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Background Gastric non-Helicobacter pylori Helicobacter (NHPH) species naturally associated with animals have been linked with gastric disease in human patients.Aim The prevalence and clinical significance of zoonotic gastric NHPHs was determined in large and well-defined, H. pylori-negative, gastric patient populations.Methods Patients were retrospectively (n = 464) and prospectively (n = 65) included for gastric biopsy collection: chronic gastritis (CG), peptic ulcer disease and gastric MALT lymphoma, without identified aetiology. PCR and sequencing was performed for the detection of gastric Helicobacter species. Retrospectively, asymptomatic gastric bypass patients (n = 38) were included as controls. Prospectively, additional saliva samples and symptom and risk factor questionnaires were collected. In this group, patients with gastric NHPH infection were administered standard H. pylori eradication therapy and underwent follow-up gastroscopy post-therapy.Results In the retrospective samples, the prevalence of gastric NHPHs was 29.1%, while no gastric NHPHs were detected in control biopsies. In the prospective cohort, a similar proportion tested positive: 27.7% in gastric tissue and 20.6% in saliva. The sensitivity and accuracy for the detection of gastric NHPHs in saliva compared to gastric tissue was 27.8% and 69.8% respectively. Following eradication therapy, clinical remission was registered in 12 of 17 patients, histological remission in seven of nine and eradication in four of eight patients.Conclusion These findings suggest a pathophysiological involvement of NHPHs in gastric disease. Patients presenting with gastric complaints may benefit from routine PCR testing for zoonotic gastric NHPHs.

Background & Aims Hepatitis C virus (HCV) has high genetic diversity with six major genotypes (GT) GT1‐6 and global distribution. HCV GT5 and 6 are rare with

Industrial decarbonization is a critical challenge along the pathway to reducing greenhouse gas (GHG) emissions at a sufficient scale and pace to avoid the worst impacts of climate change. The intrinsic energy- and emissions-intensive nature of heavy industry has led to the recognition that efforts to change the profile of industrial energy use could play a major role in meeting this challenge. This concept, defined broadly as industrial energy efficiency, encompasses a category of technology solutions such as process improvements, equipment upgrades, and fuel switching within sector boundaries. These and other efficiency technologies are notable for their potential to lower industrial emissions while improving (rather than reducing) competitiveness. Robust analysis of the costs and benefits of efficiency as a comprehensive technology suite can help to overcome known barriers to adoption including poor awareness of efficiency opportunities and perceptions of high risk for efficiency investments. Understanding the impacts of efficiency can also be beneficial to policymakers by identifying effective emissions reduction pathways. The overall objective of this thesis is to develop a novel method for fully characterizing the techno-economic potential of industrial energy efficiency and in-sector fuel switching as solutions for energy savings and emissions reductions. This thesis demonstrates application of the method to the case study of the Canadian pulp and paper sector. To achieve the objective of this thesis, a technology-explicit energy and GHG emissions modelling and analysis framework was developed based on best practices for studies of energy efficiency and resource potential. The framework integrates a bottom-up sector energy model with a comprehensive database of energy efficiency technologies validated against data from actual projects in industry. Analysis of efficiency measures was linked to the sector energy model at the point of end-use secondary energy consumption, enabling more realistic representation of how efficiency technologies can impact final energy use. Technology-explicit applicability factors and iterative, cumulative analysis techniques were used to capture the expected impacts of measure overlap, interference, and diminishing returns so as to not overestimate the effects of all measures acting in parallel. Energy savings bandwidths and cost of saved energy curves were developed to characterize the energy savings potential associated with efficiency. Energy-driven GHG emissions abatement scenarios were then developed and analyzed within a Canada-wide energy and emissions model over a long-term planning horizon at both the sector and system level. Marginal GHG abatement cost curves were produced to provide insights into the most impactful and cost-effective technologies over the study period. The key findings of this work demonstrate that natural gas, biomass, and net electricity consumption in the Canadian pulp and paper sector could be reduced by 95%, 1%, and 41%, respectively, via adoption of economically viable efficiency technologies at current energy prices. Achieving this potential would significantly improve sector competitiveness by bringing it into alignment with international energy intensity benchmarks and by dramatically reducing energy costs. At current production levels, efficiency in the pulp and paper sector could reduce net demand for natural gas and electricity by 71 PJ/year and 44 PJ/year, respectively. Energy efficiency was also found to have significant potential as a tool for reducing GHG emissions. The annual GHG emissions abatement associated with economical efficiency measures was estimated to be 3.6 MtCO2e (46%) by 2030 and 4.9 MtCO2e (66%) by 2050 relative to business as usual. Accounting for the technical potential of all measures increases the abatement potential to 6.2 MtCO2e in 2050. Over the study period, energy efficiency was found to reduce cumulative sector GHG emissions by 107.6 MtCO2e (42%) through 2050 at a weighted average abatement cost of -$162/tCO2e. When considering system-level effects, the cumulative abatement rises by 44% to 155.6 MtCO2e through 2050. The results presented in this thesis provide a clear indication to industry and policymakers that energy efficiency could be the single most important technology solution to achieve emissions reduction targets at low or negative cost while enhancing pulp and paper sector competitiveness. The novel framework developed in this thesis can be adapted to any other jurisdiction or sector to produce similar insights. Further work is needed to determine how best to achieve the potential associated with industrial energy efficiency so that it can take a leading role in the transition to a prosperous low-carbon economy.

