5 nm at 100 kV. Our analysis includes the bunch properties at the sample, as well as interactions of the main pulse of high charge density with diffracted electrons. Since our design employs only static electron optics, we believe that it will be easier to implement than concepts based on radio frequency compression. c 2009 American Institute

of PD-1/PD-L1 inhibitor drugs Physics. [DOI: 10.1063/1.3132834]“
“Background Double-suicide gene therapy is a promising strategy for the treatment of advanced cancer. It has become an important research line in the development of gene therapy to overcome the drawbacks of single-gene therapy.

Objective The aim of this study was to investigate the usefulness of double-suicide gene therapy with the two suicide genes, gef and apoptin, in colon carcinoma.

Methods gef and apoptin genes were cloned into a doxycycline-regulated retrovirus-mediated gene expression system. Expression of both genes selleck screening library in the DLD-1 cell line was confirmed by reverse transcriptase polymerase chain reaction (RT-PCR). Cell viability was determined with the sulforhodamine B colorimetric assay, and the cell cycle was studied by propidium iodide (PI) staining. Annexin V-FITC and PI assays were used to evaluate apoptosis, and the results were confirmed by electron microscopy. The mitochondrial membrane potential was measured by JC-1 assay.

Results Our results showed that the combined expression of gef and apoptin genes was strikingly

more effective NVP-BSK805 than the expression of either gene alone. Co-expression of gef and apoptin synergistically enhanced the decrease in cell viability, increasing necrosis and inducing apoptosis in colon cancer cells via the mitochondrial pathway, which can be deficient in advanced or metastatic colon cancer.

Conclusions Double-suicide gene therapy based on gef and apoptin genes may be a candidate for the development of new colon cancer strategies, and further studies are warranted to establish the usefulness of double-suicide gene therapy in vivo.”
“Background: Plasma levels of tumor marker carbohydrate 125 antigen (CA 125) have been found elevated among patients with advanced heart failure (HF). We evaluated the prognostic value of CA 125 in a population of patients with mild

to moderate HF.

Methods and Results: Serum levels of CA 125 were obtained in 102 patients with mild to moderate HF from idiopathic (48%) or ischemic (52%) dilated cardiomyopathy (age 64 +/- 10.4 years, left ventricular ejection fraction: 34.4 +/- 8.5%), under optimized medical therapy. During follow-up (43 +/- 15 months), 16 (15.7%) cardiovascular deaths and 23 (22.5%) cardiovascular deaths + HF hospitalizations were recorded. Considering cardiac death, comparison of Kaplan-Meier survival curves by the log-rank test showed that patients with CA 125 levels higher than the cut-off value (30 U/mL) had a worse survival (P < .0001). This was observed also when considering cardiovascular death+ HF hospitalizations as the secondary end point (P = .0003).

It has been commonly used in folk medicine as a substitute for the European mistletoe. In this chemical study, morolic acid was isolated as the major component (47.54% of the total composition of acetone extract) of this plant. In addition, 19 known compounds were identified: -sitosteryl and stigmasteryl linoleates, -sitosterol, stigmasterol, triacontanol, squalene, – and -amyrin, lupeol, lupenone, betulin aldehyde, betulon aldehyde, oleanolic aldehyde, betulinic acid, betulonic acid, moronic acid, morolic acid, oleanolic acid, flavonoids

acacetin and acacetin 7-methyl ether. There have been no previous reports in the literature on the chemical composition of www.selleckchem.com/products/3-deazaneplanocin-a-dznep.html this potential natural source of hypoglycaemic and antihypertensive compounds.”
“Fetal thrombotic vasculopathy (FTV) is a placental lesion characterized by Selleck Linsitinib regionally distributed

avascular villi and is often accompanied by upstream thrombosis in placental fetal vessels. Previous studies, using preselected populations, have shown associations of this lesion with adverse neurodevelopmental outcomes and potentially obstructive lesions of the umbilical cord. We investigated the prevalence of obstetric complications, perinatal disease, and placental abnormalities in cases with Fly. One hundred thirteen cases of placentas with FTV were identified in our pathology database over an 18-year period. Two hundred sixteen placentas without the diagnosis of FTV, frequency matched on year of birth, were selected as controls. Electronic medical records and pathology reports were used to extract maternal and Dinaciclib mw gestational age, method of delivery, neonatal outcome, lesions of the umbilical cord, obstetric

