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Enterprising New Yorker Caught Charging Tourists $400 for Free Ferry Ride
A man even bolder than the $30 hot-dog vendor.By Caroline Bankoff
A man even bolder than the $30 hot-dog vendor.By Caroline Bankoff
His campaign team blocked the exits, like rookies.By Adam Martin
She plugged her nose and jumped.By Brett Smiley
Has that ship sailed, er, sunk?By Alyssa Shelasky
And a ship bound for Staten Island.By Noreen Malone
An ex-employee is claiming that sexual harassment ran rampant on the boat.By Joe Coscarelli
He's floating around a game-changing restaurant plan.By Alyssa Shelasky
Emergency crews are responding to the crash at the St. George Terminal.By Adam K. Raymond
MEDIA • What is the New York Police Department's policy for awarding press credentials? Journalists wonder the same thing. [NYT] • Time managing editor Rick Stengel ponders why newspapers endorse political candidates at a time when news consumers doubt the objectivity of the media. [Time] • Details of the deal that Newsweek struck with George W. Bush's former brain have emerged: It's a two-year, sixteen-column contract. [NYO]
Curt Schilling Joins Breitbart
If You're Ever Dissed in a Hacked Email, Try to Respond Like Larry Lessig
New Polls Show More Trouble for Trump and the GOP
Saturday Night Live's 'A Girl's Halloween' Is Too Real
Alec Baldwin's Donald Trump and Kate McKinnon's Hillary Clinton Return to SNL for One Final Debate
Every Episode of Black Mirror, Ranked From Worst to Best
SNL Spoofs the Age-Old Question: How the Hell Is This TV Drama Considered a Comedy?
Taylor Swift Performs 'This Is What You Came For' During Only Concert in 2016, Giving the People That for Which They Came — More or Less
Why Saturday Night Live Destroys Trump, and John Oliver Doesn't
Taylor Swift's Groping-Lawsuit Deposition Released: 'I Remember Being Frantic, Distressed, Feeling Violated in a Way I Had Never Experienced Before'


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ACE Fit Share
Build up your biceps and triceps with these simple arm exercises from the American Council on Exercise. Learn valuable how-to information and get expert fitness advice that will help you strengthen your arm muscle groups including the biceps, triceps and wrists. We have a wide variety of arm strenghtening exercises from the beginner to advanced level including the dumbbell bench press, triceps kick-backs, bicep curls and more. For full workout routines that feature arm exercises, check out our Workouts section.
Fit Life Articles
Popular diet trends sometimes create more questions about certain nutrients than they do answers. This is especially true when it comes to sugar. Knowing how much is too much and the source of sugar can mean a great deal when it comes to managing your health.
While the popularity of high-intensity interval training has been wonderful for our ability to get results from our fitness programs, it has also brought with it an increase in the prevalence of overtraining. ACE pro Jonathan Ross explains why you may be overtraining, yet...
Planning is the name of the game as the school season gets rolling. Change is already in the air, so it's a perfect time to integrate new, healthy eating habits into your household.

subset: commoncrawl


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It's amazing to witness the nonchalance of these guys as they negotiated the narrow winding crowded road, inches away from baby carriages, rock faces and steep plunges. On Monday, she called for a constitutional amendment that would limit unaccountable money in politics. Go karting enthusiasts can head to Dubai Autodrome for some casual yet safe racing as well as ultimate F1 race experience.
The baby boy is third in line in the succession to the throne of Sweden after his mother and his sister. You will find full length videos of big tits, huge tits, fake tits, natural tits, saggy tits, hard tits, black tits, and sun tanned tits, to mention a few. This is unlike a franchise, all you have to do is sell our products and in return we will provide you with a generous amount of discount and then we take care of the rest.
Members Login MENU BBW Videos Plumper Photos XL Specials BBW Models Member Login Join Now Top Rated BBW Videos More Videos ». Why cannot they let the hogs run wild in Siberia (as the Argentines do with cattle on their pampas, (or used to, now apparently it's more economical to herd the animals, feed them in confined spaces). Most people who would once have fit the bill as working class don't define themselves as different from those who define as middle class.


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She Is A Ballerina With Blowing Skills
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Trip Planner : Europe / Spain / Canary Islands / Gran Canaria / Maspalomas / Playa del Ingles / Shopping / Shopping Centre CC Tropical
Shopping Centre CC Tropical, Playa del Ingles
Categories: Gift & Specialty Shops, Shopping
Shopping Centre CC Tropical is located in Playa del Ingles. To visit Shopping Centre CC Tropical on your holiday in Maspalomas, and find out what else Maspalomas has to offer, use our Maspalomas vacation builder.
Create a full itinerary - for free!
going to
Recommend dinner in asian restaurant with beautiful seaview,without changing the place you can party in one of the VIP karaoke rooms then must go to Mood,club with fantastic atmosphere and very known ... read more »
90% der Läden bieten billigsten Chinakitsch oder Fälschungen an! War schon viel in der Welt unterwegs, aber solche Shoppingcenter wie Maspalomas habe ich auch noch nie gesehen!90% of the shops offer cheapest China kitsch or fakes! Was quite a lot in the world, but such shopping centres such as Maspalomas I have never seen!show original
Robert W
Plenty of room to walk around here as it is in a quitter place, St Augustin, about a mile past playa de English. As usual plenty of bars and shops although some seemed to be closed, maybe siesta time?... read more »
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Fairest: The Complete Collection
When she goes into hiding from her evil Aunt Morwenna, the last thing Princess Snow expects is an erotic awakening - but that's exactly what awaits her. After losing her virginity to the hunter Jack, Snow spends a sinfully exciting night with the seven miners who are protecting her. Will Morwenna succeed in taking the crown, or will Snow and her lovers prevail?
Read alsoTop Shelf (BBW Erotic Romance)
When Lana's best friend drags her to Charity Prom, it seems like a waste of an evening - until Lana meets Ian, the sexy bartender. She knows that hot guys like Ian aren't interested in quiet, shy girls like her. All that changes when he asks her to dance. Will he be hers for just a few minutes, or will a steamy night together leave both of them…
This erotic retelling of the Snow White fairy tale contains the following stories:
Hunted - Princess Snow lives a charmed life in the kingdom her parents rule. That all changes when her evil Aunt Morwenna kills her parents in a bid for power. Morwenna pays a hunter named Jack to take Snow into the forest and kill her as well. When he takes pity on her and tells her of the plot, she repays him with the only thing she has left - her virginity.
Hidden - After losing her virginity to the hunter Jack, Princess Snow finds herself lost in the woods. She finds a cottage owned by seven handsome miners and they take her in. A night of revelry results in a confession by Snow and an offer to her new friends. Will they take her up on it, or does she risk losing everything once again?
Saved - After surviving a poisoned apple and overthrowing the evil Queen Morwenna, Princess Snow realizes that she loves Jack the hunter and they plan to marry. However, their passion is interrupted by Snow's nosy Nurse, who takes it upon herself to make sure that the lovers stay apart until they are legally wed. Will they be able to contain themselves until their happily ever after, or will they find a way to slake their thirst for one another before the big day?
This steamy collection is 11,200 words long. Warning: for adults only! Contains explicit first time sex, oral sex, a handjob, sex with multiple partners, and masturbation.


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Oct. 19- Oct. 26
Friday, Oct. 21 vs. Bourbon Co. Senior Night 7:30 PM
Monday, Oct. 24 Freshman Championship
Cross Country
Thursday, Oct. 20 Harrison Co. Invitational Cynthiana CC
Fillies Soccer
Tenth Region Tournament (H)
Wednesday, Oct. 19 vs. winner of Bourbon Co./Brossart 6 PM
Saturday, Oct. 22 Regional Championship 2 PM
Fillies Volleyball
38th District Tournament (H)
Thursday, Oct. 20 Championship 6 PM
Judge Heather Fryman
presiding Oct. 5, 2016
Amanda M. Harrod vs. Brenton A. Harrod, motion hour; (motion for show cause), parties P.S.A. waived child support in lieu of dividing school expenses and fees.
