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Tuesday, 12 September 2017

Will You Like or desire to nominate Professor Dr Pranab Kumar Bhattacharya for Ig Nobel prize -2018 Or The RIGHT LIVELI HOOD AWARD OR ALTERNATE NOBEL PRIZE-f0r 2018

The Ig Nobel Prize 
It is called Ig Nobel prize[]. The Ig Nobel Prizes are organized by the magazine Annals of Improbable Research. The ceremony is co-sponsored by the Harvard-Radcliffe Society of Physics Students and the Harvard-Radcliffe Science Fiction Association. The Ig Nobel Prizes honor achievements that first make people laugh, and then make them think.[ winners since 1991 2016 ] The prizes are intended to celebrate the unusual, honor the imaginative — and spur people's interest in science, medicine[ ] , and technology. Every year, in a gala ceremony in Harvard's university Sanders Theater, 1200 splendidly eccentric spectators watch the winners step forward. This year prize will be given on 14 th September 2017 at Harvard sanders hall . These are physically handed out by genuinely bemused genuine Nobel laureates 
Please see how to nominate a person and who are eligible nominators for 2018 prize For nomination purpose please click on URL You can nominate anyone, (So far very few self-nominees have won a Prize. the first was the team of Baerheim and Sandvik in 1996) Please include enough basic info (Who is the nominee? What, exactly, did they do that makes people LAUGH, then THINK? Where is that documented?) that the Ig Nobel Board of Governors can properly consider the nominee.CONFIDENTIALITY. All nominations are handled in strict confidence. The Ig Nobel Board of Governors prides itself on its incompetence, especially its demonstrated ability to lose all records as to when, where, and how who nominated whom for what. for Rules and regulation how to nominate Click on URL
Will you Please consider yourself to act as a Nominator of Ig Nobel & will like to nominate( for 2018 prize ) the name of Professor Dr Pranab Kumar Bhattacharya for his Published article in the year 2013 titled "Is there science behind the near-death experience: Does human consciousness survives after death?" published in journal Annals of Tropical Medicine and Public Health of AHRO [ The Africa Health Research Organization Publishes the ATMPH & Wolters Kluwer - Medknow assists in the publication] Year : 2013 | Volume : 6 | Issue : 2 | Page : 151-165 date of Publication 14--Aug-2013; DOI: 10.4103/1755-6783.116491 
URL Click for Full Text-:;year=2013;volume=6;issue=2;spage=151;epage=165;aulast=Bhattacharya 
Pranab Kumar Bhattacharya
Department of Pathology, School of Tropical Medicine, 108, C. R. Avenue; Kolkata, West Bengal, India 70973
Correspondence Address now :
Pranab Kumar Bhattacharya
Professor ( on Detailment Post) Department of Pathology, School of Tropical Medicine, 108, C. R. Avenue; Kolkata, West Bengal India
the Email id
The article matrix are Viewed =1,13, 666 ; Printed= 145 Emailed = 5
PDF Downloaded =22 , citations=6 ( Links of citations of this article are given bellow a) Nahtoderlebnisse und Naturwissenschaft Geschrieben von Cornelia Fitsch at News paper UNIQUE citations no 5,9 &13 URL (b) Payton Yerke
Professor Christensen English 2010 21 October 2014 The Science of Ghosts and the Essence of the Human Soul Citation No -1 in bibliography page 12
Pdf File url…/2010-argumentative-2nd-payton-yerke.p… (c) Pdf File URL= (d) article No 16… ( e) at Google Scholar Citations… & [f] at Research gate Citations…/Professor_Pranab_Bhattachary… [G] at Sclit…
Will like/ or Desire To Nominate  Professor Dr.Pranab kumar Bhattacharya for 2018 awards? Any person can nominate as per Rules in  The RIGHT LIVELI HOOD AWARD OR ALTERNATE NOBEL PRIZE
about-the-right-livelihood-award ----> Presented annually in Stockholm, the Right Livelihood Award is usually shared by four Recipients. The prize money shared by all Laureates is SEK 3 million ( in 2017) but not always all Laureates must receive a cash award. Often an Honorary Award is given to a person or group whose work the Jury wishes to recognize but who is not primarily in need of monetary support. The prize money is for ongoing successful work, never for personal use.
Unlike the Nobel Prizes and most other international prizes, the Right Livelihood Award has no specific categories. It recognises that, in striving to meet the human challenges of today’s world, the most inspiring and remarkable work often defies any standard classification.
The Right Livelihood Award is not an award for the world’s top most political, scientific or economic elite, but an award for the people and their work and struggles for a better future. The Laureates come from all walks of life: they are farmers, teachers, doctors, or simply, concerned citizens. The Right Livelihood Award accepts all proposals from everyone through an open nomination process in English .
The presentation of the Right Livelihood Award is only the start of a long relationship between the Laureate and the Foundation. The Foundation sees its role as being the megaphone and shield for the Laureates, and provides them with long-term support.
Proposals, preferably to be written in English, need to be submitted both electronically and also as a paper copy via regular mail to our office in Geneva. Please send only one copy, preferably printed double-sided. If possible, use encrypted email (more information below).
The deadline for submission of proposals to be valid for the 2018 year is March 1 of 2018. Any proposals received after this date will normally be held for consideration in the following year.
Thank you for your co-operation. I look forward to hearing from you for 2018 nomination by last date 1.03.2018
Postal Address to send nomination
Right Livelihood Award Foundation
Geneva office
Maison de la Paix
Chemin Eugène-Rigot 2e, Building 5
1202 Geneva
How to nominate a person please click on (public key 95EDBB19)
The following guidelines are for anyone wishing to propose a candidate( No self nomination is entertained or allowed) for the Right Livelihood Award. Prospective proposers who have not had previous contact with the Foundation are advised to contact us via email with brief information before making a formal nomination submission.
From the Nominator
The proposer should be someone who knows/ may not knows the proposed person/organisation well, is familiar with their aims and goals, and can vouch for their bonafides. No more than one new candidate may be proposed in any one year. The proposer may consult the candidate in advance but may also choose to remain anonymous.
Note: If a proposer chooses not to contact the candidate, please make sure to submit the proposal in good time before the deadline so that the candidate has sufficient time to reply to the questions.
1. Full address, e-mail and phone (if available) of self and proposed candidate.
2. Nature and length of relationship with the candidate, mentioning professional, financial or political links, if any.
3. The proposer's expertise relevant to this proposal, mentioning his/her occupation.
4. Indication, with brief reasons, of whether the proposal is intended for a cash or Honorary Award. The Honorary Award is for candidates whose primary need is not cash support but who would benefit from the considerable recognition and publicity, which the Right Livelihood Award generates.
5. A brief summary (no more than 200 words) of the candidate’s work. This paragraph will be the first information our jury receives about the candidate.
6. A statement setting out in more detail the reasons for the proposal and the candidate's special qualifications for an Award.
7. An assurance that the candidate's work is sufficiently mature to justify a Right Livelihood Award. An Award is likely to generate enquiries, requests for visits etc., from people wanting to learn about the project. We do not expect candidates to have facilities for visitors or for dealing with large numbers of enquiries, but we do expect them to be ready and able to share their knowledge.
8. Wherever possible, information about other individuals/organisations engaged in similar work. Submission of such information by the proposer is very valuable for the jury in order to make a comparative assessment.
9. Wherever possible, the names and contact details of two other qualified individuals or organisations who know the candidate well and who we could contact as references in case we have more questions. At least one of these, again where possible, should come from the candidate's country of residence
please for details read from Wikipedia on Right Livelihood Award
From Wikipedia, the free encyclopedia
So far From India (since 1980-2016) this award was given to followings
1] Lokayan in 1985 2] Ladakh Ecological Development Group / Helena Norberg-Hodge in 1986 3] Chipko movement in 1987 4] Narmada Bachao Andolan in 1991 5] Vandana Shiva writer in 1993 6] People's Science Movement of Kerala (Kerala Sasthra Sahithya Parishad) in 1996 7] Swami Agnivesh / Asghar Ali Engineer in 2003 8 Ruth Manorama in 2006 8] Krishnammal Jagannathan and Sankaralingam Jagannathan LAFTI in 2008
To nominate following links will help-:
For Short Biography of Professor Dr Pranab Kumar Bhattacharya please
click on URL…/18-QR8xcIf2PuCpinhJKI9X3bH4…/edit
 for Achievement and Short Biography of Professor Dr Pranab kumar Bhattacharya  
Please Nominate by E mail and hard copy sending if you like to nominate

