Dung Thi Le, M.D.
https://www.hopkinsmedicine.org/profiles/results/directory/profile/0016139/dung-le
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Long-term follow-up of patients with difficult to treat type 1 autoimmune hepatitis on Tacrolimus remedy. Characterization, consequence, and prognosis in 273 patients with primary sclerosing cholangitis: A single heart study. Characterization and scientific course of hepatobiliary carcinoma in sufferers with main sclerosing cholangitis. Improvement of rheumatoid arthritis and autoimmune hepatitis in a affected person treated with the tumour necrosis issue inhibitor, etanercept. Seroprevalence of Hepatitis E Virus in Autoimmune Hepatitis Patients within the Netherlands. Budesonide or prednisone together with ursodeoxycholic acid in major sclerosing cholangitis: a randomized double-blind pilot study. Combined treatment with methotrexate and ursodeoxycholic acid in noncirrhotic primary biliary cirrhosis. Tacrolimus: A potential new therapy for autoimmune continual active hepatitis: results of an openlabel preliminary trial. Obeticholic acid, a farnesoid X receptor agonist, improves portal hypertension by two distinct pathways in cirrhotic rats. Secondary sclerosing cholangitis after chemotherapy with bevacizumab and paclitaxel. Autoimmune pancreatitis/IgG4-associated cholangitis and primary sclerosing cholangitis � overlapping or separate illnesses The challenges in primary sclerosing cholangitis - Aetiopathogenesis, autoimmunity, administration and malignancy. Selection and timing of liver transplantation in primary biliary cirrhosis and first sclerosing cholangitis. Triple therapy with ursodeoxycholic acid, prednisone, and azathioprine in main biliary cirrhosis: a 1 yr randomized, placebo managed examine. Disease recurrence and rejection following liver transplantation for autoimmune persistent energetic liver illness. Prospective analysis of ursodeoxycholic acid withdrawal in patients with primary sclerosing cholangitis.
Lamivudine remedy throughout pregnancy to forestall perinatal transmission of hepatitis B virus infection. Risks of immunosuppressive therapies together with biologic brokers in sufferers with rheumatic illnesses and co-existing chronic viral infections. Acute liver failure attributable to severe acute hepatitis B: a case series from a multicenter investigation. Guidelines for the prevention, care and remedy of persons with chronic hepatitis B infection. Association of nucleos(t)ide analogueue therapy with reduced danger of hepatocellular carcinoma in sufferers with persistent hepatitis B: a nationwide cohort study. Long-Term Nucleos(t)ide Analogueues Therapy for Adults With Chronic Hepatitis B reduces the Risk of Long-Term Complications: a meta-analysis. Baseline traits and early on-treatment response predict the outcomes of 2 years of telbivudine treatment of chronic hepatitis B. Hepatitis B virus screening before chemotherapy for lymphoma: a costeffectiveness evaluation. Hepatitis D � analysis and remedy Heiner Wedemeyer Introduction Hepatitis delta is probably the most severe type of viral hepatitis in humans. Genotype 1 is probably the most regularly seen and is distributed all through the world, particularly in Europe, the Middle East, North America and North Africa. Genotype 2 is seen in East Asia and the Yakutia area of Russia, and genotype three is seen completely within the northern a half of South America, particularly within the Amazon basin. Genotype four is seen in Taiwan and Japan whereas genotypes 5�8 are found in Africa (Deny 2006). This work has been criticized as systematic reviews can only be pretty much as good as studies included (Wedemeyer 2018). However, the geographical origin of our sufferers has changed during the last decade. However, patterns suggesting a cytopathic viral disease have sometimes been noticed. A typical instance of this had been outbreaks of severe hepatitis in the northern a half of South America (Nakano 2001).