Persistent fever without focus but with lymphadenopathy: infection, inflammation or malignancy? Adult-onset Still’s disease (AOSD) is a rare auto-inflammatory disease in which four cardinal signs have been described: rash, spiking fever, arthritis or arthralgia and hyperleucocytosis with neutrophilia. Nevertheless, diagnosis can be challenging as infectious, other inflammatory or neoplastic diseases need to be ruled out. It affects typically young adults (from 16 to 35 years). The disease can be controlled with non-steroidal anti-inflammatory agents and glucocorticoids. To date, treatments as Il-6, IL-1 or anti-TNFα can be used in glucocorticoid-dependent or refractory patients. We present a case of a 22-year old woman with all four cardinal symptoms in which all cultures and infectious serology resulted negative. Also, auto-immune markers were negative. Because of diffuse bilateral supra- and infradiaphragmatic enlarged lymph nodes up to 1.6 cm in size on computed tomography (CT), additional positron emission tomography-computed tomography imaging (PET-CT-scan) was performed. Besides the multiple enlarged lymph nodes, increased tracer capture was shown in the spleen and bone marrow. All of this was suspicious for high-grade lymphoma. Eventually, an additional bone marrow biopsy with aspiration and lymph node biopsy could rule out a lymphoproliferative process and the diagnosis of AOSD could be made. This case report highlights the importance of a profound diagnostic work-up in fever of unknown origin.

This study is part of the 'Limburg Clinical Research Program (LCRP) UHasselt-ZOL-Jessa', supported by the foundation Limburg Sterk Merk, province of Limburg, Flemish government, Hasselt University, Ziekenhuis Oost-Limburg and Jessa Hospital.

Background & Aims: Whether alcohol intake increases the risk of complications in patients with HCV-related cirrhosis remains unclear. The aim of this study was to determine the impact of alcohol intake and viral eradication on the risk of hepatocellular carcinoma (HCC), decompensation of cirrhosis and death. Methods: Data on alcohol intake and viral eradication were prospectively collected in 192 patients with compensated HCV-related cirrhosis. Results: 74 patients consumed alcohol (median alcohol intake: 15 g/day); 68 reached viral eradication. During a median follow-up of 58 months, 33 patients developed HCC, 53 experienced at least one decompensation event, and 39 died. The 5-year cumulative incidence rate of HCC was 10.6% (95% CI: 4.6-16.6) in abstainers vs. 23.8% (95% CI: 13.5-34.1) in consumers (p = 0.087), and 2.0% (95% CI: 0-5.8) vs. 21.7% (95% CI: 14.2-29.2) in patients with and without viral eradication (p = 0.002), respectively. The lowest risk of HCC was observed for patients without alcohol intake and with viral eradication (0%) followed by patients with alcohol intake and viral eradication (6.2% [95% CI: 0-18.4]), patients without alcohol intake and no viral eradication (15.9% [95% CI: 7.1-24.7]), and patients with alcohol intake and no viral eradication (29.2% [95% CI: 16.5-41.9]) (p = 0.009). In multivariate analysis, lack of viral eradication and alcohol consumption were associated with the risk of HCC (hazard ratio for alcohol consumption: 3.43, 95% CI: 1.49-7.92, p = 0.004). Alcohol intake did not influence the risk of decompensation or death. Conclusions: Light-to-moderate alcohol intake increases the risk of HCC in patients with HCV-related cirrhosis. Patient care should include measures to ensure abstinence. Lay summary: Whether alcohol intake increases the risk of complications in patients with HCV-related cirrhosis remains unclear. In this prospective study, light-to-moderate alcohol intake was associated with the risk of hepatocellular carcinoma in multivariate analysis. No patients who did not use alcohol and who reached viral eradication developed hepatocellular carcinoma during follow-up. The risk of hepatocellular carcinoma increased with alcohol intake or in patients without viral eradication and was highest when alcohol intake was present in the absence of viral eradication. Patients with HCV-related cirrhosis should be strongly advised against any alcohol intake. Patient care should include measures to ensure abstinence. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

