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January - February, 2018
Annals of Hepatology: Viewpoints from Afar Eric M. Yoshida, Xingshun Qi Page 4-7
Extending a Helping Hand: Addressing Hepatitis C in Economic Migrants and Refugees Jordan J. Feld Page 8-10
Epigenome-Wide Association Studies Provide Insight into the Pathogenesis of Non-alcoholic Fatty Liver Disease and Non-alcoholic Steatohepatitis Aybike Birerdinc, Zobair M. Younossi Page 11-13
The Changing Face of the Diagnosis of Chronic and Malignant Liver Diseases: Potential New Biomarkers Vania Cruz-Ramón, Paulina Chinchilla-López, Oscar Ramírez-Pérez, Xingshun Qi, Nahum Méndez-Sánchez Page 14-17
The early diagnosis of primary sclerosing cholangitis, hepatocellular carcinoma, and cholangiocarcinoma is often challenging. In a recent study in 134 patients (Arbelaiz, Hepatology 2017; 66:1125-1143), it was reported that specific proteins found in serum extracellular vesicles of patients with primary sclerosing cholangitis, hepatocellular carcinoma,orcholangiocarcinomamay be useful as noninvasive diagnostic and prognostic tools. This current article critically appraises this study.
Meta-Analysis of Grazoprevir plus Elbasvir for Treatment of Hepatitis C Virus Genotype 1 Infection Hussien Ahmed, Abdelrahman Ibrahim Abushouk, Amr Menshawy, Attia Attia, Arwa Mohamed, Ahmed Negida, Mohamed M. Abdel-Daim Page 18-32
Background and aim. Grazoprevir is an NS3/4A protease inhibitor (PI), while elbasvir is an NS5A inhibitor. We performed this meta-analysis to directly compare grazoprevir plus elbasvir and ribavirin regimen vs. grazoprevir and elbasvir without ribavirin in the treatment of hepatitis C virus genotype 1 infection and to precisely evaluate the efficacy of the latter regimen in cirrhotic, IL28 CC genotype patients and those coinfected with human immunodeficiency virus. Material and methods. A computer literature search of PubMed, Scopus, EBSCO, Embase, and Cochrane central was conducted. Studies were screened for eligibility. Sustained virologic response (SVR) rates were pooled using OpenMeta[Analyst] software for windows. A subgroup analysis was performed to stratify the treatment efficacy according to the different baseline characteristics of HCV patients. Results. Eight randomized controlled trials (n = 1,297 patients) were pooled in the final analysis. The overall SVR rate was 96.6% with 95% CI [95.5% to 98%]. For cirrhotic patients, the SVR rate was 95.7% with 95% CI [93.9% to 97.5%] and for non-cirrhotic patients, the SVR rate was 97% with 95% CI [95.9% to 98.4%]. Furthermore, the addition of ribavirin (RBV) to the treatment regimen did not significantly improve the SVR (RR 1.003, 95% CI [0.944 to 1.065]). The dual regimen was effective in patient populations with NS3 resistance-associated (RAS). However, this regimen achieved lower SVR rates (< 90%) in patients with NS5A RAS. Conclusions. We conclude that the 12-week treatment regimen of the fixed dose combination of grazoprevir plus elbasvir achieved high SVR rates in patients with HCV genotype 1 infection. The addition of ribavirin to this regimen did not add a significant benefit.
Hepatic Hydrothorax Yong Lv, Guohong Han, Daiming Fan Page 33-46
Hepatic hydrothorax (HH) is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. Although the development of HH remains incompletely understood, the most acceptable explanation is that the pleural effusion is a result of a direct passage of ascitic fluid into the pleural cavity through a defect in the diaphragm due to the raised abdominal pressure and the negative pressure within the pleural space. Patients with HH can be asymptomatic or present with pulmonary symptoms such as shortness of breath, cough, hypoxemia, or respiratory failure associated with large pleural effusions. The diagnosis is established clinically by finding a serous transudate after exclusion of cardiopulmonary disease and is confirmed by radionuclide imaging demonstrating communication between the peritoneal and pleural spaces when necessary. Spontaneous bacterial empyema is serious complication of HH, which manifest by increased pleural fluid neutrophils or a positive bacterial culture and will require antibiotic therapy. The mainstay of therapy of HH is sodium restriction and administration of diuretics. When medical therapy fails, the only definitive treatment is liver transplantation. Therapeutic thoracentesis, indwelling tunneled pleural catheters, transjugular intrahepatic portosystemic shunt and thoracoscopic repair of diaphragmatic defects with pleural sclerosis can provide symptomatic relief, but the morbidity and mortality is high in these extremely ill patients.
Clinical Findings of HCV Chronic Infection in Undocumented Immigrants and Low-Income Refugees in Three Areas of Southern Italy Evangelista Sagnelli, Loredana Alessio, Caterina Sagnelli, Luciano Gualdieri, Mariantonietta Pisaturo, Carmine Minichini, Giovanni Di Caprio, Mario Starace, Lorenzo Onorato, Gaetano Scotto, Margherita Macera, Nicola Coppola Page 47-53
Introduction and aim. In recent decades, Italy has become a land of immigration from countries suffering a socio-economic crisis. The aim of this study was to perform an organized screening to identify and offer care to immigrants with HCV infection. Material and methods. The screening, performed from 2012 to 2015, involved 1,727 immigrants in the Campania and Apulia regions in southern Italy. Results. Screening was accepted by 1,727 (85%) out of 2,032 immigrants interviewed; 70 (4.1%) of the 1,727 were anti-HCV-positive, all unaware of their serological condition, 31 (44.3%) of whom were HCV-RNA-positive and 39 negative. The 31 HCV-RNA-positive immigrants were further investigated at a third-level clinic of infectious diseases. The HCV viral load was 2.6 x 107 ± 7.7 x107 IU/mL, and 35.5% showed HCV-genotype 1a or 1b, 23.8% genotype 2 and 22.6% genotype 3. Two immigrants had liver cirrhosis and, in accordance with the Italian Healthcare Authority guidelines, received an interferon-free regimen and achieved a sustained virological response (SVR); 18 had chronic hepatitis, 6 of whom with a high risk of progression and received interferonbased therapy, with SVR in 4, whereas 12 at low risk were put on a waiting list for future interferon-free treatment, once licensed. The remaining 11 HCV-RNA-positive immigrants were considered HCV inactive chronic carriers and were included in a long-term observational program. Conclusion. The screening program can be considered successful since it was accepted by 85% of the subjects interviewed and identified 70 anti-HCV-positive immigrants, all unaware of their clinical and virological condition.
High Prevalence of Hepatitis B Subgenotype D4 in Northeast Brazil: an Ancient Relic from African Continent? Max D. Cruz-Santos, Michele S. Gomes-Gouvêa, Jomar D. Costa-Nunes, Camila Malta-Romano, Marinilde Teles-Sousa, Lena M. Fonseca-Barros, Flair J. Carrilho, Adalgisa de S. Paiva-Ferreira, João R. Rebello-Pinho Page 54-63
Introduction. Hepatitis B virus (HBV) infection leads to a chronic liver disease that is distributed worldwide. The characterization of HBV into genotypes/subgenotypes is not only a mere procedure for distinguishing different HBV strains around the world because determining their geographic distribution is crucial to understanding their spread across the world. Material and methods. We characterized different HBV genotypes and subgenotypes in five municipalities located in northeastern Maranh�o, in the Brazilian north Atlantic coast. 92 HBsAg-positive individuals were submitted to PCR (polymerase chain reaction). Fifty samples were sequenced using automated Sanger sequencing and classified by phylogenetic methods. Results. Subgenotypes D4 and A1 were found in 42 (84%) and eight (16%) samples, respectively. To our knowledge, this is the first study to describe a high frequency of subgenotype D4 in any population. Subgenotype A1 is frequently found across Brazil, but D4 has been rarely detected and only in a few Brazilian states. This study shows the characterization of HBV subgenotypes from a population based study in the state of Maranh�o, particularly in populations that do not have frequent contact with populations from other regions of the world. Conclusion. Our findings showed a HBV subgenotype profile that probably reflect the viruses that were brought with the slave trade from Africa to Maranh�o. This study also reinforces the need to evaluate the status of HBV dispersion not only in large urban centers, but also in the hinterland, to enable the implementation of effective control and treatment measures.
Worsening of Serum Lipid Profile after Direct Acting Antiviral Treatment Stefano Gitto, Arrigo F. G. Cicero, Elisabetta Loggi, Marina Giovannini, Fabio Conti, Elena Grandini, Valeria Guarneri, Alessandra Scuteri, Giovanni Vitale, Carmela Cursaro, Claudio Borghi, Pietro Andreone Page 64-75
Introduction. Host lipid metabolism influences viral replication and lifecycle of hepatitis C virus. Our aim was to evaluate changes in glucose and lipid metabolism of patients with chronic hepatitis C after therapy with direct acting antivirals (DAA). Material and methods. We considered patients consecutively treated between January and November 2015 recording clinical data at baseline and week 24 of follow-up. Frozen serum samples were used for apolipoprotein A1 (apoA1), apolipoprotein B (apoB) and lipoprotein (a) [Lp(a)]. Wilcoxon test was utilized to estimate trends and Logistic Regression for predictors of lipid changes. Results. We enrolled 100 patients, mostly cirrhotic (81%) and with genotype 1b (59%). Ninety-three patients achieved sustained virological response (SVR), while 7 relapsed. Homeostasis model assessment of insulin resistance declined (from 3 to 2.7, p < 0.001); non-high density lipoprotein (HDL) cholesterol increased from 102 ± 29 to 116 ± 35 (p < 0.001), and Lp(a) from 5.6 ± 6.5 to 9.8 ± 11.5 mg/dL (p < 0.001). Rise of low-density lipoprotein/HDL and apoB/apoA1 ratio were registered (from 1.79 ± 1.10 to 2.08 ± 1.05 and from 0.48 ± 0.18 to 0.53 ± 0.18 mg/dL, p < 0.001). We conducted a subanalysis on patients with relapse. In this subgroup, no change of lipid profile was recorded. At multivariate analysis emerged that the addition of ribavirin to DAA, represented an independent predictor of increased Lp(a) (OR 3.982, 95% CI 1.206-13.144, p = 0.023). Conclusion. DAA therapy led to reduction of insulin resistance. In contrast, pro-atherogenic lipid changes were observed in patients with SVR. Further studies will be necessary to evaluate the cardiovascular balance between amelioration of glucose metabolism and negative changes of lipid profile.
Recreational Drug and Psychosocial Profile in Chronic Hepatitis C Patients Seeking Antiviral Therapy Nayana George, Sherrie M. Harrell, Kimberly D. Rhodes, Andrés Duarte-Rojo Page 76-84
Background and aims. Practitioners treating hepatitis C (HCV) provide healthcare to a special population with high rates of substance abuse and psychiatric disorders. We investigated the psychosocial profile in HCV patients and tested what variables affect commencement of antiviral therapy. Material and methods. Recreational drug use (RDU), marijuana (THC), alcohol use, and psychiatric history were initially investigated with a questionnaire prior to history and physical. Following an educational intervention, we reinterrogated patients for RDU and THC use, and revision of initial statement was documented. Variables affecting commencement of antiviral therapy were analysed with logistic regression. Results. Out of 153 patients, 140 (92%) answered the questionnaire. Intervention increased total yield by 6%, however, 39% (11/28) of those initially denying use revised their statement. Drug screening identified 9 more patients with RDU/THC use. Half of patients consuming alcohol were heavy drinkers, and psychiatric disease was identified in 54%. Only 73 (48%) of 139 patients eligible for antivirals received treatment. Multivariable analysis revealed that younger patients (OR = 1.04, 95% CI 1.01-1.08), and those testing positive on drug screen (OR = 0.41, 95% CI 0.19-0.92) were less likely to be treated. Denial by insurance and loss to follow-up were the most common reasons for not starting antiviral treatment. Conclusion. Substance abuse is highly prevalent among HCV patients, and it is difficult to tell prior from current users. Integral care of HCV patients should include a diligent screen for substance abuse and rehabilitation referral, aiming to increase the pool of patients eligible for antiviral therapy. This can only be achieved through a multidisciplinary approach.
Association of Adolescent Obesity with Nonalcoholic Fatty Liver Disease and Related Risk Factors in Xi'an, China Yan Rong, Niu Chun-Yan, Zhao Hong-Xin, Yu Lu, Wang Wen, Tian Yu Page 85-91
Introduction and aim. To investigate the association of adolescent obesity with nonalcoholic fatty liver disease (NAFLD) and related risk factors in Xi 'an, China. Material and methods. A total of 4141 adolescents (2,061 girls and 2,080 boys, mean age: 18.62 ± 0.66 years, age range 15-22 years) were enrolled in this investigation. Anthropometric index was measured, and liver ultrasonography and liver function biochemical test were performed in all the subjects. T test, χ2 test and logistic regression analysis were used for statistical analyses. Results. The total rates of obesity was 7.9% (08/4,141). The prevalence rate of NAFLD was 8.1% (335/4141) with a declining trend from obesity, overweight to normal BMI. NAFLD prevalence rate in obese boys was significantly higher than in girls (χ2 = 56.5, P < 0.01). BMI, body weight, ALT, and AST in NAFLD group were higher than in non-NAFLD group (P < 0.05). The tangent point of ALT was 36 U/L using Youden index in boys, and 33 U/L in girls. Conclusion. The prevalence of obesity and NAFLD in adolescents is higher in Xi'an than anticipated. Body weight and BMI may be the associated independent risk factors of NAFLD.
Cultural Validation of the Transplanted Organ Questionnaire (TOQ) for the Brazilian Population Renata Medeiros, Rita Mattiello, Emmanuelle Corruble, Edgar E. Sarria, Cibele Molski, Ajácio Brandão Page 92-97
Background and rationale. The Transplanted Organ Questionnaire (TOQ), developed in France, is a disease-targeted instrument designed to evaluate what the transplanted organ represents to the recipient in patients who have undergone liver transplantation. The present study sought to validate a version of the TOQ for use in the Brazilian population. Translation and cross-cultural adaptation were carried out in accordance with international standard practices. Convergent validity was measured by correlations between TOQ domains and the Beck Depression Inventory (BDI), while reliability was assessed by measurement of internal consistency (Cronbach's alpha coefficient), reproducibility (intraclass correlation coefficient), sensitivity to change (effect size), and floor and ceiling effects. Results. The study sample comprised 122 liver transplant recipients, with a mean age of 56.7 ± 9.9 years, treated at the outpatient clinic of a tertiary hospital in Southern Brazil. The sample was largely male (57.4%), and the predominant indication for liver transplant was hepatocellular carcinoma (34.4%). The mean total TOQ score was 32.9 ± 18.0. Cronbach's alpha for the total score was 0.89 (95%CI 0.86-0.92). Correlations between TOQ and BDI domains were acceptable, with the rejection domain correlating most strongly (r = 0.37; p ≤ 0.001). In conclusion, the Brazilian Portuguese version of the TOQ exhibited good psychometric performance, suggesting that it can be a useful tool in the Brazilian cultural context.
Exercise Capacity and Respiratory Profile in Patients after Orthopedic Liver Transplantation: a Follow-up Study Clarissa B. A. Magalhães, José Huygens P. Garcia, Cyntia F. G. Viana, Maria José N. Flor, Pedro Felipe C. de Bruin, Eanes D. B. Pereira Page 98-103
Introduction: We sought to describe: 1) The influence of orthotopic liver transplantation (OLT) on exercise capacity, pulmonary function and respiratory muscle strength after surgery, 2) The relationship between exercise capacity and symptoms of anxiety and depression. Material and methods. This is a prospective follow up study conducted with patients submitted to OLT. All patients were assessed before and 1 month after surgery through measurements: six minute walk test (6MWT), 6 min step test (6MST) and HADS (Hospital Anxiety and Depression Scale). FEV1% (forced expiratory volume), maximal inspiratory pressure (MIP) and maximal expiratory pressure (MEP) were measured in the pre-operative and on 1st, 3rd, 5th day and 1 month after surgery. Results. In 77 patients , 6MWD improved 20.2 m (95%CI 8.1-32.3) and 6MST improved 7.8 steps after surgery (95%CI 3.9-11.6). Change in 6 MWD and 6 MST did not correlated with change HADS. The FEV1% at each time point were 88.8 ± 21.3 before surgery, 32.9 ± 9.9 on 1st day, 39.6 ± 11.5 on 3rd day, 46 ± 12.1 on 5th day and 86.6 ± 21.1 one month after surgery. MIP and MEP values at each time point were -67.4 ± 23.2 and 79.7 ± 26 before surgery, -30.8 ± 12.3 and 36.4 ± 15.4 on 1st day, -38.6 ± 14.1 and 43.8 ± 17 on 3rd day, -45.8 ± 15.9 and 49.7 ± 18.7 on 5th day and -67.1 ± 29.4 and 80.9 ± 23.9 one month after surgery. Conclusion. Exercise capacity was modestly increased after OLT without any correlation with symptoms of anxiety and depression. Pulmonary function and respiratory muscle strength decreased immediately after liver transplantation, and progressively recovered, returning to baseline values after 1 month.
