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Predictors of survival in autoimmune liver disease overlap syndromes

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World Journal of Hepatology 2024年第9期16卷 1269-1277页

作者： Dujinthan Jayabalan Yi Huang Luis Calzadilla-Bertot Malik Janjua Bastiaan de Boer John Joseph Wendy Cheng Simon Hazeldine Briohny W Smith Gerry C MacQuillan Michael C Wallace George Garas Leon A Adams Gary P Jeffrey Medical School University of Western AustraliaNed-lands 6009Western AustraliaAustralia Department of Hepatology Sir Charles Gairdner HospitalNedlands 6009Western AustraliaAustralia Department of Anatomical Pathology PathWest Laboratory MedicineNedlands 6009Western AustraliaAustralia Department of Gastroenterology and Hepatology Royal Perth HospitalPerth 6000Western AustraliaAustralia Department of Gastroenterology and Hepatology Fiona Stanley HospitalMurdoch 6150Western AustraliaAustralia Medical School University of Western AustraliaNedl-ands 6009Western AustraliaAustralia

BACKGROUND Survival in patients with autoimmune liver disease overlap syndromes(AILDOS)compared to those with single autoimmune liver disease is *** To investigate the survival of patients with AILDOS and assess the accuracy of non-invasive serum models for predicting liver-related *** Patients with AILDOS were defined as either autoimmune hepatitis and primary biliary cholangitis overlap(AIH-PBC)or autoimmune hepatitis and primary sclerosing cholangitis overlap(AIH-PSC)and were identified from three tertiary centres for this cohort ***-related death or transplantation(liver-related mortality)was determined using a population-based data linkage *** scores for liver-related death were compared for accuracy[including liver outcome score(LOS),Hepascore,Mayo Score,model for end-stage liver disease(MELD)score and MELD incorporated with serum sodium(MELD-Na)score].RESULTS Twenty-two AILDOS patients were followed for a median of 3.1 years(range,0.35-7.7).Fourteen were female,the median age was 46.7 years(range,17.8 to 82.1)and median Hepascore was 1(range,0.07-1).At five years post enrolment,57%of patients remained free from liver-related mortality(74%AIH-PBC,27%AIH-PSC).There was no significant difference in survival between AIH-PBC and *** was a significant predictor of liver-related mortality(P<0.05)in patients with AIH-PBC(n=14)but not AIH-PSC(n=8).A LOS cut-point of 6 discriminated liver-related mortality in AIH-PBC patients(P=0.012,log-rank test,100%sensitivity,77.8%specificity)(Harrell's C-statistic 0.867).The MELD score,MELD-Na score and Mayo Score were not predictive of liver-related mortality in any *** Survival in the rare,AILDOS is *** current study supports the LOS as a predictor of liver-related mortality in AIH-PBC *** trials investigating predictors of survival in AILDOS are required.

关键词： Autoimmune liver disease overlap syndromes Liver outcome score Liver-related death Hepascore Autoimmune hepatitis Primary biliary cholangitis Primary sclerosing cholangitis

Effect of airplane transport of donor livers on post-liver transplantation survival

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World Journal of Gastroenterology 2016年第41期22卷 9154-9161页

作者： Yi Huang Gerry MacQuillan Leon A Adams George Garas Megan Collins Albert Nwaba Linjun Mou Max K Bulsara Luc Delriviere Gary P Jeffrey School of Medicine and Pharmacology University of Western Australia Western Australian Liver Transplantation Service Sir Charles Gairdner Hospital Institute of Health Research University of Notre Dame

AIM To evaluate the effect of long haul airplane transport of donor livers on post-transplant outcomes. METHODS A retrospective cohort study of patients who received a liver transplantation was performed in Perth, Australia from 1992 to 2012. Donor and recipient characteristics information were extracted from Western Australian liver transplantation service database. Patients were followed up for a mean of six years. Patient and graft survival were evaluated and compared between patients who received a local donor liver and those who received an airplane transported donor liver. Predictors of survival were determined by univariate and multivariate analysis using cox *** One hundred and ninety-three patients received alocal donor liver and 93 patients received an airplane transported donor liver. Airplane transported livers had a significantly lower alanine transaminase(mean: 45 U/L vs 84 U/L, P = 0.035), higher donor risk index(mean: 1.88 vs 1.42, P < 0.001) and longer cold ischemic time(CIT)(mean: 10.1 h vs 6.4 h, P < 0.001). There was a weak correlation between CIT and transport distance(r2 = 0.29, P < 0.001). Mean follow up was six years and 93 patients had graft failure. Multivariate analysis found only airplane transport retained significance for graft loss(HR = 1.92, 95%CI: 1.16-3.17). One year graft survival was 0.88 for those with a local liver and was 0.71 for those with an airplane transported liver. One year graft loss was due to primary graft non-function or associated with preservation injury in 20.8% of recipients of an airplane transported liver compared with 4.6% in those with a local liver(P = 0.027). CONCLUSION Airplane transport of donor livers was independently associated with reduced graft survival following liver transplantation.