The 1976 graduating class of Bourbon County High School has set Saturday, Oct. 29 from 6-11 p.m., as the date for their 40th class reunion.
It will be held upstairs in the Thyme Cafe annex, across the street from the cafe, at 500 Main St., Paris, Ky.
A social hour will be from 6-7 p.m. and a catered buffet will be served at 7 p.m. A cash bar will also be available.
The year 1966 was a historical one for Harrison Memorial Hospital. Not only was the land purchased for the current hospital location, but construction began shortly after for the new facility on Millersburg Pike. And, in February of that same year, our HMH Auxiliary was formed.
Harrison Memorial Hospital Physical Therapist, Phil Williams, PT, is now Certified Wound Specialist (CWS). This is an important accomplishment achieved through hours of hard work in preparation for the CWS® Examination.
10 years ago . . .
Births announced this week are: Chloe Nicole Hensley, Aug. 15, daughter of Carolina Nicole Honeycutt and Joseph Lee Hensley; Jeremiah Todd Wade, Sept. 13, son of Matthew Todd Wade and Kristy Williamson Wade; Abby Gayle Bruin, Sept. 29, daughter of Chad and Stephanie Bruin; Chloe Lynn Vance, Sept. 23, daughter of Chad and Emily Vance; Savannah Marie Graham, July 18, daughter of David Nick and Mandie Graham; Lukas Ray Jones, Sept. 19, son of Darcey Jones; Tanner Ryan Stroub, Sept. 11, son of Kevin and April Stroub.
Mike Aldridge,
Sports Writer
The Harrison County Thorobreds improved to 5-3, over-all, and 3-0 in district play, with a 35-21 win over Mason County on Friday, in Maysville.
It took a big third quarter both defensively and offensively to accomplish the task.
Tired of waiting in long lines or using personal time to renew your vehicle registration? Have you exhausted time and energy trying to enroll in state traffic school or file your trucking taxes? The Department of Vehicle Regulation (DVR) has announced a more convenient option to provide motorists the services they need while keeping them on the road and out of lines. Visit the newly revamped website http://drive.ky.gov.
Harrison County beats
Bourbon JV/frosh
Monday night was what Harrison County fans hope was a preview of this Friday as the junior varsity/freshman team defeated their Bourbon County counterparts, 20-8.
The Breds scored two rushing touchdowns and one by air to outscore the Colonels. Tyler Watts caught a touchdown throw from Quentin Pratt. Pratt and Keondre Powell each ran for a score for the Breds. Dylan Lewis picked off a pass from Bourbon County for the Breds' defense.
HCMS basketball Fillies end season
THURSDAY, Oct. 13
Berry City Commission will meet Thursday, Oct. 13 at 7 p.m., at Berry City Hall. The meetings are open to the public.
Book Babies. Thursday, Oct. 13 at 10 a.m. at the Cynthiana-Harrison County Public Library. Bring your baby up to 18 months old for a fun time reading, playing, and singing. Library time for our youngest patrons. Pre-registration is appreciated.
Copyright © 2016
The Cynthiana Democrat is your source for local news, sports, events, and information in Cynthiana, KY and the surrounding area.


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Message Subject
Lyme Disease gives you DEPRESSION-Anxiety and Anger.. SUICIDE..GET CHECKED
Poster Handle
Anonymous Coward
Post Content
Just because there is so much disinfo in this thread:
1) The OP is RIGHT.
Lyme can NOT be cured. If you do not be believe him, do your OWN research. The symptoms can be alleviated, and that is the best you can hope for. Once you contract Lyme, the infection is always present. Whether it remains very active, mildly active, or is contained in a sense, your body still carries it.
2) Normal doctors CANNOT test for Lyme. They will claim they can, but they can't. Traditional tests for Lyme are at least 70% inaccurate. This is a medical fact. Again, do your research. I was tested by a traditional doctor, and got a negative. Even though I had the bullseye rash, and all the major symptoms (well, common major symptoms. There are an infinite amount of ways your body will respond to Lyme disease).
Anonymous Coward 801546
I did MY OWN research. It's gone. Period. It's gone.
Believe what you want to believe.
You're probably a half empty glass kind of person, anyway.
Anonymous Coward 26741443
Where did you buy it? How much and how did you take it?
Did you alter your diet or anything else?
Please verify you're human:
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WikiLeaks emails show Clinton and advisers calling liberal heroes "puritanical," "pompous," "naive" and "dumb"
Preparing for Post-Election Social Unrest
Fleet of Android Robots to Begin Policing the Streets by 2017
Exposed Viral Hoaxes Prove How Easy it is to Dupe the World with Disinfo
In an Oligarchy, Voting is a Tool to Manufacture the Illusion of Consent
Court Rules That Defendant's Belief In The "Illuminati" Makes Him Unfit For Trial
Army Major Says "Everything's in Place" to Round Up Antiwar Dissenters for Military Detention
The Psychopathic Elite, Order Followers, And WWIII — YOU Are The Solution
Mystery aluminium object allegedly dates back '250,000 years
REAL OR FAKE? 'Mysterious dragon like creature' filmed flying through Chinese mountains going viral
Archeologists confirm evidence found of "Third Wall" from Second Temple era in Jerusalem
Mysterious hexagonal clouds in Bermuda Triangle behind centuries of bizarre disappearances?
Msterious Objects Spotted above Charlotte, NC Hotel
Fears Of "Dry-Run" Cyber Attack Against United States, Wikileaks Revenge
Facebook Employees Pushed to Remove Trump's Posts as Hate Speech
Pentagon orders soldiers to repay enlistment bonuses
WW3 Has Begun, And It Is Digital: "New World Hackers" Claim Cyber Attack That Took Down Major Sites
House bill seeks to make owning an 'assault weapon' a felony
Facebook co-founder drops unprecedented cash to stop Trump
The World's first biometric fingerprint scanner for newborns has arrived
ACLU Condemns School's salute to cops, Claims it sends "ominous, frightening message"
Twitter Inc. is planning widespread job cuts
Anderson Cooper Calls Project Veritas Action Videos "Damning"
Clinton Campaign Fudged Climate Change Data – Inflated Emission Numbers
Breaking the Black Box: How Machines Learn to Be Racist
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Most Cited Journal of Hepatology Articles
The most cited articles published since 2011, extracted from Scopus.