The Portuguese Version of the Immunosuppressant Therapy Adherence Scale (ITAS) among Liver Transplant Recipient Patients: Translation and Psychometric Properties Ana Paula Jesus-Nunes, Mychelle Morais-de-Jesus, Adriana Dantas-Duarte, Tayne Miranda Moreira, Felipe Coelho Argolo, Alessandra de Oliveira Castro, Maria Auxiliadora Evangelista, Liana Codes, Paulo Lisboa Bittencourt, Lucas C. Quarantini Page 104-109
Introduction and aim. Transplant recipients are chronically ill patients who rely on medical treatment throughout life to achieve positive results. Despite that, medication nonadherence after liver transplantation is extremely common. The self-report, one of several methods for measuring adherence, is easy to apply and low cost. Thus, this study aims to translate and validate the Immunosuppressant Therapy Adherence Instrument (ITAS) in Brazilian Portuguese for liver transplant recipients. Material and methods. A total of 139 liver transplant recipients were selected from a general hospital, who were assessed by using the Portuguese version of ITAS. The scale was translated based on the model proposed by Wild, et al. and its psychometric properties were assessed. Results. The average Cronbach's α coefficient was 0.830. ITAS and Basel Assessment of Adherence with Immunosuppressive Medications Scale (BAASIS) presented significant correlation, with a Spearman's ρ coefficient = 0.300 (S = 309,580; p < 0.001). The area under the receiver operating characteristics (ROC) curve was 0.638 (95% CI: 0.557 - 0.715). Factor analysis results indicated that the carelessness factor model was the optimal model, and the factor "feeling worse" was the lowest. Conclusion. The Portuguese version of ITAS has adequate psychometric properties to measure adherence to immunosuppressant therapy.
Hepatocellulary Malignancies
Prognostic ability of BCLC-B Subclassification in Patients with Hepatocellular Carcinoma Undergoing Transarterial Chemoembolization Marco Biolato, Giulia Gallusi, Massimo Iavarone, Giuseppe Cabibbo, Simona Racco, Adriano De Santis, Cristina della Corte, Marcello Maida, Adolfo Francesco Attili, Angelo Sangiovanni, Calogero Cammà, Giuseppe La Torre, Antonio Gasbarrini, Antonio Grieco Page 110-118
Background and aims. A subclassification system for intermediate hepatocellular carcinoma (HCC) was recently proposed to optimize treatment allocation. The aim of this study was to assess the prognostic ability of that substaging proposal. Patients and methods. This is a retrospective multicenter cohort study including patients with intermediate HCC treated with transarterial chemoembolization (TACE). Predictors of survival were identified using the Cox proportional regression model. Results. 289 Barcelona Clinic Liver Cancer (BCLC) B patients were included. Median overall survival of the whole cohort was 23 months (C.I. 95% 20.2-25.8). Child A status (H.R. 1.35, C.I. 95% 1.02-1.78) and tumour burden beyond the up-to-seven criterion (H.R. 1.39, C.I. 95% 1.07-1.80) were independent prognostic factors for overall survival on multivariate analysis. Analysis of the substages showed that median survival was 33.0 months for B1 stage (n = 81), 20.8 months for B2 stage (n = 106), 16.1 months for B3 stage (n = 24), 22.2 months for B4 stage (n = 42) and 15.0 months for quasi-C stage (n = 36). Regarding the discriminatory ability of the substaging proposal, the log rank test showed a significant survival difference for B1vs. B4 (p = 0.003) and B1 vs. Quasi-C (p = 0.039) and a trend for B1 vs. B2 (p = 0.05) and B1 vs. B3 (p = 0.05). Conclusions. Apart from substage B1, BCLC-B subclassification does not discriminate perfectly patients treated with TACE. Also some patients in substage B4 can benefit from TACE.
Risk and Prognosis of Acute Liver Injury Among Hospitalized Patients with Hemodynamic Instability: A Nationwide Analysis Najeff Waseem, Berkeley N. Limketkai, Brian Kim, Tinsay Woreta, Ahmet Gurakar, Po-Hung Chen Page 119-124
Introduction and aim. Critically ill patients in states of circulatory failure are at risk of acute liver injury, from mild elevations in aminotransferases to substantial rises consistent with hypoxic hepatitis or ?shock liver?. The present study aims to quantify the national prevalence of acute liver injury in patients with hemodynamic instability, identify risk factors for its development, and determine predictors of mortality. Material and methods. The 2009-2010 Nationwide Inpatient Sample was interrogated using ICD-9-CM codes for hospital admissions involving states of hemodynamic lability. Multivariable logistic regression was used to evaluate the risks of acute liver injury and death in patients with baseline liver disease, congestive heart failure, malnutrition, and HIV. Results. Of the 2,865,446 patients identified in shock, 4.60% were found to have acute liver injury. A significantly greater proportion of patients with underlying liver disease experienced acute liver injury (22.03%) and death (28.47%) as compared to those without liver disease (3.18% and 18.82%, respectively). The odds of developing acute liver injury were increased in all baseline liver diseases studied, including all-cause cirrhosis, hepatitis B, hepatitis C, alcoholic liver disease, and non-alcoholic fatty liver disease, as well as in congestive heart failure and malnutrition. All-cause cirrhosis and alcoholic liver disease, however, conferred the greatest risk. Similar trends were seen with mortality. HIV was not a predictor for acute liver injury. Conclusion. Liver injury is a major concern among patients with protracted circulatory instability, especially those suffering from underlying liver disease, heart failure, or malnutrition.
Acute Variceal Bleeding: Does Octreotide Improve Outcomes in Patients with Different Functional Hepatic Reserve? Roberto Monreal-Robles, Carlos A. Cortéz-Hernández, José A. González-González, Juan G. Abraldes, Francisco J. Bosques-Padilla, Héctor N. Silva-Ramos, Jorge A. García-Flores, Héctor J. Maldonado-Garza Page 125-133
Background. Current guidelines do not differentiate in the utilization of vasoactive drugs in patients with cirrhosis and acute variceal bleeding (AVB) depending on liver disease severity. Material and methods. In this retrospective study, clinical outcomes in 100 patients receiving octreotide plus endoscopic therapy (ET) and 216 patients with ET alone were compared in terms of failure to control bleeding, in-hospital mortality, and transfusion requirements stratifying the results according to liver disease severity by Child-Pugh (CP) score and MELD. Results. In patients with CP-A or those with MELD < 10 octreotide was not associated with a better outcome compared to ET alone in terms of hospital mortality (CP-A: 0.0 vs. 0.0%; MELD < 10: 0.0 vs. 2.9%, p = 1.00), failure to control bleeding (CP-A: 8.7 vs. 3.7%, p = 0.58; MELD < 10: 5.3 vs. 4.3%, p = 1.00) and need for transfusion (CP-A: 39.1 vs. 61.1%, p = 0.09; MELD < 10: 63.2 vs. 62.9%, p = 1.00). Those with severe liver dysfunction in the octreotide group showed better outcomes compared to the non-octreotide group in terms of hospital mortality (CP-B/C: 3.9 vs. 13.0%, p = 0.04; MELD ≥ 10: 3.9 vs. 13.3%, p = 0.03) and need for transfusion (CP-B/C: 58.4 vs. 71.6%, p = 0.05; MELD ≥ 10: 50.6 vs. 72.7%, p < 0.01). In multivariate analysis, octreotide was independently associated with in-hospital mortality (p = 0.028) and need for transfusion (p = 0.008) only in patients with severe liver dysfunction (CP-B/C or MELD ≥ 10). Conclusion. Patients with cirrhosis and AVB categorized as CP-A or MELD < 10 had similar clinical outcomes during hospitalization whether or not they received octreotide.
Short- and Long-term Outcomes between Young and Older HCC Patients Exceeding The Milan Criteria after Hepatectomy Junyi Shen, Chuan Li, Lvnan Yan, Bo Li, Mingqing Xu, Jiayin Yang, Wentao Wang, Tianfu Wen Page 134-143
Aim. The objective of this study was to evaluate short- and long-term survival after surgical treatment between young and older hepatocellular carcinoma (HCC) patients beyond the Milan criteria. Material and methods. One hundred fifty-seven HCC patients (≤ 55 years old) were categorized into group A, and one hundred fifty-eight HCC patients (> 55 years old) were categorized into group B. Postoperative complications and overall survival were retrospectively analyzed. Results. Older HCC patients had a higher rate of delayed extubation after surgery and suffered more complications after surgery, especially major complications. Intraoperative blood transfusion, liver fibrosis/cirrhosis and delayed extubation were risk factors related to postoperative complications. Microvascular invasion (MVI), tumor diameter, postoperative alpha-fetoprotein and the presence of satellites were independent risk factors for long-term survival. Young patients had more advanced tumors. Overall survival rates at 1, 3 and 5-years were 78.1%, 45.1% and 27.4% for young patients, respectively, and 86.5%, 57.5% and 42.4% for older patients, respectively (p = 0.007). Conclusion. The category A group had poorer tumor characteristics and worse prognoses than the category B group.
Hypericum Humifusum Leaves Attenuates Hepatic Ischemia-Reperfusion Injury in a Rat Model Henda Ferchichi, Issam Salouage, Sarra Bacha, Nadia Kourda, Nadia Jebabli, Emna Gaies, Anis Klouz, Sameh Trabelsi Page 144-152
Introduction. Effective prevention strategies require specific actions during the different phases of ischemia-reperfusion (I-R) injury. The objective of our study is to evaluate the effect of aqueous extract of Hypericum humifusum leaves (HHL) on liver I-R model in Rat. Material and methods. Animals were subjected to 90 min of hepatic ischemia followed by reperfusion (120 min). HHL extract (25 mg/mL/kg) was injected 15 min before reperfusion. To evaluate the effect of HHL extract on I-R, we have monitored transaminases levels, Malondialdehyde (MDA) concentration, histological lesions (apoptosis and necrosis) and compared the results to a reference oxidant vitamin E. Results. The determination of total phenol extracts of HHL was 59.91 ± 0.35 mg of Gallic Acid/g dry plant material with higher antioxidant activity (91.73% ± 1.67) compared to vitamin E (87.42%). Using aqueous extract of HHL, we noted a significant decrease of AST and ALT [1129 UI (585/1995) and 768 UI (335/1375)] compared to no-treated group [5,585.5 UI (5,035/12,070) and 8,099.5 UI (5,040/12,326)] as a decrease in MDA content [85.7% protection (50.9/91.5)]. HHL extract reduce the damage induced by I-R of 48.7% (27/48.7) and 96.1% (95.7/96.5) for necrosis and apoptosis lesions respectively. Conclusion. HHL aqueous extract have potential to protect liver from the damage effect induced by I-R better than vitamin E solution.
Efficacy of Probiotics and Smectite in Rats with Non-Alcoholic Fatty Liver Disease Nazarii Kobyliak, Ludovico Abenavoli, Tetyana Falalyeyeva, Tetyana Beregova Page 153-161
Introduction and aim. Today probiotics have been suggested as a treatment for the prevention of non-alcoholic fatty liver disease (NAFLD). Smectite is a natural silicate that binds to digestive mucous and has the ability to bind endo- and exotoxins. The present study was designed to determine whether probiotics plus smectite is superior to probiotic alone on the monosodium glutamate (MSG) induced NAFLD model in rats. Materials and methods. We included 60 rats divided into 4 groups 15 animals in each. Rats of group I were intact. Newborns rats of groups II-IV were injected with MSG. The III (Symbiter) group received 2.5 ml/kg of multiprobiotic 'Symbiter' containing concentrated biomass of 14 probiotic bacteria genera. The IV (Symbiter+Smectite) groups received 'Symbiter Forte' combination of probiotic biomass with smectite gel (250 mg). Results. In both interventional groups reduction of total NAS score as compared to MSG-obesity was observed. Indeed similar values of steatosis score (0.93 ± 0.22 vs. 0.87 ± 0.16) in both treatment groups, we observed that lower total score for Symbiter+ Smectite are associated with more pronounced reduction of lobular inflammation (0.13 ± 0.09 vs. 0.33 ± 0.15) as compared to administration of probiotic alone. This data accompanied with significant reduction of IL-1 and restoration of IL-10 between these 2 groups. Conclusions. Additional to alive probiotic administration of smectite gel due to his absorbent activity and mucus layer stabilization properties can impact on synergistic enhancement of single effect which manifested with reduction of lobular inflammation and at list partly steatohepatitis prevention.
Atypical Abdominal Pain in a Patient With Liver Cirrhosis Liz Toapanta-Yanchapaxi, Eid-Lidt Guering, Ignacio García-Juárez Page 162-164
The causes of abdominal pain in patients with liver cirrhosis and ascites are well-known but occasionally, atypical causes arise. We report the case of a patient with a ruptured, confined abdominal aortic aneurysm.
Hepatic Cyst Compressing The Right Atrial and Ventricular Inflow Tract: An Uncommon Cardiac Complication Maulik Panchal, Ahmed Alansari, Marc Wallack, Ferdinand Visco, Susan Williams, Alexander M. Sy Page 165-168
Commonly reported complications of hepatic cysts are spontaneous hemorrhage, rupture into the peritoneal cavity, infection and compression of the biliary tree however cardiac complications are not commonly reported. We are presenting a case of a large liver cyst presenting with right atrial and ventricular inflow tract impingement resulting in cardiac symptoms. A 68 year-old Hispanic female presented with one month of fatigue and shortness of breath after household work and walking less than one block, right upper quadrant pain and weight loss. She had history of multiple hepatic cysts for more than 12 years, well-controlled diabetes and hypertension. Examination of the heart revealed tachycardia with regular heart sounds. There were no murmurs. She had tenderness in her right upper quadrant on palpation and an enlarged smooth liver. Rest of physical examination was unremarkable. CT scan of the abdomen showed multiple non-enhancing liver cysts in both lobes, with the largest measuring 12 x 15 x 17 cm which was significantly increased from her baseline of 7 x 8 x 10 cm in 2003. Echocardiogram showed normal left ventricular ejection fraction, grade 1 diastolic dysfunction and a hepatic cyst impinging RA and RV inflow tract. She had successful laparoscopic enucleation of liver cyst and subsequent relief from tachycardia, fatigue and shortness of breath. In conclusion, this case illustrates that hepatic cysts may become symptomatic after remaining quiescent for an extended period. They may present with unusual symptoms and clinicians should be mindful of rare complications, such as in this case.
Pyogenic Liver Abscess Secondary to Foreign Body (Fish Bone) Treated by Laparoscopy: A Case Report Renato G. Bandeira-de-Mello, Gabriel Bondar, Eduardo Schneider, Isabel Cristina Wiener-Stensmann, Juliano Bohrer Gressler, Cleber Rosito Pinto Kruel Page 169-173
Liver abscess due to perforation of the gastrointestinal tract by a foreign body is a rare and possibly fatal event. Diagnosing this pathology is complicated by the lack of specific symptoms and unfamiliarity of ingestion by the patient and low clinical suspicion of this disease. In the case of liver abscess unresponsive to aspiration and administration of antibiotics, this hypothesis must be made, despite its low incidence. This case report describes and illustrates a case of liver abscess secondary to fish bone ingestion with consequent piercing of the lesser gastric curvature, diagnosed by computed tomography and specific anamnesis. Laparoscopy was performed to extract the foreign body, without complications; the patient is currently asymptomatic and does not present any abnormal physical examination findings. We believe this represents the first case report of a successful laparoscopic treatment in South America for the removal of an ingested foreign body associated with pyogenic liver abscess.
Hepatitis B virus Reactivation During Steroid Treatment of IgG4-Related Disease Alexandra Shingina, Robert Puckrin, Aliya Gulamhusein Page 174-175


