However, neither depletion of NK cells or neutrophils, along with DC, mitigated the exacerbated hepatotoxicity associated with DC depletion (Fig. 6), suggesting that the protective effects of DC is not simply secondary to expansion of other leukocyte populations. Similarly, because DC depletion results in elevated serum levels of TNF-α, IL-6, and MCP-1 after APAP administration, we tested whether blockade of these cytokines in vivo would prevent the exacerbated liver injury. However, none of these cytokine blockades protected APAP-DC animals (Supporting Fig. 10). Similarly, IFN-α blockade33 failed to protect APAP-DC animals (Supporting Fig.

10) There is evidence to suggest that APAP-induced liver toxicity is the result of a “two-hit” PF 2341066 mechanism, the first hit being depletion of glutathione, which in turn allows the toxic metabolite NAPQ1 to exert harmful effects Opaganib by forming covalent

bonds with cellular proteins. The second hit is the downstream activation of cells of the innate immune system. Because DC have a central function in liver immunity and inflammation, we postulated a critical role for DC in APAP-mediated toxicity. Previously, we showed that DC expand 5-fold and undergo a transformation in function from a tolerogenic to an immunogenic role in chronic liver fibrosis.25 We reported that DC contribute to the proinflammatory cascade in liver fibrosis by way of production of TNF-α and subsequent T-cell activation as well as induction of innate immune responses.25 Similar to liver fibrosis, in APAP toxicity DCs are highly proinflammatory, producing elevated levels of IL-6, TNF-α, and MCP-1 (Fig. 3D,E). However, in contrast to chronic liver disease, in acute liver injury as a result of APAP overdose, DC populations remained stable in number. Furthermore, whereas chronic liver injury resulted in the transformation

of DC from weak purveyors of tolerance MCE公司 to potent immunogenicity, in the current context DC did not gain enhanced capacity to stimulate CD4+ or CD8+ T cells (Fig. 3F) or NK cells (Supporting Fig. 9B,C). The trigger in the hepatic microenvironment that thrusts DC in certain inflammatory contexts towards immunogenicity is uncertain but may be the key to understanding hepatic tolerance. Furthermore, whereas DCs appear to contribute to the pathologic environment in chronic liver disease, in the current context DCs are protective. This is evidenced by reduced liver enzymes and histologic measurement of necrosis in APAP-treated mice cotreated with Flt3L, which expands DC populations 10-fold. Furthermore, mice depleted of DC had significantly more extensive centro-lobular necrosis (Fig. 1A,B) and increased mortality (Fig. 2) when compared to mock-depleted mice. In addition, APAP-DC mice produced markedly higher serum liver enzyme levels (Fig. 1C) and inflammatory mediators MCP-1, IL-6, and TNF-α (Fig. 1E,F) compared with APAP challenge in the absence of DC depletion.

8% aqueous solution of ammonium polyacrylate in a ratio of approximately 1:1 solid:liquid. A viscosifying agent, hydroxypropyl methylcellulose, is added to a concentration of 1% in the liquid phase, and then a counter polyelectrolyte is added to gel the slurry. There are two methods for robocasting crown structures (cores or FPD framework). One is for the core to Daporinad be printed using zirconia ink without support materials, in which the stereolithography (STL) file is inverted (occlusal surface resting on a flat substrate) and built. The second

method uses a fugitive material composed of carbon black codeposited with the ceramic material. During the sintering process, the carbon black is removed. There are two key challenges to successful printing of ceramic crowns by the robocasting technique. First is the development of suitable materials for printing, and second is the design of printing patterns for assembly of the complex geometry required for a dental restoration. Robocasting has room for

improvement. Current development involves enhancing the automation of nozzle alignment for accurate support material deposition and better fidelity of the occlusal surface. An accompanying effort involves calculation Pritelivir nmr of optimal support structures to yield the best geometric results and minimal material usage. “
“This article describes the treatment of a 61-year-old man who had a completely edentulous maxillary arch and partially edentulous mandibular arch. The patient was orthodontically

