Introduction: Although alcoholism is a common aetiological link between liver and pancreatic disorders, the frequency of coinciding pancreatic disease in patients with alcohol-related liver disease ...is not well understood. The present study mentions about the use of Endoscopic Ultrasound (EUS) with standardised criteria to assess asymptomatic or overt pancreatic pathology in patients with alcoholic liver disease. Aim: To determine the prevalence of asymptomatic Alcoholic Chronic Pancreatitis (ACP) in Indian patients affected by Alcoholic Liver Cirrhosis (ALC) using EUS. Materials and Methods: The present observational crosssectional study was conducted on patients attending the Outpatient Department of Gastroenterology at Santokba Durlabhji Memorial Hospital Cum Medical Research Institute, Jaipur, Rajasthan, India. A total of 35 patients were screened with alcoholic liver disease for pancreatic abnormalities using EUS. The patients were recruited for the study over a period of 12 months, from September 2013 to August 2014. The prevalence of chronic pancreatitis (CP) was determined, and abnormalities were graded according to the Rosemont criteria. The severity of alcoholic liver disease, as indexed by Child Pugh Scoring (CPS) and Model for End-stage Liver Disease (MELD), was evaluated for any association with endosonographic findings of CP. The influence of various clinico-demographic factors on alcoholic liver and pancreatic diseases was analysed using the PSS Inc. Chicago, IL program. Results: A total of 35 male patients, aged 28 to 65 years with a mean age of 46.97 years, fulfilled the inclusion criteria. EUS revealed a prevalence of CP in 20% of patients. Three patients showed changes suggestive of CP, of which two had ALC and one had Alcoholic Hepatitis (AH). Four patients were prioritised in categorised as indeterminate for CP, with three having cirrhosis and one having Alcoholic Fatty Liver (ALF). No significant influence of clinico-demographic profiles on the final outcome parameters was observed. The patient with endoscopic changes had a MELD score of 12.85±5.11 compared to patients without changes of ACP (19.1±5.71) (p=0.013). ALC was found to be inversely related to EUS changes of ACP. Conclusion: The EUS is an effective screening tool for evaluating pancreatic abnormalities in patients with alcoholic liver disease. The present study provides a comprehensive review of previous findings in light of the varying facts and figures. As there is still a lack of experimental animal models for ALC and ACP, studies of this kind may shed light on hidden links in disease pathology.
Abstract
Gallbladder diseases are common and include a spectrum ranging from benign to cancer. Imaging plays an integral role in the diagnosis and in guiding appropriate management. While most ...patients with gallstone (GS) diseases can be evaluated with ultrasound, those with complicated GS disease, suspicion of cancer, or staging of cancer need additional cross-sectional imaging. Computed tomography (CT) is widely available and is often the imaging test of choice following an equivocal ultrasound or negative ultrasound in patients with unexplained symptoms. Conventional CT has limited sensitivity in detecting GS or common bile duct stones. In other scenarios, including diagnosis of acute cholecystitis (AC) and characterization of gallbladder wall thickening, an increase in accuracy using novel techniques is desirable. Dual-energy computed tomography (DECT) is increasingly incorporated into clinical practice. DECT has shown promising results in the detection of cholesterol stones that otherwise go unnoticed on conventional CT. However, its role beyond GS disease has largely been unexplored. In this review, we discuss the available literature on the DECT in biliary diseases and discuss the potential applications of this technique.
A mild, operationally convenient, and practical method for the synthesis of synthetically useful
-arylsulfonylimines from
-(arylsulfonyl)benzylamines using K
S
O
in the presence of pyridine as a base ...is reported herein. In addition, a "one-pot" tandem synthesis of pharmaceutically relevant
-heterocycles by the reaction of
-arylsulfonylimines, generated in situ with
-substituted anilines is also reported. The key features of the protocol include the use of a green oxidant, a short reaction time (30 min), chromatography-free isolation, scalability, and economical, delivering
-arylsulfonylimines in excellent yields of up to 96%. While the oxidation of
-aryl(benzyl)amines to
-arylimines using K
S
O
is reported to be problematic, the oxidation of
-(arylsulfonyl)benzylamines to
-arylsulfonylimines using K
S
O
has been achieved for the first time. The dual role of the sulfate radical anion (SO
), including hydrogen atom abstraction (HAT) and single electron transfer (SET), is proposed to be involved in the plausible reaction mechanism.
Gallbladder (GB) wall thickening is a relatively common finding on imaging. While there are clear recommendations for the management of gallstones, GB wall thickening presents a significant ...challenge. Despite advances in radiological as well as endoscopic techniques, the ability to characterize GB wall thickening is still limited.
This review summarizes the currently available literature on various imaging investigations to characterize GB wall thickening. This review also summarizes the differences between benign and malignant GB wall thickening based on available imaging modalities. Transabdominal ultrasonography is the first-line investigation for evaluation of GB wall thickening. However, further characterization requires additional imaging tests. Magnetic resonance imaging (MRI) with the use of gadolinium and diffusion-weighted sequence is the preferred modality for GB wall characterization.
The accurate characterization of GB wall thickening is a challenging task. The available imaging criteria allow differentiation of benign and malignant GB wall thickening with moderate accuracy. The advanced imaging techniques, including contrast enhanced ultrasound, contrast-enhanced endoscopic ultrasound, and shear wave elastography, continue to evolve. There is a need for a well-designed reporting system for GB wall thickening to ensure uniformity of reporting of imaging tests, especially in regions with a high prevalence of GB cancer.