Background and Aim: Congenital portosystemic veno-venous malformations are rare abnomalities that often remain undiagnosed. Typically they are classified by their anatomi- cal characteristics according to Morgan (extrahepatic, Abernethy malformations type Ia,b and II) and Park (intrahepatic, types 1-4). However, their clinical presentation is less dependent on the anatomical type. Method: We reviewed the clinical characteristics of six cases drawn from our files (from 1970 to 2006). Results: One patient, a 25-year-old male, had extrahepatic shunting whereby the liver receives only arterial blood because the portal vein (PV) connects with the inferior caval vein (ICV) (Abernethy Ib); he presented with episodes of jaundice and pruritus. Three patients had extrahepatic shunting with patent intrahepatic portal veins, but with shunting of splenomesenterial blood towards the ICV (Abernethy II); these included a 66-year-old male with hepatic encephalopathy, a 17-year-old female with (porto?-)pulmonary hyper- tension without portal hypertension, and a 33-year-old female with epidsodes of acute pain secondary to spontaneous bleeding within a primary liver tumor. Two patients had intra- hepatic shunting; these included an 8-year-old boy who was diagnosed incidentally during work-up for abnormal liver enzymes with a communication between right PV and ICV (Park type 1), and a 59-year-old male with multiple PV-ICV-shunts in several liver segments (Park, type 4) who presented with hepatic encephalopathy. Conclusion: Patients often present with signs of hepatic shunting (encephalopathy, pul- monary hypertension, hepatopulmonary syndrome, and/or hypoglycemia) with relative sparing of the synthetic liver function in the absence of portal hypertension. Some shunts present with space-occupying lesions (focal nodular hyperplasia, hepatocellular carcinoma, nodular regenerative hyperplasia, etc.) or biliary atresia. Finally, some cases are detected incidentally.

Acute intermittent porphyria (AIP) is an autosomal dominant disorder of heme biosynthesis due to a mutation in the porphobilinogen deaminase gene. The mutation causes a deficiency in the porphobilinogen deaminase enzyme, thereby causing an accumulation of heme precursors (δ-aminolevulinic acid and porphobilinogen). These neurotoxic heme precursors elicit acute neurovisceral attacks, which can be treated with heme-arginate infusions. Some patients require heme-arginate infusions on a regular basis for many years, which ultimately leads to an iron accumulation (increased serum ferritin and iron accumulation in the liver, spleen, and bone marrow on MRI). We report three AIP patients, who developed iron accumulation (with serum ferritin up to 7,850 microgram/liter) due to multiple heme-arginate infusions. We report for the first time that the iron accumulation in these patients was associated with fibrosis on liver histology.Regular heme-arginate treatment in AIP does not only lead to increased serum ferritin but may also induce liver fibrosis. This should be taken into account, when weighing the risks and benefits of repeated heme-arginate treatment against the risk and benefits of treating refractory AIP by liver transplantation.

We describe the case of a 26-year-old man with acute liver failure secondary to ingestion of khat (Catha edulis) leaves. In fact, this is the first case of acute liver failure due to khat reported outside the United Kingdom. The combination of specific epidemiologic data (young man of East African origin) and clinical features (central nervous system stimulation, withdrawal reactions, toxic autoimmune-like hepatitis) led to the diagnosis. Mechanisms of action and potential side effects of khat are elaborated on.

The characteristics and response rate to pegylated interferon and ribavirin (PEG-INF + RBV) of patients with chronic hepatitis C infected with genotype 5 are poorly documented. A meta-analysis of two large phase III/IV prospective randomized clinical trials conducted in Belgium in patients with chronic hepatitis C (n = 1,073 patients) was performed in order to compare the response to antiviral therapy of hepatitis C virus (HCV) genotype 5 with that of other HCV genotypes. A subset of HCV-1 infected patients selected from within the study database were selected to match the HCV-5 sample for known prognostic factors. In Belgium HCV-5 is responsible for a significant minority of cases of chronic hepatitis C CHC (4.5%) and is characterized by a more advanced age (58.4 years), a high frequency of cirrhosis (27.7%), a specific mode of HCV acquisition, and a particular geographic origin (66.7% of patients from West Flanders). The primary comparative analysis showed that response to treatment with PEG-INF + RBV of HCV-5 is similar to HCV-1 and lower compared to HCV-2/3. The analysis of the matched patient subgroup demonstrates that the HCV-5 “intrinsic sensitivity” to PEG-IFN + RBV therapy is identical to HCV-1, with a sustained virological response of 55% in both groups. In contrast to previous publications, this meta-analysis suggests that HCV-5 response to treatment is closer to HCV-1 than to HCV-2/3 and suggests that in Belgium HCV-5 infection should be treated with the same antiviral regimen as HCV-1. J. Med. Virol. 83:815–819, 2011. © 2011 Wiley-Liss, Inc.