Hepatocellular Carcinoma within the Absence of Cirrhosis in United States Veterans Is Associated With Nonalcoholic Fatty Liver Disease. Efficacy and safety of the farnesoid X receptor agonist obeticholic acid in sufferers with type 2 diabetes and nonalcoholic fatty liver disease. Global, regional, and national age-sex particular all-cause and cause-specific mortality for 240 causes of dying, 1990-2013: a systematic evaluation for the Global Burden of Disease Study 2013. The impact of semaglutide on liver enzymes in topics with obesity and elevated alanine aminotransferase: Data from a randomised Phase 2 trial. Fatty liver predicts the danger for cardiovascular occasions in middle-aged inhabitants: a population-based cohort examine. Risk factors for primary dysfunction after liver transplantation-a multivariate analysis. Synthesis, analysis, and structureactivity relationship of a sequence of physique and facet chain modified analogues of chenodeoxycholic acid. Elafibranor, an Agonist of the Peroxisome ProliferatorActivated Receptor- and -, Induces Resolution of Nonalcoholic Steatohepatitis Without Fibrosis Worsening. Long-term morbidity following jejunoileal bypass: the continuing potential want for surgical reversal. Vitamin D deficiency in obese rats exacerbates nonalcoholic fatty liver illness and will increase hepatic resistin and Toll-like receptor activation. The Mediterranean food regimen improves hepatic steatosis and insulin sensitivity in people with nonalcoholic fatty liver disease. The effects of sibutramine and orlistat on the ultrasonographic findings, insulin 600 601 22. The fatty acid-bile acid conjugate Aramchol reduces liver fats content material in patients with nonalcoholic fatty liver illness. Gut microbiota composition is related to body weight, weight achieve and biochemical parameters in pregnant women. Nonalcoholic steatohepatitis: association of insulin resistance and mitochondrial abnormalities. No vital results of ethyl-eicosapentanoic acid on histologic features of nonalcoholic steatohepatitis in a phase 2 trial.
In general, most mutations in signaling pathway components result in the constitutive activation of the protein product. In the suitable context, p53 will increase pro-apoptotic genes and mediates cell cycle arrest. However, these research suffered from small sample measurement and the inherent low sensitivity associated with the usage of typical Sanger sequencing techniques. These mutations could be detected years earlier than illness progression and confer an increased risk of evolution to overt leukemia. The vast majority of circumstances bear two or extra mutations, so that gene�gene interactions have to be taken under consideration, particularly for prognostic analysis. Most apparently, a robust prognostic impact was only detectable when all three genes were mutated. While the person prognosis also depends on the genomic context, as already mentioned, sufferers with this subtype generally correspond properly to induction therapy and have a great prognosis. Constitutive activation of Akt by Flt3 inner tandem duplications is critical for elevated survival, proliferation, and myeloid transformation. In each groups, therapy toxicity is a big limitation leading to recurring short- and long-term morbidity. Novel molecular-oncogenetic groups have emerged providing new prognostic and predictive biomarkers for informing novel and optimized remedies. Over the last decade, a number of technologies have advanced that are able to mapping genetic change at both the submicroscopic and genome-wide ranges. The improvement of next-generation high-throughput sequencing applied sciences has paved the greatest way for massively parallel sequencing of focused gene loci, the protein-coding exome and complete genome itself contributing an in-depth perception into the global cancer genome. The nature of the chromosomal lesion varies in accordance with whether B- or T-lineage illness is current.
When bleeding is from the vagina, the cuff may be assessed and haemostasis may be achieved by a few stitches, which may be achieved with out anaesthetic. A retroperitoneal bleed could be managed conservatively and can often tamponade, forming a haematoma which can eventually be resorbed. The danger with a haematoma is the development of an infection which will necessitate additional surgery. Once sufficient exposure is obtained, the clots ought to be evacuated and the pelvis examined systematically to determine the bleeding vessels, which might then be ligated. Postoperative an infection is a standard complication following a vaginal hysterectomy and ranging rates are reported. Infection may be because of pelvic cellulitis, pelvic abscess, infected haematoma or vaginal cuff cellulitis. When there are indicators of infection, different causes must be ruled out and examination of the urine, lungs and pelvis must be carried out. This may be related to an increase in temperature with or without physical findings. When this fails to tackle the elevated temperature, the potential for a pelvic abscess should be thought-about. Other issues that can come up during a vaginal hysterectomy include visceral harm both to the urinary tract or to the bowel. If recognized on the time of surgical procedure, this can be adequately repaired; nevertheless, when missed, this can cause fistulation and the need for further surgery. The vaginal hysterectomy is the oldest route of hysterectomy and should be the default setting for benign disease. Ideally, the gynaecologist ought to be succesful of undertake any of the routes and patient choice might be primarily based on a variety of factors. Adequate patient choice and good caseload determines the success of the individual approaches.
Rattlesnake Root (Black Cohosh). Clomid.
