🔥🔥🔥 Matthew Parkin Observation

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Matthew Parkin Observation



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This habit is deeply embedded in the food culture of northeastern Thailand, as well as the broader lower Mekong region [ 11 ]. Re-infection with O. Continued consumption of raw fish will lead to individuals experiencing cycles of O. Several other diseases have been linked with the condition, including diabetes mellitus DM [ 13 , 14 ]. Recent studies have reported that DM is a risk factor for both intrahepatic and extrahepatic subtypes of CCA [ 15 ]: patients with DM were 1.

In addition, a retrospective study has shown that, although not statistically significant, DM is associated with shorter survival of CCA patients [ 17 ]. The relationship between CCA and a combination of O. However, there has been no previous investigation in humans of any relationship between CCA and a combination of O. This is particularly important in northeastern Thailand as the region, as well as having high O. Among rural females in the northeastern part of the country, one study found a prevalence of 8. In this study, residents of northeastern Thailand provide information on both O. They are then screened for CCA and associated hepatobiliary abnormalities.

We hypothesize that the group who were infected with O. All patients gave written informed consent for the study. This is achieved using multiple methods and settings including tertiary-care hospitals, district-level hospitals and through mobile screening sessions at the sub-district level. In addition to being screened for CCA, participants also filled out a questionnaire containing socio-demographic information, history of O.

The population of northeastern Thailand is approximately 21 million around one-third of the total population of Thailand. Our study includes all people who participated in CASCAP from 20 provinces separated into two groups screening and walk-in. The screening group were people attending health facilities for reasons unrelated to symptoms that could be associated with CCA, and who were invited to undergo routine ultrasonography US screening for CCA. The walk-in group comprised people who attended the hospital with symptoms indicating CCA and underwent histopathological diagnosis for CCA. Both screening and walk-in groups provided information regarding history of O. Flowchart showing the number of participants at each stage of data selection, leading to the final analysis set.

Biopsy confirmation for positive CCA was then needed. Each US examination was performed by either radiologists or well-trained general practitioners and was verified centrally by a radiologist at a tertiary hospital. The data of histological findings were based on the standard protocol of the tertiary hospital at Khon Kaen University, Thailand. The independent variables include the combinations of lifetime history of O. These were categorized into four groups, namely, uninfected with O. PZQ is used to treat O. The level factors comprise individual, and province factors. Categorical demographic characteristics were summarized using frequencies and percentages. Continuous data were summarized by their mean, standard deviation SD , and minimum and maximum values.

The rate of CCA was calculated based on a normal approximation to a binomial distribution. A multilevel mixed-effects logistic regression model was applied to consider the hierarchical structure of the subjects, where the individual level 1 was nested within the provinces level 2. The level of association between the combination of O. This model was adjusted for the variation of individual-level, and province-level effects random effects.

The highest value of maximum likelihood was estimated to assess the fitness of the model. All test statistics were two-tailed and a p-value of less than 0. A total of , participants who underwent screening for CCA were enrolled in our study Table 1. Participants were aged from 18 to years with a mean age of Almost two-thirds of them were female Among study participants, overall prevalence of O. Among the participants, Fig 2 shows the gender distribution of each of these groups. The data are presented as frequencies and percentages for the overall sample and separated by O. Data show percentages of the study population falling into each of the four possible combinations of O. Table 2 reveals the associations between frequency of O.

From a total of , participants, 0. The prevalence rate of CCA was 0. Compared to participants who were not infected with O. These effects controlled for co-variates comprising gender, age at enrollment, educational levels, occupation, smoking cigarettes, drinking alcohol, eating raw fish, and PZQ treatments fixed effect , and the variation of province levels random effects. The highest CCA rate was 1. Fig 5 shows the number of CCA cases according to the combination of O. Data show the rate of cholangiocarcinoma as percentage for overall O. Data shows the number of cholangiocarcinoma cases according to combination of O. Multilevel mixed-effects logistic-regression model results for the association of combinations of O.

These effects were controlled for co-variates comprising gender, age at enrollment, educational levels, occupation, smoking cigarettes, drinking alcohol, eating raw fish, PZQ treatments fixed effects , and the variation of province level random effects. Data show the magnitude of association of cholangiocarcinoma, comparing groups infected with O. In each case, the comparison is against the group without diabetes mellitus or O. Our study revealed that CCA was highly associated with the combination of O. To the best of our knowledge, these findings represent the first epidemiological observation among a large population in Northeast Thailand concerning co-occurrence of DM and O.

The proportion of our participants We also found that 21, participants 8. The overall rate of CCA in our study was 0. Given the nature of the study, where CCA case rates were calculated from among those who underwent screening, it is difficult to compare these results with other studies. We found that participants who had been infected with O. Our study was conducted in an area endemic for O. Our study area, besides being a liver-fluke endemic area, also has an increasing incidence of DM [ 19 , 20 ].

DM plays a key role in influencing carcinogenesis and promoting progression of CCA [ 28 ]. This is consistent with a previous study conducted in a hamster model [ 18 ]. Potential mechanisms to explain this increased CCA risk have been explored in some studies. For example, O. As well, co-occurrence of opisthorchiasis and DM in hamsters and tissue cultures of human liver cells has been found to lead to more severe disease in the liver than is caused by either condition alone [ 18 ].