For more than 40 years, People's Family of Corporations has recognized the impact of socioeconomic stress on the health of our communities.
Too often, underserved communities are preoccupied with the challenges and activities of daily living at the expense of focusing on family health maintenance and wellness issues. In response to these and other community concerns, People's Family of Corporations has established "community support" corporations that have proved successful beyond its well-known Betty Jean Kerr People's Health Centers.
While primary care community health services remain the foundation of our community efforts, People's Family of Corporations also deploys the resources of our Mental Health Center (Amanda Luckett Murphy Hopewell Center) and our People's Community Action Corporation (PCAC), to address the total needs of our underserved communities. Currently, our family of 501(c)3 corporations includes a 60 unit senior affordable housing residence, along with 18 multifamily apartments for families with disabilities, a Connective Services Corporation that houses the Social Security Administration Office adjacent to the Delmar site, and the Amanda Luckett Murphy Hopewell Behavioral Health Center.
The collection of these corporations have worked, in concert, to address the health care needs of the community, and also to remove the socioeconomic obstacles to that end. Each year, the Betty Jean Kerr People's Health Centers serves more than 51,000 unique clients. Many of whom would have nowhere else to turn if we were not there. People's Family of Corporations strives to address all of the needs of underserved communities by offering services, with dignity and respect, to all who need us. We feel we are uniquely qualified to help elevate our communities by bringing "gold standard" medical, mental/behavioral health and socioeconomic services to our underserved communities. Betty Jean Kerr People's Health Centers is Joint Commission accredited, is a Federal Torts Claims Act health center, and has obtained NCQA Level III recognition. Amanda Luckett Murphy Hopewell Center is CARF accredited.
By rallying our many years of community advocacy and service experience, with our dedicated staff and untiring dedication to service, People's Family of Corporations looks forward to many more years of community service and advocacy for those who need our voice.


