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Liver transplantation in acute liver failure:Dilemmas and challenges

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World Journal of Transplantation 2021年第6期11卷 187-202页

作者： ramesh kumar Utpal Anand Rajeev Nayan Priyadarshi Department of Gastroenterology All India Institute of Medical SciencesPatna 801507BiharIndia Department of Surgical Gastroenterology All India Institute of Medical SciencesPatna 801507BiharIndia Department of Radiodiagnosis All India Institute of Medical SciencesPatna 801507BiharIndi

Acute liver failure(ALF)refers to a state of severe hepatic injury that leads to altered coagulation and sensorium in the absence of pre-existing liver *** has different causes,but the clinical characteristics are strikingly *** clinical practice,however,inconsistency in the definition of ALF worldwide and confusion regarding the existence of pre-existing liver disease raise diagnostic *** mortality rates used to be over 80%in the past;however,survival rates on medical treatment have significantly improved in recent years due to a greater understanding of pathophysiology and advances in critical care *** survival rates in acetaminophen-associated ALF have become close to the post-transplant survival *** that liver transplantation(LT)is an expensive treatment that involves a major surgical operation in critically ill patients and lifelong immunosuppression,it is very important to select accurate patients who may benefit from ***,emergency LT remains a lifesaving procedure for many ALF ***,there is a lack of consistency in current prognostic models that hampers the selection of transplant candidates in a timely and precise *** other problems associated with LT in ALF are the shortage of graft,development of contraindications on the waiting list,vaguely defined delisting criteria,time constraints for pre-transplant evaluation,ethical concerns,and comparatively poor post-transplant outcomes in ***,there is a desperate need to establish accurate prognostic models and explore the roles of evolving adjunctive and alternative therapies,such as liver support systems,plasma exchange,stem cells,auxiliary LT,and so on,to enhance transplant-free survival and to fill the void created by the graft shortage.

关键词： Acute liver failure Fulminant hepatic failure Prognosis Kings college criteria Liver transplantation Acetaminophen

Lymphatic dysfunction in advanced cirrhosis:Contextual perspective and clinical implications

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World Journal of Hepatology 2021年第3期13卷 300-314页

The lymphatic system plays a very important role in body fluid homeostasis,adaptive immunity,and the transportation of lipid and waste *** patients with liver cirrhosis,capillary filtration markedly increases,primarily due to a rise in hydrostatic pressure,leading to enhanced production of ***,lymphatic vasculature expansion helps to prevent fluid from accumulating by returning it back to the systemic ***,the lymphatic functions become compromised with the progression of cirrhosis and,consequently,the lymphatic compensatory mechanism gets overwhelmed,contributing to the development and eventual worsening of ascites and *** changes,low-grade chronic inflammation,and compounding effects of predisposing factors such as old age,obesity,and metabolic syndrome appear to play a significant role in the lymphatic dysfunction of *** portal hypertension can contribute to the development of intestinal lymphangiectasia,which may rupture into the intestinal lumen,resulting in the loss of protein,chylomicrons,and lymphocyte,with many clinical ***,due to high pressure,the rupture of the subserosal lymphatics into the abdomen results in the formation of chylous *** being highly significant,lymphatic dysfunctions in cirrhosis have largely been ignored;its mechanistic pathogenesis and clinical implications have not been studied in *** recommendation exists for the diagnostic evaluation and therapeutic strategies,with respect to lymphatic dysfunction in patients with *** article discusses the perspectives and clinical implications,and provides insights into the management strategies for lymphatic dysfunction in patients with cirrhosis.