treated to correct an anterior crossbite by distalization of the mandibular teeth using a removable prosthesis serving as an anchorage unit. Subsequently, the patient received two zygomatic implants, five conventional implants in the maxillary arch, 上海皓元 and six conventional implants in the mandibular arch. By the end of treatment, the convexity of the facial profile improved, and esthetic and functional occlusion was established. “
“Purpose: The aim of this study was to evaluate the influence of two pigments (ceramic powder and oil paint) and one opacifier (barium sulfate) on the color stability of MDX4–4210 facial silicone submitted to accelerated aging. Materials and Methods: Sixty specimens of silicone were fabricated and divided into six groups-–colorless (G1), colorless with opacifier (G2), ceramic (G3), ceramic with opacifier (G4), oil (G5), oil with opacifier (G6). All replicas were submitted to accelerated aging for 1008 hours. The evaluations of chromatic alteration through visual analysis and reflection spectrophotometry were carried out initially and after 252, 504, and 1008 hours of aging. The results were submitted to ANOVA and Tukey’s test at 5% level of significance. Results: All groups exhibited chromatic alteration (ΔE > 0); however, this color alteration was not perceptible through visual analysis of the color. The pigmented groups with opacifier presented the lowest ΔE values, with a statistical difference from the other groups.

This therapeutic modality was selected based on the large prosthetic space and the patient’s maxillary bone width and height condition, mainly on the right area, which would require bone grafts to obtain a ridge augmentation. The patient was informed about the possible therapeutic modalities and opted for the related treatment. This therapeutic alternative was less complex and time-consuming. In addition,

the use of dental implants in the maxilla would not significantly change the treatment planning for the anterior teeth regarding their periodontal condition. Even if an attachment-retained RPD was not used, these teeth would be splinted to form a stabilized polygon, achieving better long-term prognosis. As regards the periodontal health of the abutments and condition of the residual ridge, mandibular rehabilitation was performed using six dental implants http://www.selleckchem.com/products/PD-0332991.html and a full-arch fixed prosthesis. The maxillomandibular relationship, including reestablishment of the curves

of Spee and Wilson and the OVD, was recorded with occlusion rims and an acrylic resin template, according to the metric, phonetic, and esthetic methods (Fig 3). The maxillary cast was oriented on the semiadjustable articulator with a facebow record and the mandibular cast was mounted. The artificial teeth were positioned for an esthetic and functional clinical evaluation. After this, maxillary interim prostheses (anterior crowns and RPD) were obtained. Considering the extensive caries lesions www.selleckchem.com/btk.html and the inflammatory pulpal response or pulp breakdown, the maxillary left central incisor, lateral incisor, and canine were endodontically treated. The maxillary right central incisor was submitted to root canal retreatment. According to Torabinejad and Goodacre,[23] it appears that more than 95% of teeth MCE that have undergone endodontic treatment remain functional over time. Besides the success rates of endodontically

treated teeth used as abutments in RPDs, the maintenance of the remaining teeth present advantages such as proprioception and bone level preservation. Patient psychological factors must also be considered. Considering the absence of coronal dental tissue, which may compromise the bonding procedures for composite cores, only the left central incisor was restored with cast dowel and core. The other teeth were restored using a two-piece dowel/core system (prefabricated metallic dowel/composite core). When the presence of at least 1.5 to 2.0 mm of hard dental tissue structure is limited, and a cervical ferrule may not be gained, the definitive crown seems to be unable to support the masticatory loads.

Acceptability selleck chemicals of such screening influenced by knowledge, perception and attitude of the people. The study was conducted to determine the knowledge, perception and attitude of Indonesia people toward CRC screening. Aim: this study are assessing the knowledge perception

and attitudes with regard to colorectal cancer screening. Method: Cross sectional study with an interview-based population survey carried out in adult ages 30-79 years old, the instrument was structured questionnaires consisting 9 chapters. This survey collected from health center in Depok and hospital in Sumatera and Java. Result: the result from 809 respondents collected indicates that there are 478 (59, 1%) female, 459 (56,7%) age >=50 years old, 611 (75,5%) high educated, 681 (84,2%) married, 458(56,6%) worked and 440 (54,4%) had income C646 cost > 1 million, 76 (9.4%) done cancer colorectal screening, 25 (26.6%) good knowledge, 34 (7.6%) had a positive perception and 76 (17.1%)

positive attitude and 74 (13,9%) respondent from hospital. Chi square analysis, respondent whom less knowledge have odds ratio 34,3

(95% CI ,12,7-92,5; P<0,0001) and respondent from hospital done CRC screening have odds ratio 22,34 (95% CI 5,442-91,22; P<0,0001). Conclusion: The knowledge, perception and attitude on colorectal cancer screening test still low in Indonesian people. Key Word(s): 1. CRC screening; 2. knowledge; 3. perception; attitude Presenting Author: RUPAM 上海皓元医药股份有限公司 BHATTACHARYYA Additional Authors: G. LONGCROFT-WHEATON, P. BHANDARI Affiliations: Queen Alexandra Hospital, Portsmouth, United Kingdom Introduction: ESD enables en-bloc resection reducing recurrence rates, but is technically challenging with high complication rates and hence not widely practiced in the West. We have used a novel Knife Assisted Resection (KAR) technique. We aim to evaluate the outcome of KAR in treatment of large and refractory colonic polyps and identify polyp features that predict complications and recurrence after KAR. Methods: Cohort study of patients referred to our centre.