A freshwater turtle has been rescued after being discovered apparently washed up on a Cornish beach.
The musk turtle, which measures around seven centimetres in length, is recovering at Newquay's Blue Reef Aquarium after being spotted by a couple out walking on Crantock Beach.
Aquarists believe the turtle, which cannot survive in seawater, may have been dumped into the River Gannel and was washed downstream and into the sea.
It's the latest in a growing number of exotic pets which are being abandoned or 'released' in to the wild and has prompted the Towan Promenade aquarium to issue an appeal for more responsible pet ownership.
Blue Reef's Steve Matchett said: "It's extremely fortunate this little turtle was found when it was or it would have almost certainly have died.
"Potential pet owners need to understand that turtles and terrapins can live for over 25 years, so are a long-term commitment even more than a cat or dog, plus they need the correct set-up with heating, filters and size of aquarium.
"People buy these cute little creatures and either don't realise or fail to take into account the fact that they will keep getting bigger.
"For example red-eared terrapins begin life as these incredibly miniature reptiles which are about the size of a box of matches.
"Within a few short years however they can reach 30cms or more and that's when people start abandoning them," he added.
It is also illegal to release these animals into the UK countryside.
The common musk, or stinkpot, turtle is found throughout parts of Canada and the United States.
The turtles, which only reach a maximum length of 14 centimetres, have earned their noxious nickname as a result of the highly efficient defence mechanism; when attacked by predators the turtles release a foul smelling musk from their undersides.
Anyone who spots terrapins or turtles in the wild should get in contact with their local animal rescue organisation.
Issued by Blue Reef Aquarium. For more information and to arrange interviews, picture or filming opportunities please contact Steve Matchett or Lara Mingay on 01637 878134.