complications, and fetal abnormalities. Placentas with FTV were associated with a 9-fold increase in rate of stillbirth and a 2-fold increase in intrauterine growth restriction. The increase in pregnancy-induced hypertension/preeclampsia was not significant when adjusted for maternal and gestational age. Although the rate of potentially obstructive cord lesions was similar in both groups, there was an almost 6-fold increase in the presence of oligohydramnios in FTV placentas, compared with controls. Finally, FTV was associated with a 6-fold increase in fetal cardiac abnormalities. Fetal thrombotic vasculopathy is associated with a significantly higher rate of obstetric and perinatal complications. This study points to abnormal fetal circulation, either in the form of congenital heart disease or oligohydramnios predisposing to cord compression, as a risk factor for FTV.”
“A new pentacyclic triterpenoid and three new derivatives based on the taraxer-14-ene skeleton with a C-28 attached a carboxylic acid group have been isolated from the stem bark of Hypodaphnis zenkeri, together with six known compounds. The new product was identified as 2,3-dihydroxytaraxer-14-en-28-oic acid (1).

“
“P>Transcriptome selleck kinase inhibitor analysis using the Affymetrix ATH1 platform has been completed on purified trichomes from the gl3-sst mutant. These trichomes display immature features, such as glassy cell walls and blunted branches. The gl3-sst trichome transcriptome was greatly enriched for genes involved in lipid biosynthesis, including those mediating the synthesis of fatty acids and wax. In addition, gl3-sst trichomes displayed reduced expression of the R3 MYBs TRY and CPC, which

normally function to limit trichome development. The expression of the MIXTA-like MYB gene NOK was elevated. Members of the MIXTA-like family promote conical cell outgrowth, and in some cases, trichome initiation in diverse plant species. In contrast, NOK limits trichome outgrowth in wild-type Arabidopsis plants. Similar to other MIXTA-like genes, NOK was required for the expansion of gl3-sst trichomes, as the gl3-sst nok double mutant trichomes were greatly reduced in size. Expression of NOK in nok mutants selleck screening library reduced branch formation, whereas in gl3-sst nok, NOK expression promoted trichome cell outgrowth, illustrating duel roles for NOK in both promoting and limiting trichome development. MIXTA-like genes from phylogenetically diverse plant species could substitute

for NOK in both nok and gl3-sst nok backgrounds. These findings suggest that certain aspects of NOK and MIXTA-like gene function have been conserved.”
“The objective of the study is to investigate the benefits of joining a self-help group for patients with medication overuse headache (MOH). A self-help group is a voluntary gathering of

a small number of persons who share a common problem. Little is known about support groups for people with chronic non-malignant pain such as MOH. Eight patients with refractory MOH attended a self-help group twice a month. During the meetings, patients were asked to focus on their headache experiences. Our data showed an increase in resourcefulness in coping with pain and a reduction in cephalalgiophobia. All patients reported general benefits in sharing their headache-related problems. No differences were found for headache frequency or analgesic overuse. To BI-2536 our knowledge, this is the first report on a self-help group for patients with MOH. Joining a self-help group can help patients develop positive attitudes to managing pain.”
“P>Pseudomonas syringae pv. tomato DC3000 is a bacterial pathogen of Arabidopsis and tomato that grows in the apoplast. The non-protein amino acid gamma-amino butyric acid (GABA) is produced by Arabidopsis and tomato and is the most abundant amino acid in the apoplastic fluid of tomato. The DC3000 genome harbors three genes annotated as gabT GABA transaminases. A DC3000 mutant lacking all three gabT genes was constructed and found to be unable to utilize GABA as a sole carbon and nitrogen source.