0). The remaining 131 patients were followed until death (n = 36; 23%; median time to death: 10 months [range, 0.1-41.0]) or study closure (n = 95; 61%; median follow-up: 57 months [range, 43-74]). Table 1 describes the baseline characteristics.

Median age at diagnosis of BSC was 37 years (range, 16-83), and 90 patients (57.3%) were female. Supporting Table 1 describes the etiology for the total study population. With reference to the Selleck Smoothened Agonist original EN-Vie study, we found additional causal factors in 12 patients: myeloproliferative neoplasms in 7; celiac disease in 2; and antiphospholipid syndrome, factor V Leiden mutation, and hyperhomocysteinemia in 1 each. One hundred and thirty-nine patients (88.5%) received long-term anticoagulation. Twenty-eight bleeding complications occurred in 24 patients (17%) during the study. Main causes of bleeding were portal hypertension (PH) related (n = 14; 2 died), intracranial hemorrhage (n = 3; 1 died), and abdominal wall bleeding (n = 2), genital bleeding (n = 2), bronchial bleeding (n = 1), and peptic ulcer (n = 1; all alive). Figure Lapatinib 1 shows the flowchart of treatments received by patients. Twenty-two patients underwent angioplasty (n = 13), thrombolysis (n = 7), or both (n = 2) as first invasive treatment. In 6 of these 22 patients, a vascular stent was placed at the time of angioplasty. After this initial intervention, 14 patients (64%) required further treatment with either TIPS (N = 12) or

OLT (N = 2) after a median time of 1.5 months (range, 0.2-19.0) (Fig. 1). The remaining 8 patients were only treated with angioplasty/thrombolysis (in 2 patients more than

once). Seven of them are alive and free 上海皓元医药股份有限公司 of ascites with a median follow-up of 47 months (range, 32-61), but 1 died 6 months later as a result of liver failure. Sixty-two patients underwent TIPS (39.5%). Main indications were refractory ascites (69%), liver failure (13%), and variceal bleeding (7%). Four of these (6.45%) had rescue OLT a median of 1.8 months after TIPS (range, 0.03-13.0) for the following reasons: HE (n = 1); fulminant liver failure (N = 1); and TIPS thrombosis with refractory ascites (N = 2). Three of these four patients died a median of 35 months after OLT (range, 7-45) as a result of liver failure (N = 2) and extrahepatic malignancy (N = 1). Of the remaining 58 patients, 10 (17%) died within 5.8 months (range, 0.2-39) and 48 (83%) were alive after a median follow-up of 51 months (range, 0.3-69.0). Thus, overall, 13 patients died, 9 of them resulting from a liver-related cause. One, 3-, and 5-year actuarial survival and OLT-free survival of patients treated with TIPS was 88%, 83%, and 72% and 85%, 78%, and 72%, respectively (Fig. 2). Similar results were found if deaths clearly unrelated to liver disease were removed from the analysis or considering the date of TIPS as time zero (data not shown). Median time from diagnosis to TIPS was 1 month (range, 0-38).

0). The remaining 131 patients were followed until death (n = 36; 23%; median time to death: 10 months [range, 0.1-41.0]) or study closure (n = 95; 61%; median follow-up: 57 months [range, 43-74]). Table 1 describes the baseline characteristics.

Median age at diagnosis of BSC was 37 years (range, 16-83), and 90 patients (57.3%) were female. Supporting Table 1 describes the etiology for the total study population. With reference to the Sirolimus original EN-Vie study, we found additional causal factors in 12 patients: myeloproliferative neoplasms in 7; celiac disease in 2; and antiphospholipid syndrome, factor V Leiden mutation, and hyperhomocysteinemia in 1 each. One hundred and thirty-nine patients (88.5%) received long-term anticoagulation. Twenty-eight bleeding complications occurred in 24 patients (17%) during the study. Main causes of bleeding were portal hypertension (PH) related (n = 14; 2 died), intracranial hemorrhage (n = 3; 1 died), and abdominal wall bleeding (n = 2), genital bleeding (n = 2), bronchial bleeding (n = 1), and peptic ulcer (n = 1; all alive). Figure JQ1 1 shows the flowchart of treatments received by patients. Twenty-two patients underwent angioplasty (n = 13), thrombolysis (n = 7), or both (n = 2) as first invasive treatment. In 6 of these 22 patients, a vascular stent was placed at the time of angioplasty. After this initial intervention, 14 patients (64%) required further treatment with either TIPS (N = 12) or

