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Friday, 10 November 2017

Regression of Cirrhosis-My current understanding A New Publication on Cirrhosis of Liver from authors Professor Dr. Pranab Kumar Bhattacharya et al at International Journal of Clinical Pathology of USA ( Medcrave publication )

Regression of Cirrhosis-My current understanding 
Volume 5; Issue 2; - 2017
Copyright:
©2017 Bhattacharya et al.

Authors 
*Pranab kumar Bhattacharya 1; *Sumona MUkherjee 1 * Suvodeep Panda1 ; Upasana Bhattacharya1 Rupak Bhattacharya2; Ritwick Bhattacharya 1; Rupsa Bhattacharya Dalia Mukherjee 1; Ayishi Mukherjee , Debasis Mukherjee1; Hindole Banerjee 1 and Runa Mitra 1
1 University of Calcutta, India
2 University Jadavpur, India
*Corresponding author: Pranab Kumar Bhattacharya,
Professor of Pathology, Murshidabad Medical college, University of Calcutta, Berhampore station road,
Berhampore Court, Murshidabad, West Bengal, India, Tel:
9231510435; Email: profpkb@yahoo.co.in 
Received: July 12, 2017 | Published: November 08, 2017 P 128_132
For Citation: Bhattacharya PK, Mukherjee S, Panda S, Bhattacharya R, Mukherjee D, et al. (2017)
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 [1].
 Cirrhosis is defined as a diffuse process characterised 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 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 detected 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.
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 histo pathological features have 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 micro nodular to macro nodular cirrhosis are associated with clinical improvement. The Lannec group of expert liver pathologists first proposed classification of cirrhosis in the following mannerbased or nodule size and septal thickness [2,3]: 
c. Stage-4c: At least one very broad septum or many minute nodules. 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 [1].  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 Laennec 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 [4]. 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. 
 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 [8]. 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 [9]. 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 [1-6] 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 [9], 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 no decrease of amount fibrous tissue and collagen tissue which may be assessed by sirus 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: a. Perforated delicate septa. b. Isolated thick collagen fibers. c. Delicate peri portal fibrous spikes. d. Portal tract remnants. e. Hepatic vein remnants with prolapsed hepatocytes f. Hepatocytes within portal tracts or split septa.
 Regression of cirrohosis is best demonstrated in Chronic Hepatitis B and Chronic Hepatitis C after effective treatment with drug sofusbuvir [1-6] 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 between 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 2-3cm or presence of 11 complete portal tract are considered adequate liver biopsy for this purpose. General Progression Regression Area 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. Inactive 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. Discontinuity, Perforation. Parenchymal Hepatocytes May or may not show characteristic histological feature of Aetiology. May be residual feature of underlying cause present. Hepatic Cellular Complex Absent Present Conclusion Cirrhosis of liver was considered an irreversible condition. However, many experimental findings and clinical studies have shown regression of cirrhosis is a possibility in some cases. Fibrosis has been implicated as a very important marker for the course of the disease. It is important to properly quantify fibrosis and look for other prognostic parameters in liver biopsies. The need of the hour is more clinical trials for interventions to regress cirrhosis, like antifibrotic agents developed in the light of a greater understanding of the pathophysiology of the cirrhotic process. Conflicts of Interest The author declares there are no conflicts of interest. 


Tuesday, 10 October 2017

Who were in Nominations/or in Predictions of Nobel prize -2017 by Professor Dr. Pranab kumar Bhattacharya in official face book of Nobel Prize.org as in comments sections of the each posts by Nobel prize.org and who were final 12 New Nobel Laureates in 2017!

2017 Nobel prize in Physiology and Medicine
 Professor Dr. Pranab Kumar Bhattacharya  Nominated/ or   Predicted that 2017 Nobel prize in Physiology or Medicine should go to in the face book of Nobel prize.org 

For Medicine Nobel Prize I nominate (1) Professor Denis J Salmon ,Nicholus Lyndon ,Bram J Duker & cheris I for discovery of Imatinib and its use in CML.(2) My second choice is Emmanuel Charpentier for CRISPER/ CAS-9 gene editing for cure of cancer and many gene related disorders (3) and my third choice is for Alexander Y Rudanesky ,Shiman Sakagnchi ,Evan M Shervach for "Treg cells"[ please click on   URL https://www.facebook.com/nobelprize/posts/10154965185294103?pnref=story ]

And The Nobel Prize awarded  to three persons 
 Jeffrey C. Hall Michael Rosbash Michael W. Young   for  Discoveries of Molecular Mechanisms Controlling the Circadian Rhythm

 Press Release -:https://www.nobelprize.org/nobel_prizes/medicine/laureates/2017/announcement.html
 Scientific Back ground-:  https://www.nobelprize.org/nobel_prizes/medicine/laureates/2017/advanced-medicineprize2017.pdf 

after the  Announcement  Professor Pranab Kumar Bhattacharya in face book of Nobel prize.org  as comments  Announcement of the 2017 Nobel Prize in Physiology or Medicine presented by Thomas Perlmann, Secretary of the Nobel Committee.   https://www.facebook.com/nobelprize/videos/10154989467094103/?hc_ref=ARRB_VgOkEDbyKA2-UNNVDQj2HnZ8ptkGHBoAi9fDmEv3IvfgJdI9O1mBIFjG0k_zzU&pnref=story 

