The authors are grateful to Asahi Kasei-Kuraray JQ1 concentration Medical and JIMRO for providing fine photos. Also, we should like to thank Dr Abbi R Saniabadi of

JIMRO for providing beautiful artwork for this contribution. The authors have no conflict of interest in connection with the publication of this manuscript. “
“People detained in prisons and other closed settings are at elevated risk of infection with hepatitis C virus (HCV). We undertook a systematic review and meta-analysis with the aim of determining the rate of incident HCV infection and the prevalence of anti-HCV among detainees in closed settings. We systematically searched databases of peer-reviewed literature and widely distributed a call for unpublished data. We calculated summary estimates of incidence and prevalence among general population detainees and detainees with a history of injection drug use (IDU), and explored heterogeneity through stratification and meta-regression. The summary prevalence estimates were used to estimate the number of anti-HCV positive prisoners globally.

HCV incidence among general detainees was 1.4 per 100 person-years (py; 95% confidence interval [CI]: 0.1, 2.7; k = 4), and 16.4 per 100 py (95% CI: 0.8, 32.1; k = 3) among detainees with a history of IDU. The summary prevalence estimate of anti-HCV in general detainees was 26% BCKDHA (95% CI: 23%, 29%; selleck chemicals llc k = 93), and in detainees with a history of IDU, 64% (95% CI: 58%, 70%; k = 51). The regions of highest prevalence were Central Asia (38%; 95% CI 32%, 43%; k = 1) and Australasia (35%; 95% CI: 28%, 43%; k = 9). We estimate that 2.2

million (range: 1.4-2.9 million) detainees globally are anti-HCV positive, with the largest populations in North America (668,500; range: 553,500-784,000) and East and Southeast Asia (638,000; range: 332,000-970,000). Conclusion: HCV is a significant concern in detained populations, with one in four detainees anti-HCV-positive. Epidemiological data on the extent of HCV infection in detained populations is lacking in many countries. Greater attention towards prevention, diagnosis, and treatment of HCV infection among detained populations is urgently required. (Hepatology 2013;58:1215–1224) An estimated 2%-3% of people are infected with the hepatitis C virus (HCV) globally.[1, 2] The primary routes of transmission are injection drug use (IDU) and, in developing countries, medical procedures using nonsterile syringes and needles.[3] Perhaps two-thirds of the approximately 16 million people who inject drugs are HCV antibody (anti-HCV)-positive.[4, 5] Prisons and other closed settings (i.e.

All efforts are underway to produce an alternate, novel drug for haemophilia which will have an increased half-life, subcutaneously injectable, non-immunogenic and effective both in the presence and absence of inhibitors. “
“Complications of haemophilia in the knee region are rare and difficult to treat. Use of surgical treatments such as total knee arthroplasty cannot satisfactorily restore knee function in patients with these complications, which include

massive haemophilic pseudotumour, fracture around the knee and haemarthrosis. To analyse the postoperative results of patients suffering from complications of haemophilia and treated with a knee Selleck ATR inhibitor mega-endoprosthesis, to discuss and compare this type of surgical management with other types of treatments used in similar cases. We retrospectively analyse the surgical results of patients who were treated with a knee mega-endoprosthesis for complications of haemophilia. Three severe haemophilic arthritic knees, of which two were combined with femoral condylar fractures, were treated in a one-stage surgery, and another two knees which presented with massive haemophilic pseudotumours and bony defects were treated in a two-stage operation. Mean age at time of surgery was 28.5 years old and mean follow-up time was 22.8 months; the mega-endoprosthesis surgery was successfully performed in four cases and the mean

range of motion increased from 29.5° preoperatively to 96.75° postoperatively. The Knee society http://www.selleckchem.com/products/hydroxychloroquine-sulfate.html score function score value increased from 25 to 82.5. One knee was amputated because of uncontrollable recurrent haemorrhage. Roentgenograms did not show any signs of loosening of the prostheses. Use of Mega-endoprosthesis

in the treatment of complications of haemophilia can offer patients suffering from massive pseudotumours with bone defect, severe contracture knee haemophilic arthritis and fractures around a haemophilic knee a viable treatment option. “
“Early start of prophylaxis associated with minimizing immunological danger signals during the first 20 exposure days with FVIII should be considered for future therapy of patients with severe hemophilia A to reduce the risk of inhibitor formation. Once the patients have developed tolerance to FVIII, Fludarabine usually after about 20 to 50 EDs on the low dose regimen, and venous access permitted, prophylaxis might be changed to the normal three times weekly regimen for optimal joint protection. “
“The hemostatic efficacy of factor replacement therapy in patients with hemophilia is offset by its relatively short duration of activity and is complicated by the development of inhibitors that neutralize the function of infused factor (F) VIII or FIX. Research is focused on developing new drugs with prolonged biologic activity, alternative mechanisms of action, reduced immunogenicity, and/or enhanced bypassing activity.