Monday, 4 September 2017

The Breakthrough Listen Initiative is undertaking a comprehensive search for radio and optical signatures from extraterrestrial civilizations.

Repeatative Radio burst called FRB was detected on 16 th august 2017 using LDBC band receiver at frequency above 6 GJZ from a red dwarf star of 3 billion light years [ ] indicate what ? Was there more intelligent life then human there in a planet of red dwarf in 3 billion years ago when in earth it was unicellular just ameboid life existed( life in RNA molecular form appeared in earth 5.4 billion years ago) or the burst was from a dwarf star or neutron star ? That started journey 3 billion years past when our observable universe started its journey in 14 billion years past.
The article has been published from the University of Berkeley USA in journal arxiv1707.06024v2 on 29 th August 2017]
we authors also told through our response of Title-""Hello! Are we alone? If you’re like me, you may want to know me"" By Prof. Pranab Kumar Bhattacharya Et al in the News paper ""The Canadian"" as only comment published of the Headline News ""Professor Stephen Hawking warns against alien contact"" Please Click on URL  [ URL] in 2007 and followed by in the thread at cosmoquest forums USA in the threads ""Detecting Alien radio/ TV Signals"Under same title Please Click on  URL […]   in 2007 and   in one book ""review"" Titled  as  ""Concepts in Space Science"" by the  author R.R. Daniel Universities Press, 2002 - Space sciences - 401 pages as ""How much possibility of Civilised Extra Terrestrial life in other Exo planets""in 2015…/Concepts_in_Space_Science.html…
If so were,  we authors were correct in publishing in our  views  in our own Blog i.e in Blogs of professor (Dr.) Pranab Kumar Bhattacharya MD ( cal.univ) pathology " Hello ! Are we alone? If you like me you may want to know me! Please Click on URL […/…] " and in other  blogs article ""How much possibility of Civilised Extra Terrestrial life in other Exo planets[…/… ]  this  article was Sent for journal  publications in followings  
I) Proceedings A. of the Royal Society London  under manuscript ID...RSPA-2010-0432 on 17-Aug-2010 and after External peer Review  the chief editor of RSPA Wrote to
Dear Professor Bhattacharya I am writing to you regarding your original Research  manuscript RSPA-2010-0432 entitled "Title-: Hello! Are we alone? If you're like me, you may want to know me!" which you submitted to the Proceedings A.
Unfortunately your manuscript does not fall within the remit of this journal, and so we are unable to consider your manuscript for publication in Proceedings A.
Thank you for considering Proceedings A for the publication of your original research. I hope the outcome of this specific submission will not discourage you from the submission of future manuscripts.
Yours sincerely Claire Birch
ii)  Next  time  the article was  sent in most famous journal ""Astro Biology"" under manuscript no AST 2015-1344 submitted on 27 th April 2015 status was under peer  review &  on 11 June 2015 Dr S.L Cady wrote to Professor Bhattacharya  in his e mail -: "" we are unable to publish yours original work.... we report  most unique results of experimental ,computational to push the field of science high forward .while yours work appeared to us very interesting but for general public ,given the depth and breadth covered in the manuscript of your research  paper it is not of sufficient rigour to warrant publications in journal  Astrobiology as reviewed and suggested by our peer reviewers and i am enclosing reviewer's with comments to authors
iii)  Next  it was sent at journal ""New Astronomy" it was rejected just on ground of technicals like language as per journals desired standard , authors affiliations,  highlight by 125 character,  citations and No's of tables cite in the text maximum 2 , and proper Copy Right Transfer by e mail to profpkb@ on 25 th April 2014 by administrative support agent( 17 - jan-11) New astronomy
4) Next  At international journal of space science Manuscripts ID no 75 date of submission 07.06.2015 status under review -- no further Response from the journal
If so ,were we authors were correct in publishing in our own blog i.e in Blogs of professor (Dr.) Pranab Kumar Bhattacharya MD ( cal.univ) pathology " Hello ! Are we alone? If you like me you may want to know me!"

Monday, 28 August 2017

Blogs of Professor(Dr.) Pranab Kumar Bhattacharyya MD(calcutta.Univ) Pathology; : ACHIEVEMENT AND VERY SHORT BIOGRAPHY OF PROF.(Dr....




From _:
Prof. Dr.Pranab Kumar Bhattacharya, WBMES 
Professor, Dept. of Pathology, (On Deputation)
Room No.10(c), 2nd floor,
Calcutta School of Tropical Medicine,
108,C.R.Avenue, Kolkata 700 073, West Bengal
                                          TO WHOM IT MAY CONCERN

