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In 2016, direct-acting antiviral (DAA) treatment for hepatitis C (HCV) became available through Australia's universal health care system, with the aim of HCV elimination. We report real-world effectiveness of DAA HCV treatment in Australia from a clinically well-informed cohort, enriched for cirrhosis and prior HCV treatment.3413 patients were recruited from 26 hospital liver clinics across Australia from February 2016 to June 2020. Clinical history and sustained viral response (SVR) were obtained from medical records and data linkage to the Australian Pharmaceutical Benefits Scheme. Factors associated with SVR were assessed by multivariable logistic regression (MVR).At recruitment, 32.2% had cirrhosis (72.9% Child Pugh class B/C), and 19.9% were treatment experienced. Of the 2,939 with data, 93.3% confirmed SVR. 137 patients received second-line therapy. Patients with cirrhosis had lower SVR rate (88.4 vs. 95.8%; p 0.001). On MVR, failure to achieve SVR was associated with Genotype 3 (adj-OR = 0.42, 95%CI 0.29-0.61), male gender (adj-OR = 0.49, 95%CI 0.31-0.77), fair/poor adherence (adj-OR = 0.52, 95%CI 0.28-0.94), cirrhosis (adj-OR = 0.57, 95%CI 0.36-0.88), FIB-4 3.25 (adj-OR = 0.52, 95%CI 0.33-0.83) and MELD score ≥ 20 (adj-OR = 0.25, 95%CI 0.08-0.80). Consistent results were seen in cirrhotic sub-analysis.Excellent SVR rates were achieved with DAAs in this real-world cohort of patients with chronic HCV infection. More advanced liver disease and clinician impression of poor adherence were associated with HCV treatment failure. Supports to improve liver fibrosis assessment skills for non-specialist DAA prescribers in the community and to optimize patient adherence are likely to enable more effective pursuit of HCV elimination in Australia.

Hospital-acquired infections are emerging major concurrent conditions during the coronavirus disease (COVID-19) pandemic. We conducted a retrospective review of hospitalizations during March‒October 2020 of adults tested by reverse transcription PCR for severe acute respiratory syndrome coronavirus 2. We evaluated associations of COVID-19 diagnosis with risk for laboratory-confirmed bloodstream infections (LCBIs, primary outcome), time to LCBI, and risk for death by using logistic and competing risks regression with adjustment for relevant covariates. A total of 10,848 patients were included in the analysis: 918 (8.5%) were given a diagnosis of COVID-19, and 232 (2.1%) had LCBIs during their hospitalization. Of these patients, 58 (25%) were classified as having central line‒associated bloodstream infections. After adjusting for covariates, COVID-19‒positive status was associated with higher risk for LCBI and death. Reinforcement of infection control practices should be implemented in COVID-19 wards, and review of superiority and inferiority ranking methods by National Healthcare Safety Network criteria might be needed.

Metabolic syndrome is recognized as a proinflammatory condition leading to hepatic steatosis and nonalcoholic steatohepatitis (NASH). We tested the effects of a succulent species Hoodia parviflora N.E. Br., of the genus Hoodia sweetex Dence, on animal models of NASH and insulin resistance (ob/ob mouse and the sand rat Psammomys obesus). IL6 secretion was evaluated by ELISA and hepatic signal transducer and activator of transcription 3 by Western blot. We followed liver enzymes, weight, glucose, hepatic histology, hepatic triglycerides (TGs), and total fat and serum insulin. Oral administration of extracts derived from H. parviflora alleviated the insulin resistance manifested by improved glucose tolerance tests. Treatment alleviated the liver injury noted by a decrease in liver enzyme levels, improved intrahepatic TG content, total hepatic fat, and improved hepatic histology. Similarly, treatment with H. parviflora reduced hepatic inflammation in mice with Concanavalin A-induced hepatitis. These effects were independent of food consumption and weight. H. parviflora was associated with alleviated insulin resistance, hepatic steatosis, and liver injury. The data support its use as a liver protector.

Metabolic syndrome is recognized as a proinflammatory condition leading to hepatic steatosis and nonalcoholic steatohepatitis (NASH). We tested the effects of a succulent species

Mate attraction in Aplysia involves a long-distance water-borne signal (the protein pheromone attractin), which is released during egg laying. Aplysia californica attractin attracts species that produce closely related attractins, such as Aplysia brasiliana , whose geographic distribution does not overlap that of A. californica . This finding suggests that other mollusks release attractin-related pheromones to form and maintain breeding aggregations. We describe four additional members of the attractin family: A. brasiliana , Aplysia fasciata , Aplysia depilans (which aggregates with A. fasciata aggregations), and Aplysia vaccaria (which aggregates with A. californica aggregations). On the basis of their sequence similarity with A. californica attractin, the attractin proteins fall into two groups: A. californica , A. brasiliana , and A. fasciata (91–95% identity), and A. depilans and A. vaccaria (41–43% identity). The sequence similarity within the attractin family, the conserved six cysteines, and the compact fold of the NMR solution structure of A. californica attractin suggest a common fold for this pheromone family containing two antiparallel helices. The second helix contains the IEECKTS sequence conserved in Aplysia attractins. Mutating surface-exposed charged residues within this heptapeptide sequence abolishes attractin activity, suggesting that the second helix is an essential part of the receptor-binding interface.

