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Open-label randomized controlled study of salt-restricted vs saltunrestricted diet in patients with cirrhosis with hyponatremia 认领 引用 被引量：1
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作者 Sudheer Marrapu Ramesh Kumar +4 位作者 Divendu Bhushan Sudhir Kumar Abhishek Kumar Rajeev N Priyadarshi Utpal Anand 《World Journal of Methodology》 2026年第2期146-156,共11页
BACKGROUND Salt restriction is commonly recommended for patients with cirrhosis to manage ascites;however,its safety and efficacy in patients with hyponatremia remain unclear.AIM To evaluate the effects of a salt-rest... BACKGROUND Salt restriction is commonly recommended for patients with cirrhosis to manage ascites;however,its safety and efficacy in patients with hyponatremia remain unclear.AIM To evaluate the effects of a salt-restricted diet(SRD;5 g/day)vs a salt-unrestricted diet(SUD;10 g/day)on renal,nutritional,and hemodynamic outcomes,as well as short-term mortality in patients with cirrhosis with moderate to severe hyponatremia.METHODS A total of 150 patients with serum sodium<130 mEq/L were randomized to either SRD or SUD.After excluding patients who died,were non-adherent,or were lost to follow-up within 4 weeks,105 participants(SRD:51;SUD:54)were included in the outcomes analysis.The primary outcome was the incidence of acute kidney injury(AKI)over 6 months;secondary outcomes included ascites control,nutritional markers,and mortality.RESULTS Baseline characteristics were largely comparable.AKI occurred in 45 patients(42.8%),which was significantly more in the SRD group(58.8%vs 27.7%;P=0.005).SRD was an independent predictor of AKI(odds ratio:4.85),and the risk of AKI was 66%lower in the SUD group(hazard ratio:0.34;P<0.001).While ascites control was numerically better in the SUD group,the difference was not statistically significant.The SUD group exhibited better hemodynamic and nutritional indices,including mean arterial pressure,mid-arm circumference,handgrip strength,and serum albumin.Mortality was significantly lower in the SUD group(29.6%vs 54.9%;P=0.009),and survival analysis consistently favored SUD.CONCLUSION Salt restriction in patients with cirrhosis with moderate to severe hyponatremia may predispose them to renal dysfunction,nutritional decline,and increased short-term mortality without providing a clear benefit in ascites control.These findings underscore the need for individualized sodium recommendations in patients with advanced cirrhosis. 展开更多
关键词 Dietary salt Sodium restriction Cirrhosis Hyponatremia Acute kidney injury Nutrition Sarcopenia
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Hepatitis B functional cure:Current and future perspective 认领 引用 被引量：3
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作者 Sudheer Marrapu Jinit R Soni +1 位作者 Kislaya Kamal Ramesh Kumar 《World Journal of Hepatology》 2025年第10期109-124,共16页
Chronic hepatitis B(CHB)remains a significant global health challenge,affecting more than 250 million individuals worldwide.A functional cure,defined as the loss of hepatitis B surface antigen(HBsAg)and suppression of... Chronic hepatitis B(CHB)remains a significant global health challenge,affecting more than 250 million individuals worldwide.A functional cure,defined as the loss of hepatitis B surface antigen(HBsAg)and suppression of hepatitis B virus(HBV)DNA to undetectable levels,represents the optimal therapeutic endpoint for managing CHB.However,the complex pathogenesis of CHB,which includes HBV DNA integration,persistence of covalently closed circular DNA,and impaired immune responses,presents substantial barriers to HBsAg clearance.Current therapies offer limited success in achieving a functional cure,with HBsAg seroclearance occurring in only 3%-5%of patients after 10 years of nucleos(t)ide analogs(NAs)therapy and 8%-14%within 3-5 years of pegylated interferon treatment.To overcome these limitations,novel direct-acting antivirals targeting different stages of the HBV life cycle are being investigated.Additionally,immunomodulatory approaches,including therapeutic vaccines and immune checkpoint inhibitors,are being explored to enhance HBV-specific immune responses.The concept of NAs cessation in carefully selected non-cirrhotic patients may accelerate HBsAg loss,although the risks of hepatic flare and hepatocellular carcinoma necessitate rigorous monitoring.This review provides a comprehensive overview of the current understanding of HBsAg seroclearance in CHB,discussing its clinical significance,therapeutic challenges,and evolving treatment landscape in the pursuit of a functional cure. 展开更多
关键词 Hepatitis B Hepatitis B surface antigen seroclearance Functional cure Surface antigen Virological cure
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Acute liver failure from anti-tuberculosis drug-induced liver injury:An update 认领 引用 被引量：3
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作者 Ramesh Kumar Abhishek Kumar Sudhir Kumar 《World Journal of Hepatology》 2025年第5期70-80,共11页