关键词： Airplane transportation Cold ischemic time Graft survival Donor location Organ damage

Dose Adjustment for Normal Eating: Longer Term Perspectives of Adults with Type 1 Diabetes

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Journal of Diabetes Mellitus 2014年第3期4卷 179-188页

作者： Pat Rapley Stephanie Axon Gwen Babel Krystina Creighton Joey M. Kaye Suzanne Brown Centre for Nursing Research Sir Charles Gairdner Hospital Perth Australia Department of Endocrinology and Diabetes Sir Charles Gairdner Hospital Perth Australia

Aim:?To explore the longer term blood glucose self-monitoring outcomes and frequency of monitoring for outpatients with diabetes type 1 after completion of the Dose Adjustment for Normal Eating (DAFNE) course. The hypothesis was that DAFNE outcomes would differ according to frequency of glucose ***:?A?sequential data-triangulation design using existing?baseline (T0) and 12-months (T12)?DAFNE course data and interview data from 12 randomly selected participants who had completed the course two years ago.?Results: Age range was 23 to 70 years with HbA1c 6.1% to 12.6% at T0?and 6.1% to 11.4% at T12. Comparisons of HbA1c, PAID, HAD subscales?anxiety?and?depression,?and covariate data between T0?and T12indicatedsignificant reductions in the mean depression and PAID scores (both?P?< 0.001) for the whole group. For the two groups who recorded their blood glucose less than three times or three or more times per day, changes were not significantly different. For both groups, the trend between T0?and T12?was downwards for change in mean blood glucose level and all survey scales. The proportion of all participants with T12?HbA1c at or below their T0?value was greater than 50% (Proportion = 69%, 95% CI: 56% - 79%) but only the highest HbA1c tertile group showed a significant difference (P?= 0.003). There was an average decrease in the incidence of hypoglycaemic events of 0.6 overall: The greatest change was for the high HbA1c tertile with a mean decrease of 0.8. The interview data suggested that DAFNE graduates experimented more with food, exercise, and insulin;gained knowledge;learnt personal body needs;increased awareness of blood glucose level;gained confidence and improved their quality of life. Conclusions: There was insufficient evidence to conclude that frequency of blood glucose monitoring influenced metabolic control. However, people with type 1 diabetes who undertake the less restricted DAFNE approach to diabetes self-management can improve their qualit

关键词： DAFNE Adults Type 1 Diabetes Long Term

B vitamins for stroke prevention

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Stroke & Vascular Neurology 2018年第2期3卷 51-58页

作者： Graeme J Hankey UWA Medical School Faculty of Health and Medical SciencesThe University of Western AustraliaPerthWestern AustraliaAustralia Department of Neurology Sir Charles Gairdner HospitalNedlandsWestern AustraliaAustralia

Supplementation with B vitamins(vitamin B9(folic acid),vitamin B_(12) and vitamin B_(6))lowers blood total homocysteine(tHcy)concentrations by about 25%and reduces the relative risk of stroke overall by about 10%(risk ratio(RR)0.90,95%CI 0.82 to 0.99)compared with ***-lowering interventions have no significant effect on myocardial infarction,death from any cause or adverse *** that appear to modify the effect of B vitamins on stroke risk include low folic acid status,high tHcy,high cyanocobalamin dose in patients with impaired renal function and concurrent antiplatelet *** regions with increasing levels or established policies of population folate supplementation,evidence from observational genetic epidemiological studies and randomised controlled clinical trials is concordant in suggesting an absence of benefit from lowering of homocysteine with folic acid for prevention of *** trials indicate that in countries which mandate folic acid fortification of food,folic acid supplementation has no significant effect on reducing stroke risk(RR 1.05,95%CI 0.90 to 1.23).However,in countries without mandatory folic acid food fortification,folic acid supplementation reduces the risk of stroke by about 15%(RR 0.85,95%CI 0.77 to 0.94).Folic acid alone or in combination with minimal cyanocobalamin(≤0.05 mg/day)is associated with an even greater reduction in risk of future stroke by 25%(RR 0.75,95%CI 0.66 to 0.86),whereas the combination of folic acid and a higher dose of cyanocobalamin(≥0.4 mg/day)is not associated with a reduced risk of future stroke(RR 0.95,95%CI 0.86 to 1.05).The lack of benefit of folic acid plus higher doses of cyanocobalamin(≥0.4 mg/day)was observed in trials which all included participants with chronic kidney *** metabolic B_(12)deficiency is very common and usually not diagnosed,future randomised trials of homocysteine-lowering interventions for stroke prevention should probably test a combinati