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Copyright © 2019 Actagro. All rights reserved.
©2017 Actagro. Important: Always read and follow label instructions. Some products may not be available for sale or use in all states or counties. Please check with your local Actagro representative to ensure availability. Actagro®, Actagro Organic Acids®, Natural Extraction Technology Platform™, Nutri-Guard®, and the Actagro logo are trademarks of Actagro, LLC.


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1 Taylor Street San Francisco CA 94102
Get Tips About This Venue
Golden Gate Theatre Tickets and Event Schedule
Tuesday, Jan 31, 2023 / 7:30pm
Wednesday, Feb 1, 2023 / 1:00pm
Thursday, Feb 2, 2023 / 7:30pm
Friday, Feb 3, 2023 / 7:30pm
Saturday, Feb 4, 2023 / 1:00pm
Sunday, Feb 5, 2023 / 1:00pm
Tuesday, Feb 7, 2023 / 7:30pm
Friday, Feb 10, 2023 / 7:30pm
Saturday, Feb 11, 2023 / 1:00pm
Sunday, Feb 12, 2023 / 1:00pm
Tuesday, Feb 14, 2023 / 7:30pm
Wednesday, Feb 15, 2023 / 1:00pm
Thursday, Feb 16, 2023 / 7:30pm
Accessible or ADA seating may be available at this venue through Goldstar. Contact us before buying tickets to make arrangements.
Access to the loge, mezzanine and balcony requires stairs — there is no elevator to these sections.
Golden Gate Seating JPG
Children age 5 or younger are not admitted. This venue has no elevator. Orchestra/Mezzanine tickets may require the use of stairs. If you cannot use stairs, please contact help@goldstar.com after your purchase to ensure that you can be seated in an accessible area. The listed ticket price includes an $11-$16 fee that is additional to the face value of the ticket. This is a required fee for all tickets purchased for this theatre.
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redpajama_set_name: RedPajamaCommonCrawl


An oversized, long jacket is just what you need when you want to maintain a professional look in a garment with practical features such as this robin's egg blue jacket. A softly curved neckline opens up to a full length buttoned front and a softly curved hem edge. All edges are carefully topstitched for durable construction and long term wear. Twin front pockets give you a place to keep your phone so it is handy and accessible when you need it. Can be worn with any outfit, casual or dressy. Small size; shoulder 35 cm, lap 100 cm, bust 90 cm, sleeve length 59 cm, total length 80 cm.


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Shilpa Gupta's successful start to 2013
June 18, 2013•Art, Installations
Kanika Pruthi of Saffronart discusses Shilpa Gupta's works and her eventful start to 2013
New York: A contemporary Indian new media artist, Shilpa Gupta's body of work presents a consistent progression in theory and practice that has rightfully earned her a firm spot in the arena of contemporary Indian art. Alumni of the Sir J. J. School of Fine Arts in Mumbai, the main crux of her artistic practice is to explore the role and purpose of art- this enquiry taking many forms.
The artists has had a packed start to the year, currently exhibiting at Galerie im Taxispalais in Innsbruck, Austria in a show titled Will we ever be able to mark enough?, curated by Renee Baert and which will subsequently travel to Montreal and Bruges.
Gupta is also showing at Art Basel. Her works at the art fair include Stars on flags of the world with the Mumbai based gallery Chemould Prescott Road, Untitled shown by the Parisian gallery Yvon Lambert and 2651-1 by Dvir Gallery from Tel Aviv, Israel.
In the first half of 2013 alone, she has been featured in various group shows at places including the Bristol Museum & Art Gallery in England, the Singapore Art Museum, the Golden Thread Gallery in Belfast, the Guggenheim in New York, the Sharjah Biennial in the United Arab Emirates and a group show at the Faurschou Foundation in Copenhagen.
Gupta is careful in her rhetoric not to delegate categories to identify her work or practice. She prefers to call it 'everyday art' given her preoccupation with daily observations and current events. To relegate her works to set categories would be limiting the scope of their discourse and its reception by the viewer. In "Stars on flags of the world" a glass vitrine holds hundreds of steel stars, like those found on national flags from around the world. The piles of stars are reflective of the appropriation of this particular insignia in constructing a national identity and narrative- much like alphabets that are put together to form words. Although seemingly political, her works hold a wider conversation with a willing ear and keen eye.
Stars on Flags of the World, 2012, Mild Steel stars in a vitrine and an etched brass plate, 64x64x97 cm
Image Credit: http://artgalleriesintelaviv.com/2012/11/14/shilpa-gupta-at-dvir-gallery/nahum-2-stars-on-flags-of-the-world/
Regardless of the content and narrative of her works, Gupta is clear that her works are not simply 'political'- a badge often pinned to works of art that comment on political and social scenarios. Her preoccupation is rather centered on the meaning of language. The multi layered contexts of her works not only point at the different tangents that they traverse, but their reception by the viewer also highlight the gamut of popular perception that a work encounters on its completion- the afterlife of the work. The viewers' response is an integral part of her practice- sometimes evident and at other times concealed.
Shilpa Gupta's "Threat", first created in 2009, depicts a stack of bricks simulating a wall. The bricks are cast soap embossed with the word THREAT. The smell is powerfully soapy; it builds as you near the work. The work is performative- the viewer is encouraged to pick and take back a brick, this action depleting the 'threat'- physically and symbolically. The degenerative and fleeting tactility of a bar of soap makes the viewer think of the emotional response to threat- sudden and strong, yet impermanent and short-lived.
Threat, Bathing Soaps, 2008-09,5.9×2.5×1.6 in | 15×6.2×4 cm each soap, 28.5x90x42 in | 72x229x107 cm stack of 4500 soaps
Image Credit: http://shilpagupta.com/pages/2009/09threat.htm
"2652-1", being shown by the Tel Aviv gallery Dvir at Art Basel, recounts the number of steps the artist took between Al Aksa Mosque, the Western Wall and the Church of the Holy Sepulcher in Jerusalem. Gupta assembled small photographs that she took while walking between the three sites, resulting in a thin 42-meter long canvas. The work highlights the physical proximity of these geographical locations juxtaposed with the political, religious and ideological schisms that creates separation between them. The process of globalization over the past decades is traced in varying doses in her works. Narratives of identity, nationhood, borders and boundaries and power relations are implicitly imbedded is the coded discourse of her multivalent works. It is this quality that makes her works relevant to a contemporary international audience of varying sensibilities.
2652-1, 2010, archival print on canvas, 42 meters x 4 cm
Image Credit: http://www.dvirgallery.com/exhibitions/exhibition_de
.asp?exhibitionID=94&exhibitionCatID=4&contentCatID=
12&exhibitionPastName=2010
The artist has recently featured in a two-part film on contemporary Indian art entitled 'Let the World in'.
Art Basel, Bristol Museum & Art Gallery, Chemould Prescott Road, Dvir Gallery, Faurschou Foundation Copenhagen, Galerie im Taxispalais, Guggenheim Museum, Renee Baert, Sharjah Biennale, Shilpa Gupta, Singapore Art Museum, Sir J.J. School of Fine Arts Mumbai, The Golden Thread Gallery, Yvon Lambert


Mission: To support the charitable needs of the covington county citizens, especially youth, health, leadership, and recreational programs. Also, to provide and maintain the kiwanis community center for the benefit of the citizens of andalusia and covington county, al.
Programs: Youth and educational services ($12,696) - funding for programs that develop leadership and recreational programs in the city of andalusia and covington county al.
community service ($2,000) - funding for service organizations that provide food, housing, counseling, recreational, and arts activities in andalusia and covington county alabama.
young children priority one ($2,500) - funding for food, safety, and recreational programs.
A donation of to The Andalusia Kiwanis Club Foundation Inc has been added to your Giving Basket!


Do you feel safe answering you door? Would you like that extra bit of security?
Whilst Brentwood is one of the safest boroughs in Essex. Brentwood Borough Council and Safer Brentwood, with the help of MenShed are launching a new project aimed at elderly and vulnerable residents. We have been awarded funding from the Police & Crime Commissioner to install door chains into homes for FREE.
The primary aim of the project is to make the most vulnerable residents of Brentwood feel safer in their homes.
If you would like to be considered for this project and have a door chain fitted for free, please download the Door Chain application formand send to Daniel Cannon, Community Safety, Brentwood Borough Council, Town Hall, Ingrave Road, Brentwood CM15 8AY or email todaniel.cannon@brentwood.gov.uk. Once we have received the form, you will be notified within 10 working days if your application has been successful. You will then be contacted by a MenShed volunteer who will arrange a suitable date and time for the door chain to be installed at your property. All volunteers will have undergone appropriate vetting.