Tuberculosis(TB)is still a major public health issue in developing countries,where it causes a heavy disease burden.Although current anti-TB treatment regimens demonstrate high efficacy,the hepatotoxic potential of fi... Tuberculosis(TB)is still a major public health issue in developing countries,where it causes a heavy disease burden.Although current anti-TB treatment regimens demonstrate high efficacy,the hepatotoxic potential of first-line anti-TB drugs(ATDs)-particularly isoniazid,rifampicin,and pyrazinamide-poses a considerable risk,as these agents are associated with a significant incidence of ATD-induced liver injury(AT-DILI).The clinical presentation of AT-DILI can range from asymptomatic elevations in serum transaminases,which may resolve spontaneously due to hepatic adaptation,to acute liver failure(ALF),a potentially life-threatening condition.A recent meta-analysis reported a global incidence of AT-DILI of 11.5%,with rates varying from 2%to 28%.Approximately 7%of patients with AT-DILI progress to ALF,a condition characterized by a poor survival rate with medical therapy.ATD-induced ALF(AT-ALF)is clinically indistinguishable from ALF due to other causes and disproportionately affects young female patients,typically within eight weeks of treatment initiation.Emergency liver transplantation has become an effective therapeutic option for AT-ALF,although outcomes are generally poorer compared to elective transplantation.This minireview provides a comprehensive overview of AT-ALF,covering its epidemiology,risk factors,clinical presentation,prognosis,and treatment options. 展开更多
关键词 Tuberculosis Anti-tuberculosis drugs Hepatotoxicity Drug-induced liver injury Acute liver failure
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Hypochloremia is an underutilised prognostic marker in patients with advanced liver cirrhosis and liver failure 认领 引用 被引量：1
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作者 Jinit R Soni Sudheer Marrapu Ramesh Kumar 《World Journal of Hepatology》 2025年第3期42-49,共8页
Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,... Patients with advanced liver cirrhosis and liver failure frequently experience abnormalities in their serum electrolyte levels.In such patients,hyponatremia has been identified as a predictor of poor outcomes.However,emerging evidence suggests that serum chloride may provide even better prognostic information in similar situations.Hypochloremia,characterised by low serum chloride levels,has been linked to increased mortality,exacerbated organ dysfunction,and higher requirements for renal replacement therapy and vasopressors in various critical conditions,including advanced liver diseases.The pathophysiological mecha-nisms underlying the association between low serum chloride levels and poor outcomes in liver disease appear to involve complex interactions among electro-lyte imbalances,renal function,and systemic hemodynamics.Chloride dysregu-lation can influence renal salt-sensing mechanisms,disrupt acid-base homeostasis,and exacerbate complications such as hepatic encephalopathy and hepatorenal syndrome.This article aims to elucidate the prognostic significance of lower serum chloride levels in patients with advanced liver disease.By reviewing recent literature and analysing clinical data,we seek to establish serum chloride as an underutilised but valuable prognostic marker.Understanding the role of serum chloride in liver disease could enhance prognostic accuracy,refine treatment strategies,and ultimately improve patient outcomes. 展开更多
关键词 Chloride Hypochloremia Liver failure Cirrhosis Hyponatremia Prognosis
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Sepsis in liver failure patients:Diagnostic challenges and recent advancements 认领 引用 被引量：1
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作者 Ramesh Kumar Abhishek Kumar Sudhir Kumar 《World Journal of Critical Care Medicine》 2025年第2期7-17,共11页
Acute liver failure(ALF)and acute-on-chronic LF(ACLF)are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections(BI),despite significant systemic inflammation.Literature indi... Acute liver failure(ALF)and acute-on-chronic LF(ACLF)are prevalent hepatic emergencies characterized by an increased susceptibility to bacterial infections(BI),despite significant systemic inflammation.Literature indicates that 30%–80%of ALF patients and 55%–81%of ACLF patients develop BI,attributed to immu-nological dysregulation.Bacterial sepsis in these patients is associated with adverse clinical outcomes,including prolonged hospitalization and increased mortality.Early detection of bacterial sepsis is critical;however,distinguishing between sterile systemic inflammation and sepsis poses a significant challenge due to the overlapping clinical presentations of LF and sepsis.Conventional sepsis biomarkers,such as procalcitonin and C-reactive protein,have shown limited utility in LF patients due to inconsistent results.In contrast,novel biomarkers like presepsin and sTREM-1 have demonstrated promising discrim-inatory performance in this population,pending further validation.Moreover,emerging research highlights the potential of machine learning-based approaches to enhance sepsis detection and characterization.Although preliminary findings are encouraging,further studies are necessary to validate these results across diverse patient cohorts,including those with LF.This article provides a compre-hensive review of the magnitude,impact,and diagnostic challenges associated with BI in LF patients,focusing on novel advancements in early sepsis detection and characterization. 展开更多
关键词 Liver failure Sepsis Bacterial infection Acute liver failure Acute-on-chronic liver failure
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Optimizing Efficiency and Performance in a Rankine Cycle Power Plant Analysis 认领 引用
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作者 Ramesh Kumar Abdullah Bin Queyam +2 位作者 Manish Kumar Singla Mohamed Louzazni Mishra Dipak Kumar 《Energy Engineering》 EI 2025年第4期1373-1386,共14页
