Outpatient albumin infusions reduce hospitalizations and improve outcomes in decompensated cirrhosis: A real-world cohort study.

Background and Aim: Long-term human albumin (HA) infusions improve survival in cirrhotic patients with diuretic resistant ascites. We aimed to determine whether there is a significant benefit in a more unwell real-world cohort. Methods: This is a single-center retrospective cohort study. Patients received outpatient HA between April 2017 and June 2021. Inclusion criteria were age ≥18 years, cirrhosis with ascites, and received at least 1 month of HA. Patients with significant comorbidities and ongoing alcohol use were not excluded. Outcomes assessed were transjugular intrahepatic portosystemic shunt (TIPS)/transplant-free survival (TTFS), and biochemical and prognostic outcomes. Results: Twenty-four patients were included. Median age was 59.5 years. Seven were female (29.2%). Etiology included were alcohol (50%), non-alcoholic steatohepatitis (16.7%), and viral/alcohol (12.5%). Median model for end-stage liver disease-sodium (MELD-Na) was 18.5, with Child-Pugh scores (CPS) A (4.2%), B (50%), and C (45.8%). Improvements in serum sodium (P = 0.014), albumin (P = 0.003), and CPS (P = 0.017) were observed. Reduction in hospitalizations (P = 0.001), particularly portal hypertensive related admissions was observed (relative risk 0.39; 95% confidence interval [CI] 0.21-0.69, P = 0.003), needed to treat 2.09 (95% CI 1.25-3.67). There was a reduction in total paracentesis requirements (P = 0.005). On multivariate analysis, type 2 diabetes mellitus significantly increased risk of TIPS/transplant/death (hazard ratio 6.16; 95% CI 1.23-30.84, P = 0.027). Median TTFS improved in patients with a change in MELD-Na ≤1 at 1 month: 29.4 months versus 7.7 months (P = 0.011). Conclusion: Outpatient HA infusions decrease portal hypertensive related hospital admissions, improve serum sodium, albumin levels, and CPS. Type 2 diabetes mellitus and change in MELD-Na score help discriminate those likely to benefit most.

Toward transmural healing: Sonographic healing is associated with improved long-term outcomes in patients with Crohn's disease.

BACKGROUND AND AIMS: Transmural healing has emerged as a treatment target in Crohn's disease (CD). We investigated whether transmural healing assessed with intestinal ultrasound (IUS) is associated with improved clinical outcomes in patients with CD in clinical remission. METHODS: Patients with CD in clinical remission at baseline (HBI <4) having IUS between August 2017 and June 2020 with at least 6-months' follow-up were retrospectively studied. Time to medication escalation, corticosteroid use and CD-related hospitalisation or surgery were compared by the presence or absence of sonographic healing, defined as bowel wall thickness ≤3 mm without hyperemia on color Doppler, inflammatory fat, or disrupted bowel wall stratification. Factors associated with survival were analyzed by Kaplan-Meier analysis using Cox proportional-hazard model. RESULTS: Of 202 consecutive patients (50% male), sonographic inflammation was present in 61%. During median follow-up of 19 (IQR 13-27) months, medication escalation occurred in 52%, corticosteroid use in 23%, hospitalisation in 21%, and CD-related surgery in 13%. Sonographic healing was significantly associated with a reduced risk of medication escalation (p = 0.0018), corticosteroid use (p = 0.0247), hospitalisation (p = 0.0102), and surgery (p = 0.083). On multivariable analysis, sonographic healing was significantly associated with an increased odds of medication escalation-free survival (hazard ratio [HR]:1.94; 95% CI 1.23-3.06; p = 0.004) and corticosteroid-free survival (HR:2.41; 95% CI 1.24-4.67; p = 0.009), but not with hospitalisation or surgery. CONCLUSION: In patients with CD in clinical remission, sonographic healing is associated with improved clinical outcomes. Further studies are needed to determine whether sonographic healing should be a treatment target.

Characterization and evaluation of tea bag papers.

The infusion kinetics of tea bags containing black tea or green tea has been studied in detail in the past. However, the tea bag papers have never been characterized and evaluated earlier to understand their contribution towards tea bag infusion. In the present work, papers used for making tea bags were characterized for thickness, wettability, surface topography, pore size, porosity and permeance to understand their influence on infusion kinetics of tea bags. Scanning electron microscopy studies highlighted the pore structure and porous nature of tea bag papers. The porosity of tea bag paper was quantified using image processing and permeance was determined experimentally. Besides, a relationship between porosity and permeance of tea bag papers has been perceived. A general trend of increase in permeance with increasing porosity was observed. Woven nylon paper showed the highest permeance (23.9 × 10-5 m/s) when compared with other tea bag papers. Furthermore, an initial infusion rate was determined using initial infusion data of tea bag infusion for different tea bag papers. The influence of permeance on the initial infusion rate of tea bag papers has also been investigated.