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The Holodomor. All news
Museum concept
Holodomor Research Institute
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Architectural Project of the Museum
Who is creating the museum
Partnership between state and society
History of the National Museum of the Holodomor-Genocide
The theme of the Holodomor in art
Movies about the Holodomor
Recognition of the Holodomor as Genocide
Holodomor Remembrance Day
Places of mass burial
Unified Register of the Holodomor victims
Digital atlas of the Holodomor
Telling Children about the Holodomor. Tips for Parents to the International Children's Day
To the International Children's Day, the Holodomor Museum team has prepared a series of tips on how to speak to children about the Holodomor
To tell or not?
Parents often ask themselves this question because the history of the Holodomor is one of the most tragic and difficult to explain pages of Ukrainian history. The main arguments of parents who ignore the Holodomor are "difficult topic", "trauma for children", "too early", "once they will learn", "it was a long time ago".
Children will learn about the Holodomor in any case. This can happen at school, while talking to adults, watching a movie or reading a book. But what will this first acquaintance be like? Will the child come across the material that they will not be able to comprehend by their own? Psychologists argue that traumatic topics should be discussed with adults children trust. In most cases, of course, it's the parents. Mom and dad are people who show love and care, next to them the child feels safe. Parents often try to protect their children from negative emotions, and, therefore, ignore topics related to crime, death and grief. Will it be useful for the child? Experts urge adults not to avoid such conversations and not to postpone them, but to prepare, create a calm atmosphere, control emotions and choose simple words for explanations.
So how should one tell children about the Holodomor?
You should first identify certain markers, such as taboos.
We do not recommend:
– show photos of Ukrainians killed by starvation;
– talk about the physical and moral suffering of the starving;
– discuss cannibalism and other similar situations that took place during the Holodomor;
– watch documentaries and feature films about the Holodomor, intended for an adult audience.
It is best to start the conversation about the Holodomor by compiling a family tree.
Tell children about the lives of older family members — your parents. Then move on to the story of great-grandparents. Indicate their place of residence, type of activity, family traditions and interesting facts from their biography. It is good when you can accompany your story with relevant family photos. This is the way to reach the generation that lived during the Holodomor. Personal stories (memories) are easy to perceive, especially if it is a story about your own family.
You can download the Holodomor Museum template for family tree by following the link.
It is clear that many Ukrainians have not preserved family memories of the events that happened almost 90 years ago. Also 7 modern regions of Ukraine (Zakarpattia, Chernivtsi, Lviv, Ivano-Frankivsk, Ternopil, Volyn and Rivne) were not part of the USSR, so there was no Holodomor there.
What to do then?
The Museum of the Holodomor Genocide has created an online resource, where eyewitnesses' accounts of the Holodomor of 1932–1933 are collected. Here you can find memories of people who lived during the Holodomor in your area. The "Testimonies" page contains video and audio testimonies, photos, and digitized text stories. We recommend you to read these stories, and then invite the child to watch a video or retell the story of an eyewitness to the Holodomor. It is worth noting that children often do not know how Ukrainians lived in the 1930s, so they will ask many questions. Don't be shy if you don't know the answers. Say you will learn them together.
What points should be explained?
First, it must be said that in 1932–1933 the Ukrainian people did not have their own state, despite the fact that there were many attempts to created it (for example, during Bohdan Khmelnytsky and Ivan Mazepa times). And 100 years ago (1917–1920) Ukraine restored its statehood and proclaimed the Ukrainian National Republic, which was recognized by many European countries. But there was aggression from Russia. Russian military units seized Ukrainian territory (as today they occupied Crimea and part of Donbass). Subsequently, all of Ukrainian territory, except for seven modern western regions, was occupied and became part of the newly created Soviet Union with its capital in Moscow. The country was ruled by communists and headed by Stalin. They organized the crime of the Holodomor.
Second, it should be clarified that Ukrainians still aspired to be masters of their land, to have an independent state. The Ukrainian people rebelled against the power seized by the Communists and the changes they sought to implement.
Third, the cause of the famine was the government's actions, as grain, potatoes and other products were confiscated from Ukrainians. People did not become hungry because of unfavorable weather conditions or crop failures and not because they were lazy to work (the Ukrainian people are hardworking, people worked on the land every day, engaged in farming).
Fourth, Stalin and other communists committed the Holodomor to break the resistance of Ukrainians and to discourage them from creating their own state. He wanted to be feared and obeyed immediately.
Such moments are worth mentioning in a short historical excursion. By following the link, you can get acquainted with the topic in more detail and form the basis of the conversation. When talking about the Holodomor, it is worth emphasizing the manifestations of humanity and mutual assistance during the famine, as well as the facts of public resistance to the actions of the Communists.
We offer a feature movie about the Holodomor Red Necklace for viewing. The plot is based on the story of a girl Antonina, who describes the life of her family during the Holodomor of 1932–1933. The film gives the opportunity to empathize with the characters during the trials, but has an optimistic finale.
The child has the right to condemn the actions of the organizers and perpetrators of the Holodomor. A negative attitude towards the actions of people who have caused the deaths of millions is a perfectly normal reaction. Along with feelings of injustice, empathy for victims also develops. Accordingly, the question arises: what can be done to prevent such crimes from happening again now?
By telling children about genocides and other crimes, we try to avoid them from happening again in the future. Explain to children what tolerance, nonviolence, compassion and respect are, since these are traits that a person is not born with. People acquire them in the process of education. Express your opinion about injustice, explain how to act in such situations. It is not accidental that the topics of bullying and inclusion have become acute today. In addition, the example of arents is the best mean of education. Your beliefs, attitudes toward people and good deeds will be the foundation for shaping the worldview and behavior of children.
Finally, it would be great to do a creative task with the children, such as drawing, applique, poem, and so on. Creativity makes it easier to release the emotions caused by the traumatic topic. During classes at the Museum, we create memory candles and commemorative badges with the children. You can book excursions and educational classes at the link.
Remember: no one knows your children better than you, and our tips are for guidance only. Be honest and open while communicating with children, and you will get a positive result.
Prepared by Olha Vyhodovanets, tour guide and lecturer of the museum
 Kyiv, Lavrska str. 3
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Holodomor – is a genocide
© Holodomor Museum 2021. All rights reserved.
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History Teacher 7-12
Santa Sabina College
Strathfield · New South Wales
History Teacher (NESA Mandatory History, Elective History, Ancient History, Modern History, Philosophy, IBDP History and Global Politics) 7-12
Commencing 21 January 2022
Santa Sabina College Strathfield is a P-12 Catholic School in the Dominican tradition educating students to achieve personal excellence, to act with justice and compassion, and to embrace the future with an optimistic global vision. Located across eight hectares in Strathfield in Sydney's multicultural inner west and enrolling over 1230 students, we offer a comprehensive co-education on our Del Monte Campus for P-4 and for girls 5-12 on our Santa Sabina Campus. Our outdoor education campus, Tallong, is located on 97 hectares in the Southern Highlands.
Our Early Education Centre (Mary Bailey House) and Out of School Hours (OOSH) services are located in the grounds of the Primary (Del Monte) Campus. Mary Bailey House provides education and care for children aged from six weeks to five years and the College also operates three separate OOSH services for five-year-olds to Year 6 students. OOSH provides before school, after school and vacation care for children during school holiday periods.
Santa Sabina College is seeking dynamic professionals with an ability to inspire students through engaging and challenging teaching in the area of History. Knowledge of the Australian Curriculum and International Baccalaureate Diploma Programme would be highly regarded. There is an expectation that all teachers actively participate and contribute to the broader life of the College, including student wellbeing, co-curricular activities and outdoor education experiences.
The successful candidate will:
support and commit to the Catholic Dominican Mission of the College
be an experienced and qualified teacher of History in one or more of the subject areas listed
demonstrate knowledge of recent developments in these curriculum areas and the NESA and IBDP syllabus, assessment and reporting requirements
demonstrate an understanding of innovative, contemporary education practices that are student-centred, technology-rich and differentiated
possess outstanding interpersonal skills and the ability to work collaboratively in a team, including effective co-planning and co-teaching skills
Teaching across various subject areas would be advantageous and highly regarded.
Please visit the College website for further application details: https://www.ssc.nsw.edu.au/about-santa-sabina/employment/
Applications must contain a cover letter addressed to the College Principal, Ms Paulina Skerman, outlining relevant experience, a Curriculum Vitae and a completed College employment application form. Completed applications are to be emailed to [email protected]. For further information, please contact Ann McGovern, Director of People,Culture and Professional Learning on (02) 9745 7025.
Applications close: 4pm 3 December 2021.
The College is committed to the National Principles for Child Safe Organisations. The successful applicant will be required to have a current Working with Children Check and be committed to our Child Protection Policy.
Applications closed Friday 3 December 2021
Santa Sabina College ›


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KLAWS returns to Castaic Animal Shelter with blankets, books
Christina Cox
Castaic Middle School Seventh-graders Ashley Yomto, center, and Amie De La Rosa read the book "Lost in the Snow" to a one-year-old Siberian Husky during the after school club, Kids Loving Animals Within Shelters event called "Bark for Books" held at the Castaic Animal Shelter in Castaic on Tuesday. 092716 Dan Watson/the Signal
Castaic Middle School students are still doing their part to ensure that animals at the Castaic Animal Shelter are comfortable in their cages and are more likely to get adopted.
As part of the school's Kids Loving Animals Within Shelters (KLAWS) club, students returned to the local shelter Tuesday afternoon to read to dogs as part of the club's second "Bark for Books" program.
KLAWS was created by teachers Karen Gagnon and Christine Racina a year ago. The students adopted the Castaic Animal Shelter as the club's primary mission to support the needs of the shelter and to educate students of the responsibilities of owning an animal.
"As people start to come here the word gets out about the shelter… and the club," Gagnon said.
Tuesday's event, "Bark for Books PAWt2," was paired with the club's "Shelter Snuggles Donation Drive," where students gave donated blankets and items to the shelter before reading to shelter dogs.
One of three cars packed full for the Castaic Middle School's Kids Loving Animals Within Shelters (KLAWS) club's "Shelter Snuggles" donations. Courtesy of KLAWS
"We got hundreds of blankets and snuggly toy donations from all over the country," Gagnon said.
According to Gagnon, the nationwide donations were because of friends at Rescue Strong, a local company that raises money and awareness for rescues, who asked its supporters to donate items to the club on social media.
"I like to say they 'took us under their paw' because they shared this with their followers," Gagnon said.
KLAWS also received book donations from animal right author Amy Luwis for the middle school students to read to shelter dogs.
Another individual donated money to support a customized T-shirt design and order for all of the KLAWS students.
"People from all over the country are involved," Gagnon said. "These kids are making such a big difference all over the county and, in some cases, the world."
On Twitter as @_ChristinaCox_
Christina Cox is a multimedia journalist covering education, community and breaking news in the Santa Clarita Valley. She joined The Signal as a staff writer in August 2016.