Source: http://www.rxlist.com/script/main/art.asp?articlekey=96830
Alteration of this ratio giving desire in the path of one isoform versus the other can result in antiproliferative and pro-apoptotic effects [16]. The study discovered that long-term use was properly tolerated by patients, with high compliance [21]. At the end of the remedy, sufferers reported higher quality of life (QoL), decreased bleeding and pain, and no increase in fibroid dimension [21]. Fortunately, these modifications have been proven to be benign and are reversible within a quantity of weeks to 6 months after cessation of the agent [13, 15]. The downstream effect is a reduction in both bleeding and bulk-related signs, and a reduction in fibroid quantity [27]. Due to these antagonistic results, therapy is restricted to 6 months or much less with out the addition of add-back remedy [29]. Addback remedy is an method to alleviate hypooestrogenic unwanted effects by concomitant use of a second agent. Hormonal regimens have explored the utilization of progestins, oestrogens, a mixture of progestin/oestrogen, tibolone and raloxifene as addback therapies [29]. Accordingly, alleviating hypooestrogenic signs via add-back remedy improves compliance to remedy. Accordingly, leuprolide is just permitted for preoperative shrinkage of fibroids rather than a long-term administration option. A massive meta-analysis of mifepristone used to treat symptomatic fibroids discovered that a dose of two. Contrastingly, one other systematic evaluation found there was no discount of fibroid volume after mifepristone use [19]. Several preliminary research were discontinued after there was fear of endometrial hyperplasia; nonetheless, there was a latest resurgence of studies specializing in mifepristone. A massive study found that a 12-week regimen of asoprisnil resulted in a reduction in fibroid size and management of uterine bleeding [25]. A latest trial revealed data stating that a 300 mg twice-daily dose of elagolix confirmed a 36% reduction in fibroid and fibroid uterus quantity in addition to significantly lowering heavy menstrual bleeding, but an add-back therapy is required to keep away from postmenopausal-like signs [31]. Time will inform whether relugolix will be efficiently added to the record of medications for controlling symptomatic fibroids. The two main agents on this family are tamoxifen and raloxifene, both of that are commonly used in the remedy of breast most cancers.
Syndromes
Sickle cell anemia Genetics the genetic foundation of sickle cell anemia is central to the historical past of medical genetics. In 1947 James Neel concluded that with respect to the mode of inheritance, sickle cell anemia was a homozygous state and sickle cell trait (the asymptomatic service state) the heterozygous state for a genetic character that had yet to be outlined. Linus Pauling proposed that sickling mirrored an abnormality of the hemoglobin molecule, based on the observation of Irving Sherman, then a medical pupil, that under the polarizing microscope sickle cells, induced by deoxygenation, exhibited birefringence. Birefringence signified to Pauling that some type of molecular alignment or orientation existed in these cells, and since the predominant molecule within the purple cell is hemoglobin, it had to be this that was concerned in the pathology. Electrophoretic research, which demonstrated the altered mobility of sickle hemoglobin (HbS), confirmed this interpretation and the concept of molecular disease was born. The chemical structure of HbS was outlined by Vernon Ingram, who had developed a method for probing the primary sequence of a protein based on its fingerprint after cleavage by trypsin. This revealed that the structure of HbS differed from normal hemoglobin by only one tryptic peptide, subsequently found to have a single amino acid change at position 6 of the chain, the place a polar glutamic acid residue was replaced by a non-polar valine. The and -like globin genes are located on the brief arm of chromosome 11 at 11p15. The geographical attain of the sickle mutation spread additional with the invention of a different haplotype linked to the S gene within the japanese oasis of Saudi Arabia and among tribal inhabitants groups in central India. It was postulated this Indo-European sickle mutation originated within the Harappa individuals of the Indus Valley, after which dispersed, in all probability through the Sassanian Empire, to areas in the Middle East (now eastern Saudi Arabia, Bahrain, Kuwait, and Oman). Based on these haplotypes a multicentric mannequin has been proposed by which the sickle gene arose independently around the globe on no less than 5 events. This has just lately been challenged by evaluation of whole-genome sequencing knowledge which counsel a single origin for the sickle mutation approximately 7300 years ago. The present-day gene frequency, which equates to provider rates that attain 25% in sub-Saharan Africa, displays a heterozygote benefit that outweighs the decreased fitness within the homozygous state (balanced polymorphism). This selection pressure in favor of HbS heterozygotes is attributable to partial safety against the life-threatening problems of Plasmodium falciparum malaria, with a consequent discount in mortality. The sickle gene has also unfold via gene flow; for instance, the S allele linked to the Benin haplotype has unfold to North Africa, Sicily, Greece, Turkey, a lot of the Arab world, and the Americas, by way of the vicissitudes of war. Sudanese troops in Sicily through the Arab conquest), commerce, and the horrors of the Atlantic slave commerce. It is estimated that worldwide roughly 300 000 kids with sickle cell anemia are born yearly, and that the determine may rise to 400 000 by 2050.