MBBS from The Medical College, Kolkata”, University of Calcutta, W.B (year January 1981); M.D (in Pathology) from Institute of Post Graduate Medical Education & Research of University of Calcutta (year December 1989), Fellows of Indian College of Pathology (year December 1997), Presently working as “Professor” (on deputation) at Department of Pathology, Calcutta School of Tropical Medicine, Kolkata, West Bengal  & Professor of Pathology at Murshidabad Medical College, Behrampore , West Bengal India. He was Ex-Professor and  Ex- Head of Pathology at Calcutta School of Tropical Medicine and Ex supervisor , convener ,member of Board of Studies for UG/PG/PD and D.C.P (at Calcutta School of Tropical Medicine) course of  West Bengal University of Health Sciences (WBUHS); also Ex Professor & Head of Pathology at Regional Institute of Ophthalmology, The Medical College, Kolkata. He was Additional Professor in pathology at IPGME&R Kolkata and was Professor of West Bengal University of Health Sciences(WBUHS) at University college of Medicine ,Kalyani,  Nadia, West Bengal ( in 2011) . He acquired vast teaching, administrative and also diplomatic experiences in Government services (Both in WBHS and in WBMES),under the Health and Family Welfare department of West Bengal government ,Swasthya Bhavan, Salt lake city, Kolkata -93  , spanning more than  three decades (35 years).He also have credited himself as very much popular and one of the most knowledgeable MCI Recognized Doctoral /Post Graduate teacher; Examiner; MD /PhD Thesis Guide and Adjudicators in discipline Pathology in this country/as well in the state of West Bengal and worked as teacher in Pathology in all capacities in previous five tire promotional system of WBMES cadre he  still belongs  . He has been regularly publishing most spectacular and excellent scientific articles, as Editorials / Review articles/ case reports / as comments / Rapid responses published/ Responses/ Letters to the Editor / Electronic letters/ correspondences/  and  his original research papers in Indian National level and of International level reputed, external double blinded peer reviewed, indexed journals of Biomedicine and of Science, like Physics/  Particle Physics/, Theoretical Physics/, Space Sciences, Astronomy / Astrophysics/ Astro biology journals  with very high or topmost impact factors by Reuter Thomson /ISI/Copernicus/Excerpta Medicus or Elsevier Science/ Research Gate/ Pub Facts/ Pub-lon/ Pub med / Google scholar/ science Gate with his sibling brothers Mr .Rupak Bhattachrya, Mr Ritwick Bhattacharya ,sister  Mrs Dalia Mukherjee and his  daughter Miss Upasana Bhattacharya under his own Intellectual Property Rights (all acts and laws) Copy Right as a registered personal , RDF Copy Right , PIP Copy Right USA  and in Copy Right works, USA . He published 300 Research papers /articles in various journal of National and International repute and in National and International conferences of academic body as Abstracts.
He has more than 148 citations references of his published articles in International Journals; MD/ MS Thesis of WBUHS / or University of Calcutta  and in books chapters by various international authors. He owns  a blog in his name at  Google blogs spot  with more than 210 posts  by himself and his Associate authors . Average viewers of his free blogs articles published are 90000 every year. He was recipient of several (09)  Medals , Prizes of University of Calcutta, 89 Certificates of merits , and Medals of college , and of various academic bodies ,Organizations and many Guest speakers, Chairpersons , Judges of  free and award paper presentation certificates including certificate of his excellences. He is recipient of “Rashtriya Gaurav Award (conferred 2016 August) and” Glory of India Award”( conferred 2016 October), Bharat Ratna  Dr. APJ Abdul Kalam Award for Astronomy ( conferred 2017 January) ; Mother Teresa  Peace Prize ( conferred  2017 May); Mahamta Gandhi Excellence awardconferred 4th October 2017)    from India International Friendship Society (IIFS) of New Delhi, India, and Bangkok  Thailand in 2016 and 2017. He was nominated for the  highest  Awards  likeCoates Medal” of University of Calcutta (  year 1999-2000); “Ranbaxy Research  Award ( 2011)” ; “Padmashree”- Indian highest Civil national award;  BMJ Best Research Award and LaL  Bahadur Shastri  National Award ( in 2017);; He  applied and was  officially nominated  before  the selection and search committees  for the Prestigious Posts of “ The Director of All India Institute of Medical Sciences, New Delhi (  in  year 2013  & in year 2016); Director of  Medical Education Services of West Bengal Sate [ WBMES cadre] (in 2017 )  and Vice chancellor of WBUHS (in  year 2012) West Bengal    He is member or life member of many ( 30) international organizations and acted as nominator for the Noble Prizes; member of  the Royal Swedish academy of Sciences ; member & nominator for Kavoli foundations , Norway,  for Theoretical physics ; nominator for BMJ best awards ;  Ependroff prize of American Association for Advancement of Science; community member of Nobel Peace Prize Forum, Oslo ; member of International Peace Bauru (Indian Division); Nominator for  Emeritus Professor  of National Board of Examinations New Delhi ; Community Members of “The Guardian” News paper UK ; World literature ;  Wall Street Journal USA ;  member of cosmoquest forum org ; BAD Astronomy and Universe Today USA ; Faculty Rows USA as Super Professor ; to name a few such   . He acted as  external peer reviewer or Associate Editor  or Editorial Board members  of many International journals of high repute  for Biomedical  Sciences including of Pathology and Thesis guide, Adjudicators, Paper setters , External / Internal  examiner of DM/ Mch / MD/DCP/PhD/MBBS courses of WBUHS and other many universities of the country India  outside the state of West Bengal . He is the member and Member Secretary of Board of Studies( BOS)  of WBUHS both for UG and PG courses in pathology .  He is the  eldest son of Late Mr. Bholanath Bhattacharya B. Com(honors)  University of Calcutta; FCA; SAS ( 1926-2009)  and Late Mrs. Bani Bhattacharya ( 1935-2006) of 7/51 Purbapally, P.O: Sodepur, Dist.24 Parganas (North), Kolkata-110 West Bengal  and father of Miss Upasana Bhattacharya who is also his co authors in almost all publications  .His spouse is Mrs .Sumita Bhattacharya BSc  MBA  now a Ph.D scholar at JIS University in  the management science and  employee  of LIC india  .