OLT (N = 2) after a median time of 1.5 months (range, 0.2-19.0) (Fig. 1). The remaining 8 patients were only treated with angioplasty/thrombolysis (in 2 patients more than

once). Seven of them are alive and free 上海皓元 of ascites with a median follow-up of 47 months (range, 32-61), but 1 died 6 months later as a result of liver failure. Sixty-two patients underwent TIPS (39.5%). Main indications were refractory ascites (69%), liver failure (13%), and variceal bleeding (7%). Four of these (6.45%) had rescue OLT a median of 1.8 months after TIPS (range, 0.03-13.0) for the following reasons: HE (n = 1); fulminant liver failure (N = 1); and TIPS thrombosis with refractory ascites (N = 2). Three of these four patients died a median of 35 months after OLT (range, 7-45) as a result of liver failure (N = 2) and extrahepatic malignancy (N = 1). Of the remaining 58 patients, 10 (17%) died within 5.8 months (range, 0.2-39) and 48 (83%) were alive after a median follow-up of 51 months (range, 0.3-69.0). Thus, overall, 13 patients died, 9 of them resulting from a liver-related cause. One, 3-, and 5-year actuarial survival and OLT-free survival of patients treated with TIPS was 88%, 83%, and 72% and 85%, 78%, and 72%, respectively (Fig. 2). Similar results were found if deaths clearly unrelated to liver disease were removed from the analysis or considering the date of TIPS as time zero (data not shown). Median time from diagnosis to TIPS was 1 month (range, 0-38).

LT should be carefully considered in patients with GSD type IIIa as muscle weakness and cardiomyopathy can be slowly progressive and will not be reversed by LT and may progress despite LT.[294] GSD IV (glycogen brancher

deficiency) is a systemic, yet heterogeneous disorder resulting in accumulation of insoluble amylopectin-like polyglucosan in the liver heart, muscle, nervous system, and skin.[295] The most common form in children appears to be predominantly hepatic with relatively rapid progression to cirrhosis and liver failure, with death by 5 years of age. Similar to GSD III, HCC can occur. The majority of reported cases of LT for GSD IV suggest a favorable outcome.[294, 296, 297] However, systemic progression of amylopectin-like deposits in the heart and muscle find more can occur post-LT resulting in cardiac and neuromuscular dysfunction and, in some cases, death. GSD type III and type IV may be associated with hepatocellular Imatinib cell line carcinoma or hepatic failure.[6, 298] LT for GSD serves to replace the enzyme deficiency in the liver and significantly improve metabolic control. Long-term survival following LT for GSD I, III, and IV appears to be better than a comparable control population who received an LT for conditions other than GSD.[289] However, this study was not able to assess the impact or development of extrahepatic morbidities such as cardiomyopathy, myopathy, infectious complications,

or inflammatory bowel disease. 66. LT evaluation

should be considered for patients with: GSD I with poor metabolic control, multiple hepatic adenomas, and/or concern for HCC (1-B); GSD III and IV with poor metabolic control, complications of cirrhosis, progressive hepatic failure, and/or suspected liver malignancy. (1-B) 67. Disease-specific counseling for post-LT expectations should include, for: GSD Ia and Ib: heightened 上海皓元 risk of renal complications; GSD 1b: development of inflammatory bowel disease; GSD IIIa and GSD IV: development of neuromuscular and cardiac complications; GSD I, III, IV: identification of HCC in explanted liver and risk of recurrence if it is present. (2-B) Fatty acid β-oxidation is a key metabolic pathway for the maintenance of energy homeostasis for high energy requiring organs such as the heart and skeletal muscle, and provides the main energy supply during prolonged fasting.[299] Fatty acid oxidation defects (FAOD) are inherited metabolic diseases with serious life-threatening symptoms such as hypoketotic hypoglycemia,[300, 301] acute encephalopathy, cardiomyopathy,[302] rhabdomyolysis,[303] metabolic acidosis, and liver dysfunction.[304] Triggering events include febrile illnesses, vomiting, and fasting can lead to severe complications. Hepatic presentation with hypoketotic hypoglycemia and Reye-like syndrome is usually seen in infancy, but can extend into childhood and adolescence.