EASL clinical practice guidelines: Management of chronic hepatitis B virus infection
Volume 57, Issue 1, July 2012, Pages 167-185
EASL-EORTC Clinical Practice Guidelines: Management of hepatocellular carcinomaJosep M. Llovet | Michel Ducreux | Riccardo Lencioni | Adrian M. Di Bisceglie | Peter R. Galle | Jean Francois Dufour | Tim F. Greten | Eric Raymond | Tania Roskams | Thierry De Baere | Vincenzo Mazzaferro | Mauro Bernardi | Jordi Bruix | Massimo Colombo | Andrew Zhu
Volume 56, Issue 4, April 2012, Pages 908-943
EASL clinical practice guidelines: Management of hepatitis C virus infection
Volume 55, Issue 2, August 2011, Pages 245-264
EASL Clinical Practice Guidelines: Management of hepatitis C virus infection
Volume 60, Issue 2, February 2014, Pages 392-420
Triple therapy in treatment-experienced patients with HCV-cirrhosis in a multicentre cohort of the French Early Access Programme (ANRS CO20-CUPIC) - NCT01514890Christophe Hézode | Hélène Fontaine | Céline Dorival | Dominique Larrey | Fabien Zoulim | Valérie Canva | Victor De Ledinghen | Thierry Poynard | Didier Samuel | Marc Bourlière | Jean Pierre Zarski | Jean Jacques Raabe | Laurent Alric | Patrick Marcellin | Ghassan Riachi | Pierre Henri Bernard | Véronique Loustaud-Ratti | Sophie Métivier | Albert Tran | Lawrence Serfaty | Armand Abergel | Xavier Causse | Vincent Di Martino | Dominique Guyader | Damien Lucidarme | Véronique Grando-Lemaire | Patrick Hillon | Cyrille Feray | Thong Dao | Patrice Cacoub | Isabelle Rosa | Pierre Attali | Ventzislava Petrov-Sanchez | Yoann Barthe | Jean Michel Pawlotsky | Stanislas Pol | Fabrice Carrat | Jean Pierre Bronowicki
Volume 59, Issue 3, September 2013, Pages 434-441
Background & Aims In phase III trials, the safety profile of triple therapy (pegylated interferon/ribavirin with boceprevir or telaprevir) seems to be similar in HCV treatment-experienced cirrhotic and non-cirrhotic patients, but few cirrhotics were included. We report the week 16 safety and efficacy analysis in a cohort of compensated cirrhotics treated in the French Early Access Programme. Methods 674 genotype 1 patients, prospectively included, received 48 weeks of triple therapy. The analysis is restricted to 497 patients reaching week 16. Results A high incidence of serious adverse events (40.0%), and of death and severe complications (severe infection or hepatic decompensation) (6.4%), and a difficult management of anaemia (erythropoietin and transfusion use in 50.7% and 12.1%) were observed. Independent predictors of anaemia <8 g/dl or blood transfusion were: female gender (OR 2.19, 95% CI 1.11-4.33, p = 0.024), no lead-in phase (OR 2.25, 95% CI 1.15-4.39, p = 0.018), age ≥65 years (OR 3.04, 95% CI 1.54-6.02, p = 0.0014), haemoglobin level (≤12 g/dl for females, ≤13 g/dl for males) (OR 5.30, 95% CI 2.49-11.5, p = 0.0001). Death or severe complications were related to platelets count ≤100,000/mm3 (OR 3.11, 95% CI 1.30-7.41, p = 0.0105) and albumin <35 g/dl (OR 6.33, 95% CI 2.66-15.07, p = 0.0001), with a risk of 44.1% in patients with both. However, the on-treatment virological response was high. Conclusions The safety profile was poor and patients with platelet count ≤100,000/mm3 and serum albumin <35 g/L should not be treated with the triple therapy. © 2013 European Association for the Study of the Liver.
Hepatocellular carcinoma in non-alcoholic fatty liver disease: An emerging menaceGyörgy Baffy | Elizabeth M. Brunt | Stephen H. Caldwell
Volume 56, Issue 6, June 2012, Pages 1384-1391
Hepatocellular carcinoma (HCC) is a common cancer worldwide that primarily develops in cirrhosis resulting from chronic infection by hepatitis B virus and hepatitis C virus, alcoholic injury, and to a lesser extent from genetically determined disorders such as hemochromatosis. HCC has recently been linked to non-alcoholic fatty liver disease (NAFLD), the hepatic manifestation of obesity and related metabolic disorders such as diabetes. This association is alarming due to the globally high prevalence of these conditions and may contribute to the rising incidence of HCC witnessed in many industrialized countries. There is also evidence that NAFLD acts synergistically with other risk factors of HCC such as chronic hepatitis C and alcoholic liver injury. Moreover, HCC may complicate non-cirrhotic NAFLD with mild or absent fibrosis, greatly expanding the population potentially at higher risk. Major systemic and liver-specific molecular mechanisms involved include insulin resistance and hyperinsulinemia, increased TNF signaling pathways, and alterations in cellular lipid metabolism. These provide new targets for prevention, early recognition, and effective treatment of HCC associated with NAFLD. Indeed, both metformin and PPAR gamma agonists have been associated with lower risk and improved prognosis of HCC. This review summarizes current evidence as it pertains to the epidemiology, pathogenesis, and prevention of NAFLD-associated HCC. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Endoplasmic reticulum stress in liver diseaseHarmeet Malhi | Randal J. Kaufman
Volume 54, Issue 4, April 2011, Pages 795-809
The unfolded protein response (UPR) is activated upon the accumulation of misfolded proteins in the endoplasmic reticulum (ER) that are sensed by the binding immunoglobulin protein (BiP)/glucose-regulated protein 78 (GRP78). The accumulation of unfolded proteins sequesters BiP so it dissociates from three ER-transmembrane transducers leading to their activation. These transducers are inositol requiring (IRE) 1α, PKR-like ER kinase (PERK), and activating transcription factor (ATF) 6α. PERK phosphorylates eukaryotic initiation factor 2 alpha (eIF2α) resulting in global mRNA translation attenuation, and concurrently selectively increases the translation of several mRNAs, including the transcription factor ATF4, and its downstream target CHOP. IRE1α has kinase and endoribonuclease (RNase) activities. IRE1α autophosphorylation activates the RNase activity to splice XBP1 mRNA, to produce the active transcription factor sXBP1. IRE1α activation also recruits and activates the stress kinase JNK. ATF6α transits to the Golgi compartment where it is cleaved by intramembrane proteolysis to generate a soluble active transcription factor. These UPR pathways act in concert to increase ER content, expand the ER protein folding capacity, degrade misfolded proteins, and reduce the load of new proteins entering the ER. All of these are geared toward adaptation to resolve the protein folding defect. Faced with persistent ER stress, adaptation starts to fail and apoptosis occurs, possibly mediated through calcium perturbations, reactive oxygen species, and the proapoptotic transcription factor CHOP. The UPR is activated in several liver diseases; including obesity associated fatty liver disease, viral hepatitis, and alcohol-induced liver injury, all of which are associated with steatosis, raising the possibility that ER stress-dependent alteration in lipid homeostasis is the mechanism that underlies the steatosis. Hepatocyte apoptosis is a pathogenic event in several liver diseases, and may be linked to unresolved ER stress. If this is true, restoration of ER homeostasis prior to ER stress-induced cell death may provide a therapeutic rationale in these diseases. Herein we discuss each branch of the UPR and how they may impact hepatocyte function in different pathologic states. © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
EASL clinical practical guidelines: Management of alcoholic liver disease
Volume 57, Issue 2, August 2012, Pages 399-420
Hepatitis B surface antigen quantification: Why and how to use it in 2011 - A core group reportHenry Lik Yuen Chan | Alex Thompson | Michelle Martinot-Peignoux | Teerha Piratvisuth | Markus Cornberg | Maurizia Rossana Brunetto | Hans L. Tillmann | Jia Horng Kao | Ji Dong Jia | Heiner Wedemeyer | Stephen Locarnini | Harry L A Janssen | Patrick Marcellin
Volume 55, Issue 5, November 2011, Pages 1121-1131