Official Signature of

Professor Dr Pranab kumar Bhattacharya 

Tuesday, 8 August 2017

Mahatma Gandhi Excellance award of India International Friendship Society New Delhi To Prof Dr Pranab kumar Bhattacharya

 Mahatma Gandhi Excellence award of India International Friendship Society 
New Delhi To be Awarded  in4th October 2017 at  new delhi 
 Patrons of the society are
 any News Paper is allowed to print the news 

India International Friendship Society was founded as a non-Profit non-Governmental Organization (NGO)in the year …… on four very strong pillars – friendship, patriotism, commitment and ethical values.The guiding force of the Society is based on the noble philosophy of serving the cause of motherland - headed by one of the most distinguished personalities of India possessing some rare attributes like uprightness and discipline, loyalty and concern - the former CBI Director Sardar Joginder Singh.
The activities of the Society move round the nucleus of patriotism created by the founders. The organization has been relentlessly working towards creating a congenial and healthy environment for the Non-Resident Indians reveal the emotional feelings towards their motherland that they always nurture and actively participate in the developmental projects of the country.

Indians are bestowed with extraordinary talent and skill – which is manifested across the world where Indians stand out in distinction and excellence in their respective fields of activities. The Society has been working with patriotically spirited objective to promote and strengthen greater unity and friendship between resident and non-resident Indians and to create a congenial atmosphere of rapport and closeness as well as greater mutual understanding for the NRIs to invest in Indian projects on industries, services and social welfare.

As appreciation and recognition, the Society also confers prestigious awards to Indian and non-Indian nationals who has made significant contributions in country’s socio-economical developments and glorified the country by their exquisite work anywhere in the world.

Aim & Objects of the society :-

To develop social and cultural cooperation between our progressive people and of all countries.
To honestly share and exchange important evolution between any two countries in culture, education, sports and others.
To arrange conferences, seminars and exhibitions and producing and distributing relevant literature, including books and journals for universal benefit from them.
To celebrate festivals for each other and exchange greetings on such occasions to make friendship more deeper and practical.
To arrange visits of different delegations to friendly countries to meet people in all fields and vocations, including science and technology and education.
To arrange money and other infrastructure for new joint ventures established in close cooperation or help of the other society or its members.
To exchange scientific and technical education.
To arrange meeting with Government Ministries to promote Society's aim and objective.
To act in the best interests of the Government, the country and the members of the Society.
To enroll members throughout the world among people of Indian origin. Person who receive the award will be the member of society.
To establish and develop the international friendship and fraternity and foster the bondage of humanity and service by different schemes and programmes.
To honour its member with "Award and Certificate of Excellence" for outstanding leadership in the field, such as education, medical services, engineering, architecture and other exceptional performance of high order and services. This society, however, reserves the right to present or not to present the Award(s) even after the selection of the candidate without assigning any reasons whatsoever, without being answerable to anyone. No legal or any other action can be taken against the society. The applies to the jurisdiction of Delhi State.
To collect a most reasonable delegate fee from the Awardee, in order to raise the necessary funds. The delegate fee, however, is strictly voluntary and no delegate is under any obligation to pay.
In case any information is lost, the Awardees can collect his Award at a later date from New Delhi.

Thursday, 13 July 2017

Regression of cirrhosis-my current understanding

 Title - : Regression of cirrhosis-my current understanding
Authors  are
*Pranab kumar Bhattacharya; MD (University of Calcutta) FIC path  WBMES *  Sumona MUkherjee * Suvodeep Panda  ** upasana Bhattacharya daughter of. Pranab kumar Bhattacharya ; *** Rupak Bhattacharya BSc( University of Calcutta)  Msc ( Jadavpur University )   ; *** Ritwick Bhattacharya;  ( University of Calcutta) ***. Rupsa Bhattacharya- student  ;****. Dalia Mukherjee BA ( Honors) ( University of Calcutta)   ;**** Ayishi Mukherjee  student ;**** Debasis Mukherjee Bsc ( University of Calcutta)   ; **** Hindole Banerjee BA ( University of Calcutta)   and *****Runa Mitra MA ( University of Calcutta)  

* Professor  Department of Pathology; Murshidabad Medical college ; Berhampore station road; Berhampore court ;  Murshidabad  District ;West Bengal; India and Professor of Pathology(on Deputation)  Calcutta school of Tropical Medicine ; 108 CR Avenue Kolkata-700073 West Bengal
** Associate Professor,  Dept of Pathology , Calcutta School of Tropical Medicine,   108, CR Avenue Kolkata -700073  West Bengal 
*** of all Residents 7/51 purbapalii sodepur 24 parganas north west Bengal India
 **** Swamiji Nagar South Habra North 24 parganas West Bengal India
*****  BK Mitra Palliative  care institute Barrackpore North 24 parganas West Bengal India