Patients with severe Th2 type asthma often have a steroid resistant phenotype and are prone to acute exacerbations. Current novel therapies have only marginal therapeutic effects. One of the ...hypotheses for lack of major efficacy in most patients is targeting only one redundant pathway leaving others active. Hence, we have designed and developed novel highly potent bispecific anti-TSLP/IL13 antibodies called Zweimabs (monovalent bispecific) and Doppelmabs (bivalent bispecific) that concurrently inhibits the signaling by these two cytokines.
•Lack of efficacy from anti-IL13 monotherapies.•Dual targeting TSLP and IL13 due to great overlap of signaling pathways.•Design and development of Zweimab and Doppelmab bispecifics targeting TSLP and IL13.•Zweimabs and Doppelmabs are highly potent with picomolar affinity to the targets.
A series of seven linear homopolymers of poly(methylmethacrylate) ranging from 12,470 to 365,700
g/mol
M
w, were utilized to further explore scaling relationships between viscosity and concentration ...in a good solvent at 25
°C and to investigate the impact of these relationships on fiber formation during electrospinning. For each of the polymers investigated, chain dimensions (hydrodynamic radius and radius of gyration) were measured by dynamic light scattering to determine the critical chain overlap concentration,
c
*. The experimentally determined
c
*, was found to be in good agreement with the theoretically determined value that was calculated by the criteria
c
*∼1/
η, where the intrinsic viscosity was estimated from the Mark–Houwink parameters,
K and
a (at 25
°C in dimethyl formamide) obtained from the literature. The plot of the zero shear viscosity vs.
c/
c
* distinctly separated into different solution regimes, viz. dilute (
c/
c
*<1), semidilute unentangled (1<
c/
c
*<3) and semidilute entangled (
c/
c
*>3). The crossover between semidilute unentangled and semidilute entangled regimes in the present investigation occurred at
c/
c
*∼3, which, therefore, marked the onset of the critical chain entanglement concentration,
c
e, according to the procedure utilized by Colby and co-workers Colby RH, Rubinstein M, Daoud M. J de Phys II 1994;4(8):1299–310.
52. Electrospinning of all solutions was carried out at identical conditions to ascertain the effects of solution concentration, molecular weight, molecular weight distribution and viscosity on fiber formation and morphological features of the electrospun material. Only polymer droplets were observed to form from electrospinning of solutions in the dilute concentration regime due to insufficient chain overlap. As the concentration was increased, droplets and beaded fibers were observed in the semidilute unentangled regime; and beaded as well as uniform fibers were observed in the semidilute entangled regime. Uniform fiber formation was observed at
c/
c
*∼6 for all the narrow MWD polymers (
M
w of 12,470–205,800
g/mol) but for the relatively broad MWD polymers (
M
w of 34,070 and 95,800
g/mol), uniform fibers were not formed until higher concentrations,
c/
c
*∼10, were utilized. Dependence of fiber diameter on concentration and viscosity was also determined, viz. fiber dia∼(
c/
c
*)
3.1 and
fiber
dia
∼
η
0
0.71
respectively. These scaling relationships were in general agreement with that observed by Mckee et al. McKee MG, Wilkes GL, Colby RH, Long TE. Macromolecules 2004;37(5):1760–67.
33.
Corporate Governance has acquired a significant place in the national economies globally. Quality of governance impacts the business confidence index and resource mobilizations in the global ...marketplace. In various countries there is a conventional dominance of promoters or majority shareholders on the board of companies which implicates various propensities of risks and forms of risk cultures, making the problem of governance typical and critical for the regulators. Our paper examines the risk behaviour of firms in context of CG practices and creates distinct bundles of companies with specific risk cultures. Using a sample of 10 years' panel data of 84 companies listed on the National Stock Exchange in India (NSE) for selected risk and CG variables, we measure the influence of CG measures on the risk propensity and behaviour and based on combinations of selected CG practices formulated the risk bundles. Based on the derived bundles of risk behaviour, regulators and policymakers can make informed decisions.
Stricturing gastrointestinal tuberculosis (GITB) may result in persistent symptoms even after antitubercular therapy (ATT) and may require surgical intervention. Data on efficacy and safety of ...endoscopic dilatation for management GITB related strictures is scarce.
A retrospective analysis of database of patients who underwent endoscopic balloon dilatation for suspected or proven gastrointestinal tuberculosis was performed. The analysis included the site of involvement, technical success, clinical success (response), relapse and requirement of surgery in these patients.
Out of 34 patients (47.1% males, mean age 31.9 ± 12.9 years), eventually four patients were diagnosed to have Crohn's disease while the rest had GITB. Initial technical success was achieved in 30 (88.2%) patients. Initial clinical success was achieved in 28 (82.3%) patients. Median number of dilatation sessions required to obtain symptomatic relief were 2.5 (1-5) per patient. Two patients with initial clinical success had recurrence of symptoms over follow up of 1 year, out of which one patient was managed with repeat endoscopic balloon dilatation successfully. Of 30 patients with technical success, 16 (53.4%) were on ATT when they underwent dilatation while two were in intestinal obstruction. Eventually 7 patients required surgical intervention for various reasons.
Non-fluoroscopic endoscopic balloon dilatation is an acceptable and fairly safe modality for symptomatic tuberculous strictures of gastrointestinal tract.
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