Quantitative HBsAg had been suggested to be helpful in management of HBV, but assays were cumbersome. The recent availability of commercial quantitative assays has restarted the interest in quantitative serum hepatitis B surface antigen (HBsAg) as a biomarker for prognosis and treatment response in chronic hepatitis B. HBsAg level reflects the transcriptional activity of cccDNA rather than the absolute amount of cccDNA copies. Serum HBsAg level tends to be higher in hepatitis B e antigen (HBeAg)-positive than HBeAg-negative patients. Among patients with a low HBV DNA (<2000 IU/ml), HBsAg <1000 IU/ml in genotype D HBV infection and HBsAg <100 IU/ml in genotype B/C HBV infection is associated with inactive carrier state in HBeAg-negative patients. The HBsAg reduction by nucleos(t)ide analogues (NA) is not as pronounced as by interferon treatment. On peginterferon treatment, sustained responders tend to show greater HBsAg decline than the non-responders. The optimal on-treatment HBsAg cutoff to predict response needs further evaluation in HBeAg-positive patients, but an absence of HBsAg decline together with a <2 log reduction in HBV DNA at week 12 can serve as stopping rule in HBeAg-negative patients with genotype D HBV infection. A rapid serum HBsAg decline during NA therapy may identify patients who will clear HBsAg in the long-term. There are early reports among Asian patients that an HBsAg level of <100 IU/ml might predict lower risk of relapse after stopping NA treatment. In clinical practice, serum HBsAg level should be used together with, but not as a substitute for, HBV DNA. © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Omega-3 supplementation and non-alcoholic fatty liver disease: A systematic review and meta-analysisHelen M. Parker | Nathan A. Johnson | Catriona A. Burdon | Jeffrey S. Cohn | Helen T. O'Connor | Jacob George
Volume 56, Issue 4, April 2012, Pages 944-951
Non-alcoholic fatty liver disease (NAFLD) is a frequent accompaniment of obesity and insulin resistance. With the prevalence approaching 85% in obese populations, new therapeutic approaches to manage NAFLD are warranted. A systematic search of the literature was conducted for studies pertaining to the effect of omega-3 polyunsaturated fatty acid (PUFA) supplementation on NAFLD in humans. Primary outcome measures were liver fat and liver function tests: alanine aminotransferase (ALT) and aspartate aminotransferase [1]. Data were pooled and meta-analyses conducted using a random effects model. Nine eligible studies, involving 355 individuals given either omega-3 PUFA or control treatment were included. Beneficial changes in liver fat favoured PUFA treatment (effect size = -0.97, 95% CI: -0.58 to -1.35, p <0.001). A benefit of PUFA vs. control was also observed for AST (effect size = -0.97, 95% CI: -0.13 to -1.82, p = 0.02). There was a trend towards favouring PUFA treatment on ALT but this was not significant (effect size = -0.56, 95% CI: -1.16 to 0.03, p = 0.06). Sub-analyses of only randomised control trials (RCTs) showed a significant benefit for PUFA vs. control on liver fat (effect size = -0.96, 95% CI: -0.43 to -1.48, p <0.001), but not for ALT (p = 0.74) or AST (p = 0.28). There was significant heterogeneity between studies. The pooled data suggest that omega-3 PUFA supplementation may decrease liver fat, however, the optimal dose is currently not known. Well designed RCTs which quantify the magnitude of effect of omega-3 PUFA supplementation on liver fat are needed. © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
A prospective and open-label study for the efficacy and safety of telbivudine in pregnancy for the prevention of perinatal transmission of hepatitis B virus infectionGuo Rong Han | Min Kai Cao | Wei Zhao | Hong Xiu Jiang | Cui Min Wang | Shu Fen Bai | Xin Yue | Gen Ju Wang | Xun Tang | Zhi Xun Fang
Volume 55, Issue 6, December 2011, Pages 1215-1221
Background & Aims: In the Asia-Pacific region, perinatal transmission of the hepatitis B virus (HBV) is the primary cause of chronic hepatitis B infection. Despite the use of HBIG and HBV vaccination, HBV perinatal transmission (PT) occurs in 10-30% of infants born to highly viremic mothers. We evaluated the efficacy and safety of LTD use during late pregnancy in reducing HBV transmission in highly viremic HBeAg+ mothers. Methods: Two hundred and twenty-nine HBeAg+ HBV DNA levels >1.0 × 10 7 copies/ml mothers received telbivudine 600 mg/day from week 20 to 32 of gestation (n = 135) or served as untreated controls (n = 94). All infants in both arms received 200 IU of HBIg within 12 h postpartum and recombinant HBV vaccine of 20 μg at 0, 1, and 6 months. HBsAg and HBV DNA results of infants at week 28 were used to determine perinatal transmission rate. All telbivudine treated subjects were registered in the Antiretroviral Pregnancy Registry. Results: Telbivudine treatment was associated with a marked reduction in serum HBV DNA and hepatitis B e antigen (HBeAg) levels and normalization of elevated ALT levels before delivery. A striking decline of HBV DNA levels started from treatment onset to week 4, and sustained in a low level since week 12. Forty-four (33%) of the 135 telbivudine-treated mothers and none (0%) of the untreated controls had polymerase chain reaction-undetectable viremia (DNA <500 copies/ml) at delivery. Seven months after delivery, the incidence of perinatal transmission was lower in the infants that completed follow-up born to the telbivudine-treated mothers than to the controls (0% vs. 8%; p = 0.002). HBV DNA levels were only detectable in HBsAg+ infants. No significant differences in anti-HBs levels were observed during postnatal follow-up. No serious adverse events were noted in the telbivudine-treated mothers or their infants. Conclusions: Telbivudine used during pregnancy in CHB HBeAg+ highly viremic mothers can safely reduce perinatal HBV transmission. Telbivudine was well-tolerated with no safety concerns in the telbivudine-treated mothers or their infants on short term follow up. These data support the use of telbivudine in this special population. © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Survival of patients with hepatocellular carcinoma treated by transarterial chemoembolisation (TACE) using Drug Eluting Beads. Implications for clinical practice and trial designMarta Burrel | María Reig | Alejandro Forner | Marta Barrufet | Carlos Rodríguez De Lope | Silvia Tremosini | Carmen Ayuso | Josep M. Llovet | María Isabel Real | Jordi Bruix
Volume 56, Issue 6, June 2012, Pages 1330-1335
Background & Aims: Transarterial chemoembolisation (TACE) improves survival of properly selected patients with hepatocellular carcinoma (HCC). Drug eluting beads (DEB) provide a calibrated and homogenous procedure while increasing efficacy. Outcome data applying this technology is lacking, and this is instrumental for clinical decision-making and for trial design. We evaluated the survival of HCC patients treated with DEB-TACE following a strict selection (preserved liver function, absence of symptoms, extrahepatic spread or vascular invasion). Methods: We registered baseline characteristics, the development of treatment-related adverse events, and the overall survival of all HCC patients treated by DEB-TACE from February 2004 to June 2010. Results: One hundred and four patients were treated with DEB-TACE. All but one were cirrhotic, 62.5% HCV+, 95% Child-Pugh A, 41 BCLC-A and 63 BCLC-B. Causes of DEB-TACE treatment in BCLC-A patients were: 35 unfeasible ablation, and six post-treatment recurrences. After a median follow-up of 24.5 months, 38 patients had died, two patients had received transplantation and 24 had received sorafenib because of untreatable tumour progression. Median survival of the cohort was 48.6 months (95% CI: 36.9-61.2), while it was 54.2 months in BCLC stage A and 47.7 months in stage B. Median survival after censoring follow-up at time of transplant/sorafenib was 47.7 (95% CI: 37.9-57.5) months. Conclusions: These data validate the safety of DEB-TACE and show that the survival expectancy applying current selection criteria and technique is better than that previously reported. A 50% survival at 4 years should be considered when suggesting treatment for patients fitting into controversial scenarios such as expanded criteria for transplantation/resection for multifocal HCC. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Management of HCCCarlos Rodríguez De Lope | Silvia Tremosini | Alejandro Forner | María Reig | Jordi Bruix
Volume 56, Issue SUPPL. 1, February 2012, Page
Hepatocellular carcinoma (HCC) is a highly prevalent and lethal neoplasia, the management of which has significantly improved during the last few years. A better knowledge of the natural history of the tumor and the development of staging systems that stratify patients according to the characteristics of the tumor, the liver disease, and the performance status, such as the BCLC (Barcelona Clinic Liver Cancer) system, have led to a better prediction of prognosis and to a most appropriate treatment approach. Today curative therapies (resection, transplantation, ablation) can improve survival in patients diagnosed at an early HCC stage and offer a potential long-term cure. Patients with intermediate stage HCC benefit from chemoembolization and those diagnosed at advanced stage benefit from sorafenib, a multikinase inhibitor with antiangiogenic and antiproliferative effects. In this article we review the current management in HCC and the new advances in this field. © 2012 European Association for the Study of the Liver.