Since the introduction of Transient Elastography (TE) into Australia in 2008, non-invasive liver fibrosis assessments have integrated themselves into clinical hepatology. The Australian Liver Association (ALA) recognizes these technologies perform an important role in the assessment of chronic viral hepatitis B and C. However, in the setting of viral hepatitis and many other chronic liver diseases, there remains no consensus or guidelines regarding the performance, utility or reporting of TE. Accordingly, the ALA sought to produce an expert consensus statement for the use of TE in chronic viral hepatitis. The recommendations incorporated in this document are based upon a thorough literature review and draw on extensive clinical experience using TE. The initial draft was presented at Australian Gastroenterology Week (AGW) 2013. Through a collaborative process and expert external review a finalized document was presented at AGW 2014.

We examined whether swimming and inking, two defensive responses inAplysia fasciata, are facilitated by a classical conditioning procedure that has been shown to facilitate a third defensive response, respiratory pumping. Training consisted of pairing a head shock (UCS) with a modified seawater (85%, 120%, or pH 7.0 seawater—CSs). Animals were tested by re-exposing them to the same altered seawater 1 hr after the training. For all three altered seawaters, only respiratory pumping is specifically increased by conditioning. Swimming is sensitized by shock, and inking is unaffected by training, indicating that the conditioning procedure is likely to affect a neural site that differentially controls respiratory pumping. Additional observations also indicate that the three defensive responses are differentially regulated. First, different noxious stimuli preferentially elicit different defensive responses. Second, the three defensive responses are differentially affected by shock. Inking is elicited only immediately following shock, whereas swimming and respiratory pumping are facilitated for a period of time following the shock. Third, swimming and respiratory pumping are differentially affected by noxious stimuli that are delivered in open versus closed environments. These data confirm that neural pathways exist that allowAplysiato modulate separately each of the three defensive behaviors that were examined.

The rate of respiratory pumping is gradually increased when Aplysiafasciata are trapped in either natural or artificial tide pools, in which the O2 concentration, temperature, salinity and CO2 concentration are gradually changed. There are also gradual changes in the time spent on additional behaviors. Immobility increases, while feeding and mating decrease. Respiratory pumping is likely to contribute to the ability of Aplysia to survive in a tide pool, since procedures causing a decrease in the respiratory pump rate (ablation of the osphradium or cutting the pleural-abdominal connectives) also cause an increase in the number of animals that become moribund in the tide pool. Respiratory pumping in artificial tide pools is triggered by a combination of all four stimuli that are changed, but the effects caused by changes in the O2 concentration and temperature are the largest. Changes in other behaviors were also caused by all of the stimuli that are altered in artificial tide pools.

Respiratory pumping in the marine gastropod Aplysia is a well-characterized behavior controlled by identified neurons. The behavior is affected by stimuli such as change in ambient pH and shock. This study investigates learned changes in effects of these stimuli on rate of respiratory pumping movements. A sharp threshold exists for effects of environmental pH on respiratory pumping. Lowering the ambient pH from 7.8 to 7.0 does not affect the rate of respiratory pumping movements, but when pH is decreased further to 6.5 a large increase in pump rate is seen. Sensitizing stimuli, such as brief head shock and preexposure to pH 7.0, change the threshold so that respiratory pumping rate is increased in pH 7.0. Pairing exposure to pH 7.0 with head shock leads to pairing-specific amplification of the response in pH 7.0 alone. Pairing-specific consequences can be distinguished from sensitization only after an hour.

Pheromones released during mating and egg laying in Aplysia facilitate various aspects of behavior. We now show that the chemosensory rhinophores sense these pheromones. Ablating the rhinophores causes a significant decrease in the time spent mating. In addition, the lesion blocks the increases of feeding in response to pheromones released by egg cordons and by mating conspecifics. Respiratory pumping is significantly increased in response to egg cordons, mating conspecifics and egg laying hormone (ELH). The increase in response to egg cordons is blocked by ablating the rhinophores, but not by lesioning the osphradium, a second chemosensory organ.

