabetes risk and also regresses liver disease. Weight reductions of ≥ ...10% are required for inducing near universal NASH resolution or fibrosis improvement by at least one stage. However, modest weight losses (>5%) also produce important benefits on NAS and its components. In addition, to improve the success of this intervention we need to explore, beyond total calories and type of weight loss diet, the role of micro and macronutrients, evidence-based benefits of physical activity and exercise and finally supporting these modifications through established behaviour change models and techniques. The Mediterranean diet can reduce liver fat even without weight loss and is the most recommended dietary pattern in NAFLD. The Mediterranean diet is characterized by reduced carbohydrates intake, especially sugars and refined carbohydrates (40% of the calories vs. 50-60% in a typical low fat diet), and increased monounsaturated and omega-3 fatty acids intake (40% of the calories as fat vs. up-to 30% in a typical low fat diet). Both TV sitting (a reliable marker of overall sedentary behaviour) and physical activity are associated with cardio-metabolic health, NAFLD and overall mortality. A ‘ triple hit behavioural phenotype ’ of 1) sedentary behaviour, 2) low physical activity, and 3) poor diet have been defined. Clinical evidence strongly supports the role of lifestyle modification as a primary therapy for the management of NAFLD and NASH, and this should be accompanied by the implementation of strategies to avoid relapse and weight regain.
Summary Hepatic encephalopathy in a hospitalized cirrhotic patient is associated with a high mortality rate and its presence adds further to the mortality of patients with acute-on-chronic liver ...failure (ACLF). The exact pathophysiological mechanisms of HE in this group of patients are unclear but hyperammonemia, systemic inflammation (including sepsis, bacterial translocation, and insulin resistance) and oxidative stress, modulated by glutaminase gene alteration, remain as key factors. Moreover, alcohol misuse, hyponatremia, renal insufficiency, and microbiota are actively explored. HE diagnosis requires exclusion of other causes of neurological, metabolic and psychiatric dysfunction. Hospitalization in the ICU should be considered in every patient with overt HE, but particularly if this is associated with ACLF. Precipitating factors should be identified and treated as required. Evidence-based specific management options are limited to bowel cleansing and non-absorbable antibiotics. Ammonia lowering drugs, such as glycerol phenylbutyrate and ornithine phenylacetate show promise but are still in clinical trials. Albumin dialysis may be useful in refractory cases. Antibiotics, prebiotics, and treatment of diabetes reduce systemic inflammation. Where possible and not contraindicated, large portal-systemic shunts may be embolized but liver transplantation is the most definitive step in the management of HE in this setting. HE in patients with ACLF appears to be clinically and pathophysiologically distinct from that of acute decompensation and requires further studies and characterization.
Today, ≈20% of the electric consumption is devoted to refrigeration; while, ≈50% of the final energy is dedicated to heating applications. In this scenario, many cooling devices and heat‐pumps are ...transitioning toward the use of CO2 as an eco‐friendly refrigerant, favoring carbon circular economy. Nevertheless, CO2 still has some limitations, such as large operating pressures (70–150 bar) and a critical point at 31 °C, which compromises efficiency and increases technological complexity. Very recently, an innovative breathing‐caloric mechanism in the MIL‐53(Al) compound is reported, which implies gas adsorption under CO2 pressurization boosted by structural transitions and which overcomes the limitations of stand‐alone CO2. Here, the breathing‐caloric‐like effects of MOF‐508b are reported, surpassing by 40% those of MIL‐53(Al). Moreover, the first thermometry device operating at room temperature and under the application of only 26 bar of CO2 is presented. Under those conditions, this material presents values of ΔT ≈ 30 K, reaching heating temperatures of 56 °C and cooling temperatures of −10 °C, which are already useful for space heating, air‐conditioning, food refrigeration, and freezing applications.
MOF‐508b displays enhanced breathing‐caloric‐like effects related to two consecutive phase transitions, where barocaloric effects and sorption thermal changes coexist. Moreover, the first thermometry device to characterize this type of thermomaterials is presented, where MOF‐508b shows remarkable temperature changes of 30 K under CO2 pressurization of only 26 bar, which can empower existing CO2 heating and cooling systems.