Corresponding authors
Pranab kumar Bhattacharya; MD ( University of Calcutta) FIC path  WBMES * Professor  Department of Pathology Murshidabad Medical college Berhampore Murshidabad West Bengal India and Professor of Pathology Calcutta school of Tropical Medicine ; 108 CR Avenue Kolkata-700073 West Bengal  
 Mobile- 9231510435 
Copyright- Belongs to Professor Dr. Pranab  Kumar Bhattacharya as per Copyright Laws of IPR
Abstract -:
 The anatomical and histo pathological   state of chronic liver diseases is a balance between the effects of liver injury and repair  . As cirrhosis develops and progress the fibrous bands tends to be thick and widened with evidence of histological  activity and Cirrhosis  is more of a macro nodular pattern . If the  cause of  ensuing liver injury  is removed or  if effective  treatment of underlying  liver injury diseases are ensured , regeneration of hepatocytes dominates over fibrosis  resulting   enlargement of regenerative nodules and expansion  against septae as well as  lyses of sepate. Nodules surrounded by thin sepate  then  coalesce  first giving rise to  macro nodular  pattern cirrhosis. Incomplete septal cirrhosis  is morphological  land mark  in this dynamic process of regeneration  and repair and thus  these authors  postulate  that  incomplete cirrhosis  is a feature of regressing  cirrhosis  rather than a separate entity  as it was told by Poper H etal in 1966                      
Keyword     Histopathological Sub classification of Cirrhosis; Regression of Cirrhosis, Histological criteria of Regression  of cirrhosis, incomplete Cirrhosis  
Introduction- Cirrhosis is defined as a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally &functionally abnormal nodule. A new patho physiological relevant definition of cirrhosis state and cirrhosis is the collection of anatomic changes in the liver that results from presence of wide spread imbalance of hepatic blood flow where inflow exceeds the outflow capacity in cirrhosis fibrous septea develops when there is formation of parechymal extinction lesions with loss of contagious hepatocytes. Parenchymal  extinction lesions accumulates to form confluent regions of extinctions that results in morphological pattern recognizable of cirrhosis. Activation of hepatic fibroblasts is mediated mainly by inflammatory or congestive mechanism.
So Cirrhosis becomes the end stage of liver fibrosis and it results from a variety of chronic liver insults we know, which includes, congenital, metabolic, toxic, inflammatory and various infective causes and cirrhosis leads to complete  morphologic alteration of liver and switch from lobular to a nodular organization associated with vascular remodeling & biochemical changes