Results: In total, 149 and 4 patients were diagnosed with early cancer and advanced cancer. Almost all them had atrophic gastritis. The proportion of endoscopically treatable gastric cancers was not significantly difference between the 2 groups (Group A vs

Group B: 81.3% vs 80.0%, P = 0.884). In addition, the proportion of advanced gastric cancers was not significantly difference (Group A vs Group B: 1.5% vs 8.0%, P = 0.065). Conclusion: Annual endoscopy MK-2206 cell line cannot facilitate the detection of endoscopically treatable gastric cancers compared with biennial endoscopy. Because there is little number of cases, it is necessary to repeat further examination. Key Word(s): 1. Screening endoscope; 2. gastric cancer Presenting Author: MATTHEW SMITH Additional Authors: ANDRE CHONG, MARCUS CHIN, SIMON EDMUNDS, SPIRO RAFTOPOULOS, YUSOFF

IAN, DEV SEGARAJASINGAM, CHIANG SIAH Corresponding Author: MATTHEW SMITH Affiliations: Fremantle Hospital, Royal Perth Hospital, Royal Perth Hospital, Sir Charles Gairdner Hospital, Sir Charles Gairdner Hospital, Sir Charles Gairdner Hospital, Royal Perth Hospital Objective: Whilst surgery is advocated for large gastric GISTs (20–30 mm +), management of small (<20 mm) lesions is controversial. A strategy of endoscopic ultrasound surveillance is commonly used, but data on its utility is limited. We analysed our experience in evaluation and surveillance buy NVP-AUY922 of gastric GISTs in Western MCE公司 Australia across all tertiary centres. Methods: All patients undergoing EUS for the evaluation of a gastric subepithelial lesion in Western Australia between

February 2002 and May 2014 were identified. Data was represented as mean or median +/− range as appropriate. Results: 263 patients with gastric subepithelial lesions were identified. EUS diagnosis was GIST in 161 cases (62%). 77 of the endosonographically suspected GISTs were recommended for surveillance. Of these, 55 patients proceeded to EUS surveillance, male 27 (49%) with mean age 59.1. Mean size of lesion 14.5 mm (range 6–40 mm). 155 EUS procedures were performed with mean number of EUSs per patient 2.8 (range 2–7). Mean time of EUS follow up was 33 months, median 26 months (range 4–113 months). In this time mean change in size was −0.65 mm, median 0 (range −19 to +5 mm). Longer follow up time had no relation to change in size. 5 patients (9%) went for surgery after a surveillance period of 5.0, 5.8, 13.6, 26.3 and 27.3 months respectively. 3 lesions were ≥30 mm on first EUS and indication was new lymph nodes (1) and cystic areas (2). The remaining 2 lesions were 20 mm and grew by 1 mm and 5 mm on first FU respectively. Histopathology showed no high risk lesions; low risk GIST 2, leiomyoma 2, schwannoma 1. Conclusion: In our cohort, there appears to be little evidence of significant growth of small gastric GISTs with up to 9 years of EUS follow up.

03 log) at initiation to 158 IU/mL (2.20 log) at week 4 and became undetectable (<43 IU/mL; COBAS TaqMan) at week 12. Wnt inhibitor The undetectability of viral load persisted during the whole duration of treatment and 6 months after its discontinuation. Currently, viral load is still undetectable, and noninvasive serum markers suggest a METAVIR score of A0F0. Interleukin (IL)28B genotype (rs12979860), retrospectively assessed, was C/T. In this case report, we show, for the first time, the efficacy

of dual therapy with Peg-IFN/RBV in a patient who failed to respond to telaprevir-based triple therapy, despite the presence of a telaprevir-resistant variant. Because of cross-resistance between telaprevir and boceprevir, retreatment with triple therapy was not an option. A previous Japanese study has shown efficiency of Peg-IFN/RBV in patients with a resistant variant secondary to telaprevir monotherapy.[4] As expected, the telaprevir-resistant