Any small bowel polyp ≥ 1 cm in size on radiological imaging click here was referred for DBE-assisted polypectomy. Antegrade and retrograde DBE were successful in reaching and resecting targeted polyps in 90% (18/20) and 71.4% (10/14) of procedures, respectively. The overall success rate for DBE-assisted polypectomy

was 82.3% (95% confidence interval: 66.5–91.6%). The median size of resected polyps was 2 cm (range 1–5 cm) and all were hamartomas. Minor adverse events occurred in four (11.8%) procedures, including abdominal pain (n = 2), immediate post-polypectomy bleeding (n = 1), and self-limited hematochezia (n = 1). DBE-assisted polypectomy was successful in over 80% of HPS patients with an acceptable margin of safety. To the knowledge of the authors, this is one of the largest single-center studies to report on the performance and safety of DBE-assisted polypectomy in HPS Tamoxifen chemical structure patients. “
“Department of Microbiology, Ewha Womans University School of Medicine, Seoul, Republic of Korea Mixed cryoglobulinemia (MC) is the most common extrahepatic manifestation of chronic hepatitis C virus (HCV) infection. Although the formation of inflammation-triggering immune complexes is driven by clonal expansions of autoreactive B

cells, we found total B cell numbers paradoxically reduced in HCV-infected patients with MC. HCV patients with MC (n = 17) also displayed a reduced number and a reduced frequency of naïve B cells compared with HCV-infected patients without MC (n = 19), hepatitis B virus–infected patients (n = 10), and uninfected controls (n = 50). This was due to an increased sensitivity of naïve B cells to apoptosis resulting in a reduction in the size of the naïve B cell subset. In addition, 4-fold expansion and skewing (lower T1/T2-ratio) Acesulfame Potassium of the immature B cell subset was noted in MC patients, suggesting that apoptosis of naïve B cells triggered the release of B cell precursors from bone marrow in an attempt to maintain normal B cell numbers. Following treatment of MC with the B cell–depleting antibody rituximab, the size of all B cell subsets, the T1/T2-ratio, and the cyroglobulin levels all normalized. Cryoglobulin

levels correlated with in vivo proliferation of T2 B cells, suggesting a link between the skewing of the T1/T2 ratio and the formation of immune complexes. Conclusion: This study provides insight into the mechanisms maintaining B cell homeostasis in HCV-induced MC and the ability of rituximab therapy to restore normal B cell compartments. (HEPATOLOGY 2012;56:1602–1610) Chronic hepatitis C virus (HCV) infection is associated with extrahepatic manifestations that include B cell disorders. Mixed cryoglobulinemia (MC), the most common of these B cell abnormalities, is characterized by clonal proliferation of B cells and the formation of cold-precipitable cryoglobulin complexes composed of immunoglobulin M antibodies with rheumatoid factor activity (reviewed by Agnello et al.1 and Charles and Dustin2).

, the in-hospital mortality was slightly higher for patients undergoing resection, whereas the long-term result was better for transplantation in patients with a small number of tumors (five tumors or fewer) (LF003472 level 2b). Nonetheless, as to the criterion of a small (5 cm or less in diameter) mass, the results of

the two were comparable. A tumor criterion that can clearly be identified before surgery is mass diameter; therefore, the author concluded that superiority of transplantation over resection for hepatocellular carcinoma could not be affirmed. In a report by Figueras et al., transplantation was Sorafenib nmr performed as the first choice for hepatocellular carcinoma, and resection was conducted in patients who were not candidates for transplantation because of age and other concurrent diseases (LF001873 level 2a). A comparison