Enhancing the efficiency of Rankine cycles is crucial for improving the performance of thermal power plants,as it directly impacts operational costs and emissions in light of energy transition goals.This study sets it... Enhancing the efficiency of Rankine cycles is crucial for improving the performance of thermal power plants,as it directly impacts operational costs and emissions in light of energy transition goals.This study sets itself apart from existing research by applying a novel optimization technique to a basic ideal Rankine cycle,focusing on a specific power plant that has not been previously analyzed.Currently,this cycle operates at 41%efficiency and a steam quality of 76%,constrained by fixed operational parameters.The primary objectives are to increase thermal efficiency beyond 46%and raise steam quality above 85%,while adhering to operational limits:a boiler pressure not exceeding 15 MPa,condenser pressure not dropping below 10 kPa,and turbine temperature not surpassing 500℃.This study utilizes numerical simulations to model the effects of varying boiler pressure(Pb)and condenser pressure(Pc)within the ranges of 12MPa<Pb<15 MPa and 5 kPa<Pc<10 kPa.By systematically adjusting these parameters,the proposed aimto identify optimal conditions that maximize efficiency and performance within specified constraints.The findings will provide valuable insights for power plant operators seeking to optimize performance under real-world conditions,contributing to more efficient and sustainable power generation. 展开更多
关键词 Rankine cycle thermal efficiency steamquality boiler pressure condenser pressure cycle performance operational constraints efficiency improvement
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Advanced Nodal Pricing Strategies for Modern Power Distribution Networks:Enhancing Market Efficiency and System Reliability 认领 引用
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作者 Ganesh Wakte Mukesh Kumar +2 位作者 Mohammad Aljaidi Ramesh Kumar Manish Kumar Singla 《Energy Engineering》 EI 2025年第6期2519-2537,共19页
Nodal pricing is a critical mechanism in electricity markets,utilized to determine the cost of power transmission to various nodes within a distribution network.As power systems evolve to incorporate higher levels of ... Nodal pricing is a critical mechanism in electricity markets,utilized to determine the cost of power transmission to various nodes within a distribution network.As power systems evolve to incorporate higher levels of renewable energy and face increasing demand fluctuations,traditional nodal pricing models often fall short to meet these new challenges.This research introduces a novel enhanced nodal pricing mechanism for distribution networks,integrating advanced optimization techniques and hybrid models to overcome these limitations.The primary objective is to develop a model that not only improves pricing accuracy but also enhances operational efficiency and system reliability.This study leverages cutting-edge hybrid algorithms,combining elements of machine learning with conventional optimization methods,to achieve superior performance.Key findings demonstrate that the proposed hybrid nodal pricing model significantly reduces pricing errors and operational costs compared to conventional methods.Through extensive simulations and comparative analysis,the model exhibits enhanced performance under varying load conditions and increased levels of renewable energy integration.The results indicate a substantial improvement in pricing precision and network stability.This study contributes to the ongoing discourse on optimizing electricity market mechanisms and provides actionable insights for policymakers and utility operators.By addressing the complexities of modern power distribution systems,our research offers a robust solution that enhances the efficiency and reliability of power distribution networks,marking a significant advancement in the field. 展开更多
关键词 Nodal pricing distribution networks optimization renewable energy pricing accuracy system reliability
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Optimal Location of Renewable Energy Generators in Transmission and Distribution System of Deregulated Power Sector:A Review 认领 引用
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作者 Digambar Singh Najat Elgeberi +3 位作者 Mohammad Aljaidi Ramesh Kumar Rabia Emhamed Al Mamlook Manish Kumar Singla 《Energy Engineering》 EI 2025年第3期823-859,共37页
The literature on multi-attribute optimization for renewable energy source(RES)placement in deregulated power markets is extensive and diverse in methodology.This study focuses on the most relevant publications direct... The literature on multi-attribute optimization for renewable energy source(RES)placement in deregulated power markets is extensive and diverse in methodology.This study focuses on the most relevant publications directly addressing the research problem at hand.Similarly,while the body of work on optimal location and sizing of renewable energy generators(REGs)in balanced distribution systems is substantial,only the most pertinent sources are cited,aligning closely with the study’s objective function.A comprehensive literature review reveals several key research areas:RES integration,RES-related optimization techniques,strategic placement of wind and solar generation,and RES promotion in deregulated powermarkets,particularly within transmission systems.Furthermore,the optimal location and sizing of REGs in both balanced and unbalanced distribution systems have been extensively studied.RESs demonstrate significant potential for standalone applications in remote areas lacking conventional transmission and distribution infrastructure.Also presents a thorough review of current modeling and optimization approaches for RES-based distribution system location and sizing.Additionally,it examines the optimal positioning,sizing,and performance of hybrid and standalone renewable energy systems.This paper provides a comprehensive review of current modeling and optimization approaches for the location and sizing of Renewable Energy Sources(RESs)in distribution systems,focusing on both balanced and unbalanced networks. 展开更多