The results show that the major effect of hl on pubescence results from structural distortion (bending and swelling) of all trichome types in aerial tissues. Leaf surface extracts and isolated type VI glands from hl plants contained wild-type levels of monoterpenes, glycoalkaloids, and acyl sugars, but were deficient in sesquiterpene and polyphenolic compounds implicated in anti-insect defence. No-choice bioassays Selleckchem GSK461364 showed that hl plants are compromised in resistance to the specialist herbivore Manduca sexta. These results establish a link between the morphology and chemical composition

of glandular trichomes in cultivated tomato, and show that hl-mediated changes in these leaf surface traits correlate with decreased resistance to insect herbivory.”
“The aim of this study was to determine the effect of the ester carbon chain length of curing agents modified by epoxidized oleic esters on the toughness of cured epoxy resins. An amine-terminated prepolymer (i.e., curing agent Selleck P005091 G) was synthesized from a bisphenol A type liquid epoxy resin and triethylene tetramine. The toughening curing agents (G1 and G2) were prepared by reactions of epoxidized oleic methyl ester and epoxidized oleic capryl ester, respectively, with curing agent G. Fourier transform infrared spectrometry was used to characterize the chemical structure of the curing agents. The effects of the carbon chain length

of the oleic ester group in the curing agents on the toughness and other performances of the curing epoxy resins were investigated by analysis of the Izod impact strength,

tensile strength, elongation at break, thermal properties, selleck kinase inhibitor and morphology of the fracture surfaces of the samples. The results denote that the toughness of the cured epoxy resins increased with the introduction of oleic esters into the curing agents without a loss of mechanical properties and that the toughness and thermal stability of the materials increased with increasing ester carbon chain length. The toughness enhancement was attributed to the flexibility of the end carbon chains and ester carbon chains of the oleic esters in the toughening curing agents. (C) 2010 Wiley Periodicals, Inc. J Appl Polym Sci 119: 3504-3510, 2011″
“Pluripotency, a characteristic of cells in the inner cell mass of the mammalian preimplantation blastocyst as well as of embryonic stem cells, is defined as the ability of a cell to generate all of the cell types of an organism. A group of transcription factors is essential for the establishment and maintenance of the pluripotent state. Recent studies have demonstrated that differentiated somatic cells could be reverted to a pluripotent state by the overexpression of a set of transcription factors, further highlighting the significance of transcription factors in the control of pluripotency. Among these factors, a member of the POU transcription factor family, Oct4, is central to the machinery governing pluripotency.

Therefore, the total number of the mature particles remained constant from this point until the end of the reaction. (C) 2011 Wiley Periodicals, Inc. J Appl Polym Sci 122: 203-209, 2011″
“Pelvic floor (PF) dysfunctions represent a frequent and complex problem for women. The interaction between the vagina and its supportive structures, that are designed to support Pitavastatin ic50 increases in abdominal pressure, can

be considered a biomechanical system. Recent advances in imaging technology have improved the assessment of PF structures. The aim of this paper is to review the applications of biomechanics in urogynecology.

The available literature on biomechanics research in urogynecology was reviewed.

Computational models have been demonstrated

to be an effective tool to investigate the effects of vaginal delivery and PF dysfunctions. Biomechanical analysis of PF tissues provides a better understanding on PF dysfunctions etiology. These studies are also HM781-36B mouse important for the development of synthetic prostheses utilized in PF surgery.

An interdisciplinary and multidisciplinary collaborative research, involving bioengineers and clinicians, is crucial to improve clinical outcomes in patients with PF dysfunctions.”
“This paper reports the design, fabrication, and performance characterization of a magnetostrictive microworm actuator. The suggested worm actuator is partially coated with NiFe film of 10 mu LY2606368 research buy m thickness. This actuator consists of a body plate of 50 mu m thickness and four legs fabricated using SU-8 spin coating together with development and bonding process. Three square sections of NiFe film of 10 mu m

thickness are in turn electroplated on the top and bottom sides of the SU-8 body. The external magnetic fields are controlled for sinusoidal form of 3 Hz frequency. For the magnetomechanical characterization of the film, the magnetic moment is examined using a vibrating sample magnetometer. For assaying the movement of the actuator, the curvatures of each section under the applied external magnetic field are measured using a microscope measurement system with electromagnet set. The results show wave shape movement and maximum contractile distance between the end tips of legs is 0.777 mm. (C) 2011 American Institute of Physics. [doi:10.1063/1.3536525]“
“An operating window, which is bounded by two temperatures and draw ratios, defines the stable and defect-free stretching region of a polymer film. Physical properties including the coefficient of thermal expansion (CTE), birefringence, and Young’s modulus of a recyclable polyimide (PIR) film were measured under stretching conditions. While values of birefringence and Young’s modulus increased with increasing stretching stress in the machine direction, the CTE was found to decrease.