High glucose levels can stimulate the proliferation and metastatic ability of CCA cells derived from patients with chronic O. Other studies have assessed whether DM is a risk factor or protective factor in patients diagnosed with biliary tract diseases. One study in a non-endemic area for liver-fluke infection reported that DM may be a protective factor against CCA development in those with biliary tract diseases. However, DM was also associated with significantly increased risk of CCA in patients without these conditions [ 14 ]. This finding is consistent with another study in northeastern Thailand, which found that, before praziquantel PQZ treatment, O.

The association between DM and O. There is still some possibility that the increased risks for CCA development that are associated with infection by O. In conclusion, our findings have revealed that O. These findings suggest that CCA-screening programs, as well as health-education efforts, should concentrate not only on O. A limitation of our study was that the data regarding history of O. This may particularly affect reporting of O. Detailed dietary data were not collected. This information may have given more explanatory power to the differences in CCA observed between groups of study participants.

This study was conducted in northeastern Thailand and may not reflect the general population of the country or of SE Asia more generally. Further study is necessary in the region to test the generality of our results. Nevertheless, the methodology and results of our study can be used as a guideline in formulating clinical practice and future research priorities. We would like to acknowledgement Prof. Principal findings Overall, , participants were included, of whom Conclusions The combination of O.

Author summary Northeastern Thailand has a high prevalence of liver fluke infection and increasing incidence of diabetes mellitus. Introduction The liver fluke, Opisthorchis viverrini is a food-borne trematode which is a key public health problem with a well-documented distribution in Thailand, Lao PDR, Cambodia, Myanmar, and Vietnam [ 1 , 2 ]. Download: PPT. Statistical analysis Categorical demographic characteristics were summarized using frequencies and percentages. Results Descriptive summary A total of , participants who underwent screening for CCA were enrolled in our study Table 1. Table 1. Demographic characteristics of participants according to O. Fig 2. Breakdown of study population according to O.

Get comfortable with that. Slowly, you will find your way. There will be things that you hate in your painting which will suddenly become your option and your possibility. He encourages his students to embrace and accept their ugly, boring personal history. Tal R, Hermes, The works are at once familiar and estranged. In technical terms, the employment of a vivid but limited palette is underpinned by a fluid stream of consciousness-style drawing. The format of many works can be seen to refer to the layout of the screen of early 80s video games.

It is exciting to behold, energetic, chaotic often menacing, the random compositions forming deep signifiers in subconscious conceptual terms. He does not want to draw or sculpt like a child, but he does desire to approach and refract seeing with the alpha-wave intensity of childhood. His timeline is thus a primer in sustaining the quicksilver quality of enchantment, on both sides of the creative process: for the artist the making, for the viewer the reception. Tal R, March to Goodwill, With either, viewers are able to serve themselves, to identify elements with personal resonance, while the artist alludes to cultural heritage, quotidian rituals that often centre on mealtimes and in doing so, asserts the importance and survival of family, the result of his own dual heritage and global culture.

I constantly have this hot-pot boiling and I throw all kinds of material into it. Tal R, Rosa Smoke, His enigmatic work transforms everything in his life; as a keen observer, he draws from external reality where his work is characterised by quick perceptual sketches as well as from his imagination. The two sources become a singular vision through fluid drawn images. Tal R, The Drawing Class, Collection of Howard and Katie Read. She uses the explosion as an archetypal image, familiar to us through life. You were being constantly bombarded with its imagery, from the violence of the comic strip, through action films, in documentaries about Super Novas and the Big Bang, and least of all on the news in never ending reports of war.

Tal R, Retired Professor, He creates a sense of involvement in a domestic world because it represents family and survival. We are drawn in to the brooding adolescent doodles, feel exhilarated by the inclusivity of his attitudes and enjoy his irreverent mix. Sexuality is explored through a preponderance of, mostly female, nudes in highly charged settings. Tal R, Deaf Institute, I fell for the intriguing work of Tal R through his drawings in black pigment and rabbit-skin glue. I had been writing about contemporary drawing since , but the visionary authenticity of his graphic images blew me away.

They felt encouraging of the essential creative act, the freedom to draw with the humble ballpoint pen enabling a visual stream of consciousness as first language. Drawing, as the most direct form of expression, is an appropriate means of traversing the critical storms and cul-de-sacs that have created barriers for the comprehension and enjoyment of much contemporary art. They attest rather to an absolute and all-absorbing need within the line itself to keep on the move. Tal R, Keyhole, In many of the early drawings of Tal R, there are singular identifiable stories being told.

He straddles abstract patterning that might have been observed on a Persian rug or a Matisse still life. There are symbolic forms the caged bird and a sense that the artist belongs to the rich northern tradition, from Hieronymus Bosch and Pieter Bruegel c to Max Beckmann Tal R, House Red, For example, in his book Sexshops, he presents 99 drawings from that use different approaches. The unique collaboration results in a cohesive body of work in crayon, pigment and rabbit-skin glue offering voyeurism for the viewer. Drawn to aspects of culture and everyday life, Sisters of Kolbojnik depicts a gang of long-haired, bell-bottomed nymphs in a magic-mushroom forest.

Tal R, Riders in the Sky, He prefers to inhabit a slipstream of not knowing and trust in the subconscious, the percolating back-brain, and not only in formal terms; he also has a deep animus towards symbolism, imagery standing for something.

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