The safety and efficacy of granulocyte-colony stimulating factor (G-CSF) for the treatment of acute-on-chronic liver failure (ACLF) remain controversial. This meta-analysis aimed to evaluate the ...effectiveness and safety of G-CSF in treating ACLF. The estimated pooled risk ratio (RR) and 95% confidence interval (CI) assessed the treatment effects of G-CSF. Mean differences (MD) and 95% confidence intervals were used to analyze continuous data. Heterogeneity was explored by sensitivity analysis. Potential publication bias was assessed using Egger's test. Ten studies, comprising a total of 603 participants, were included in the analysis. The G-CSF group showed significantly lower MELD scores at 7-day (MD = -2.39, 95%CI: -3.95 to -0.82), CTP scores at 7-day (MD = -0.77, 95%CI: -1.41 to -0.14), and MELD scores at 30-day (MD = -3.01, 95%CI: -5.36 to -0.67) compared to the control group. Furthermore, the G-CSF group was associated with a reduced risk of sepsis (RR = 0.53, 95%CI: 0.35-0.80). The 30-day survival (RR = 1.26, 95%CI:1.10-1.43), 60-day survival (RR = 1.47, 95%CI:1.17-1.84, and 90-day survival (RR = 1.73, 95%CI: 1.27-2.35) of patients with ACLF treated with G-CSF were significantly higher than those of the control group. Our meta-analysis suggests that G-CSF therapy may be a promising treatment for ACLF, with significant improvements in liver function and survival rates, however, further studies are needed to verify this conclusion.
•Development of a novel closed-loop regasification system with ORC and CO2 capture.•Energy, exergy and environmental analyses of the proposed regasification system.•Integration of post-combustion CO2 ...capture with chemical absorption using MEA.•Exploitation of LNG cold energy for electricity generation and CO2 liquefaction.•The proposed system is more eco-friendly than current regasification systems.
Regasification systems in Floating Storage Regasification Units (FSRUs) that use the steam generated by the boilers as the heat source (closed loop) in the liquefied natural gas (LNG) regasification process are less detrimental to the marine environment than those systems that use seawater (open loop). Their drawback, however, lies in the significant increase in fuel consumption and, thus, CO2 emissions. The present paper performs an energy, exergy and environmental analysis of a novel closed-loop regasification system for FSRUs that integrates an organic Rankine cycle (ORC) and post-combustion CO2 capture system with a 30 wt% aqueous solution of monoethanolamine (MEA). LNG cold energy is utilised for power generation through the ORC as well as in the processes of CO2 capture, compression, drying and liquefaction. The system proposed is able to meet the electrical power demand of the FSRU without the use of dual fuel engines, while CO2 capture efficiency in the boiler flue gases exceeds 90%. Fuel consumption is cut by 18% in this system in comparison with existing closed-loop regasification systems, and exergy efficiency increases by 14%, while CO2 emissions decrease by approximately 75% compared to open-loop systems commonly installed on board.
Review of propulsion systems on LNG carriers Fernández, Ignacio Arias; Gómez, Manuel Romero; Gómez, Javier Romero ...
Renewable & sustainable energy reviews,
January 2017, 2017-01-00, Letnik:
67
Journal Article
Recenzirano
Vessel ozone depleting emission regulations are regulated in Annex VI of the MARPOL Convention, wherein the maximum levels of NOx, SOx and suspended particles are established. These increasingly ...strict regulations, together with the increase in natural gas consumption and its price, have conditioned propulsion systems implemented on board vessels.
This article reviews the different propulsion systems used on board vessels for the transport of Liquefied Natural Gas (LNG). The study describes the main characteristics of the propulsion systems, and the advantages and drawbacks that come along with these, from its very beginnings up to the systems installed to date. The described propulsion systems include both gas and steam turbines, combined cycles, 2 and 4 stroke internal combustion engines, as well as reliquefaction plants, while encompassing mechanical, electric and Dual Fuel (DF) technology systems.
The propulsion systems implemented have undergone continual alteration in order to adjust to market needs, which were always governed by both efficiency and the possibility of consuming boil-off gas (BOG), always in compliance with the strict antipollution regulations in force.
The current direction of LNG vessel propulsion systems is the installation of 2-stroke DF low pressure engines due to their high efficiency and their possibility of installing a BOG reliquefaction plant. Another great advantage of this propulsion system is its compliance with the IMO TIER III emission regulations, without the need to install any supplementary gas treatment system.
Summary
Background
Non‐alcoholic steatohepatitis (NASH) can adversely affect health‐related quality of life (HRQoL).
Aims
This double‐blind, placebo‐controlled, phase 2 trial aimed to report the ...effects of the glucagon‐like peptide‐1 receptor agonist, semaglutide, on HRQoL in patients with NASH as a secondary endpoint.
Methods
Adults with biopsy‐proven NASH and stage 1–3 fibrosis were randomised (3:3:3:1:1:1) to once‐daily subcutaneous semaglutide 0.1, 0.2 or 0.4 mg, or placebo, for 72 weeks. Patients were invited to complete the Short Form‐36 version 2.0 questionnaire at weeks 0, 28, 52 and 72.