关键词： Lymphatic dysfunction Cirrhosis Lymphedema Lymphangiectasia Chylous ascites Refractory ascites

Baicalin provides protection against fluoxetine-induced hepatotoxicity by modulation of oxidative stress and inflammation

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World Journal of Hepatology 2022年第4期14卷 729-743页

作者： Risha Ganguly ramesh kumar Abhay K Pandey Department of Biochemistry University of AllahabadPrayagraj 211002India

BACKGROUND Fluoxetine is one of the most widely prescribed anti-depressant drugs belonging to the category of selective serotonin reuptake ***-term fluoxetine treatment results in ***,a natural compound obtained from the Chinese herb Scutellaria baicalensis is known to have antioxidant,hepatoprotective and anti-inflammatory ***,the beneficial effects of baicalin against fluoxetine-induced hepatic damage have not previously been *** To evaluate the protective action of baicalin in fluoxetine-induced liver toxicity and *** Male albino Wistar rats were divided into seven *** 1 was the normal *** fluoxetine was administered at 10 mg/kg body weight to groups 2,3,4 and *** addition,groups 3 and 4 were also co-administered oral baicalin(50 mg/kg and 100 mg/kg,respectively)while group 5 received silymarin(100 mg/kg),a standard hepatoprotective compound for *** 6 and 7 were used as a positive control for baicalin(100 mg/kg)and silymarin(100 mg/kg),*** treatments were carried out for 28 *** sacrifice of the rats,biomarkers of oxidative stress[superoxide dismutase(SOD),catalase(CAT),reduced glutathione(GSH),glutathione-S-transferase(GST),advanced oxidation protein products(AOPP),malondialdehyde(MDA)],and liver injury[alanine transaminase(ALT),aspartate transaminase(AST),alkaline phosphatase(ALP),total protein,albumin,bilirubin]were studied in serum and tissue using standard protocols and diagnostic *** markers[tumor necrosis factor(TNF-α),interleukin(IL)-6,IL-10 and interferon(IFN)-γ]in serum were evaluated using ELISA-based *** effect of baicalin on liver was also analyzed by histopathological examination of tissue *** Fluoxetine-treated rats showed elevated levels of the serum liver function markers(total bilirubin,ALT,AST,and ALP)and inflammatory markers(TNF-α,IL-6,IL-10 and IFN-γ),with a decline in total protein and albumin

关键词： Fluoxetine Hepatotoxicity Oxidative stress Baicalin Anti-inflammatory Hepatoprotective and antioxidant

A versatile approach for temporary storage and shipping of in vitro cultured cells,cell sheets and tissue engineered constructs-a preliminary report

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Engineered Regeneration 2022年第3期3卷 283-291页

作者： Anju MS Athira RK ramesh Babu V Anil kumar PR Naresh Kasoju Division of Tissue Culture Department of Applied BiologyBiomedical Technology WingSree Chitra Tirunal Institute for Medical Science and TechnologyThiruvananthapuram 695012KeralaIndia Division of Precision Fabrication Department of Medical Devices EngineeringBiomedical Technology WingSree Chitra Tirunal Institute for Medical Science and TechnologyThiruvananthapuram 695012KeralaIndia

Temporary storage/shipping of cell/tissue engineering products from bench to bedside is a key aspect of re-generative *** current proof-of-concept study presents a multipurpose device for temporary storage/shipping of cell culture dishes containing cell/tissue *** device,made with readily available raw ma-terials,contains three elements viz.a specialized lid,polymeric plates having grooves and a set of nuts and *** part of the performance evaluation,the device was first subjected to a simulated storage/shipping process,wherein the leak-proof and aseptic containment of the contents was ***,the setup was used for temporary storage/shipping of dishes having(a)L929 cell monolayers cultured on treated surfaces,(b)SIRC,HaCaT and A549 cell sheets cultured on thermo-responsive surfaces,(c)HOS-cell encapsulated agar gels and(d)HOS-cell seeded silk fibroin *** results showed that the health of cell monolayers/cell sheets/tissue constructs after the process was comparable to that before the *** device was scalable,simple to handle,can be made for a single or multi-use purpose,and can be resizable to load other culture *** design of the storage/shipping device described in this report thus offers versatile features and applications.

关键词： Tissue engineering Scaffolds Tissue equivalents Translational medicine

Cytotoxic and antibacterial substances against multi-drug resistant pathogens from marine sponge symbiont:Citrinin,a secondary metabolite of Penicillium sp.