关键词 Optimization of RESs distributed generation modeling and selection of RESs hybrid systems standalone systems optimal location
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Transition from acute kidney injury to chronic kidney disease in liver cirrhosis patients:Current perspective 认领 引用
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作者 Sudheer Marrapu Ramesh Kumar 《World Journal of Nephrology》 2025年第1期80-92,共13页
In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a comp... In liver cirrhosis patients,acute kidney injury(AKI)is a common and severe complication associated with significant morbidity and mortality,often leading to chronic kidney disease(CKD).This progression reflects a complex interplay of renal and hepatic pathophysiology,with AKI acting as an initiator through maladaptive repair mechanisms.These mechanisms—such as tubular cell cycle arrest,inflammatory cascades,and fibrotic processes—are exacerbated by the hemodynamic and neurohormonal disturbances characteristic of cirrhosis.Following AKI episodes,persistent kidney dysfunction or acute kidney disease(AKD)often serves as a bridge to CKD.AKD represents a critical phase in renal deterioration,characterized by prolonged kidney injury that does not fully meet CKD criteria but exceeds the temporal scope of AKI.The progression from AKD to CKD is further influenced by recurrent AKI episodes,impaired renal autoregu-lation,and systemic comorbidities such as diabetes and metabolic dysfunction-associated steatotic liver disease,which compound kidney damage.The clinical management of AKI and CKD in cirrhotic patients requires a multidimensional approach that includes early identification of kidney injury,the application of novel biomarkers,and precision interventions.Recent evidence underscores the inadequacy of traditional biomarkers in predicting the AKI-to-CKD progression,necessitating novel biomarkers for early detection and intervention. 展开更多
关键词 Renal dysfunction Acute kidney injury Chronic kidney disease Cirrhosis Hepatorenal syndrome
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Current therapeutic modalities and chemopreventive role of natural products in liver cancer:Progress and promise 认领 引用 被引量：7
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作者 Amit Kumar Singh Shiv Vardan Singh +3 位作者 Ramesh Kumar Shashank Kumar Sabyasachi Senapati Abhay K Pandey 《World Journal of Hepatology》 2023年第1期1-18,共18页
Liver cancer is a severe concern for public health officials since the clinical cases are increasing each year,with an estimated 5-year survival rate of 30%–35%after diagnosis.Hepatocellular carcinoma(HCC)constitutes... Liver cancer is a severe concern for public health officials since the clinical cases are increasing each year,with an estimated 5-year survival rate of 30%–35%after diagnosis.Hepatocellular carcinoma(HCC)constitutes a significant subtype of liver cancer(approximate75%)and is considered primary liver cancer.Treatment for liver cancer mainly depends on the stage of its progression,where surgery including,hepatectomy and liver transplantation,and ablation and radiotherapy are the prime choice.For advanced liver cancer,various drugs and immunotherapy are used as first-line treatment,whereas second-line treatment includes chemotherapeutic drugs from natural and synthetic origins.Sorafenib and lenvatinib are first-line therapies,while regorafenib and ramucirumab are secondline therapy.Various metabolic and signaling pathways such as Notch,JAK/STAT,Hippo,TGF-β,and Wnt have played a critical role during HCC progression.Dysbiosis has also been implicated in liver cancer.Drug-induced toxicity is a key obstacle in the treatment of liver cancer,necessitating the development of effective and safe medications,with natural compounds such as resveratrol,curcumin,diallyl sulfide,and others emerging as promising anticancer agents.This review highlights the current status of liver cancer research,signaling pathways,therapeutic targets,current treatment strategies and the chemopreventive role of various natural products in managing liver cancer. 展开更多
关键词 Liver cancer Hepatocellular carcinoma Signaling pathways Therapeutic targets Natural products Chemopreventive
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Clinical profile and outcomes of hepatocellular carcinoma in primary Budd-Chiari syndrome 认领 引用 被引量：2
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作者 Ankit Agarwal Sagnik Biswas +14 位作者 Shekhar Swaroop Arnav Aggarwal Ayush Agarwal Gautam Jain Anshuman Elhence Arun Vaidya Amit Gupte Ravi Mohanka Ramesh Kumar Ashwani Kumar Mishra Shivanand Gamanagatti Shashi Bala Paul Subrat Kumar Acharya Akash Shukla Shalimar 《World Journal of Gastrointestinal Oncology》 SCIE 2024年第3期699-715,共17页