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Goldfrapp close to finishing new album
NME Oct 9, 2007 10:34 am BST
Record set for release next year
Goldfrapp are putting the finishing touches to their new album.
The album, which is set to be released next year, is the follow up to 2005's 'Supernature'.
A statement on Goldfrapp.com reads: "News has reached these parts that after months of beavering away in studios from the West Country to the West Coast and having returned from their recent stint in LA LA land, Alison [Goldfrapp] and Will [Gregory] are in the UK putting the finishing touches to the album this week.
"As yet untitled, it will be rearing its antlers early next year."


We capture and reveal the arc of change across restored fresh-water wetlands.
We have partnered with the MIT Media Lab to develop sensor networks that document ecological change.
Learn from our collaborating scientists, engineers, practitioners, and artists.
Living Observatory (LO) is a learning collaborative of scientists, artists, and wetland restoration practitioners engaged in the documenting, interpreting, and revealing aspects of change as it occurs prior to, during, and following the Tidmarsh Farms Restoration Project, the largest freshwater wetland restoration project to date in Massachusetts.
Listen to Joe Paradiso's latest audio patch. Joe's sound media is created from data run on the ALCATOR C-Mod at MIT's Plasma Science and Fusion Center. This patch was taken from the last test shot where the world record for plasma pressure was broken. "I use the data in various ways - stretching it out and slowing it down to make direct audio samples, or using it to control and modulate other voices in the synth". The installation was part of the 50th Anniversary of MIT's Center of Advanced Visual Studies.
UPLOAD PHOTOS YOU HAVE TAKEN AT TIDMARSH HERE!


ESIC Punjab Recruitment 2018: Employees State Insurance Corporation Punjab (ESIC Punjab) has issued Recruitment Notification 2018 for 58 Staff Nurse, Pharmacist, Lab Assistant, OT Assistant, ECG Technician Posts. All interested, Eligible and Aspiring Candidates can Apply On-line on or before 21st January 2019 (21/01/2019). The detailed information such as Name of Posts, Total No of Posts, Pay Scale & Grade Pay, Educational Qualification, Age Limit, Application Fee, Selection Procedure, How to Apply, Last Date for Submission of Application Form etc. can be obtained further either by visiting Employees State Insurance Corporation Punjab (ESIC Punjab) Official Website http://www.esicpunjab.org/ or by Continue reading….
Age Limit – Candidates age should not exceed 32 years (for Posts 1-4, 6), 37 years (for Posts 7, 8) & in between 18 – 27 years (for Post 5). However for age relaxations details, candidates can go through the detailed advertisement.
Selection Procedure – All Interested, Eligible and Aspiring Candidates who are applying for ESIC Punjab Recruitment 2018 will have to appear in Written Test and your final score will decide your fate.
How to Apply – All Interested, Eligible and Aspiring Candidates who are applying for ESIC Punjab Recruitment 2018 will have to visit Employees State Insurance Corporation Punjab (ESIC Punjab) Official Website http://www.esicpunjab.org/ and fill the On-line Application Form.


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text:
Fran Healey Wants To Stop Rabbit Farm
Fran Healy, the lead singer of legendary indie rock band Travis, is hopping mad following the submission of a planning application to build an intensive rabbit farm in his native Staffordshire.
Emmylou Harris, Patty Griffin, Buddy Miller To Tour Together
Emmylou Harris, Patty Griffin and Buddy Miller have announced that they have set eleven dates in October for a tour to benefit the Jesuit Refugee Center/USA.
Wishbone Ash US Dates
Classic rockers Wishbone Ash are once again coming back to the U.S. for a tour.
Michael Franti & Spearhead September 2016 Dates
Michael Franti & Spearhead will return to Australia in September.
Jason Derulo Releases 'Kiss The Sky'
Jason Derulo has quietly slipped out a new song 'Kiss The Sky'.
Twenty One Pilots Release Heathens From Suicide Squad
Twenty One Pilots have new music on the 'Suicide Squad' soundtrack.
New Green Day Is Days Away
Green Day will have new music on August 11.
The Simpsons Take A Dump On Trump
The Simpsons have created a short video about the insanity of America's upcoming election and the nutter running for President.
Melbourne Guitar Show Program Now Online
The two-day program for the Melbourne Guitar Show is now online.
Out On The Weekend Offers Cripple Creek Ferry Package For 2016
Tickets for the Out On The Weekend festival are now on sale with the premium Cripple Creek Ferry package once again available for 2016.
Watch New Massive Attack 'Come Near Me' VIDEO
Massive Attack have a video for their new song 'Come With Me'.
Casey Barnes Delivers 'Live As One' Video
Casey Barnes has released a video for the title track from his upcoming album 'Live As One'.
Beenie Man Banned From Canada After Contracting Zika Virus
Jamaican reggae legend Beenie Man was not able to play his headlining show at this weekend's OVO Festival in Toronto after he could not get a Canadian visa due to the Zika virus.
Helen Gifford To Receive APRA Distinguished Services To Australian Music Award
Composer Helen Gifford OAM has been announced as the 2016 recipient of the Distinguished Services to Australian Music Award for 2016 at the APRA Art Music Awards to be handed out in Melbourne on 16 August, 2016.
Australian Albums: Human Nature 'Gimme Some Lovin' Clocks Up No 1
The eleventh studio album for former 90's boy-band and now Vegas doo-woppers Human Nature becomes their fourth No.1 album here, as "Gimme Some Lovin': Jukebox Vol.II" debuts at the top of the ARIA Albums Chart this week.
Australian Singles: Major Lazer Registers A No 1 Hit With Bieber and MØ
Similar to last weeks chart, we have new No.1's debuting on both the singles and albums chart this week, one a collaboration between an American group with both a Canadian and Danish guest vocalist, and then an Australian 90's boy-band claim the top of the Albums chart.
Barbra Streisand Hugh Jackman Duet Premieres
When Barbra Streisand started to work on her 'Encore: Movie Partners Sing Broadway' she said the first person she thought of singing with was Australia's Hugh Jackman.
Dee Synder And Steve Vai Speak Out For Artist Royalties
Steve Vai has written an impassioned plea for help in getting the royalties paid to artists updated to a modern standard.
The Beatles Historic Shea Stadium Concert To Have Cinema Premiere
The Beatles historic Shea Stadium concert from 1965 will screen in cinemas with the new Ron Howard documentary 'Eight Days A Week'.
Rolling Stones 'Havana Moon' Cuba Concert To Screen In Cinemas
Good Friday, March 25, 2016, is a date that will go down in Cuban and Rock 'n' Roll history. On that date, The Rolling Stones became the first rock band to play a massive free outdoor concert to hundreds of thousands in Havana, Cuba.
David Bowie Blackstar Band To Release Salute To Singer
The musicians that backed David Bowie on his final album, Blackstar, have reformed to record an album saluting the late singer.
Australian Charts: Imany 'Don't be So Shy' Remains Most Shazamed Song of the Week
Imany 'Don't Be So Shy' continues to be the most Shazamed song in Australia this week with Illy 'Papercuts' in hot pursuit.
Peter Garrett's First Solo Tour Is Underway #SETLIST
Peter Garrett kicked off his first solo tour in Perth last weekend this week took the show to Brisbane.
Australian Singles: Major Lazer Blocks Illy For Australia's No 1 Song
Cold Water, Major Lazer's collaboration with Justin Bieber and MØ, has maintained its lead over Illy's 'Papercuts' as the biggest selling song in Australia again this week.
Australian Singles: Major Lazer's 'Cold Water' Was Most Listened To Song This Week
'Cold Water' by Major Lazer featuring Justin Bieber and MØ was the most listened to song in Australia this past week.
Billy Corgan To Release His Second Solo Album
Billy Corgan posted a new update on Facebook Friday confirming a host of new projects.
ELO Has First UK No 1 In 35 Years
Jeff Lynne's ELO has now officially scored their first number 1 album in 35 years.
Judge Rejects 29 People Claiming To Be Prince Relatives
A Minnesota judge has shot down 29 claims from would-be heirs hoping to get a piece of late Prince's estate.
Wiz Khalifa Defends His Derogatory Lyrics
Wiz Khalifa has defended his use of offensive terms for women in his lyrics.
Spice Girls GEM Reunion To Make $14m Per Member
Spice Girls bandmates Mel B, Geri Horner and Emma Bunton will pick up $14 million (£10 million) each for a two-hour long performance, according to new reports.