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Asian Pacific Journal of Tropical Biomedicine 2013年第4期3卷 291-296页

作者： ramesh Subramani Rohitesh kumar Pritesh Prasad William Aalbersberg Centre for Drug Discovery and Conservation Institute of Applied SciencesThe University of the South Pacific.Laucala CampusSuva.Fiji Islands

Objective:To Isolate,purify,characterize,and evaluate the bioaclive compounds from the sponge-derived fungus Penicillium ***001 and to elucidate its ***:The fungal strain FF001 with an interesting bioactivity profile was isolated from a marine Fijian sponge Melophlus *** on conidiophores aggregation,conidia development and mycelia morphological characteristics,the isolate FF001 was classically identified as a Penicillium *** bioactive compound was identified using various spectral analysis of UV,high resolution electrospray ionization mass spectra,1H and 13C NMR spectral *** minimum inhibitory concentrations(MICs)assay and brine shrimp cytotoxicity assay were also carried out to evaluate the biological properties of the purified ***:Bioassay guided fractionation of the EtOAc extract of a static culture of this Penicillium *** different chromatographic methods led the isolation of an antibacterial,anticryptococcal and cytotoxic active compound,which was identified as citrinin(1).Further,citrinin(1)is reported for its potent antibacterial activity against methicillin-resistant Staphylococcus aureus(***),rifampicin-resistant ***,wild type *** and vancomycin-resistant Enterococcus faecium showed MICs of 3.90,0.97,1.95 and7.81μg/mL,*** citrinin(1)displayed significant activity against the pathogenic yeast Cryptococcus neoformans(MIC 3.90μg/mL),and exhibited cytotoxicity against brine shrimp larvae LD_(50)of 96μg/***:Citrinin(1)is reported from sponge associated Penicillium *** this study and for its strong antibacterial activity against multi-drug resistant human pathogens including cytotoxicity against brine shrimp larvae,which indicated that sponge associated Penicillium *** promising sources of natural bioactive metabolites.

关键词： Penicillium sp. Sponge derived Citrinin Multi-drug resistant Antimicrobial Cytotoxic activity

Hepatogenous diabetes:Knowledge,evidence,and skepticism

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World Journal of Hepatology 2022年第7期14卷 1291-1306页

作者： ramesh kumar Diego García-Compeán Tanmoy Maji Department of Gastroenterology All India Institute of Medical SciencesPatna 801507BiharIndia Department of Gastroenterology University HospitalUniversidad Autónoma de Nuevo LeónMéxicoMonterrey 64700México

The diabetogenic potential of liver cirrhosis(LC)has been known for a long time,and the name"hepatogenous diabetes"(HD)was coined in 1906 to define the *** mellitus(DM)that develops as a consequence of LC is referred to as *** patients with LC,the prevalence rates of HD have been reported to vary from 21%to 57%.The pathophysiological basis of HD seems to involve insulin resistance(IR)and pancreaticβ-cell *** neurohormonal changes,endotoxemia,and chronic inflammation of LC initially create IR;however,the toxic effects eventually lead toβ-cell dysfunction,which marks the transition from impaired glucose tolerance to *** addition,a number of factors,including sarcopenia,sarcopenic obesity,gut dysbiosis,and hyperammonemia,have recently been linked to impaired glucose metabolism in *** is associated with complications and poor outcomes in patients with LC,although the individual impact of each type 2 DM and HD is unknown due to a lack of categorization of diabetes in most published *** fact,there is much skepticism within scientific organizations over the recognition of HD as a separate disease and a consequence of ***,T2DM and HD are being treated in a similar manner although no standardized guidelines are *** different pathophysiological basis of HD may have an impact on treatment *** review article discusses the existence of HD as a distinct entity with high prevalence rates,a strong pathophysiological basis,clinical and therapeutic implications,as well as widespread skepticism and knowledge gaps.