In Aplysia fasciata, the sea hare, shock paired with moderate increases or decreases in the seawater concentration leads to pairing-specific increases in the respiratory pump rate in response to the same solutions an hour later. A common neural circuit underlies learned changes to increased and decreased seawater concentration, as shown by complete generalization of learning between these stimuli. Different neural circuitry controls learning after pairing a shock with pH 7 seawater, as shown by a lack of generalization of learning to this stimulus. Preexposure to strong changes in the seawater leads to sensitization of respiratory pumping. The hypothesis was tested that associative learning and sensitization arise from activation of common pathways. However, patterns of generalization of sensitization elicited by preexposure to altered seawaters differ from those produced by associative learning.

Respiratory pumping in Aplysia is a spontaneously occurring behavior whose neural circuitry has been explored, but whose natural functions are incompletely understood. Respiratory pump rate was examined in freely behaving pairs of Aplysia fasciata, to determine whether it is modified by the occurrence of mating and other behaviors. The background rate of respiratory pumping was approximately 2/hour. This rate was maintained while animals were immobile, moving in place, crawling, or feeding. The rate was increased to over 8/hour during courtship and to approximately 4/hour during female mating and was reduced to approximately 1/hour during male-mating. These data suggest that respiratory pumping has a reproductive function, perhaps in dispersal of pheromones that are released during female-mating and courtship. Respiratory pumping never occurred while animals were swimming, suggesting that respiratory pumping and swimming may be mutually incompatible behaviors. Respiratory pumping was less common by night than by day.

Neural circuits responsible for both conditioned and unconditioned respiratory pumping to three stimuli modulating respiratory pumping were examined. The stimuli used were: (i) reduction of pH; (ii) increase and (iii) decrease in seawater concentration. Ablation of the osphradium, but not of the rhinophores, abolished responses to all 3 stimuli. Cutting the pleural-abdominal connectives led to a decrease in responses to lowered pH, but did not affect responses to changes in seawater concentration. Further lesions showed that integrity of the cerebral-pleural ganglion is needed for animals to respond to a decrease in pH. Thus, neural circuitry entirely within the abdominal ganglion and the periphery innervated by the ganglion is sufficient for mediating responses to changes in seawater concentration, while the cerebral ganglion is needed to respond to lowered pH. Different transmitter mechanisms are also used by pathways responding to changes in seawater concentration and to decreased pH: 5,7-dihydroxytryptamine in concentrations which cause depletion of serotonin blocked the response to lowered pH, but not to altered seawater concentrations.

Much of the neural circuitry controlling respiratory pumping in Aplysia has been well characterized, but the function of this movement is incompletely understood. To gain insight into possible functions of respiratory pumping, responses were examined for a 40 min exposure to two stimuli that modulate the movement: 1) increase and 2) decrease in seawater concentration. Thresholds were present for both stimuli to affect respiratory pumping. Above threshold, there were graded increases in the number of pumps elicited. There were decrements in respiratory pump frequency as a function of time exposed to the stimulus. Increased respiratory pumping did not contribute to volume regulation in response to exposure to altered seawaters, but was associated with increased defensive responses, such as escape locomotion (swimming) and inking. In addition, head shock, a well-established noxious stimulus, elicited temporal patterns of respiratory pumping similar to those elicited by altered seawaters. The data indicate that in our experimental conditions, respiratory pumping is elicited as part of an integrated defensive response to noxious seawaters.

Respiratory pumping in Aplysia is a well-characterized behaviour controlled by identified neurones, but its function is unknown. To gain insight into the function of this behaviour, respiratory pumping and oxygen consumption were examined under identical conditions, in Aplysia fasciata Poiret and in A. depilans Gmelin. A. fasciata is found in less turbulent environments than is A. depilans, suggesting that control of respiratory pumping may differ in the two species. Rates of respiratory pumping and oxygen consumption were poorly correlated. The basal rate of respiratory pumping was similar in both species and was not significantly dependent on animal mass, but the resting rate of oxygen consumption was higher in A. depilans than in A. fasciata and was an inverse function of animal mass in both species. Brief, moderate hypercapnia led to an increase in oxygen consumption in both Aplysia species. In A. fasciata, the increase was much greater. Increase in oxygen consumed was not accompanied by changes in the rate of respiratory pumping. Longer, more severe periods of hypercapnia led to decreases in oxygen consumption in both Aplysia species, and an increase in the rate of respiratory pumping. Decreased oxygen consumption was more gradual in A. fasciata. Severe hypoxia produced a decrease in the rate of oxygen consumed, and an increase in the rate of respiratory pumping.

A new instrument is described for measurements of circular dichrosim (CD) in the vacuum ultraviolet region. A reflecting biotite plate is used as a linear polarizer and enables us to extend the CD measurements to about 1300A. The CD spectra of d‐camphor and of 3‐methyl cyclopentene are presented.