BACKGROUND There is scant literature on hepatocellular carcinoma(HCC)in patients with Budd-Chiari syndrome(BCS).AIM To assess the magnitude,clinical characteristics,feasibility,and outcomes of treatment in BCS-HCC.MET... BACKGROUND There is scant literature on hepatocellular carcinoma(HCC)in patients with Budd-Chiari syndrome(BCS).AIM To assess the magnitude,clinical characteristics,feasibility,and outcomes of treatment in BCS-HCC.METHODS A total of 904 BCS patients from New Delhi,India and 1140 from Mumbai,India were included.The prevalence and incidence of HCC were determined,and among patients with BCS-HCC,the viability and outcomes of interventional therapy were evaluated.RESULTS In the New Delhi cohort of 35 BCS-HCC patients,18 had HCC at index presentation(prevalence 1.99%),and 17 developed HCC over a follow-up of 4601 person-years,[incidence 0.36(0.22-0.57)per 100 person-years].BCS-HCC patients were older when compared to patients with BCS alone(P=0.001)and had a higher proportion of inferior vena cava block,cirrhosis,and long-segment vascular obstruction.The median alpha-fetoprotein level was higher in patients with BCS-HCC at first presentation than those who developed HCC at follow-up(13029 ng/mL vs 500 ng/mL,P=0.01).Of the 35 BCS-HCC,26(74.3%)underwent radiological interventions for BCS,and 22(62.8%)patients underwent treatment for HCC[transarterial chemoembolization in 18(81.8%),oral tyrosine kinase inhibitor in 3(13.6%),and transarterial radioembolization in 1(4.5%)].The median survival among patients who underwent interventions for HCC compared with those who did not was 3.5 years vs 3.1 mo(P=0.0001).In contrast to the New Delhi cohort,the Mumbai cohort of BCS-HCC patients were predominantly males,presented with a more advanced HCC[Barcelona Clinic Liver Cancer C and D],and 2 patients underwent liver transplantation.CONCLUSION HCC is not uncommon in patients with BCS.Radiological interventions and liver transplantation are feasible in select primary BCS-HCC patients and may improve outcomes. 展开更多
关键词 Budd chiari syndrome Cancer Cirrhosis Thrombosis Liver Varices Transarterial chemoembolization Hepatic venous outflow tract obstruction
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Heat-tolerant maize for rainfed hot,dry environments in the lowland tropics:From breeding to improved seed delivery 认领 引用
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作者 Pervez H.Zaidi Madhumal Thayil Vinayan +11 位作者 Sudha K.Nair Prakash H.Kuchanur Ramesh Kumar Shyam Bir Singh Mahendra Prasad Tripathi Ayyanagouda Patil Salahuddin Ahmed Aamir Hussain Atul Prabhakar Kulkarni Passang Wangmo Mitchell R.Tuinstra Boddupalli M.Prasanna 《The Crop Journal》 SCIE CSCD 2023年第4期986-1000,共15页
Climate change-induced heat stress combines two challenges:high day-and nighttime temperatures,and physiological water deficit due to demand-side drought caused by increase in vapor-pressure deficit.It is one of the m... Climate change-induced heat stress combines two challenges:high day-and nighttime temperatures,and physiological water deficit due to demand-side drought caused by increase in vapor-pressure deficit.It is one of the major factors in low productivity of maize in rainfed stress-prone environments in South Asia,affecting a large population of smallholder farmers who depend on maize for their sustenance and livelihoods.The International Maize and Wheat Improvement Center(CIMMYT)maize program in Asia,in partnership with public-sector maize research institutes and private-sector seed companies in South Asian countries,is implementing an intensive initiative for developing and deploying heat-tolerant maize that combines high yield potential with resilience to heat and drought stresses.With the integration of novel breeding tools and methods,including genomics-assisted breeding,doubled haploidy,fieldbased precision phenotyping,and trait-based selection,new maize germplasm with increased tolerance to heat stress is being developed for the South Asian tropics.Over a decade of concerted effort has resulted in the successful development and release of 20 high-yielding heat-tolerant maize hybrids in CIMMYT genetic backgrounds.Via public–private partnerships,eight hybrids are presently being deployed on over 50,000 ha in South Asian countries,including Bangladesh,Bhutan,India,Nepal,and Pakistan. 展开更多
关键词 Climate change Drought Heat stress Lowland tropics Maize Vapor pressure deficit
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Surveying the genomic landscape of silage-quality traits in maize(Zea mays L.) 认领 引用
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作者 Jatin Sharma Shubham Sharma +8 位作者 Krishna Sai Karnatam Om Prakash Raigar Chayanika Lahkar Dinesh Kumar Saini Sushil Kumar Alla Singh Abhijit Kumar Das Priti Sharma Ramesh Kumar 《The Crop Journal》 SCIE CSCD 2023年第6期1893-1901,共9页
Despite the longstanding importance of silage as a critical feed source for ruminants,its quality improvement has been largely overlooked.Although numerous quantitative trait loci(QTL)and genes affecting silage qualit... Despite the longstanding importance of silage as a critical feed source for ruminants,its quality improvement has been largely overlooked.Although numerous quantitative trait loci(QTL)and genes affecting silage quality in maize have been reported,only a few have been effectively incorporated into breeding programs.Addressing this gap,the present study undertook a comprehensive meta-QTL(MQTL)analysis involving 523 QTL associated with silage-quality traits collected from 14 published studies.Of the 523 QTL,405 were projected onto a consensus map comprising 62,424 genetic markers,resulting in the identification of 60 MQTL and eight singletons.The average confidence interval(CI)of the MQTL was 3.9-fold smaller than that of the source QTL.Nine of the 60 identified MQTL were classified as breeder’s MQTL owing to their small CIs,involvement of more QTL,and large contribution to phenotypic variation.One-third of the MQTL co-localized with DNA marker-trait associations identified in previous genomewide association mapping studies.A set of 78 high-confidence candidate genes influencing silage quality were identified in the MQTL regions.These genes and associated markers may advance marker-assisted breeding for maize silage quality. 展开更多