Reproducibility of real-time shear wave elastography in the evaluation of liver elasticity. Diagnosis of cirrhosis by transient elastography (FibroScan): a potential examine. Reproducibility of transient elastography in the evaluation of liver fibrosis in sufferers with chronic liver illness. Hepatic stellate cells: protean, multifunctional, and enigmatic cells of the liver. Performance of Acoustic Radiation Force Impulse imaging for the staging of liver fibrosis: a pooled meta-analysis. Performance of transient elastography for the staging of liver fibrosis: a meta-analysis. Significant adjustments in liver stiffness measurements in sufferers with chronic hepatitis B: 3-year follow-up study. Assessment of liver fibrosis with 2-D shear wave elastography compared to transient elastography and acoustic radiation drive impulse imaging in sufferers with chronic liver disease. Interobserver variation in interpretation of serial liver biopsies from sufferers with persistent hepatitis C. Transient elastography in autoimmune hepatitis: Timing determines the impact of irritation and fibrosis. Prevalence of clinically important liver disease inside basic population, as definded by non-invasive markers of liver fibrosis: a scientific review. Minilaparoscopy in the diagnosis of cirrhosis: superiority in patients with Child-Pugh A and macronodular illness. Quantitative evaluation of fibrosis in liver biopsies from sufferers with chronic hepatitis B. The relationship between transient elastography and histological collagen proportionate area for assessing fibrosis in continual viral hepatitis. Transjugular liver biopsy � indications, adequacy, high quality of specimens, and issues � a scientific evaluation. Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic persistent active hepatitis.
Since then, handbook morcellation was performed routinely in gynaecology during each vaginal and open surgical procedure for hysterectomy and myomectomy. The document also said that less than 1 in 1,000 girls present process hysterectomy for fibroids have an underlying malignancy. They recommended knowledgeable consent to enable patients to make an knowledgeable determination to settle for or decline the option of morcellation [16]. Since then, the concern for dissemination of tumour cells on the time of digital power morcellation has led many hospitals and hospital methods in the United States to ban using electronic energy morcellation, thus by necessity leading to the conversion of several cases to a laparotomy. Nevertheless, the controversy has remained contentious as a end result of further evaluate of literature, revealing a a lot smaller danger of sarcoma and the decreased risks of minimally invasive surgical procedure as compared to laparotomy. Other medical institutions issued new policies advocating the utilization of a morcellation bag to try containment of the specimen and decrease the danger of spread of pathology into the peritoneal cavity. The Task Force additional beneficial that consideration of electronic power morcellation should be granted for sufferers with reassuring preoperative evaluation, together with cervical cytology and endometrial biopsy. Moreover, alternate options to morcellation, together with laparotomy, must be thought-about in instances of a nonreassuring analysis. Finally, the significance of informed consent and the further investigation of morcellation throughout the specimen retrieval bag containment system was confused. Dr Brown cautioned against eliminating a beneficial expertise primarily based on scant and imprecise data concerning the danger of undetected uterine malignancy prior to hysterectomy with deliberate digital energy morcellation, and further emphasised the restricted data on the risk of upstaging, or worsening prognosis, of a leiomyosarcoma after energy morcellation. Outcomes included postoperative complications, incidence of leiomyosarcoma, death related to leiomyosarcoma, and procedure-related dying. The analysis predicted fewer total deaths with laparoscopic hysterectomy in comparison with belly hysterectomy (98 vs. Morbidity outcomes for the laparoscopic group included decrease rates of transfusion (2,four hundred vs. Out of 9 research, eight have been retrospective, one was a non-peer-reviewed letter to the editor, and one other was an abstract from an unpublished examine. Excluding the info from the non-peer-reviewed letter and the three circumstances of atypical leiomyomas, the Leiomyoma Morcellation Review Group recognized eight instances of leiomyosarcoma among 12,402 women who underwent surgical procedure for suspected leiomyomas, with a prevalence of 1 in 1,550 (0. Lastly, the group suggested the next scientific suggestions: the danger of leiomyosarcoma is higher in older postmenopausal girls, and greater caution must be exercised earlier than recommending morcellation procedures for these girls. Preoperative consideration of leiomyosarcoma is necessary, and ladies aged 35 years or older with irregular uterine bleeding and presumed leiomyomas should have an endometrial biopsy, which occasionally might detect leiomyosarcoma earlier than surgery.
Cronos, 59 years: Population-based genome-wide association studies reveal six loci influencing plasma ranges of liver enzymes.
Asam, 23 years: Nevertheless, single genotype 2, three, 4, and 6 isolates had been misclassified on the genotype level, indicating a necessity for assay optimisation (Ciotti 2010).
Inog, 42 years: The first detailed reviews of deliberate vaginal hysterectomy were for carcinoma, performed by Langenbeck in 1813.
Runak, 43 years: Quantitative hepatitis B core antibody level could help predict remedy response in continual hepatitis B patients.
References
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