Clinical Staging of Cirrhosis
Clinical Staging of Cirrhosis is based on the factors that predict death. The utility of clinical sub classification is meant mainly for identification of patients who will require liver transplant. Broadly clinically Cirrhosis have been classified as I) compensated cirrhosis II) de-compensated cirrhosis. Now de-compensated cirrhosis is defined by the clinically defected ascities, varicial  hemorrhage, hepatic encephalopathy with jaundice and all these complications results from portal hypertension and or liver cells functional insufficiency. The hepatic venous pressure gradient (HVPG) is used for sub classification and predictor of poor outcome. Advantage of HVPG is that a trans jugular liver biopsy can be obtained during the same procedure, which can help histological & hemodynamic correlations.
Histological sub-classification of Cirrhosis- Though liver biopsy is an invasive procedure and mostly today replaced by fibroscan, however it is still the gold standard for diagnose of liver disorders, for staging of chronic liver diseases and for establishing the diagnosis. Liver biopsy provides more information regarding patho physiology of the diseases and has added advantages that it can be reviewed retrospectively. Several  histopathological features has been evaluated to correlate with severity of chronic liver disease including cirrhosis. The three features which are most important and significant are nodule size, septal fibrosis / and width to correlate with clinical outcome. With increasing severity of liver diseases, the amount of fibrosis increases and parenchymal mass of hepatocytes decreases. Along similar liver, a reported case of conversion from  micronodular to macronodular cirrhosis are associated with clinical improvement.
The Lannec group of expert liver pathologists  first proposed classification of cirrhosis in the following manner-based or nodule size and septal thickness
Stage-4a-: Definite or probable Cirrhosis, Thin Septa, 1(one) broad septum can be allowed.
Stage-4b-: At least two(2) broad Septa, but no very broad septum.
Stage-4c-: At least One( 1) very broad septum or many minute nodules.
Septa are defined as broad when the thickness is equivalent the size of the small module and as very broad septa when the thickness is greater than the size of nodule.
Laennec  system of fibrosis & staging of cirrhosis correlated with not only HVPG but also with severity of varies and ascities. In the Laennc system fibrosis septae  are described as broad when the thickness is equivalent to the size of the nodule and very thick when the thickness is greater than the size of the nodule.
However Nagula et al sub-classified cirrhosis, when they did study on chronic hepatitis C patients showed small nodules and thick septae  were more likely to have HVPG greater than 10mm Hg pressure. In their  study they compared the size of the nodule to width of liver biopsy and showed that small nodules were less than 1mm, large nodules were greater than 2mm, thin septae  were less than 0.2mm and thick septae  were greater than 0.4mm and they devised a scoring system to categorize cirrhosis into Category A and Category B, based on nodule size and septal thickness.
Most Recent Classification system
                The most recent classification was done Jain-Garciawhere the histologic criteria had been better defined in more objective ways. The Jain-Garcia system that their author followed  are based on different histological criteria to classify cirrhosis. For classification of cirrhosis the type of predominant (>2/3 septa)  or nodules in the biopsy is taken into account to classify, otherwise considered as mixed as it is given below
                Nodule                                                                 Septa                                                                    Score
Large Nodule (>2mm)=1                               Thin septae (<0.1mm)=3                                                      <4(Stage-4a)
Mixed Nodules =2                                           Intermediate septae (0.1-0.2mm)=2                4(Stage 4b)
Small Nodules (<1mm)=3                             Thick septae  (>0.2mm)=4                                    >4(Stage4c)
Collagen proportionate is important in sub classifying chronic liver disease for Hepatitis C  patients to be done with Elastic Vangesion Stain(EVG) Stain or Sirius stain . Fibrosis   is expressed  as the area occupied by collagen as a proportion  of total biopsy area referred as collagen proportionate area and collagen proportionate area correlate well with clinically significant portal hypertension. This procedure is done by these  authors  by Sirus Red Stained sections using computer assisted digital imaging technology. However crude assessment of collagen can also be done by a well trained histopathologist in good in good  bi ocular Microscope too.
Why this Sub Classification required?