关键词 Meta-QTL Silage quality Maize GWAS Candidate genes
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Clinical implications of diabetes in chronic liver disease:Diagnosis,outcomes and management,current and future perspectives 认领 引用 被引量：13
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作者 Diego García-Compeán Emanuela Orsi +6 位作者 Ramesh Kumar Felix Gundling Tsutomu Nishida Jesús Zacarías Villarreal-Pérez Ángel N Del Cueto-Aguilera JoséA González-González Giuseppe Pugliese 《World Journal of Gastroenterology》 SCIE CAS 2022年第8期775-793,共19页
Diabetes mellitus(DM)is common in liver cirrhosis(LC).The pathophysiological association is bidirectional.DM is a risk factor of LC and LC is a diabetogenic condition.In the recent years,research on different aspects ... Diabetes mellitus(DM)is common in liver cirrhosis(LC).The pathophysiological association is bidirectional.DM is a risk factor of LC and LC is a diabetogenic condition.In the recent years,research on different aspects of the association DM and LC has been intensified.Nevertheless,it has been insufficient and still exist many gaps.The aims of this review are:(1)To discuss the latest understandings of the association of DM and LC in order to identify the strategies of early diagnosis;(2)To evaluate the impact of DM on outcomes of LC patients;and(3)To select the most adequate management benefiting the two conditions.Literature searches were conducted using Pub Med,Ovid and Scopus engines for DM and LC,diagnosis,outcomes and management.The authors also provided insight from their own published experience.Based on the published studies,two types of DM associated with LC have emerged:Type 2 DM(T2 DM)and hepatogenous diabetes(HD).High-quality evidences have determined that T2 DM or HD significantly increase complications and death pre and post-liver transplantation.HD has been poorly studied and has not been recognized as a complication of LC.The management of DM in LC patients continues to be difficult and should be based on drug pharmacokinetics and the degree of liver failure.In conclusion,the clinical impact of DM in outcomes of LC patients has been the most studied item recently.Nevertheless many gaps still exist particularly in the management.These most important gaps were highlighted in order to propose future lines for research. 展开更多
关键词 Diabetes mellitus Liver cirrhosis Hepatogenous diabetes Clinical implications Therapy
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Chronic renal dysfunction in cirrhosis:A new frontier in hepatology 认领 引用 被引量：11
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作者 Ramesh Kumar Rajeev Nayan Priyadarshi Utpal Anand 《World Journal of Gastroenterology》 SCIE CAS 2021年第11期990-1005,共16页
Chronic kidney disease(CKD)in patients with liver cirrhosis has become a new frontier in hepatology.In recent years,a sharp increase in the diagnosis of CKD has been observed among patients with cirrhosis.The rising p... Chronic kidney disease(CKD)in patients with liver cirrhosis has become a new frontier in hepatology.In recent years,a sharp increase in the diagnosis of CKD has been observed among patients with cirrhosis.The rising prevalence of risk factors,such as diabetes,hypertension and nonalcoholic fatty liver disease,appears to have contributed significantly to the high prevalence of CKD.Moreover,the diagnosis of CKD in cirrhosis is now based on a reduction in the estimated glomerular filtration rate of<60 mL/min over more than 3 mo.This definition has resulted in a better differentiation of CKD from acute kidney injury(AKI),leading to its greater recognition.It has also been noted that a significant proportion of AKI transforms into CKD in patients with decompensated cirrhosis.CKD in cirrhosis can be structural CKD due to kidney injury or functional CKD secondary to circulatory and neurohormonal imbalances.The available literature on combined cirrhosis-CKD is extremely limited,as most attempts to assess renal dysfunction in cirrhosis have so far concentrated on AKI.Due to problems related to glomerular filtration rate estimation in cirrhosis,the absence of reliable biomarkers of CKD and technical difficulties in performing renal biopsy in advanced cirrhosis,CKD in cirrhosis can present many challenges for clinicians.With combined hepatorenal dysfunctions,fluid mobilization becomes problematic,and there may be difficulties with drug tolerance,hemodialysis and decision-making regarding the need for liver vs simultaneous liver and kidney transplantation.This paper offers a thorough overview of the increasingly known CKD in patients with cirrhosis,with clinical consequences and difficulties occurring in the diagnosis and treatment of such patients. 展开更多
关键词 Acute kidney injury Cirrhosis Chronic kidney disease Renal failure Hepatorenal syndrome Renal function
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Amebic liver abscess: An update 认领 引用 被引量：8
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作者 Ramesh Kumar Rishabh Patel +4 位作者 Rajeev Nayan Priyadarshi Ruchika Narayan Tanmoy Maji Utpal Anand Jinit R Soni 《World Journal of Hepatology》 2024年第3期316-330,共15页
Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily... Amebic liver abscess(ALA)is still a common problem in the tropical world,where it affects over three-quarters of patients with liver abscess.It is caused by an anaerobic protozoan Entamoeba hystolytica,which primarily colonises the cecum.It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris.People of the male gender,during their reproductive years,are most prone to ALA,and this appears to be due to a poorly mounted immune response linked to serum testosterone levels.ALA is more common in the right lobe of the liver,is strongly associated with alcohol consumption,and can heal without the need for drainage.While majority of ALA patients have an uncomplicated course,a number of complications have been described,including rupture into abdomino-thoracic structures,biliary fistula,vascular thrombosis,bilio-vascular compression,and secondary bacterial infection.Based on clinico-radiological findings,a classification system for ALA has emerged recently,which can assist clinicians in making treatment decisions.Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA.Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy.Metronidazole has been the drug of choice for ALA patients for many years.However,concerns over the resistance and adverse effects necessitate the creation of new,safe,and potent antiamebic medications.Although the indication of the drainage of uncomplicated ALA has become more clear,high-quality randomised trials are still necessary for robust conclusions.Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis,for whom surgery represents a significant risk of mortality.With regard to all of the aforementioned issues,this article intends to present an updated review of ALA. 展开更多
关键词 Amebic liver abscess Amebiasis Ruptured liver abscess Percutaneous drainage Metronidazole
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Modulatory effect of caffeic acid in alleviating diabetes and associated complications 认领 引用 被引量：5
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作者 Risha Ganguly Shiv Vardan Singh +2 位作者 Kritika Jaiswal Ramesh Kumar Abhay K Pandey 《World Journal of Diabetes》 SCIE 2023年第2期62-75,共14页
Diabetes mellitus(DM)is one of the most common metabolic disorders characterized by elevated blood glucose levels.Prolonged uncontrolled hyperglycemia often leads to multi-organ damage including diabetic neuropathy,ne... Diabetes mellitus(DM)is one of the most common metabolic disorders characterized by elevated blood glucose levels.Prolonged uncontrolled hyperglycemia often leads to multi-organ damage including diabetic neuropathy,nephropathy,retinopathy,cardiovascular disorders,and diabetic foot ulcers.Excess production of free radicals causing oxidative stress in tissues is often considered to be the primary cause of onset and progression of DM and associated complications.Natural polyphenols can be used to induce or inhibit the expression of antioxidant enzymes such as glutathione peroxidase,heme oxygenase-1,superoxide dismutase,and catalase that are essential in maintaining redox balance,and ameliorate oxidative stress.Caffeic acid(CA)is a polyphenolderived from hydroxycinnamic acid and possesses numerous physiological properties including antioxidant,anti-inflammatory,anti-atherosclerotic,immune-stimulatory,cardioprotective,antiproliferative,and hepatoprotective activities.CA acts as a regulatory compound affecting numerous biochemical pathways and multiple targets.These include various transcription factors such as nuclear factor-B,tumor necrosis factor-α,interleukin-6,cyclooxygenase-2,and nuclear factor erythroid 2-related factor 2.Therefore,this review summarizes the pharmacological properties,molecular mechanisms,and pharmacokinetic profile of CA in mitigating the adverse effects of DM and associated complications.The bioavailability,drug delivery,and clinical trials of CA have also been discussed. 展开更多
关键词 Diabetes mellitus Caffeic acid Diabetic foot ulcer Retinopathy Nephropathy
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Molecular signalling during cross talk between gut brain axis regulation and progression of irritable bowel syndrome:A comprehensive review 认领 引用 被引量：4
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作者 Shiv Vardan Singh Risha Ganguly +3 位作者 Kritika Jaiswal Aditya Kumar Yadav Ramesh Kumar Abhay K Pandey 《World Journal of Clinical Cases》 SCIE 2023年第19期4458-4476,共19页
Irritable bowel syndrome(IBS)is a chronic functional disorder which alters gastrointestinal(GI)functions,thus leading to compromised health status.Pathophysiology of IBS is not fully understood,whereas abnormal gut br... Irritable bowel syndrome(IBS)is a chronic functional disorder which alters gastrointestinal(GI)functions,thus leading to compromised health status.Pathophysiology of IBS is not fully understood,whereas abnormal gut brain axis(GBA)has been identified as a major etiological factor.Recent studies are suggestive for visceral hyper-sensitivity,altered gut motility and dysfunctional autonomous nervous system as the main clinical abnormalities in IBS patients.Bidirectional signalling interactions among these abnormalities are derived through various exogenous and endogenous factors,such as microbiota population and diversity,microbial metabolites,dietary uptake,and psychological abnormalities.Strategic efforts focused to study these interactions including probiotics,antibiotics and fecal transplantations in normal and germfree animals are clearly suggestive for the pivotal role of gut microbiota in IBS etiology.Additionally,neurotransmitters act as communication tools between enteric microbiota and brain functions,where serotonin(5-hydroxytryptamine)plays a key role in pathophysiology of IBS.It regulates GI motility,pain sense and inflammatory responses particular to mucosal and brain activity.In the absence of a better understanding of various interconnected crosstalks in GBA,more scientific efforts are required in the search of novel and targeted therapies for the management of IBS.In this review,we have summarized the gut microbial composition,interconnected signalling pathways and their regulators,available therapeutics,and the gaps needed to fill for a better management of IBS. 展开更多