We present the case of a 55-year-old woman who underwent a Whipple procedure for pancreatic adenocarcinoma. The preoperative work-up showed no signs of liver metastasis and confirmed the patient's operability, but at less than 40 days postoperatively there were diffuse liver metastasis present on CT. This rapid evolution raises the question whether current staging systems are adequate in determining a patient's operability. It also suggests an interaction between the primary tumor and the host and the existence of disseminated tumor cells.In this article, we give an explanation for the clinical evolution presented in our case using the "integrated organ" and the "concomitant resistance" hypotheses. We believe that, if these theories continue to prove their viability, the search for disseminated tumor cells will be essential for good clinical practice in this type of pathology.

We report a 25-year-old man who presented with congenital absence of the portal vein, or Abernethy malformation, a rare congenital disorder in which the mesenteric and splenic venous drainages bypass the liver and directly drain into the inferior vena cava through an extrahepatic portosystemic shunt. Magnetic resonance imaging, which showed multiple nodular lesions in both liver lobes that were associated with an absence of intrahepatic portal venous branches, strongly suggested the diagnosis of the Abernethy malformation. Carbon dioxide wedged venography and transvenous liver biopsy, which were performed in the same session by a right jugular approach, confirmed these findings. This technique can be considered a valuable alternative diagnostic tool to catheter arteriography and percutaneous transhepatic liver biopsy.

The second law of thermodynamics, for quantum systems, is formulated, on the microscopic level. As for classical systems, such a formulation is only possible when specific conditions are satisfied (continuous spectrum, nonvanishing of the collision operator, etc.). The unitary dynamical group can then be mapped into two contractive semigroups, reaching equilibrium either for t → +∞ or for t → -∞. The second law appears as a symmetry-breaking selection principle, limiting the observables and density functions to the class that tends to thermodynamic equilibrium in the future (for t → +∞). The physical content of the dynamical structure is now displayed in terms of the appropriate semigroup, which is realized through a nonunitary transformation. The superposition principle of quantum mechanics has to be reconsidered as irreversible processes transform pure states into mixtures and unitary transformations are limited by the requirement that entropy remains invariant. In the semigroup representation, interacting fields lead to units that behave incoherently at equilibrium. Inversely, nonequilibrium constraints introduce correlations between these units.

A generalized transformation theory which leads to a non-Hamiltonian description of dynamics is introduced. The transformation is such that all averages of observables remain invariant. However, the time evolution of the density matrix can no longer be expressed in terms of a commutator with the Hamiltonian. Therefore such transformations are not canonical in the usual sense. An explicit „two components” representation of the equations of motion is given which has the following properties: ( a ) each of the components satisfies a separate equation of motion, and ( b ) one component satisfies a kinetic equation of a generalized Boltzmann type. We obtain, therefore, the most remarkable result that the relation between dynamics and statistical mechanics (or thermodynamics) takes a specially transparent and simple form: thermodynamics appears in a precise sense as the random phase approximation of dynamics. Other problems such as the meaning of diagonalization of the Hamiltonian and definition of excitations will be treated in a forthcoming paper.

NOTXT, info:eu-repo/semantics/published

The investigation of the recently described generalized transformation theory which leads to a non-Hamiltonian description of dynamics is pursued. The concept of generalized unitary transformations of superoperators is introduced and a specific class of transformations studied. For nondissipative systems it is equivalent to the usual unitary transformations that diagonalize the Hamiltonian. The important point is that this class of transformations remains meaningful for dissipative systems, hence a new representation of dynamics that we shall call the „physical particle” representation. It has the following properties: ( a ) The energy (or an arbitrary function of the energy) is represented by a diagonal matrix. ( b ) In the (0) II space (see these Proceedings , 65 , 789 (1970)) corresponding to the coherent processes, the evolution can be described in terms of the changes in population of the physical particles. ( c ) At thermodynamic equilibrium, the physical particles are uncorrelated and behave as independent entities; the entropy has a purely combinatorial meaning. A full description of dynamics in this representation will be given in a forth-coming paper.