Global epidemiology and genotype distribution of the hepatitis C virus infectionErin Gower | Chris Estes | Sarah Blach | Kathryn Razavi-Shearer | Homie Razavi
Volume 61, Issue 1, January 2014, Pages S45-S57
© 2014 European Association for the Study of the Liver.The treatment of chronic hepatitis C virus (HCV) infection has the potential to change significantly over the next few years as therapeutic regimens are rapidly evolving. However, the burden of chronic infection has not been quantified at the global level using the most recent data. Updated estimates of HCV prevalence, viremia and genotypes are critical for developing strategies to manage or eliminate HCV infection. To achieve this, a comprehensive literature search was conducted for anti-HCV prevalence, viraemic prevalence and genotypes for all countries. Studies were included based on how well they could be extrapolated to the general population, sample size and the age of the study. Available country estimates were used to develop regional and global estimates. Eighty-seven countries reported anti-HCV prevalence, while HCV viraemic rates were available for fifty-four countries. Total global viraemic HCV infections were estimated at 80 (64-103) million infections. Genotype distribution was available for ninety-eight countries. Globally, genotype 1 (G1) was the most common (46%), followed by G3 (22%), G2 (13%), and G4 (13%). In conclusion, the total number of HCV infections reported here are lower than previous estimates. The exclusion of data from earlier studies conducted at the peak of the HCV epidemic, along with adjustments for reduced prevalence among children, are likely contributors. The results highlight the need for more robust surveillance studies to quantify the HCV disease burden more accurately.
Lifestyle interventions for the treatment of non-alcoholic fatty liver disease in adults: A systematic reviewChristian Thoma | Christopher P. Day | Michael I. Trenell
Volume 56, Issue 1, January 2012, Pages 255-266
Non-alcoholic fatty liver disease is a serious and growing clinical problem. Despite lifestyle modification, i.e. diet and physical activity, being the recommended therapy, there are currently no systematic evaluations of its efficacy. This review applies a systematic approach to evaluating lifestyle modifications studied to date. Medline (Pubmed), Scopus, and the Cochrane Controlled Trials Register were searched for studies and study groups assessing the effect of diet, physical activity, and/or exercise modification in adult populations with non-alcoholic fatty liver disease. The outcome markers of interest were indicators of steatosis, histological evidence of inflammation and fibrosis, and glucose control/insulin sensitivity. We identified 23 studies for inclusion; seven had control groups, but only six were randomised. Eleven groups received diet-only interventions, two exercise-only, and 19 diet and physical activity/exercise. Studies consistently showed reductions in liver fat and/or liver aminotransferase concentration, with the strongest correlation being with weight reduction. Of the 5 studies reporting changes in histopathology, all showed a trend towards reduction in inflammation, in 2 this was statistically significant. Changes in fibrosis were less consistent with only one study showing a significant reduction. The majority of studies also reported improvements in glucose control/insulin sensitivity following intervention. However, study design, definition of disease, assessment methods, and interventions varied considerably across studies. Lifestyle modifications leading to weight reduction and/or increased physical activity consistently reduced liver fat and improved glucose control/insulin sensitivity. Limited data also suggest that lifestyle interventions may hold benefits for histopathology. © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Antiviral strategies in hepatitis C virus infectionChristoph Sarrazin | Christophe Hézode | Stefan Zeuzem | Jean Michel Pawlotsky
Volume 56, Issue SUPPL. 1, February 2012, Page
Resolution of the three-dimensional structures of several hepatitis C virus (HCV) proteins, together with the development of replicative cell culture systems, has led to the identification of a number of potential targets for direct-acting antiviral (DAA) agents. Numerous families of drugs that potently inhibit the HCV lifecycle in vitro have been identified, and some of these molecules have reached early to late clinical development. Two NS3/4A protease inhibitors, telaprevir and boceprevir, were approved in Europe and the United States in 2011 in combination with pegylated interferon (IFN)-α and ribavirin for the treatment of chronic hepatitis C related to HCV genotype 1, in both treatment-naïve and treatment-experienced patients. Sustained virological response rates in the range of 6675 and 5966 (2988 if the response to the first course of therapy is taken into account) have been achieved in these two patient populations, respectively, with treatment durations of 24 to 48 weeks. A number of other DAAs are at the clinical developmental stage in combination with pegylated IFN-α and ribavirin or with other DAAs in IFN-free regimens, with or without ribavirin. They include second-wave, first-generation, and second-generation NS3/4A protease inhibitors, nucleoside/nucleotide analogue inhibitors and non-nucleoside inhibitorsof HCVRNA-dependent RNA polymerase, inhibitors of nonstructural protein 5A (NS5A) and host-targeted compounds, such as cyclophilin inhibitors and silibinin. The proof of concept that IFN-free regimens may lead to HCV eradication has recently been brought. However, new drugs may be associated with troublesome side effects and drugdrug interactions, and the ideal IFN-free DAA combination remains to be found. © 2012 European Association for the Study of the Liver.