There are evidences, both in animal models and in human that liver fibrosis and even cirrhosis can be regressed or  completely revert to normal  liver architecture and function, either on cessation of the cause of liver injury or treatment of the underlying cause. In 1979, there was a land mark  published paper in journal Pathology Annual  by Perez Tamzyao, who first described the  evidence for reversal of fibrosis and cirrhosis in both animal model and in human. They demonstrated first that arrest of fibrogenic  stimulus can cause reversion of liver fibrosis induced by CCl4 intoxications or bile duct ligation in rat models . We today know that following antiviral treatment of hepatitis B, a shift from fully developed hepatitis B induced cirrhosis  to incomplete septal cirrhosis . The best demonstration of such reversibility of cirrhosis is demonstrated in patients with hepatitis C virus (HCV) or hepatitis B virus (HBV) cirrhosis treated effectively with drug  sofusbuvir( for genotypes 1, 2, 3, 4, 5, and 6)  or with velpatasvir , or with γ-interferon(peginterferon) , . In additions there are also several reports  of histo pathological proof (Stage 4c cirrhosis) in auto Immune hepatitis , hereditary heamochromotosis, secondary briliary cirrhosis and occasional cases of wilson’s disease.
The morphological features of regressing cirrhosis in human have been defined above. Regression of cirrhosis involves two main processes, namely decrease in fibrosis and repopulation of fibrogenic region by regenerating hepatocytes. There is not decrease of amount fibrous tissue and collagen tissue which may be assessed by sinus red stain followed by computer assisted digital images or by vangision stain and reticulin stain followed by morphometric measurement of fibrous area. There will be thinning of fibrous septa with disappearance of shunting vessels where the septa and septa becomes incomplete gradually thinned out and finally disappear. Bile ductular proliferation will disappear quickly in a regressing liver where as sinusoidal capillaries proliferation and peri sinusoidal fibrosis become inconsistent regression of fibrosis is associated with partial or full restoration lobular organization. There are eight parameters which represent hepatic repair complex or regression of cirrhosis. 1)Perforated delicate septa, 2)isolated thick collagen fibers,3)delicate peri portal fibrous spikes,4) portal tract remnants,5)hepatic vein remnants with prolapsed hepatocytes ,6)hepatocytes within portal tracts or split septa.
 A New Concept of Incomplete Septal Cirrhosis
 Histo pathologically different pattern of Cirrhosis can be described which depends on interplay between hepatocyte injury, regeneration  and fibrosis . Morhphologically Cirrhosis is usally  termed Micronodular or macronodular or mixed type . There is another type of Cirrhosis which was  introduced  by Popper .H etal as incomplete septal cirrohosis(9) – a type of  macronodular  cirrhosis  in which slender  incomplete septae  demarcate  larger inconspicuous  nodules . On needle biopsy of liver  apart from  then  1) incomplete septa  render 2)  a vague nodule  formation  to the liver . Incomplete  Septal cirrohosis  is also associated with 3) Hypoplastic  Portal tract 4) Increase in venous chanels 5) Abnormal spacing between portal  tracts  and veins 6) Crowding of Reticulin fibers between  adjacent zones of Hyperplastic Parenchyma 7) hepatocyte cell plate thickening  8) dilated Sinusiods
 Regression of Cirrohosis is best demonstrated in Chronic Hepatitis B and Chronic Hepatitis C after effective treatment  with drug  sofusbuvir( for genotypes 1, 2, 3, 4, 5, and 6)  or with velpatasvir , with or without Ribavirin  or with γ-interferon(peginterferon) . Regression may be demonstrated  also in Alcoholic cirrohosis  in compensated state after abstinence  of alcohol and with antifibrogenic drugs
 Similarly Histopathological  improvement beween pared liver biopsies  is also observed  after weight loss, hypocaloric diet, Blood sugar control , control of hyperlipidimia   and exercise  in established  NASH  or NAFLD related cirrhosis . There are  many reports  of regression of cirrohosis  in autoimmune hepatitis  after treatment with Prednisilone and Azothiaprine
 In contrast  features of  regressions  have not been yet well established in primary billiary  cirrhosis , primary sclerosing cholangitis  and vascular obliterative  disease
Progression versus Regression  assessment  by pathologists
 As a pathologist  while we authors evaluate liver biopsy  from a case of  established cirrhosis  we must try to evaluate whether cirrhosis is progressive or regressive as per Wanless criteria(10). This should be assessed in paired liver biopsies taken after  significant  time interval of complete treatment. A biopsy Length of at least 2-3 cm or presence of 11 complete portal tract are considered adequate liver biopsy for this purpose
 Enlarged with chronic inflammation & fibrosis
Normal or enlarged , but with fibrosis only
Bile ducts
 Preserved or absent
Usually preserved
 Hepatic Artery
 May be prominent due to formation of vascular shunts
 Prominence of hepatic arterioles persist
Portal veins
 Obscured due to obliterative venopathy
Obscuring portal veins
Interface Activity
 Frequently active interface hepatitis, cholestasis , ductular proliferation
 Fibrous Septa
 With or without bridging: Pattern of septal fibrosis depends on Etiology _: broad inflamed septa in case of viral hepatitis 
More delicate sinusoidal fibrosis in Alcohol, Toxic  and Metabolic conditions
 Thinned delicate ( even bridging) may  exhibit . Discontinuty ,Perforation