关键词 Irritable bowel syndrome Microbiota Gut brain axis Stress Serotonin
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Effect of thrombocytopenia and platelet transfusion on outcomes of acute variceal bleeding in patients with chronic liver disease 认领 引用 被引量：4
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作者 Sagnik Biswas Manas Vaishnav +8 位作者 Piyush Pathak Deepak Gunjan Soumya Jagannath Mahapatra Saurabh Kedia Gyanranjan Rout Bhaskar Thakur Baibaswata Nayak Ramesh Kumar Shalimar 《World Journal of Hepatology》 2022年第7期1421-1437,共17页
BACKGROUND Platelet transfusion in acute variceal bleeding(AVB)is recommended by few guidelines and is common in routine clinical practice,even though the effect of thrombocytopenia and platelet transfusion on the out... BACKGROUND Platelet transfusion in acute variceal bleeding(AVB)is recommended by few guidelines and is common in routine clinical practice,even though the effect of thrombocytopenia and platelet transfusion on the outcomes of AVB is unclear.AIM To determine how platelet counts,platelets transfusions,and fresh frozen plasma transfusions affect the outcomes of AVB in cirrhosis patients in terms of bleeding control,rebleeding,and mortality.METHODS Prospectively maintained database was used to analyze the outcomes of cirrhosis patients who presented with AVB.The outcomes were assessed as the risk of rebleeding at days 5 and 42,and risk of death at day 42,considering the platelet counts and platelet transfusion.Propensity score matching(PSM)was used to compare the outcomes in those who received platelet transfusion.Statistical comparisons were done using Kaplan-Meier curves with log-rank tests and Coxproportional hazard model for rebleeding and for 42-d mortality.RESULTS The study included 913 patients,with 83.5%men,median age 45 years,and Model for End-stage Liver Disease score 14.7.Platelet count50×109/L were found in 23(2.5%),168(18.4%),and 722(79.1%)patients,respectively.Rebleeding rates were similar between the three platelet groups on days 5 and 42(13%,6.5%,and 4.7%,respectively,on days 5,P=0.150;and 21.7%,17.3%,and 14.4%,respectively,on days 42,P=0.433).At day 42,the mortality rates for the three platelet groups were also similar(13.0%,23.2%,and 17.2%,respectively,P=0.153).On PSM analysis patients receiving platelets transfusions(n=89)had significantly higher rebleeding rates on day 5(14.6%vs 4.5%;P=0.039)and day 42(32.6%vs 15.7%;P=0.014),compared to those who didn't.The mortality rates were also higher among patients receiving platelets(25.8%vs 23.6%;P=0.862),although the difference was not significant.On multivariate analysis,platelet transfusion and not platelet count,was independently associated with 42-d rebleeding.Hepatic encephalopathy was independently associated with 42-d mortality.CONCLUSION Thrombocytopenia had no effect on rebleeding rates or mortality in cirrhosis patients with AVB;however,platelet transfusion increased rebleeding on days 5 and 42,with a higher but nonsignificant effect on mortality. 展开更多
关键词 Gastrointestinal Hemorrhage Platelet transfusion Thrombocytopenia Fresh frozen plasma Portal hypertension Mortality
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Lymphatic dysfunction in advanced cirrhosis:Contextual perspective and clinical implications 认领 引用 被引量：8
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作者 Ramesh Kumar Utpal Anand Rajeev Nayan Priyadarshi 《World Journal of Hepatology》 2021年第3期300-314,共15页
The lymphatic system plays a very important role in body fluid homeostasis,adaptive immunity,and the transportation of lipid and waste products.In patients with liver cirrhosis,capillary filtration markedly increases,... The lymphatic system plays a very important role in body fluid homeostasis,adaptive immunity,and the transportation of lipid and waste products.In patients with liver cirrhosis,capillary filtration markedly increases,primarily due to a rise in hydrostatic pressure,leading to enhanced production of lymph.Initially,lymphatic vasculature expansion helps to prevent fluid from accumulating by returning it back to the systemic circulation.However,the lymphatic functions become compromised with the progression of cirrhosis and,consequently,the lymphatic compensatory mechanism gets overwhelmed,contributing to the development and eventual worsening of ascites and edema.Neurohormonal changes,low-grade chronic inflammation,and compounding effects of predisposing factors such as old age,obesity,and metabolic syndrome appear to play a significant role in the lymphatic dysfunction of cirrhosis.Sustained portal hypertension can contribute to the development of intestinal lymphangiectasia,which may rupture into the intestinal lumen,resulting in the loss of protein,chylomicrons,and lymphocyte,with many clinical consequences.Rarely,due to high pressure,the rupture of the subserosal lymphatics into the abdomen results in the formation of chylous ascites.Despite being highly significant,lymphatic dysfunctions in cirrhosis have largely been ignored;its mechanistic pathogenesis and clinical implications have not been studied in depth.No recommendation exists for the diagnostic evaluation and therapeutic strategies,with respect to lymphatic dysfunction in patients with cirrhosis.This article discusses the perspectives and clinical implications,and provides insights into the management strategies for lymphatic dysfunction in patients with cirrhosis. 展开更多
关键词 Lymphatic dysfunction Cirrhosis Lymphedema Lymphangiectasia Chylous ascites Refractory ascites
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