EASL Recommendations on Treatment of Hepatitis C 2015
Volume 63, Issue 1, January 2015, Pages 199-236
The interaction of hepatic lipid and glucose metabolism in liver diseasesLars P. Bechmann | Rebekka A. Hannivoort | Guido Gerken | Gökhan S. Hotamisligil | Michael Trauner | Ali Canbay
Volume 56, Issue 4, April 2012, Pages 952-964
It is widely known that the liver is a central organ in lipogenesis, gluconeogenesis and cholesterol metabolism. However, over the last decades, a variety of pathological conditions highlighted the importance of metabolic functions within the diseased liver. As observed in Western societies, an increase in the prevalence of obesity and the metabolic syndrome promotes pathophysiological changes that cause non-alcoholic fatty liver disease (NAFLD). NAFLD increases the susceptibility of the liver to acute liver injury and may lead to cirrhosis and hepatocellular cancer. Alterations in insulin response, β-oxidation, lipid storage and transport, autophagy and an imbalance in chemokines and nuclear receptor signaling are held accountable for these changes. Furthermore, recent studies revealed a role for lipid accumulation in inflammation and ER stress in the clinical context of liver regeneration and hepatic carcinogenesis. This review focuses on novel findings related to nuclear receptor signaling - including the vitamin D receptor and the liver receptor homolog 1 - in hepatic lipid and glucose uptake, storage and metabolism in the clinical context of NAFLD, liver regeneration, and cancer. © 2011 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Dual oral therapy with daclatasvir and asunaprevir for patients with HCV genotype 1b infection and limited treatment optionsYoshiyuki Suzuki | Kenji Ikeda | Fumitaka Suzuki | Joji Toyota | Yoshiyasu Karino | Kazuaki Chayama | Yoshiiku Kawakami | Hiroki Ishikawa | Hideaki Watanabe | Wenhua Hu | Timothy Eley | Fiona McPhee | Eric Hughes | Hiromitsu Kumada
Volume 58, Issue 4, April 2013, Pages 655-662
Background & Aims Improved therapeutic options for chronic hepatitis C virus (HCV) infection are needed for patients who are poor candidates for treatment with current regimens due to anticipated intolerability or low likelihood of response. Methods In this open-label, phase 2a study of Japanese patients with chronic HCV genotype 1b infection, 21 null responders (<2 log10 HCV RNA reduction after 12 weeks of peginterferon/ribavirin) and 22 patients intolerant to or medically ineligible for peginterferon/ ribavirin therapy received dual oral treatment for 24 weeks with the NS5A replication complex inhibitor daclatasvir (DCV) and the NS3 protease inhibitor asunaprevir (ASV). The primary efficacy end point was sustained virologic response at 12 weeks post-treatment (SVR12). Results Thirty-six of 43 enrolled patients completed 24 weeks of therapy. Serum HCV RNA levels declined rapidly, becoming undetectable in all patients on therapy by week 8. Overall, 76.7% of patients achieved SVR12 and SVR24, including 90.5% of null responders and 63.6% of ineligible/intolerant patients. There were no virologic failures among null responders. Three ineligible/intolerant patients experienced viral breakthrough and four relapsed post-treatment. Diarrhea, nasopharyngitis, headache, and ALT/AST increases, generally mild, were the most common adverse events; three discontinuations before week 24 were due to adverse events that included hyperbilirubinemia and transaminase elevations (two patients). Conclusions Dual therapy with daclatasvir and asunaprevir, without peginterferon/ribavirin, was well tolerated and achieved high SVR rates in two groups of difficult-to-treat patients with hepatitis C virus genotype 1b infection. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Elastography for the diagnosis of severity of fibrosis in chronic liver disease: A meta-analysis of diagnostic accuracyE. A. Tsochatzis | K. S. Gurusamy | S. Ntaoula | E. Cholongitas | B. R. Davidson | A. K. Burroughs
Volume 54, Issue 4, April 2011, Pages 650-659
Background & Aims: Transient elastography is a non-invasive method, for the assessment of hepatic fibrosis, developed as an alternative to liver biopsy. We studied the performance of elastography for diagnosis of fibrosis using meta-analysis. Methods: MEDLINE, EMBASE, SCI, Cochrane Library, conference abstracts books, and article references were searched. We included studies using biopsy as a reference standard, with the data necessary to calculate the true and false positive, true and false negative diagnostic results of elastography for a fibrosis stage, and with a 3-month maximum interval between tests. The quality of the studies was rated with the QUADAS tool. Results: We identified 40 eligible studies. Summary sensitivity and specificity was 0.79 (95% CI 0.74-0.82) and 0.78 (95% CI 0.72-0.83) for F2 stage and 0.83 (95% CI 0.79-0.86) and 0.89 (95% CI 0.87-0.91) for cirrhosis. After an elastography result at/over the threshold value for F2 or cirrhosis ("positive" result), the corresponding post-test probability for their presence (if pre-test probability was 50%) was 78%, and 88% respectively, while, if values were below these thresholds ("negative" result), the post-test probability was 21% and 16%, respectively. No optimal stiffness cut-offs for individual fibrosis stages were validated in independent cohorts and cut-offs had a wide range and overlap within and between stages. Conclusions: Elastography theoretically has good sensitivity and specificity for cirrhosis (and less for lesser degrees of fibrosis); however, it should be cautiously applied to everyday clinical practice because there is no validation of the stiffness cut-offs for the various stages. Such validation is required before elastography is considered sufficiently accurate for non-invasive staging of fibrosis. © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Decoding cell death signals in liver inflammationCatherine Brenner | Lorenzo Galluzzi | Oliver Kepp | Guido Kroemer
Volume 59, Issue 3, September 2013, Pages 583-594
Inflammation can be either beneficial or detrimental to the liver, depending on multiple factors. Mild (i.e., limited in intensity and destined to resolve) inflammatory responses have indeed been shown to exert consistent hepatoprotective effects, contributing to tissue repair and promoting the re-establishment of homeostasis. Conversely, excessive (i.e., disproportionate in intensity and permanent) inflammation may induce a massive loss of hepatocytes and hence exacerbate the severity of various hepatic conditions, including ischemia-reperfusion injury, systemic metabolic alterations (e.g., obesity, diabetes, non-alcoholic fatty liver disorders), alcoholic hepatitis, intoxication by xenobiotics and infection, de facto being associated with irreversible liver damage, fibrosis, and carcinogenesis. Both liver-resident cells (e.g., Kupffer cells, hepatic stellate cells, sinusoidal endothelial cells) and cells that are recruited in response to injury (e.g., monocytes, macrophages, dendritic cells, natural killer cells) emit pro-inflammatory signals including - but not limited to - cytokines, chemokines, lipid messengers, and reactive oxygen species that contribute to the apoptotic or necrotic demise of hepatocytes. In turn, dying hepatocytes release damage-associated molecular patterns that-upon binding to evolutionary conserved pattern recognition receptors-activate cells of the innate immune system to further stimulate inflammatory responses, hence establishing a highly hepatotoxic feedforward cycle of inflammation and cell death. In this review, we discuss the cellular and molecular mechanisms that account for the most deleterious effect of hepatic inflammation at the cellular level, that is, the initiation of a massive cell death response among hepatocytes. © 2013 European Association for the Study of the Liver.
The burden of liver disease in Europe: A review of available epidemiological dataMartin Blachier | Henri Leleu | Markus Peck-Radosavljevic | Dominique Charles Valla | Françoise Roudot-Thoraval
Volume 58, Issue 3, March 2013, Pages 593-608
To survey the burden of liver disease in Europe and its causes 260 epidemiological studies published in the last five years were reviewed. The incidence and prevalence of cirrhosis and primary liver cancer are key to understand the burden of liver disease. They represent the end-stage of liver pathology and thus are indicative of the associated mortality. About 0.1% of Hungarian males will die of cirrhosis every year compared with 0.001% of Greek females. WHO estimate that liver cancer is responsible for around 47,000 deaths per year in the EU. Harmful alcohol consumption, viral hepatitis B and C and metabolic syndromes related to overweight and obesity are the leading causes of cirrhosis and primary liver cancer in Europe. Chronic hepatitis B affects 0.5-0.7% of the European population. In the last decade the prevalence of chronic hepatitis C was 0.13-3.26%. It is of great concern that about 90% of people in Europe infected by viral hepatitis are unaware of their status. Available data suggest the prevalence rate of NAFLD is 2-44% in the general European population (including obese children) and 42.6-69.5% in people with type 2 diabetes. Each of these four major causes of liver disease is amenable to prevention and treatment, reducing the burden of liver disease in Europe and saving lives. Further surveys are urgently needed to implement cost-effective prevention programmes and novel treatments to tackle this problem.