Results
Between January 2017 and September 2018, 320 patients were enrolled. At 72 weeks, semaglutide was associated with significant improvements in physical component summary (PCS) score (estimated treatment difference ETD 4.26; 95% confidence interval CI: 1.96–6.55; p = 0.0003); bodily pain (ETD 5.07; 95% CI: 2.15–7.99; p = 0.0007); physical functioning (ETD 3.51; 95% CI: 1.16–5.86; p = 0.0034); role limitations due to physical health problems (ETD 2.80; 95% CI: 0.28–5.33; p = 0.0294); social functioning (ETD 3.16; 95% CI: 0.53–5.78; p = 0.0183) and vitality (ETD 4.47; 95% CI: 1.63–7.32; p = 0.0021). There was no significant difference in the mental component summary score (ETD 1.02; 95% CI: −1.59 to 3.62; p = 0.4441). After 72 weeks, improvements in PCS scores were significantly greater in patients (pooled semaglutide and placebo) with NASH resolution than without (p = 0.014).
Conclusions
Treatment with semaglutide is associated with improvements in the physical components of HRQoL in patients with biopsy‐proven NASH and fibrosis compared with placebo. ClinicalTrials.gov: NCT02970942.
Significant impact on physical components of Health Related Quality of Life of the treatment with semaglutide in patients living with NAFLD.
It is unclear what biopsychosocial factors influence the impact of NAFLD on health-related quality of life (HRQoL), and if these factors are equally important predictors between different ...nationalities.
HRQoL (CLDQ) was measured in both Southern European (Spain, n = 513) and Northern European (United Kingdom -UK-, n = 224) cohorts of patients with NAFLD in this cross-sectional study. For each cohort, participant data were recorded on histological grade of steatohepatitis, stage of fibrosis and biopsychosocial variables. Regression analysis was used to explore which of these variables predicted HRQoL. Moderated mediation models were conducted using SPSS PROCESS v3.5 macro.
Participants with severe fibrosis reported more fatigue, systemic symptoms and worry, and lower HRQoL than those with none/mild fibrosis, regardless of place of origin. In addition, body mass index (BMI) and gender were found to be significant predictors of HRQoL in both Spanish and UK participants. Female gender was associated with worse emotional function, higher BMI and more fatigue, which predicted lower participants' HRQoL. UK participants showed more systemic symptoms and worry than Spanish participants, regardless of liver severity. The negative effects of gender on HRQoL through emotional function, BMI and fatigue were reported to a greater degree in UK than in Spanish participants.
UK participants showed a greater impairment in HRQoL as compared to Spanish participants. Higher fibrosis stage predicted lower HRQoL, mainly in the Spanish cohort. Factors such as female gender or higher BMI contributed to the impact on HRQoL in both cohorts of patients and should be considered in future multinational intervention studies in NAFLD.
Background & Aims
Squamous cell carcinoma antigen (SCCA) and its immune complex (SCCA‐IgM) have been proposed for use in the screening of hepatocellular carcinoma (HCC). We conducted a meta‐analysis ...to evaluate the diagnostic performance of SCCA and SCCA‐IgM and of both combined with alpha‐foetoprotein.
Methods
After a systematic review of the relevant studies, the sensitivity, specificity, positive and negative likelihood ratios, diagnostic odds ratio (DOR) and area under curve (AUC) for the diagnosis of HCC were pooled using bivariate meta‐analysis. Hierarchic summary receiver operating characteristic curves were used to summarize the overall test performance. Bivariate boxplots were used to confirm whether the threshold effect existed. A Fagan nomogram was used to assess the clinical utility. Heterogeneity was explored by sensitivity analysis, univariable meta‐regression and subgroup analysis.
Results
Eleven studies that had HCC diagnosis as their purpose were ultimately included in the quantitative analysis. The summary estimates were as follows: SCCA (AUC: 0.80 95% CI: 0.76‐0.83) and SCCA‐IgM (AUC: 0.77 95% CI: 0.74‐0.83) demonstrated similar diagnostic performance, while a combination of AFP and SCCA‐IgM had an AUC of 0.90 (95% CI: 0.87‐0.92) and a DOR of 22.87 (95% CI: 8.38‐62.40). Meta‐regression showed that patient selection, cut‐off values, reference standards and tumour biopsy as the diagnostic method significantly influenced the heterogeneity of the included studies.
Conclusions
Both SCCA and SCCA‐IgM showed a moderate diagnostic accuracy for HCC screening; the combination of SCCA‐IgM and AFP is the best diagnostic option.
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