关键词： vitamin prevention impaired

Artificial Intelligence-Supported Systems in Anesthesiology and Its Standpoint to Date—A Review

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Open Journal of Anesthesiology 2023年第7期13卷 140-168页

作者： Fiona M. P. Pham Department of Anaesthesia Sir Charles Gairdner Hospital Perth Australia

Artificial intelligence (AI) is the technique that enables computers to solve problems and perform tasks that traditionally require human intelligence. The availability of large amounts of medical data from electronic medical records and powerful modern microcomputers enables the development of AI in medicine. AI has proven its applicability in many different medical areas, such as drug discovery, diagnostic radiology and pathology, as well as interventional applications in cardiology and surgery. However, until today, AI is scarcely used in the clinical practice of anesthesiology. Although there has been a significant body of research published on AI applications for anesthesiology in the literature, the number of developed robot systems for commercial use or those ready for clinical trials remains limited. The limitations of AI systems are identified and discussed, which include incorrect medical data formatting, individual patient variability, the lack of ability of current AI systems, anesthesiologist inexperience in AI usage, system unreliability, unexplainable AI conclusions and strict regulations. In order to ensure anesthesiologists’ trust in AI systems and improve their implementation in daily practice, strict quality control of the systems and algorithms should be undertaken. Further, anesthesiology personnel should play an integral role in the development of AI systems before we are able to see more AI integration in clinical anesthesiology.

关键词： Artificial Intelligence Anesthesiology Machine Learning Pharmacological Robot Mechanical Robot ChatGPT

Enriched Diets and the Growth,Development and Survival of Litoria moorei(Anura)Tadpoles Reared in Captivity at Low Density

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Asian Herpetological Research 2010年第2期1卷 103-110页

作者： Phillip Matson Glen Gaikhorst Wendy Kappelle Sandy Webb Suzanne Brown Perth Zoo 20 Labouchere RoadSouth PerthWestern Australia 6151 School of Veterinary and Biomedical Sciences Murdoch University Department of Endocrinology and Diabetes Sir Charles Gairdner Hospital

Increasing numbers of amphibian species require conservation breeding programs for their survival.A major challenge is the efficient rearing of tadpoles,many of which require complex habitats and specialised *** tadpoles of the West Australian frog Litoria moorei were kept at low density(1 tadpole per 1.95 litres water) in aquaria at 25℃.Fed on a staple diet of boiled lettuce and leaf litter,group of diets were supplemented with either control,Wardley Premium Spirulina Discs,SeraTMGVG-mix tropical fish food,or a combination of Wardley Premium Spirulina discs and SeraTMGVG-mix fish *** was a relatively high loss(i.e.,found dead,euthanized due to scoliosis,or not found) of tadpoles fed with the lettuce/leaf litter alone,but this was increased significantly when supplemented with Wardley Premium Spirulina discs,either alone or with SeraTMGVG-mix fish food,and SeraTMGVG fish food ***,the survived tadpoles fed on the three supplements were all heavier after three weeks and at metamorphosis than those fed with lettuce/leaf litter alone,and reached metamorphosis *** is concluded that any benefit of the food supplements in terms of increasing the rate of growth and development of the tadpoles is outweighed by greater *** is now a need for the efficient rearing of tadpoles,many from novel species that need complex *** studies of diet are required due to the current conservation crisis of amphibians.

关键词： Litoria moorei commercial food protein tadpole

Family responsibility dynamics for young adults in transition to adult health care

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Journal of Diabetes Mellitus 2013年第3期3卷 139-144页

作者： Pat Rapley Gwen Babel Joey Kaye Suzanne Brown Adjunct Senior Lecturer Curtin University and Centre for Nursing Research Sir Charles Gairdner Hospital Perth Australia Department of Endocrinology and Diabetes Sir Charles Gairdner Hospital Perth Australia

Aim: To explore family responsibility dynamics, metabolic control, clinic attendance, and emergency admissions when young adults (YA) with type 1 diabetes transition to an adult hospital. Method: A longitudinal mixed method design with two study groups (parents, n = 28;YA intervention group, n = 23) and a YA comparison group (n = 20). Sample recruited from an outpatient diabetes centre. Demographic, clinic attendance, emergency admissions, biodata, and the Diabetes Family Responsibility Questionnaire (DFRQ) were completed on entry and sixmonths later as part of an 18-month trial of a diabetes transition coordinator (DTC). The selfreport DFRQ were analyzed using derived parent-child dyadic variables to explore differences at baseline and end of study using Wilcoxon Signed Rank Test. The relationship between metabolic control and the DFRQ patterns was explored using Spearman’s rho. Results: On completion of the study, the change in HBA1Cfor both adolescent groups was not significant but was less than ideal for 25% of adolescents in the study. The YA intervention group had significantly fewer missed appointments between them compared to the comparison group. The DFRQ indicated that the derived parent-child dyadic variable of task-discordance increased during the study. Conclusion: The clinically relevant diabetes-task dissonance between parents and young adults offers a challenge and a diagnostic opportunity for diabetes educators.