Hepatitis C virus resistance to protease inhibitorsPhilippe Halfon | Stephen Locarnini
Volume 55, Issue 1, July 2011, Pages 192-206
Recent advances in molecular biology have led to the development of novel small molecules that target specific viral proteins of the hepatitis C virus (HCV) life cycle. These drugs, collectively termed directly acting antivirals (DAA) against HCV, include a range of non-structural (NS) 3/NS4A protease, NS5B polymerase, and NS5A inhibitors at various stages of clinical development. The rapid replication rate of HCV, along with the low fidelity of its polymerase, gives rise to generations of mutations throughout the viral genome resulting in remarkable sequence variation in the HCV population, known as a quasispecies. The efficacy of DAAs is limited by the presence of those mutations that give rise to amino-acid substitutions within the targeted protein, and that affect the viral sensitivity to these compounds. Thus, due to the high genetic variability of HCV, variants with reduced susceptibility to DAA can occur naturally even before treatment begins, but usually at low levels. Not surprisingly then, these changes are selected in patients either breaking through or not responding to potent DAA treatment. In vitro or in vivo, six major position mutations in the NS3 HCV protease (36, 54, 155, 156, 168, and 170) have now been reported associated with different levels of resistance. The amino acid composition at several of the drug resistance sites can vary between the HCV genotypes/subtypes, resulting in different consensus amino acids leading to a reduction in replicative fitness as well as reduced DAA sensitivity. Different amino acid diversity profiles for HCV genotypes/subtypes suggest differences in the position/type of immune escape and drug resistance mutations. Also, different pathways of resistance profiles based on the chemical scaffold (linear or macrocyclic) of the protease inhibitors have been described. This review first describes how resistance to a protease inhibitor can develop and then provides an overview of the mechanism of how particular mutations confer varying levels of resistance to protease inhibitor, which have been identified and characterized using both genotypic and phenotypic tools. Future potential therapeutic strategies to assist patients who do develop resistance to protease inhibitors are also outlined. The challenge developing new HCV protease inhibitors should take into consideration not only the antiviral potency of the drugs, the occurrence and importance of side effects, the frequency of oral administration, but also the resistance profiles of these agents. © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Vitamin D deficiency and a CYP27B1-1260 promoter polymorphism are associated with chronic hepatitis C and poor response to interferon-alfa based therapyChristian Markus Lange | Jörg Bojunga | Elizabeth Ramos-Lopez | Michael Von Wagner | Angela Hassler | Johannes Vermehren | Eva Herrmann | Klaus Badenhoop | Stefan Zeuzem | Christoph Sarrazin
Volume 54, Issue 5, May 2011, Pages 887-893
Background & Aims: Vitamin D is an important immune modulator and preliminary data indicated an association between vitamin D deficiency and sustained virologic response (SVR) rates in hepatitis C virus (HCV) genotype 1 patients. We, therefore, performed a comprehensive analysis on the impact of vitamin D serum levels and of genetic polymorphisms with functional relevance within the vitamin D cascade on chronic hepatitis C and its treatment. Methods: Vitamin D serum levels, genetic polymorphisms within the vitamin D receptor and 1α-hydroxylase were determined in a cohort of 468 HCV genotype 1, 2, and 3 infected patients who were treated with interferon-alfa based regimens. Results: Chronic hepatitis C was associated with a high incidence of severe vitamin D deficiency compared to controls (25(OH)D3 <10 ng/ml in 25% versus 12%, p <0.00001). 25(OH)D3 deficiency correlated with SVR in HCV genotype 2 and 3 patients (50% and 81% SVR for patients with and without severe vitamin D deficiency, respectively, p <0.0001). In addition, the CYP27B1-1260 promoter polymorphism rs10877012 had substantial impact on 1,25-dihydroxyvitamin D serum levels (72, 61, and 60 pmol/ml for rs10877012 AA, AC, and CC, respectively, p = 0.04) and on SVR rates in HCV genotype 1, 2, and 3 infected patients (77% and 65% versus 42% for rs10877012 AA, AC, and CC, respectively, p = 0.02). Conclusions: Chronic hepatitis C virus infection is associated with vitamin D deficiency. Reduced 25-hydroxyvitamin D levels and CYP27B1-1260 promoter polymorphism leading to reduced 1,25-dihydroxyvitamin D levels are associated with failure to achieve SVR in HCV genotype 1, 2, and 3 infected patients. © 2010 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Acute-on chronic liver failureRajiv Jalan | Pere Gines | Jody C. Olson | Rajeshwar P. Mookerjee | Richard Moreau | Guadalupe Garcia-Tsao | Vicente Arroyo | Patrick S. Kamath
Volume 57, Issue 6, December 2012, Pages 1336-1348
Acute-on-chronic liver failure (ACLF) is an increasingly recognised entity encompassing an acute deterioration of liver function in patients with cirrhosis, which is usually associated with a precipitating event and results in the failure of one or more organs and high short term mortality. Prospective data to define this is lacking but there is a large body of circumstantial evidence suggesting that this condition is a distinct clinical entity. From the pathophysiologic perspective, altered host response to injury and infection play important roles in its development. This review focuses upon the current understanding of this syndrome from the clinical, prognostic and pathophysiologic perspectives and indicates potential biomarkers and therapeutic targets for intervention. © 2012 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.


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On Mon, Jun 10, 2013 at 12:02:11AM +0530, Ramkumar Ramachandra wrote: > This is all very good, Jeff. Various people have expressed what's > wrong with fc's "demeanour", "tone", and "style of discussion" in > various different ways at various different points in time. This goes > on and on and on with no end in sight. WHAT do we do?
My advice would be to ignore him when the discussion proceeds in an unproductive direction. But I never wanted to tell other people what to do with respect to Felipe. My point was to express public agreement with Jonathan, and show that individual members of the community may be less interested in helping you if you behave in certain ways. At this point, I do not have any hope of impacting Felipe's behavior, but I thought it might be demonstrative to other list members. We do not have an explicit code of conduct on the list, but it is not as if behavior is without consequences. If you are not easy to work with, people will get tired of dealing with you eventually[1]. -Peff [1] Or maybe not. Maybe there are enough people interested in what Felipe has to say that he will continue to get review. I even try to review his patches myself when there is something factually and obviously wrong to point out, and it won't suck me into a time-wasting argument that goes nowhere. But the point is that each individual can make the choice themselves, and then the problem is solved for them. -- To unsubscribe from this list: send the line "unsubscribe git" in the body of a message to majord...@vger.kernel.org More majordomo info at http://vger.kernel.org/majordomo-info.html


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The Committee on Payments and Market Infrastructures (CPMI) and the International Organization of Securities Commissions (IOSCO) have today published for public comment a consultative report on Harmonisation of critical OTC derivatives data elements (other than UTI and UPI) – second batch.
The Board of the International Organization of Securities Commission today published the final report on Good Practice for Fees and Expenses of Collective Investment Schemes (CIS), which aims to identify common international examples of good practice that can be applied to CIS fees and expenses.
Derivatives central counterparties (CCPs) have made meaningful progress in boosting their resilience in recent years but more work is needed to ensure consistency around the world, according to new reports from major global bodies.
Against the backdrop of a rising number of sophisticated cyber-attacks on the financial services sector, new guidance on how financial market infrastructures (FMIs) should protect themselves has been put out by a couple of global bodies.
Securities regulators collect data on the asset management industry to help them fulfil their regulatory responsibilities, such as supervision, enforcement and monitoring of risk.
The Board of the International Organization of Securities Commissions today published The Impact of Storage and Delivery Infrastructure on Commodity Derivatives Market Pricing.
International securities regulatory body Iosco has identified the disruptive threats from technological innovation as a key risk factor facing financial markets in 2016.
International securities regulators are stepping up their research into the disruptive potential posed by the development of distributed ledgers, robo-advisors and cybersecurity threats.
The International Organization of Securities Commissions (IOSCO) today published a Statement on regulation of crowdfunding.
Technology vendors supplying services to financial market infrastructures (FMI) should be subject to rigorous cyber-security checks to protect the integrity and stability of the financial system, say global regulators in a new consultative paper.
© Finextra Research 2016


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Paramedics grant dying man's wishes
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It started with stomach pains and ended with a dying man's dreams becoming reality.
Lindsay Best, 53, had a smile from ear to ear as he and his mother, Frances, were chauffeur-driven around the capital by Wellington Free Ambulance staff, ticking off locations from his "bucket list" yesterday.
The pair visited Zealandia and the Weta Cave after paramedics Les McKay and Jane Borrell decided to make the dying man's wishes come true.
Mr Best, an administration assistant at law firm Buddle Findlay, was diagnosed with terminal bowel and liver cancer in August and told he had only two months to live. He had gone to the doctor with what he thought was flu.
Last week, as he was driven to Wellington Hospital with stomach pains, he got chatting in the ambulance to Mr McKay, who asked him: "Have you got a bucket list?"