of results in patients undergoing resection who had a solitary tumor, no vascular invasion and good liver function (however, cirrhosis patients) with those of transplantation patients demonstrated that the recurrence-free survival rate was better for the latter, but there was no difference in the survival rate. In a report by Llovet et al., resection was selected for patients with a solitary tumor of 5 cm or less in diameter and good liver function, and transplantation was chosen for patients with unresectable tumors, and an intention-to-treat analysis including dropouts during the waiting period was performed (LF002994 level 2a). The in-hospital mortality was Fulvestrant comparable (2–4%) between resection and transplantation. However, when long-term results were compared by dividing patients undergoing resection into good and poor liver function groups, the best results were for the good liver function group undergoing resection, followed by the transplantation group and finally the poor liver function group undergoing resection. Tau-protein kinase Similarly, in a report by Pierie et al., transplantation was actually performed in 22 of 33 patients who were candidates for liver transplantation. An intention-to-treat analysis revealed that the results were good in the non-cirrhosis

patients undergoing resection, followed by transplantation patients and cirrhosis patients undergoing resection (LF111545 level 2a). In a report by Margarit et al., a comparison in Child–Pugh class A patients showed that the in-hospital mortality was higher for transplantation patients (0% vs 5.6%), and the duration of hospitalization was also longer for these patients. In contrast, there was no difference in the results of survival (recurrence-free survival was better for the transplantation patients) (LF114986 level 4). Shabahang et al. compared Child–Pugh class A patients. However, the in-hospital mortality was 7% in both groups, whereas the duration of hospitalization was longer for transplantation patients (LF117887 level 2a). As to long-term results, there was no difference in either recurrence-free survival or survival between the two groups.

MRI images from 21 fetuses at 16–26 weeks of gestation and eight embryos at Carnegie stage (CS)23 were investigated in the present study. Using the image data, the morphology of the liver as well

as its adjacent organs was extracted and reconstructed three-dimensionally. Morphometry of fetal liver growth was performed using simple regression analysis. The fundamental morphology was similar in all cases of the fetal livers examined. The liver tended to grow along the transversal axis. The four lobes were see more clearly recognizable in the fetal liver but not in the embryonic liver. The length of the liver along the three axes, liver volume and four lobes correlated with the bodyweight (BW). The morphogenesis of the fetal liver on the dorsal and caudal sides was affected by the growth of the abdominal organs, such as the stomach, duodenum and spleen, and retroperitoneal organs, such as the right adrenal gland and right kidney. The main blood vessels such as inferior vena cava, portal vein and umbilical vein made a groove on the surface of the liver. Morphology of the fetal liver was different from that of the embryonic liver at CS23. The present data will be useful for evaluating the development of the fetal liver and the adjacent organs that affect its morphology. “
“Amplification of 1q is one of the most frequent chromosomal alterations in human hepatocellular

carcinoma (HCC). In this study we identified and characterized a novel oncogene, Maelstrom (MAEL), at 1q24. Amplification and overexpression of MAEL was frequently detected in HCCs Sirolimus and significantly associated with HCC recurrence selleck products (P = 0.031) and poor outcome (P = 0.001). Functional study demonstrated that MAEL promoted cell growth, cell migration, and tumor formation in nude mice, all of which were effectively inhibited when MAEL was silenced with short hairpin RNA (shRNAs). Further study found that MAEL enhanced AKT

activity with subsequent GSK-3β phosphorylation and Snail stabilization, finally inducing epithelial-mesenchymal transition (EMT) and promoting tumor invasion and metastasis. In addition, MAEL up-regulated various stemness-related genes, multidrug resistance genes, and cancer stem cell (CSC) surface markers at the messenger RNA (mRNA) level. Functional study demonstrated that overexpression of MAEL increased self-renewal, chemoresistance, and tumor metastasis. Conclusion: MAEL is an oncogene that plays an important role in the development and progression of HCC by inducing EMT and enhancing the stemness of HCC. (Hepatology 2014;59:531–543) “
“Background and Aim:  Crohn’s disease (CD) is a chronic inflammatory bowel disease (IBD) of unknown etiology. We aimed to identify the etiological agent of CD using a molecular cloning strategy that was particularly focused on identifying agents causing immune abnormalities and infectious agents.