关键词： Diabetes Health-Care Transition Parent Adolescent Transition Coordinator

Human pluripotent stem cell-derivedβcells:Truly immature isletβcells for type 1 diabetes therapy?

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World Journal of Stem Cells 2023年第4期15卷 182-195页

作者： Helen Jiang Fang-Xu Jiang sir charles gairdner hospital University of Western AustraliaPerth 6009Australia School of Biomedical Sciences University of Western AustraliaPerth 6009Australia School of Health and Medical Sciences Edith Cowan UniversityPerth 6027Australia

A century has passed since the Nobel Prize winning discovery of insulin,which still remains the mainstay treatment for type 1 diabetes mellitus(T1DM)to this *** to the words of its discoverer sir Frederick Banting,“insulin is not a cure for diabetes,it is a treatment”,millions of people with T1DM are dependent on daily insulin medications for *** donor islet transplantation has proven that T1DM is curable,however due to profound shortages of donor islets,it is not a mainstream treatment option for *** pluripotent stem cell derived insulin-secreting cells,pervasively known as stem cell-derivedβcells(SC-βcells),are a promising alternative source and have the potential to become a T1DM treatment through cell replacement *** we briefly review how isletβcells develop and mature in vivo and several types of reported SC-βcells produced using different ex vivo protocols in the last *** some markers of maturation were expressed and glucose stimulated insulin secretion was shown,the SC-βcells have not been directly compared to their in vivo counterparts,generally have limited glucose response,and are not yet fully *** to the presence of extra-pancreatic insulin-expressing cells,and ethical and technological issues,further clarification of the true nature of these SC-βcells is required.

关键词： Human pluripotent stem cells Stem cell-derivedβcells Isletβcells Type 1 diabetes mellitus Cell replacement therapy

Transradial versus transfemoral access for anterior circulation mechanical thrombectomy: analysis of 375 consecutive cases

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Stroke & Vascular Neurology 2021年第2期6卷 207-213页

作者： Timothy John Phillips Matthew Thomas Crockett Gregory D Selkirk Ruchi Kabra Albert Ho Yuen Chiu Tejinder Singh Constantine Phatouros William McAuliffe Neurological Intervention and Imaging Service of Western Australia Sir Charles Gairdner HospitalPerthWestern AustraliaAustralia Neurological Intervention and Imaging Service of Western Australia Fiona Stanley HospitalPerthWestern AustraliaAustralia Neurological Intervention and Imaging Service of Western Australia Royal Perth HospitalPerthWestern AustraliaAustralia

Objective To compare transradial artery access(TRA)to the gold standard of transfemoral artery access(TFA)in mechanical thrombectomy(MT)for stroke caused by anterior circulation large vessel *** The clinical outcomes,procedural speed,angiographic efficacy and safety of both techniques were analysed in 375 consecutive cases over an 18-month period in a high volume statewide neurointerventional *** There was no significant difference in patient characteristics,stroke parameters,imaging techniques or intracranial *** median time elapsed between CT scanning and reperfusion was 96.5 min(IQR 68-123)in the TFA group and 95 min(IQR 68-123)in the TRA group(p=0.456).Of 336 patients who were independent at presentation 58%(124/214)of the TFA group and 67%(82/122)of the TRA group had a modified Rankin score of 0-2 at 90-day follow-up(p=0.093).Cross-over from radial to femoral was 4.6%(4/130)compared with 1.6%cross-over from femoral to radial(4/245),but did not meet the predetermined level of statistical significance(OR2.92,95% CI 0.81 to 10.52,p=0.088) and did not impact median procedural *** angiographic reperfusion,first pass reperfusion,embolisation to new territory and symptomatic intracranial haemorrhage were similar in both *** was a significant difference in major access site complications requiring an additional *** of the TRA cases had a major access site complication but 6.5%(16/245)of the TFA cases did(p=0.003).Conclusion This study suggests that using TRA for anterior circulation MT is fast,efficacious,safe and not inferior to the gold standard of TFA.

关键词： service radial cases