001) 6 months after the cystocele repair. A concomitant sling procedure was significantly correlated with changes in the UDI-6 score (p < 0.001); the patients without stress urinary incontinence selleck kinase inhibitor (SUI) who underwent cystocele repair only showed no symptomatic improvements in the UDI-6 score (p = 0.560). Conclusions: Correction of SUI resulted in urinary symptom improvement in cystocele patients. Cystocele repair with or without sling placement did not change Q(max), RU or sexual functioning at the 6-month follow-up. Copyright (C)

2012 S. Karger AG, Basel”
“Depression and suicide are increased in patients with epilepsy. The U.S. Food and Drug Administration warns that antiepileptic drugs (AEDs) are associated with increased risk of suicidality. This study examines the relationship among depression, suicidal ideation,

and AEDs in a prospective cohort of 163 patients with epilepsy from a registry at the University of Florida (January 2006 to August 2008). The Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) was used to measure mood and suicidal ideation across two time points (median = JQ-EZ-05 154 days). Groups included: (1) No AED Change, (2) New AED Added, (3) AED Dose Increased, (4) AED Reduced/Stopped, (5) Multiple AED Changes, and (6) Combined Any AED Change (groups 2-5 combined). No group had worsening mood or suicidal ideation. Significant improvements in proportions of depression and suicidal ideation were seen only for the No AED Change group, which differed only with the AED Dose Increased group with respect to suicidal ideation. (C) 2010 Elsevier Inc. All rights reserved.”
“The dielectric response of Rb-0.5(ND4)(0.5)D2PO4 (DRADP-50) dipolar glass has been studied at low temperatures. From the experimental results, the distribution of the relaxation times and of the local LY2157299 mw polarization at various temperatures is calculated. It is shown that the local-polarization distribution function obtained from

the dielectric response epsilon*(nu, T) is consistent with that obtained from NMR results. The results also show that the dielectric dispersion is due to diffusion, creation, and annihilation of Takagi groups. (C) 2011 American Institute of Physics. [doi:10.1063/1.3590147]“
“Objectives: To determine whether sacral neuromodulation (SNM) for urinary symptoms or fecal incontinence gives improvement of female sexual function and whether improvement is due to physiological or psychological factors. Methods: Between 2002 and 2008, 8 patients had an array of questionnaires before and after SNM implantation. The questionnaires were: the Questionnaire for Screening for Sexual Dysfunctions, the Golombok Rust Inventory of Sexual Satisfaction, the Symptom Checklist-90, the Maudsley Marital Questionnaire and the McGill-Mah Orgasm Questionnaire. Three of these 8 patients underwent vaginal plethysmography before and after implantation.

The integrated intensities of mineral phase (phosphate and carbonate bands at 959 and 1,071 cm(-1), respectively) and organic phase (amide I band at 1,665 cm(-1)) Raman bands were analyzed. The mineral-to-matrix

(phosphate/amide I), carbonate-to-phosphate, and carbonate-to-amide I ratios were analyzed to assess bone quality. The phosphate content on trabecular bone was higher in the CRE group than the OVX group (p < 0.05). No significant changes in mineral or organic phases on cortical bone were observed. A radiographic assessment of bone density was encouraging as the same findings were showed by Raman intensity of phosphate from cortical (r (2) = 0.8037) and trabecular bones (r (2) = 0.915). Severe ovariectomy-induced bone loss was confirmed by FT-Raman spectroscopy. The results suggest that the chemical composition of trabecular bone tissue may be positively influenced by Cr supplementation after ovariectomy.”
“The thin-walled structure of veins leads VX-689 them to stay collapsed during anastomoses, thereby the incidence of technical failures is more common than arterial anastomoses. In order to overcome this ACY-241 problem, we are introducing the use of viscoelastic material based on our experience on rats. Six rats were used in order to study the technical feasibility of the viscoelastic material during microsurgical vein anastomosis. End-to-end anastomoses were

performed on rat jugular veins using 0.5-1 mL of the viscoelastic medium applied to the ends of the veins and surgical field

under X30 operating microscope magnification. Then 1.8% (n:3) and 3.0% (n:3) hyaluronic acid was used as a viscous medium in order to keep the vein lumens open during anastomosis. In conclusion, we have found that 3.0% hyaluronic acid viscoelastic medium facilitates microvenous anastomosis in rat. Studies involving human practice are needed for further evaluation of this technical refinement.”
“While some studies have shown that long-limb gastric bypass with Roux limb length of 150 to 200 cm can attain better weight loss outcomes in super-obese patients (BMI > 50 kg/m(2)) than the standard limb gastric bypass with Roux limb length of 100 to 150 cm, other studies have not shown similar findings. Additionally, no study has demonstrated the optimal length find more of the Roux limb that will result in ideal weight loss. The purpose of this study is to compare the long-term weight loss and weight regain of standard limb length (SLL) and long limb length (LLL) gastric bypass in patients with BMI > 50 kg/m(2).