variant (R155T) was eliminated with Peg-IFN/RBV in our patient. Relapse subsequent to the first 12-week course of telaprevir-based triple therapy might be explained by the short duration of treatment, together with unfavorable IL28B genotype.[5] Retreatment with a 48-week course of Peg-IFN/RBV was able to achieve SVR, suggesting therapeutic insufficiency during the first course of treatment. Therefore, pending new molecules, retreatment http://www.selleckchem.com/products/Adrucil(Fluorouracil).html with a reinforced regimen of Peg-IFN/RBV could be a therapeutic option in genotype 1–naïve patients who failed to achieve sustained virological response with telaprevir-based triple 上海皓元医药股份有限公司 therapy. AlinaPascale M.D. “
“Kong Chee Fat Choi. As many Asian cultures celebrate the zodiac or lunar New Year, ‘Chinese New Year’ as it

is often known, February 2010 is also auspicious for JGH. Twenty-four years of hard work have won this Asia–Pacific gastroenterology and hepatology journal a high international reputation, and JGH at last enjoys a much-welcomed boost in Impact Factor—to 2.27. This is the first time we have been ‘in the twos’, and after taking a decade or so to get from 1.0 to > 2, we plan to leave the ‘terrible twos’ behind as quickly as possible! Before announcing what we have in store for you, the JGH team respectfully acknowledges two retiring editors, each of whom have contributed much to the recent prodigious growth and popularity of the Journal. Professor Tsutomu Chiba has followed Professors Kunio Okuda, Nobharu Sato and Hiromatsu Ishii in the strong tradition of senior JGH leadership from Japan. We are glad that Professor Chiba remains an Editor Emeritus of JGH and a Trustee of the JGH Foundation, which will allow him to continue active contribution to our Journal. Professor Ian Roberts-Thomson has coordinated the very popular Images of Interest and Education section of JGH for more than 12 years. Respecting his wish that his involvement in this section diminish during 2010, we have appointed him as an Editor Emeritus.

03 log) at initiation to 158 IU/mL (2.20 log) at week 4 and became undetectable (<43 IU/mL; COBAS TaqMan) at week 12. Autophagy activator The undetectability of viral load persisted during the whole duration of treatment and 6 months after its discontinuation. Currently, viral load is still undetectable, and noninvasive serum markers suggest a METAVIR score of A0F0. Interleukin (IL)28B genotype (rs12979860), retrospectively assessed, was C/T. In this case report, we show, for the first time, the efficacy

of dual therapy with Peg-IFN/RBV in a patient who failed to respond to telaprevir-based triple therapy, despite the presence of a telaprevir-resistant variant. Because of cross-resistance between telaprevir and boceprevir, retreatment with triple therapy was not an option. A previous Japanese study has shown efficiency of Peg-IFN/RBV in patients with a resistant variant secondary to telaprevir monotherapy.[4] As expected, the telaprevir-resistant

variant (R155T) was eliminated with Peg-IFN/RBV in our patient. Relapse subsequent to the first 12-week course of telaprevir-based triple therapy might be explained by the short duration of treatment, together with unfavorable IL28B genotype.[5] Retreatment with a 48-week course of Peg-IFN/RBV was able to achieve SVR, suggesting therapeutic insufficiency during the first course of treatment. Therefore, pending new molecules, retreatment NVP-BKM120 manufacturer with a reinforced regimen of Peg-IFN/RBV could be a therapeutic option in genotype 1–naïve patients who failed to achieve sustained virological response with telaprevir-based triple medchemexpress therapy. AlinaPascale M.D. “
“Kong Chee Fat Choi. As many Asian cultures celebrate the zodiac or lunar New Year, ‘Chinese New Year’ as it

is often known, February 2010 is also auspicious for JGH. Twenty-four years of hard work have won this Asia–Pacific gastroenterology and hepatology journal a high international reputation, and JGH at last enjoys a much-welcomed boost in Impact Factor—to 2.27. This is the first time we have been ‘in the twos’, and after taking a decade or so to get from 1.0 to > 2, we plan to leave the ‘terrible twos’ behind as quickly as possible! Before announcing what we have in store for you, the JGH team respectfully acknowledges two retiring editors, each of whom have contributed much to the recent prodigious growth and popularity of the Journal. Professor Tsutomu Chiba has followed Professors Kunio Okuda, Nobharu Sato and Hiromatsu Ishii in the strong tradition of senior JGH leadership from Japan. We are glad that Professor Chiba remains an Editor Emeritus of JGH and a Trustee of the JGH Foundation, which will allow him to continue active contribution to our Journal. Professor Ian Roberts-Thomson has coordinated the very popular Images of Interest and Education section of JGH for more than 12 years. Respecting his wish that his involvement in this section diminish during 2010, we have appointed him as an Editor Emeritus.