However, the observed effects of CagA were rather small. While the literature on NF-κB activation and IL-8 release is contradictory [11], it is nonetheless clear that the pro-inflammatory BGJ398 solubility dmso response of gastric epithelial cells is dominated by the presence of the cagPAI. This has been further validated in rhesus monkey and mouse isolates in which CagY protein mutations directly affected the ability to induce IL-8 in gastric epithelial cells ex vivo [12]. While the cagPAI clearly produces a pro-inflammatory response, its primary benefit

to the bacteria appears to be its ability to suppress the host defense. Upon CagA translocation, gastric epithelial cells were found to downregulate β-defensin-3 secretion via a CagA-SHP-2-complex-dependent signaling pathway [13]. Intriguingly, two opposing H. pylori-triggered regulatory circuits seem to control expression of this defensin so that its particular relevance in host defense is not directly revealed by an upregulation in the infected host tissue [14]. In addition, a mouse cathelicidin antimicrobial peptide, CRAMP, was found to be effective against H. pylori in vitro and in vivo [15]. The second line of defense against H. pylori is controlled by the phagocytic

cells of the stomach. Fehlings et al. [16] observed similar patterns of IL-6, IL-1β, IL-10, and IL-12 upregulation in monocytes, macrophages, and DCs ex vivo upon H. pylori Belnacasan infection. Macrophage migration inhibitory factor (MIF) was downregulated in DCs but not in the other cell types [16]. Different members of the TLR family mediate recognition of H. pylori by DCs and macrophages in vitro [17]. In a recent report, TLR9−/− mice were found to show increased signs of gastritis upon H. pylori infection [18], indicating that the pro-inflammatory Fluorometholone Acetate response to H. pylori is negatively modulated via TLR9 expressed in DCs and macrophages. However, the question remains whether gastric tissue DCs and macrophages in vivo are anergic to TLR ligands, as suggested for intestinal macrophages [19]. Cole et al. showed that H. pylori sonicate can induce

tolerance in bone marrow-derived DCs, leading to significantly reduced TNF-α release in response to a second stimulation. By contrast, the release of IL-10 was increased [20], suggesting that although DCs and macrophages show no TLR response, they can nevertheless respond to other H. pylori-dependent stimuli. The dendritic cell-specific ICAM-grabbing nonintegrin (DC-SIGN) that binds to fucose sugar residues in the Lewis antigen of H. pylori could be such a factor [21]. Bone marrow-derived macrophages lacking TLR and NOD1/2 responses can detect the functional CagT4SS, as evidenced by induction of miR-155 expression, suggesting that there is a direct interaction between the cagT4SS and macrophages [22]. The question remains, “How H. pylori survives despite such a strong innate immune response?” It has been hypothesized that H.

8%). The second most common location of the tragus was the middle part (24.7%), followed by the superior location (12.1%). The results of this study indicated that the occlusal plane was

found parallel to a line joining the ala of the nose and the inferior part of the tragus in a slight majority of the participants. “
“This in vitro study evaluated the 3D and 2D marginal fit of pressed and computer-aided-designed/computer-aided-manufactured (CAD/CAM) all-ceramic crowns made from digital and conventional impressions. A dentoform tooth (#30) was prepared for an all-ceramic crown (master die). Thirty type IV definitive casts were made from 30 polyvinyl Saracatinib clinical trial siloxane (PVS) impressions. Thirty resin models were produced from thirty Lava Chairside Oral Scanner impressions. Thirty crowns were pressed in lithium disilicate (IPS e.max Press; 15/impression technique).

Thirty crowns were milled from lithium disilicate Selleckchem JQ1 blocks (IPS e.max CAD; 15/impression technique) using the E4D scanner and milling engine. The master die and the intaglio of the crowns were digitized using a 3D laser coordinate measurement machine with accuracy of ±0.00898 mm. For each specimen a separate data set was created for the Qualify 2012 software. The digital master die and the digital intaglio of each crown were merged using best-fitting alignment. An area above the margin with 0.75 mm occlusal-gingival width circumferentially was defined. The 3D marginal fit of each specimen was an average of all 3D gap values on that area. For the 2D measurements, the marginal gap was measured at two standardized points (on the margin