Mr Best said he had three places he wanted to visit before he died: the Milford Track, Weta and Zealandia.
The Milford Track was out of the question, but the ambulance crew arranged visits to the other two yesterday, taking an ambulance out of service for part of the day.
"He hasn't got a lot of time left on the planet," Mr McKay said. "He only had a short bucket list and it wasn't a very hard one [to organise], so we just made it happen."
Mrs Best said she was blown away by what the ambulance service had done for her son. "It's absolutely wonderful; we can't believe it."
Mr Best said he could not thank the organisers enough.
Mr McKay said he was just six days older than Mr Best, which made him realise how vulnerable he was.
"I guess every day you wake up you're in front. You never know what's around the corner. It's nice to give a bit back, I suppose."
Wellington Free Ambulance operations team manager Helen Berry said extra staff were rostered yesterday, which allowed the ambulance to be released for a few hours.
Although Mr Best is unlikely to walk the Milford Track, Ms Borrell said she planned to walk it in aid of a cancer charity.
- The Dominion Post
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Project Main Details
I'm looking for an exciting, yet believable (meaning not overly hype-ey), voice that sounds like they know the product, use the product, believe in the product, and really believe everyone should try it.
Script attached. I don't know if I'm looking for a male or female. I want to hear how you guys sound...I may select one of each, so please show me what you got!
I'm excited to hear your read! 2016-03-16 20:10:06 GMT 2016-03-26 15:00:00 (GMT -05:00) Eastern Time (US & Canada) Yes (click here to learn more about ) Closed 46 39 0 direct invitation(s) have been sent by the voice seeker resulting in 0 audition(s) and/or proposal(s) so far. Voice123 SmartCast is seeking 50 auditions and/or proposals for this project (approx.) Invitations sent by SmartCast have resulted in 46 audition(s) and/or proposal(s) so far.
Project Parameters
Script Details
Two things everybody wants, yet so many struggle with every day…
Introducing HiBurn8, the ground breaking NEW product by Skinny Body Care, scientifically formulated to help your body manage weight AND help you get a great night's sleep.
What many people don't realize and what MOST weight management products fail to address, is that without good sleep, managing your weight can be VERY difficult!
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Next, Stress Relief. One of the biggest enemies to healthy sleep is stress and anxiety. With the worlds most recognized stress relieving ingredients like Lemon Balm, Aloe, and Ginseng along with the ground-breaking clinically studied ingredient Sensoril that helps your body manage weight, relieve stress, and promote restful sleep, managing your stress levels plays a BIG part in helping you get great sleep.
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Order Yours TODAY!
Voice-Seeker Details
Voice123 Team Comments
Voice123 consultations with this voice seeker regarding this project and/or other projects by this voice seeker, via phone, chat, and/or email.
This project - phone.
Previous projects - phone.
This project - email or chat.
Previous projects - email or chat.
Corporate web site for this voice-seeker confirmed by Voice123
Note: Voice123 strives to establish the legitimacy of all projects posted. However, Voice123 subscribers and users are responsible for confirming information stated by prospective voice seekers, agents and/or clients. Voice123 subscribers and users assume all liability for use of any information found through Voice123, or any of its publications.
This page contains the most important details of this project. If you find the information on this project inaccurate or inappropriate, please let us know by contacting us.


text:
- San Clemente, California
- Sep 08, 2015
- 46 views
- 1 comment
I am sooooo fed up with Cox Communications I could spit! I am constantly unable to send email because of "too many login attempts" and it doesn't matter how many times I call, reboot my router and box, examine the settings on my mobile devices, go tier by tier up the ladder…Cox cannot fix it. Even changed the ISP to no avail. Then my 4 cable boxes refused to show channels I am paying for (Premium Pkg bundled with phone service) and the pay stations are all pixilated. Replaced every box, rewired the house, the outside box, tore up the street…Cox cannot fix it! I am looking at alternatives to remove Cox from my life for good! No internet, no cable TV and no phone service. Why? Because Cox is completely unreliable, sends subcontracted labor out to do repairs they cannot do and after two steady years of this (insert any series of four letter words here-it works) I am done!
Bruce Carter
H8r of Cox
More Review Details
|Billing Practices
|Coverage Area
|Customer service
|Product or Service Quality
|Price Affordability
|Diversity of Products or Services
What I liked
No items
What I disliked
- Horrible customer service
- Reason of review:
- Poor customer service
- Preferred solution:
- Deliver product or service ordered
- Product or service
- Cox Bundle
- Review category
- Media
Author wants to be contacted by the company. Learn more ›
Sep 13, 2015
its not any better here in Oklahoma0 0 Reply
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Mosop, who won the Chicago race in October, has suffered an Achilles tendon injury that has ruled him out of the Games. Double world champion Abel Kirui and Wilson Kipsang, who won the London Marathon in April, are the other members of the team.
"Emmanuel Mutai was among the six marathoners we named in the provisional team. We did not want to go outside that list, and we think Mutai is best placed for that assignment," Athletics Kenya secretary general, David Okeyo, told reporters.
"He (Mosop) has had persistent Achilles tendon injury and we all thought it would heal. But he wrote a letter to us withdrawing from the team after it became apparent it would not heal in time for the Games."
Athletics Kenya will name the rest of the team for the London Olympics on June 23, except the women's 10 000 metres team which will be named at the east African nation's National Championships to be held later this week.
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Miss Cal Bar Fancy is a 2014 AQHA filly. She is out of a 14.3 Zan Parr Bar bred stud (Zans Chancealot) and a 14.3 Poco bred mare ( Light and Fancy Lady…SOLD
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Copart Auto Auction HYUNDAI Lot Details
- Lot # 35058046
- Est. Retail Value $11,504 USD
- Repair Est $9,236 USD
- Ownership Doc Type UT - NON-REPAIRABLE CERTIFICATE
- Odometer 40,503 ACTUAL
- Primary Damage REAR END
- Color RED
- Engine 1.8L 4
- Drive Front-wheel Drive
- Cylinders 4
- Fuel GAS
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- Auction Location Salt Lake City, UT show on map
- Sale Date Future Sale
- Live Auction Item Item # 0
- Sale Status Pure Sale
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Humour with a serious health message Add to ...
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Terry Jones of 'Monty Python' fame teamed with late Canadian cancer specialist Dr. Robert Buckman to produce videos combining health tips with humour.
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- 10-21-2015, 05:00 PM Thread Author #1iMore Newbie
- Posts
- 10 Posts
- Global Posts
- 19 Global Posts
New iPhone 6S - restore from backup question
I ordered my new iPhone 6S last week, and it's supposed to arrive in two days. I currently have an iPhone 5S.
My question is the following: I still want to have my old text messages on my new iPhone but that's all, other than that I want to start fresh.
Would this work if I would delete all apps and stuff from my 5S and make a new backup of my 5S in iCloud and then restore from backup on my new 6S? Or will some other data from my old phone still be in the new backup?
Thanks in advance for the help
- Posts
- 1,278 Posts
- Global Posts
- 1,471 Global Posts
Re: New iPhone 6S - restore from backup question
Congrats on your new iPhone, yes that would work. If you delete everything you didn't want to save then did a iCloud backup that would save what's on your iPhone at that moment.
Sent from my Super iPhone 6s Plus using Tapatalk
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I wish things were different, but significant sponsorship from any entity in marine industry for offshore racing is unlikely. When your choices are employing people or providing race support, you go with your employees.
But there are smart people involved in OSS and I'm sure they've thought outside the marine industry and are looking to lure non-endemic (i.e. nothing to do with marine) sponsorship dollars.
The most obvious problem is the economy. But even in a great economy, offshore racing (not matter how much we love it) is a very tough sell.


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