A total of 120 patients with BMI > 50 kg/m(2) underwent either SLL (total bypass length = 200, biliopancreatic limb = 50-80 cm, Roux limb = 120-150 cm) or LLL (total bypass length = 250 biliopancreatic limb = 50-80 cm, Roux limb = 170-200 cm) RYGB. The excess weight loss (EWL), the weight regain, and the rate of complications were measured at 1-, 2-, and 3-year follow-up. Statistical comparisons were performed using t-test.

MATERIALS AND METHODS

Autologous adipose-derived stromal cells were isolated, cultured, and differentiated to adipocytes in vitro.

The differentiated adipocytes were suspended in Dulbecco’s modified Eagle medium and injected into the lesion requiring soft tissue augmentation. Eight patients were treated with this tissue-engineered filler. Long-term follow-up for longer than 1 year was possible in all patients.

RESULTS

Two or 3 weeks after the injection, volume increment of subcutaneous tissue was observed around the injection area in the ensuing 1 to 5 weeks. Thereafter, additional volume augmentation was not found and the augmentation effect was well-maintained. All patients agreed on the clinical effectiveness of the GSK1838705A mw procedure, and no complications occurred.

CONCLUSIONS

The results obtained indicate that this method is well tolerated and may be an effective means of achieving soft tissue augmentation.

The authors have indicated no significant interest

with commercial supporters.”
“Vinasse is a sulfate-rich liquid substrate, from which high levels of hydrogen sulfide in biogas can be obtained due to the sulfate reduction process under anaerobic conditions. Hydrogen sulfide is corrosive and toxic and must be removed for any utilization of the biogas. Mathematical models have been developed to study separately sulfate reduction in anaerobic digestion and sulfide removal from biogas streams. However, the levels of hydrogen sulfide produced in the anaerobic digestion stage have see more an effect on the sulfide removal processes in the next stage. As a method to study both processes and their interaction, a new approach is introduced and reviewed in the present article: the sulfur chain in biogas production. The necessity of studying the sulfate reduction processes in vinasse as a typical sulfate-rich substrate to predict hydrogen sulfide concentrations in the gas phase,

as well as the best model approach to that aim are established here. In addition, the approaches to model sulfide removal based on direct conversion processes, the models’ capability to predict the removal of hydrogen sulfide from the biogas (at levels between 20 000 drug discovery and 30 000 ppm(v)) as well as the concentration profile of the reactants in this removal processes are discussed. (c) 2013 Society of Chemical Industry”
“We report on the measurements of current-driven dynamics in magnetic nanopillars as a function of the current-sweep rate. These measurements were intended to verify the recently predicted thermal-activation nature of current-induced precessional states in spin-valve multilayers. For a fixed temperature and field (applied perpendicular to the layers), the critical current for dynamic excitations was found to increase logarithmically with the sweep rate as expected for a thermally activated process. However, we observed little if any dependence of this behavior on temperature.

The tumour metastasises early to both paratracheal and lateral cervical lymph nodes. Metastases outside the neck may occur in the liver, lungs, bones and, less frequently, brain and skin.

Surgery is the main treatment for local and distant metastases whenever feasible. Systemic Angiogenesis inhibitor chemotherapy with dacarbazine, 5-fluorouracil and doxorubicin (alone or in combination) has shown very limited efficacy, achieving only partial responses in the range of 10-20% and of short duration. Several kinase inhibitors are currently under evaluation and preliminary results are promising. Familial cases must be identified by searching for RET proto-oncogene mutations in the proband and in family members. Carriers of the RET gene are candidates for prophylactic thyroidectomy at different ages depending on the risk associated with the specific RET mutations. (C) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.”
“A novel epoxidized hemp oil (EHO) based bioresin Copanlisib nmr was synthesized by epoxidation in situ with peroxyacetic acid. In this research the cure kinetics of an EHO based bioresin system cured with triethylenetetramine (TETA) was studied by differential scanning calorimetry using both isothermal and nonisothermal data. The results show that the

