Effect modification of hepatitis B viral load on the association between metabolic risk factors and hepatic steatosis.

Background: It is not clear if chronic hepatitis B (CHB) infection potentiates the severity of hepatic steatosis (HS) in patients with metabolic risk factors. We tested for the effect modification of hepatitis B viral load on the association between metabolic risk factors and HS. Methods: In this retrospective cross-sectional study, we included adult subjects, who had non-cirrhotic nonalcoholic fatty liver disease and CHB infection with positive hepatitis B envelope antibody. We reported descriptive statistics, stratified by detectable and undetectable hepatitis B viral load, by Kruskal-Wallis Rank Sum Test and chi-square. We reported coefficients of two multivariate regression predicting odds of HS > stage 2, testing for interaction between metabolic risk factors and hepatitis B viral load. Results: When controlled for age, sex, and hepatitis B treatment, the odds of HS > stage 2 increased significantly by 77% for each additional metabolic risk factor [odds ratio (OR) 1.77, 95% confidence interval (CI): 1.20-2.69, P=0.005]. The odds of HS > stage 2 was not associated with detectable hepatitis B viral load (OR 1.00, 95% CI: 0.83-1.19, P=0.986). The association between the odds of HS > stage 2 and metabolic risk factors did not significantly change as hepatitis B viral load increased [ratio of odds ratio (ROR) 1.01, 95% CI: 0.94-1.08, P=0.839]. Conclusions: Our study does not find evidence of effect modification of hepatitis B viral load on the association between metabolic risk factors and HS in non-cirrhotic and hepatitis B envelope antibody positive patients with CHB viral infection. It suggests that the odds of HS in CHB infected patients is affected by metabolic risk factors and not by hepatitis B viremia.

Smoking Characteristics and Readiness-to-Quit Status Among Smokers Attending Preoperative Assessment Clinic - A Prospective Cohort Study.

BACKGROUND: Perioperative smoking is associated with an increased incidence of general postoperative morbidity and mortality. The perioperative period is recognized as an important "teachable moment" that can motivate patients to adopt health changing behaviors. OBJECTIVE: In this study, we aimed to determine the prevalence of smokers among elective surgical patients in an Asian tertiary hospital. We also investigated their smoking characteristics, previous quitting attempts, readiness-to-quit status as well as knowledge of smoking-related postoperative complications. METHODS: We conducted a single-center prospective cohort study among all patients who attended a preoperative assessment clinic within a 2-month period (August to September 2020) using a preoperative smoking questionnaire. RESULTS: A total of 3362 patients participated in the study, of which 348 (10.4%) were current smokers. More than half (65.6%) of the smokers had previously attempted to quit smoking, with most (78%) having made more than one attempt. Forty-nine percent of current smokers were in the pre-contemplation stage of quitting and thirty-one percent were in the contemplation stage. Only twenty-one percent were in the preparation stage of quitting. Thirty-eight percent of patients recognized the importance of smoking cessation perioperatively but only twenty-eight percent were confident of quitting perioperatively. Less than sixty percent of smokers were aware of at least one type of smoking-related postoperative complication. Less than half of the patients (45%) had ever received advice on perioperative smoking cessation from the surgeons. CONCLUSION: A thorough understanding of smokers' smoking characteristics, barriers to quit and readiness-to-quit status are crucial to establishing a successful multidisciplinary perioperative smoking cessation program. Counselling should address knowledge deficits and be tailored to a patient's stage-of-change in order to seize this precious perioperative "teachable moment".

Non-alcoholic fatty liver and chronic kidney disease: Retrospect, introspect, and prospect.

With the growing prevalence of obesity and diabetes in the United States and across the world, a rise in the overall incidence and prevalence of non-alcoholic fatty liver disease (NAFLD) is expected. The risk factors for NAFLD are also associated with the development of chronic kidney disease (CKD). We review the epidemiology, risk factors, genetics, implications of gut dysbiosis, and specific pathogenic mechanisms linking NAFLD to CKD. Mechanisms such as ectopic lipid accumulation, cellular signaling abnormalities, and the interplay between fructose consumption and uric acid accumulation have led to the emergence of potential therapeutic implications for this patient population. Transplant evaluation in the setting of both NAFLD and CKD is also reviewed. Potential strategies for surveillance and management include the monitoring of comorbidities, the use of non-invasive fibrosis scoring systems, and the measurement of laboratory markers. Lastly, we discuss the management of patients with NAFLD and CKD, from preventative measures to experimental interventions.

A hybrid dielectrophoretic system for trapping of microorganisms from water.

Assessment of the microbial safety of water resources is among the most critical issues in global water safety. As the current detection methods have limitations such as high cost and long process time, new detection techniques have transpired among which microfluidics is the most attractive alternative. Here, we show a novel hybrid dielectrophoretic (DEP) system to separate and detect two common waterborne pathogens, Escherichia coli (E. coli), a bacterium, and Cryptosporidium parvum (C. parvum), a protozoan parasite, from water. The hybrid DEP system integrates a chemical surface coating with a microfluidic device containing inter-digitated microelectrodes to impart positive dielectrophoresis for enhanced trapping of the cells. Trimethoxy(3,3,3-trifluoropropyl) silane, (3-aminopropyl)triethoxysilane, and polydiallyl dimethyl ammonium chloride (p-DADMAC) were used as surface coatings. Static cell adhesion tests showed that among these coatings, the p-DADMAC-coated glass surface provided the most effective cell adhesion for both the pathogens. This was attributed to the positively charged p-DADMAC-coated surface interacting electrostatically with the negatively charged cells suspended in water leading to increased cell trapping efficiency. The trapping efficiency of E. coli and C. parvum increased from 29.0% and 61.3% in an uncoated DEP system to 51.9% and 82.2% in the hybrid DEP system, respectively. The hybrid system improved the cell trapping by encouraging the formation of cell pearl-chaining. The increment in trapping efficiency in the hybrid DEP system was achieved at an optimal frequency of 1 MHz and voltage of 2.5 Vpp for C. parvum and 2 Vpp for E. coli, the latter is lower than 2.5 Vpp and 7 Vpp, respectively, utilized for obtaining similar efficiency in an uncoated DEP system.