 2017 Nobel prize in Physics
Professor Dr Pranab Kumar Bhattacharya  Nominated/ or   Predicted that 2017 Nobel prize in Physiology or Medicine should go to in the face book of Nobel prize.org 


 For The Physics Nobel Prize my nominations are in folowing orders 1) Prof.Alan Guth for cosmic inflation theory in BigBang .( 2) My next choice for Nomination is Mr. Rupak Bhattacharya of his residence 7/51 Purbapalli ,P.O Sodepur,District 24 Parganas ( North,) Kolkata -110, West Bengal, India; for his concept of "Tachyon Particle - a Faster Than Light particle in the Universe"(  under Title-Tachyon - Faster than light particle exist in our universe or an imaginary mathematical particles - Published in international journal of Astronomy ,Astrophysics & Space science 2015:2(3) 12-29 [ V] & in Nature news; and also in science News blogs of AAAS - The American Association for the Advancement of Science [ http://scienceblogs.com/.../faster-than-a-speeding-photon/ ] ) or for his concept of "Multiple Bubble Universe or Parallel Universe " ( under Title -: Schrodinger cats experiments interpretation and parallel universe or multiple universe - Research and Review : journal of space science & Technology vol 5; issue 1; 2016) [http://stmjournals.com/sci/index.php?journal=RRJoSST... ] and or for his concept of "Zero Rest Mass Particles at planks time " ( under title -:where from the mass came in the universe .Did mass originate from a zero rest mass particle in higg's field - published in Research and Review : journal of space science & Technology - vol 5; issue 3 p 42-63;2016 [https://www.slideshare.net/.../research-reviews-journal... ] and in article " Cosmic web,the seeds of galaxies are made of warm intergalactic medium( WHIM) and dark energy - Global journal of science and frontier Research (A) vol 17;issue 1; verson 1; p57-72; 2017)[ https://globaljournals.org/.../E-Journal_GJSFR_(A)_Vol_17... ]; he already published in various indexed international journals of High impact factors like Nature ,science etc  ( 3) My third choice are for Rainer Weises (of MIT) Kip Thron ( of caltech) for LIGO experiment that first showed evidence of ripples of gravitational waves near black holes 

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For the Nobel prize in physics my long years nominations are for 1) Professor Alan Guth for his cosmic inflation theory in Big Bang 2) My next choice and Nominations is Mr.Rupak Bhattacharya-43 years hindu of residence at 7/51 Purbapalli ,P.O- Sodepur, District - 24 Parganas ( north),West Bengal,India for his published concepts on "Tachyon Particles- a FTL particle " in this universe and time travels or for his concepts of " Multiple Bubble Universe and Parallel Universe" and or " Zero Rest Mass Particles " in Planck's epoch he published already in very high impact factor international indexed journals of Astronomy,physics, including in journals like Nature, Science etc. ( 3) My third choice are for Rainer Weises (of MIT) Kip Thron ( of caltech) for LIGO experiment that first showed evidence of ripples of gravitational waves near black holes

https://www.facebook.com/nobelprize/posts/10154973149714103?pnref=story 

  The Nobel prize awarded  to  Rainer Weiss ;  Barry C. Barish Kip S. Thorne  The Nobel Prize in Physics 2017 was divided, one half awarded to Rainer Weiss, the other half jointly to Barry C. Barish and Kip S. Thorne "for decisive contributions to the LIGO detector and the observation of gravitational waves" 
advanced information  https://www.nobelprize.org/nobel_prizes/physics/laureates/2017/advanced-physicsprize2017.pdf 
 For the peace prize my nomination for 2017 is for "Eastern India Palliative care" (EIPC) ( www.eipc.org.uk ) ,its mentor Professor Sankha Suvra Mitra and Mrs Runa Mitra of BKMitra palliative care west Bengal who are pioneer in Palliative care movement in west Bengal odissha state of India at free of costs to cancer ,HIV patients as reform of health care
Palliative care has become an emerging need of the day as the existing health Care in india plays almost no role in the care of chronically I'll patients in India in public and private set up.patients with terminal illness in most cases spend their life in the community among their family and neighbours.so there is need for multidisciplinary team for their cate.