Parenchymal Hepatocytes
 May or may not show characteristic histological feature of Etiology
 May be residual feature of underlying cause present
 Hepatic cellular complex

①Kutami R, Girgrah N, Wanless IR etal. The Laennec grading system for assessment of hepatic fibrosis: validation by correlation with wedged hepatic vein pressure as clinical feature.  Heptalogy 32:407A:2000
②Wanless IR,Sweeney G,Dhilon A.P etal “Lack of progressive hepatic Fibrosis during long term therapy with deferiprone in subjects with transfusion dependent Beta Malassemia  Blood .” 100:1566-9:2002.
③Nagula S, Jain D, Groszmann R.J etal- Histological-hemodynamic correlation in cirrhosis- a histological classification of the severity of cirrhosis. J. Hepatol-44:177-7,2006
④Pierre Bedosa, Guadal Pepe-Garcia-Tsao, Dhanpat Jain “Cirrhosis regression and Sub classification.”                Surgical Pathology 6:295-309:2013
⑤Calvaruso V, Burroughs A.K, Standish R etal “computer assessed Image analysis of Liver collagen: relationship to Ishak scoring and hepatic venous pressure gradient” Heptalogy 49.1236-44:2009
⑥Friedman S.L, Bansal MB “reversal of hepatic fibrosis- fact or fantasy? “ Hepatogy 43:82-88:2006
⑦Perez-Tamzyo R ”Cirrhosis of the Liver: a reversible disease? “ Pathol.Annu 14(2):183-213 1979
⑧Czaja A.J, Carpenter HA. Decreased fibrosis during Cortico Steroid Therapy of auto immune hepatitis. J.Hepatol 40:646-52:2004
(9) Poper H  What is the major types of Hepatic Cirrhosis In Ingelflinger F, Relman A ; Finland  M Eds Controversy in Internal Medicine  Philadelphia ,Publishers Saunders  1966 : 233-243

(10)  Wanless I R , Nakashime E, Shirman M  Regression of  Human cirrhosis : Morphological Features and the genesis of incomplete  septal cirrhosis  Arch.Pathol. Lab. Med 12:1599-1607: 2000

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