Written instructions to patients to confirm pathology results: is this effective in the transmission of results?

BACKGROUND: Bowel cancer is the second most common internal malignancy in Australia. Bowel cancer is suited to community screening methods such as faecal occult blood testing and colonoscopy. Typical reporting of histopathology results after colonoscopy takes 3-5 days. Patients were given written instructions to call the clinician within 3-5 days to discuss the histopathology results. The objective of the study was to perform an audit whether patients call the clinician to discuss their histopathology results after undergoing a colonoscopy, gastroscopy or both. METHODS: A retrospective study was performed of patients attending for gastroscopy or colonoscopy at a single colorectal clinic at Cabrini Hospital, Melbourne, between 1 January and 31 December 2014. Age, pre-scope category and compliance with written instructions to callback were analysed. RESULTS: A total of 176 patients met the selection criteria, of whom 32.9% did not callback to discuss their histopathology results. Age and pre-scope category were independent predictors for patients to callback after endoscopy. The mean age of the patients who called back was higher (P < 0.01). Compared with patients who had a previous polyp or resection, patients in the pre-scope category of faecal occult blood testing/screening were more likely to callback (odds ratio: 4.37; 95% confidence interval: 1.17-16.31). CONCLUSION: Patients undergoing a colonoscopy for the purposes of screening and older patients were more likely to callback. Patients aged 62 years and younger were less likely to callback and should be targeted. Enhancements to the way information is presented to patients (e.g. video) should be considered for future studies.

Swelling and infusion of tea in tea bags.

The present study deals with swelling and infusion kinetics of tea granules in tea bags. The swelling and infusion kinetics of tea bags differing in tea loading and tea bag shapes were compared with loose tea. Increment in temperature and dipping frequency of tea bag in hot water increased the infusion kinetics of tea bags. Reduction in particle size enhanced the swelling and infusion kinetics of tea in a tea bag. The effects of tea particle size, tea bag dipping rate, loading of tea granules in tea bag and tea bag shapes on infusion kinetics were investigated. Increase in tea loading in tea bags resulted in reduced infusion kinetics. Double chambered tea bag showed the highest swelling (30%) and infusion kinetics (8.30% Gallic acid equivalence) while single chambered tea bags showed the lowest kinetics, amongst the various bags studied. The swelling and infusion kinetics of loose tea was always faster and higher than that of tea bags. It was found that overall effect of percentage filling of tea granules and height of tea bed in a tea bag affects tea infusion kinetics the most. Weibull model was found to be in good agreement with the swelling data.

Swelling kinetics of tea in hot water.

In this study, the swelling kinetics of individual tea particles as well as bed of tea granules were investigated for different types of teas. The swelling experiments involved image analysis and volume measurements of tea particles. Each individual particle shows different swelling characteristics. Separating funnels and cylindrical columns of varying sizes were used to study the changes in volume of tea bed. Swelling in separating funnel was observed to be more than that in column. The effect of temperature, particle size, bed height and vessel diameter were investigated. The extent as well as the rate of swelling is found to increase with rise in temperature (60 to 80 °C) and reduction in particle size. A decrease in swelling is observed with increase in bed height as well as decrease in vessel diameter and vice a versa. About 70 to 75 % swelling occurs in the first 40 to 45 s. Two empirical models viz. Weibull and Peleg were used to fit the experimental data. The rate parameters obtained for a sample T5 at different temperatures were in the range of 0.012 to 0.016. The volume changes of all the teas were compared with their elution behavior, by measuring the absorbance of a diluted sample of brew at 272 nm. The activation energies for the process of tea swelling calculated for T1 (1.2 mm), T5 (2.2 mm) and T5 (0.72 mm) were 14.156, 8.37 and 13.42 kJ/mol respectively.

Combined effect of hydrodynamic and interfacial flow parameters on lysozyme deactivation in a stirred tank bioreactor.

The dynamic environment within a bioreactor and in the purification equipment is known to affect the activity and yield of enzyme production. The present research focuses on the effect of hydrodynamic flow parameters (average energy dissipation rate, maximum energy dissipation rate, average shear rate, and average normal stress) and the interfacial flow parameters (specific interfacial area and mass transfer coefficient) on the activity of lysozyme. Flow parameters were estimated using CFD simulation based on the k-epsilon approach. Enzyme deactivation was investigated in 0.1, 0.3, 0.57, and 1 m i.d. vessels. Enzyme solution was subjected to hydrodynamic stress using various types of impellers and impeller combinations over a wide range of power consumption (0.03 < P(G)/V < 7, kW/m3). The effects of tank diameter, impeller diameter, blade width, blade angle, and the number of blades on the extent of deactivation were investigated. At equal value of P(G)/V, epsilon(max), and gamma(avg), the extent of deactivation was dramatically different for different impeller types. The extent of deactivation was found to correlate well with the average turbulent normal stress and the mass transfer coefficient.