Loyola's softball team came swinging out of the gates as it opened up its season with 2-2 record at the Total Control Sports Invitational held in Rosemont, Illinois, this past weekend.
The Ramblers started this season with a new head coach, Jeff Tylka.
Tylka was an assistant coach last season under Missy Beseres. He is joined by his co-assistant coach from last season, Brittany Cervantes, and new assistant coach, Marina Demore.
The transition from assistant coach to head coach has gone smoothly, according to Tylka, especially with the help of his assistants.
Junior pitcher Ashley Rogers said Tylka's experience with the program is an advantage for him as he begins his head coaching career.
Along with a new coaching staff, the team is welcoming five fresh faces to its roster this season, including two pitchers and three infielders.
Senior catcher Tarran Shaffer is excited to welcome the new talent to her team.
Rogers is eager to have a new infield to accompany her this year.
The freshmen infielders, Jamie O'Brien and Brooke Wyderski, started this past weekend at third and short, respectively. Freshman Ashley Parenti started her collegiate career at left field.
Freshman Maddie Hope will be competing against Rogers for time on the pitcher's mound.
Tylka said the entire class will be seeing playtime within the first two weeks, and he said he thinks they're meshing well with the upperclassmen.
"All of the freshmen will get [to] start within the first two weeks, and we kind of expect big things from them," he said.
The Ramblers are currently ranked No. 2 in the Missouri Valley Conference (MVC).
Loyola is out for vengeance this season, after its heartbreaking loss to the Bradley Braves in the MVC championship game last spring.
Shaffer said the team's goal is to win the conference championship.
Rogers believes the Ramblers' biggest challenge this year will be their size compared to other teams in the Valley, but they will continue to have success if they strategize to their advantage.
Tylka said the Ramblers needs to maintain a healthy roster and continue to push through the hardships they may face this season.
The Ramblers will be on the road to Tucson, Arizona, from Feb. 13 to 15 as they play in the Hillenbrand Invitational.


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Kolkata, Belgachia, Kolkata, West Bengal and Hyderabad, Bhagya Nagar Colony, Kukatpally, Hyderabad, Telangana is 1549 Km. This distance take about 1 day 4 hours. If you want to know, flight distance is 1189 Km and flight duration is 2 hours 5 mins .


Ralph Mayer Robey was born on 8 January 1809, son of William and Elizabeth Robey, and was christened on 12 February 1809 at Bethesda Methodist Chapel at Shelton, Stafford, England. He married Mary Ann Leese, in England. After her death, he married Louisa Townsend (d.1889) of Cork, Ireland, at St Lawrence Church in Sydney on 21 October 1842. They had five sons and four daughters. He died on 1 April 1864 at Langton, Staffordshire, England, leaving considerable debts and a large family. One of his daughters, Anne Maria, married his business partner and future NSW Premier George Dibbs in 1857.
Ralph Robey, a widower with five children, arrived in Sydney on the Larne on 8 November 1841. By 1843 he had a general fancy warehouse and ironmongery store at 427 George Street selling China earthenware and soft goods. He expanded his business to include importing, exporting and a shipping agency. By 1855, he was the Chairman of the Sydney and Melbourne Steam Packet Company and a shareholder in the Sydney Railway Company. Other positions he held were Director of Sydney Fire Insurance Company and, from 1858, the Australasian Steam Navigation Co. and the Newcastle Coal and Copper Co. From 1847 to 1854, he was the Chairman of Directors of the Australasian Sugar Co. In 1850 he promoted a company to grow sugar at Moreton Bay and in 1855 became an original shareholder and manager of Colonial Sugar Refining Company. In 1857, with the future NSW Premier George Dibbs, he set up a rival company but sold out to CSR in 1859. He invested in land and buildings in the County of Cumberland and had 20 pastoral stations in NSW and Queensland. From 1845 he lived at his Linthorpe Estate at Newtown and is commemorated by both Linthorpe and Robey streets in Newtown. He left for England in 1863 where he died a year later.
Ralph Robey was commissioned as a Justice of the Peace in 1855. He was active in the Australasian League for the Abolition of Transportation. He was also a member of St Andrews Parochial Association.
He was a member of the Legislative Council from 24 March 1858 to 13 May 1861 and was re-appointed for life on 3 September 1861.
Robey was an assessor for Sydney Municipal Council in 1844 and Alderman of the Sydney City Council for Brisbane Ward, 2 November 1846 until 18 November 1847. He was on the Lighting and Finance standing committees.
Suzanne Edgar, 'Robey, Ralph Mayer (1809–1864)', Australian Dictionary of Biography, National Centre of Biography, Australian National University, http://adb.anu.edu.au/biography/robey-ralph-mayer-4492/text7341, accessed 6 December 2012.


Journey Through Denmark's Fascinating History , Royal Palaces and Fairytales .From Rennaisance castles to ancient Villages and Viking Ruins .Dive into Denmark's long & fascinating history Journey into a world of fairytales & Hans Christian Anderson, grand royal palaces & medieval old towns, and walk in the foot prints of Vikings.
A land of royal palaces and fairytales, Denmark's history stems from the Viking era. Today, renaissance castles and 18th century villages sit side-by-side with Neolithic remains and Viking ruins. This tour takes you on a journey through Denmark's fascinating history, and to cosy Copenhagen - a small city with a big heart, bursting with beautiful building sand relaxing green spaces.
Denmark is full of historical treasures waiting to be discovered. From Copenhagen's old town and grand royal palaces, to Aarhus's 16thcentury Old Town museum, and Ribe - the oldest town in Scandinavia, Denmark's history is rich and diverse.
Learn all about Denmark's history in one hour – take the 'History of Denmark in 60 minutes' do-it-yourself tour at Copenhagen's Nationalmuseet.
Climb to the top of the tower at Aarhus Cathedral, built in 1201, for a bird's-eye view of the rooftops and streets of the city.
Immerse yourself in Viking history at the Ribe Viking centre, an outdoor museum full of fascinating facts on Viking living.
1&2 Copenhagen, sightseeing and the Royal Palaces Explore Copenhagen on foot the city is small and compact. Take in three royal palaces – the 18th century Amalienborg Palace and square with is four impressive rococo buildings, the beautiful medieval fortification of Kastellet set in a peaceful green oasis, and the magnificent renaissance Rosenborg Castle. A network of bridges and drawbridges connects the two main islands of the city. Don't miss the Nationalmuseet – set inside an 18thcentury royal residence with exhibits on Stone Age and Vikings. And visit the vibrant Tivoli Gardens – an amusement park created in 1840.
3&4 Aarhus – guided tours in the footsteps of the Vikings Take a bus or train, or drive to Denmark's second-largest city, set on the island of Jutland. Its underground canal was uncovered a few years ago and is now the hub of the city. Enjoy medieval history at Den Gamle By (Old Town), the city's open-air museum. Its 75 historic buildings, including 70 half-timber houses, a mill, and a millstream have been re-located from around Denmark and meticulously re-created. Walk in the footprints of Vikings, hear stories about Viking ancestors, and visit the Viking Museum in an Aarhus walking tour. Starts from outside Aarhus Cathedral, dating back to 1201 - don't miss its soaring, whitewashed nave and beautiful chalk frescoes.
5-7 Ribe – oldest town in Scandinavia Soak up history dating back to 869 in Ribe. Walk its crooked cobblestone streets and take in its compact confection of crooked, half-timbered 16thcentury houses, clear flowing streams and lush water meadows.Ribe's entire 'old town' has been designated a preservation zone, with more than 100 buildings registered by the National Trust.Experience Ribe's rich history at the Ribe Viking Museum and Viking Centre. Walk around a reconstructed life-size Viking estate. And check out medieval Ribe Cathedral, and the renaissance house Taamborg,close by.Spot a seal in The Wadden Sea, not far from Ribe and Denmark's third National Park. An area of clean and sparkling white sandy beaches, it is home to rich birdlife, and flora and fauna.
A beautiful bonze and granite sculpture sitting at Langelingje Pier, Copehagen. Now 100 years old she was a gift from a Danish brewer and was inspired by Hans Christian Anderson's famous fairy tale.
A beautiful open-air museum with a series of reconstructed settlements, houses, and workshops from the Iron, Stone and Viking ages.
Visit Roskilde, near Copenhagen, an ancient city of kings and Vikings. Its cathedral is the final resting place of 38 Danish monarchs. See five Viking ships in the Viking ship Museum and go sailing in the fjord on a Viking longboat.
Visit Kalundborg Castle, and its royal borough of old half-timbered houses and cobbled streets. The castle dates back to the 14th & 15th centuries.
Experience the history of the city through text and illustration.
A 45 minute tour through the town's historic streets.
During the first week of May, more than 500 Vikings from all over Europe flock to the Ribe Viking Centre. See how the Vikings lived and worked; watch battle re-enactments, riding and archery displays.
Take an 'Activity Cart' down to the sea flats of the Wadden Sea and hunt for nuggets of prehistoric golden amber and pine resin.
The best time to visit Denmark is during the summer months of June, July and August, when the climate is warm and the blossoming landscape at its prettiest, and when travel season is in full swing .