curing behavior can be modeled with a modified Kamal autocatalytic model that accounts for a shift to a diffusion-controlled reaction postvitrification. The total order of the reaction was found to decrease with an increase in temperature from similar to 5.2 at 110 degrees C to similar to 2.4 at 120 degrees C. Dynamic activation energies were determined from the Kissinger (51.8 kJ/mol) and Ozawa-Flynn-Wall (56.3 kJ/mol) methods. Activation energies determined

from the autocatalytic method were 139.5 kJ/mol and -80.5 kJ/mol. The observed negative activation energy is thought to be due to an unidentified competitive reaction that gives rise to the appearance of k(2) decreasing with increasing temperature. The agreement of fit of the model predictions with experimental values was satisfactory for all temperatures. (C) 2011 Wiley Periodicals, CH5424802 solubility dmso Inc. J Appl Polym Sci 122: 444-451, 2011″
“The effect of the Au capping layer on the magnetic anisotropies and molecular magnetic moment of ultrathin epitaxial Fe3O4 films on GaAs(100) substrate was studied by MO Kerr effect, superconducting quantum interference device, and Ferromagnetic resonance, respectively. The films with and without capping layers show a predominant in-plane uniaxial magnetic anisotropy and a minor fourfold anisotropy. The Au capping layer was found to increase significantly the uniaxial magnetic anisotropy related to the magnetoelastic interactions at the Au/Fe3O4 interface, and unexpectedly reduce saturation molecular magnetization due to the interfacial diffusion between Au layer and Fe3O4 layer. (C) 2011 American Institute of Physics. [doi:10.1063/1.

In the reproductive www.selleckchem.com/products/ly2835219.html phase sym28 shoots develops additional flowers, the stem fasciates, and the normal phyllotaxis is perturbed. Mutational substitution of an amino acid in one leucine rich repeat of the corresponding Lotus japonicus LjCLV2 protein results in increased nodulation. Similarly, down-regulation of the Lotus Clv2 gene by RNAi mediated reduction of the transcript level also

resulted in increased nodulation. Gene expression analysis of LjClv2 and Lotus hypernodulation aberrant root formation Har1 (previously shown to regulate nodule numbers) indicated they have overlapping organ expression patterns. However, we were unable to demonstrate a direct protein-protein interaction between LjCLV2 and LjHAR1 proteins in contrast to the situation between equivalent proteins in Arabidopsis. LjHAR1 was localised to the plasma membrane using a YFP fusion whereas LjCLV2-YFP localised to the endoplasmic reticulum when transiently expressed in Nicotiana benthamiana

leaves. This finding is the most likely explanation for the lack of interaction between these two proteins.”
“The reason(s) that hepatitis A virus (HAV) infection may progress infrequently to acute liver failure are poorly understood. We examined host and viral factors in 29 consecutive adult patients with HAV-associated acute liver failure enrolled at 10 sites participating learn more in the US ALF Study Group. Eighteen of twenty-four acute liver failure sera were PCR positive while six had no detectable virus. HAV genotype was determined using phylogenetic analysis and

the full-length genome sequences of the HAV from a cute liver failure sera were compared to those from self-limited acute HAV cases selected from the CDC database. We found that rates of nucleotide substitution did not vary significantly between the liver failure and non-liver failure cases and there was no significant variation in amino acid sequences between the two groups. Four of 18 HAV isolates were sub-genotype IB, acquired from the same study site over a 3.5-year period. Sub-genotype IB was found more frequently among acute liver failure cases compared to the non-liver failure cases (chi-square test, P < 0.01). At another centre, a mother and her son presented with HAV and liver failure within 1 month of each other. Predictors of spontaneous survival included detectable LBH589 price serum HAV RNA, while age, gender, HAV genotype and nucleotide substitutions were not associated with outcome. The more frequent appearance of rapid viral clearance and its association with poor outcomes in acute liver failure as well as the finding of familial cases imply a possible host genetic predisposition that contributes to a fulminant course. Recurrent cases of the rare sub-genotype IB over several years at a single centre imply a community reservoir of infection and possible increased pathogenicity of certain infrequent viral genotypes.