 URl    https://www.facebook.com/nobelprize/photos/a.164901829102.119895.81239734102/10154977364149103/?type=3&theater 
https://www.nobelprize.org/nobel_prizes/peace/laureates/2017/announcement.html 
 The Swedish Academy awarded  Literature Prize to   Kazuo Ishiguro  ""The Nobel Prize in Literature 2017 was awarded to Kazuo Ishiguro "who, in novels of great emotional force, has uncovered the abyss beneath our illusory sense of connection with the world"
https://www.nobelprize.org/nobel_prizes/literature/laureates/2017/press.html 
https://www.nobelprize.org/nobel_prizes/literature/laureates/2017/announcement.html
and after after the  Announcement  of  Literature   Prize  Professor Pranab Kumar Bhattacharya in face book of Nobel prize.org  as comments 

The Sveriges Riksbank Prize in Economic Sciences in Memory of Alfred Nobel  2017

Thursday, 21 September 2017

i -PROCLAIM RESEARCH AWARD -2017( ARA-2017) -3RD ANNUAL RESEARCH AWARD FOR BEST PUBLICATIONS AND GOOGLE CITATIONS AWARDED TO PROF.DR PRANAB KUMARBHATTACHARYA MD(UNIVERSITY OF CALCUTTA) AS LIFE TIME ACHIEVEMENT AWARDS Lifetime Achievement (Awards for Publication Excellence) & Lifetime Achievement (Awards for Publication Citation)






 The  i -PROCLAIM RESEARCH AWARD -2017( ARA-2017) -3RD ANNUAL RESEARCH AWARD FOR BEST PUBLICATIONS AND GOOGLE CITATIONS AWARDED TO PROF.DR PRANAB KUMARBHATTACHARYA MD(UNIVERSITY OF CALCUTTA) AS LIFE TIME ACHIEVEMENT AWARDS Lifetime Achievement (Awards for Publication Excellence) & Lifetime Achievement (Awards for Publication Citation at Google Scholar )

2] Professor Dr Pranab Kumar bhattacharya   please Click on URL
[ http://i-proclaim.my/archive/index.php/ara/article/view/322  ) 
The i-Proclaim Annual Research Awards (ARA), a most prestigious Research Awards program organised by ABC Malaysiahttp://abcmalaysia.com.my/ ] , seeks to recognize and reward the most outstanding performance, talent and effort of the best research contributors, recognized PhD holders and agencies dealt with research and publication in the Asia and global context. The ARA 2017 is patronized & was announced by the i-Proclaim of ABC Malaysia  [   provides publishing support to scholars, scholarly societies and academic institutions for helping them reach out to a wider audience. Registered address: Jalan TK5/13, Taman Mawar Batu 8, 47100 Puchong, Selangor, Malaysia SSM Registration no.: 002508060-A]  and conducted in accordance with the ABC Board Meeting held on July 28, 2017 at Asian Business Consortium & invited nominations from eligible nominators those are in 'Continuous Regular Service in Research or Academic Institution/ Agency' and working on the Frontiers of Business Management, Agricultural Science, Physics ,chemistry ,mathematics, biological science, Engineering, Medical Science, Science, Humanities and Social Science. This award was established in 2015 for the contribution towards the Fundamental Discoveries, New Theories, new patent or Insight have had an Impact on their own discipline and beyond and cutting-edge achievements
2017 AWARDS CEREMONY WILL BE AS Follows -:
DATE AND TIME -:Sun, December 31, 2017 Time 9:00 AM – 3:00 PM Malaysia Time Malaysia (Kuala Lumpur)
LOCATION--: International Islamic University Malaysia; Venue- IIUM Mini Auditorium, Kuala Lumpur, 50728
Malaysia
Nominations received - Total 54
http://i-proclaim.my/archive/index.php/ara/issue/view/54   
Registration cost 
$41.99 – $462.24 
 
STEP 1​
It is similar to the initial process of the screening system. Once your Contribution has been approved, an email notification will be sent to you regarding the verification results..
STEP 2​
Awards for Publication Excellence Competition Nomination Application will be rated by i-Proclaim ARA Independent Judges, total marks 100 for rating. 
STEP 3​
​The Top Rated Nominees will be automatically included as one of the “Awards for Publication Excellence” Nominee, and will be entitled for the announcement & the Winners will be announced at the ARA Ceremony.

 About ARA 2017-:
It is the 3 rd in the series. This year it was open to scholars, academician, professors, Researchers, writter, Patent holders, Designers Engineers physicists, Medical professional in corporate, nonprofits and independent settings


Announcement of Winners --:
1st round Announcement: September 20, 2017
Registration Deadline September 20 to September 29, 2017
2nd round Announcement: September 30, 2017
Registration Deadline September 30 to October 09, 2017
3rd round Announcement: ​October 22  , 2017
Registration Deadline October 10 to October 19, 2017
4th round Announcement: October 20, 2017
Registration Deadline October 20 to October 29, 2017
Final Announcement ​November 01, 2017
Registration Deadline November 01 to November 05, 2017

Note -: This post is  however open for news  reporters in any medias / News Papers ( Bengali news papers, Hindi news papers or English news papers) in West Bengal State or in country India or in other countries  provided a single issue of that News papers  containing the news is to be mailed to Professor Dr.Pranab Kumar Bhattacharya at his e mail box profpkb@ yahoo.co.in if printed as a news