关键词： Cirrhosis Diabetes Hepatogenous diabetes Glucose intolerance Insulin resistance Metabolism

Effect of processing routes on microstructure and mechanical properties of 2014 Al alloy processed by equal channel angular pressing

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Transactions of Nonferrous Metals Society of China 2010年第10期20卷 1822-1828页

作者： P.VENKATACHALAM S.ramesh kumar B.RAVISANKAR V.THOMAS PAUL M.VIJAYALAKSHMI Department of Metallurgical and Materials Engineering National Institute of Technology Physical Metallurgy Division IGCAR

Al-Cu alloy was deformed through equal channel angular pressing(ECAP) by routes A,Ba,Bc and C up to 5 *** was done using a 90° die for three different conditions,namely 1) as received,2) solutionised at 768 K for 1 h and 3) solutionised at 768 K for 1 h + aged at 468 K for 5 *** microstructure,microhardness and tensile strength were studied for all the three conditions and four *** improvement in hardness(HV 184 after five passes) and strength(602 MPa after three passes) was observed in solutionised and aged 2014 Al alloy deformed through route *** evolution was reasonably equiaxed in route Bc with aspect ratio of *** and aged 2014 Al alloy deformed through route Bc was identified to have better microstructure and mechanical property than the other processing routes and conditions.

关键词： ECAP processing route 2014 aluminium alloy

Nuclear medicine imaging in osteonecrosis of hip:Old and current concepts

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World Journal of Orthopedics 2017年第10期8卷 747-753页

作者： Kanhaiyalal Agrawal Sujit kumar Tripathy ramesh kumar Sen S Santhosh Anish Bhattacharya Department of Nuclear Medicine All India Institute of Medical Sciences Department of Orthopedics All India Institute of Medical Sciences Department of Orthopedics Fortis Hospital Institute of Nuclear Imaging and Molecular Medicine Tamilnadu Government Multi Super Specialty Hospital Department of Nuclear Medicine PGI-MER

Osteonecrosis(ON) is caused by inadequate blood supply leading to bone death, which results in the collapse of the architectural bony structure. Femoral head is the most common site involved in ON. Magnetic resonance imaging(MRI) is a commonly used imaging modality to detect early ON. When MRI is inconclusive, bone scan is helpful in detecting ON during early phase of the disease. As newer nuclear medicine equipment, like single photon emission computed tomography/computed tomography(CT) and positron emission tomography/CT, are emerging in medical science, we review the role of these imaging modalities in ON of femoral head.

关键词： Osteonecrosis Avascular necrosis Bone scan Magnetic resonance imaging Photon emission computed tomography scan Single photon emission computed tomography/computed tomography

Antioxidant and antimutagenic activities of bark extract of Terminalia arjuna

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Asian Pacific Journal of Tropical Medicine 2010年第12期3卷 965-970页

作者： Gollapalle Lakshminarayana shastry Viswanatha Santosh kumar Vaidya ramesh C Nandakumar Krishnadas Srinath Rangappa Department of Pharmacology PES College of PharmacyBangalore-560050 India Department of Pharmacology St.John's College of PharmacyBangalore-560040 India Department of Pharmacology Manipal College of Pharmaceutical SciencesManipal-576104 India

Objective:The alcoholic extract of stem bark of Terminalia arjuna（ALTA） was screened for antioxidant and antimutagenic（anticlastogenic） ***:Antioxidant property was determined by l,l,Diphynyl,2-Picryl hydrazyl（DPPH） assay,super oxide radical scavenging activity,lipid peroxidation assay and total polyphenolic content was determined by Folin-Ciocalteau’s *** activity was evaluated using micronucleus test in mice. Results:The ALTA has shown potent antioxidant activity with EC50 of 2.491±0.160,50.110±0.150 & 71.000±0.250 in DPPH assay,superoxide radical scavenging activity and lipid peroxidation assay, which is comparable with ascorbic acid with EC50 of 2.471±0.140,40.500±0.390 and 63.000±0.360 *** micronucleus test,ALTA（100 & 200 mg/kg,p.o.） showed significant reduction in percentage of micronucleus in both polychromatic erythrocytes（PCE） and normochromatie erythrocytes（NCE） and also shown significant reduction in P/N ***:These results suggested that ALTA possess significant antioxidant and antimutagenic activity.

关键词： Terminalia arjuna Antioxidant activity Antimutagenic activity Micronuclease test