and at 0.75 mm above the margin), from standardized facial-lingual and mesial-distal digitized sections. One-way ANOVA with post hoc Tukey’s honestly significant difference and two-way ANOVA tests were used, separately, for statistical analysis of the 3D and 2D marginal data (alpha = 0.05). One-way ANOVA revealed that both 3D and 2D mean marginal BCKDHA gap for group A: PVS impression/IPS e.max Press (0.048 mm ± 0.009 and 0.040 mm ± 0.009) were significantly smaller than those obtained from the other three groups (p < 0.0001), while no significant differences were found among groups B: PVS impression/IPS e.max CAD (0.088 mm ± 0.024 and 0.076 mm ± 0.023), C: digital impression/IPS e.max Press (0.089 mm ± 0.020 and 0.075 mm ± 0.015) and D: digital impression/IPS e.max CAD (0.084 mm ± 0.021 and 0.074 mm ± 0.026). The results of two-way ANOVA revealed a significant interaction between impression techniques and crown fabrication methods for both 3D and 2D measurements. The combination of PVS impression method and press fabrication technique produced the most accurate 3D and 2D marginal fits.

2 However, not all individuals with MetS develop hepatic steatosis, nor do all individuals with hepatic steatosis develop NASH or cirrhosis.3

Thus, the factors leading to steatosis and steatohepatitis in humans remain poorly understood. Among potential factors for the development of NASH, ethnicity is believed to be an independent risk factor for NASH that has recently received increasing attention.3-11 Several studies have suggested a significant variation in the risk for NAFLD and disease severity based MK 2206 on ethnicity, with Hispanics believed to be more and African Americans less predisposed to develop NAFLD compared with Caucasians.3-6, 8-10 However, these studies had limitations posed either by their retrospective nature or by the fact that groups were not carefully matched for major clinical variables—namely, Hispanics were usually more obese or had more diabetes or features of MetS (e.g., higher levels of triglycerides and lower levels of high-density lipoprotein cholesterol). Previous studies also have the shortcoming of having used surrogate markers of NASH (e.g., elevated aminotransferase levels or imaging)3, 4, 6, 11, 12 rather than a histological diagnosis when comparing both ethnic

groups. In addition, none of the studies performed an assessment of hepatic, adipose tissue, or muscle insulin sensitivity using glucose GS-1101 concentration turnover measurements when comparing Hispanic versus Caucasian subjects with NASH. The aim of this study was to determine the role of ethnicity (Hispanic versus Caucasian) in the severity of NASH and whether differences could be explained by the degree of hepatic, adipose tissue, and muscle insulin resistance between ethnic groups. ALT, alanine aminotransferase; AST, aspartate aminotransferase; Adipo-IRi, adipose tissue insulin resistance index; BMI, body mass index; DXA, dual energy Adenosine triphosphate x-ray absorptiometry; EGP, endogenous glucose production; FFA, free fatty acid; FPI, fasting plasma insulin; HIRi, hepatic insulin resistance

index; MetS, metabolic syndrome; MRS, magnetic resonance imaging and spectroscopy; NAFLD, nonalcoholic fatty liver disease; NASH, nonalcoholic steatohepatitis; T2DM, type 2 diabetes mellitus; UTHSCSA, University of Texas Health Science Center at San Antonio. A total of 152 overweight or obese patients were recruited from the general population of San Antonio, Texas. Patients with elevated liver aminotransferases and/or hepatic steatosis on magnetic resonance spectroscopy (MRS) were identified either from responses to local newspaper advertisements or from referrals from Hepatology clinics at the University of Texas Health Science Center at San Antonio, Texas (UTHSCSA) or the VA Medical Center. The study included 45 participants with biopsy-proven NASH previously reported.13 Ten healthy subjects without T2DM and without fatty liver by MRS served as controls for the metabolic studies.

growth; Presenting Author: KAI DENG Additional Authors: LIYA ZHOU, SANREN LIN, YUAN LI Corresponding Author: LIYA ZHOU Affiliations: Peking University Third Hospital, Department of Gastroenterology Objective: Generally, the prognosis of gastric cancer is poor except early detection. Patients with early gastric cancer (EGC) are mostly symptomless and might be detected easily by population screening. But the useful methods for detection of EGC are rare. Methods: After fasting for 12 hours, gastric juice was collected from 185 patients who were divided into three groups: non-neoplastic gastric disease (NGD) group (n=70), advanced

gastric cancer (AGC) group (n = 66) and EGC group (n = 49). Exciting with a light of wavelength 288 nm, fluorescence spectrum of gastric juice was performed, and the maximum fluorescence GPCR Compound Library price intensity of the first peak (P1FI) was measured. Results: The median (25th to 75th percentile) of P1FI of gastric juice were:

35.77 (15.04-71.36) in NGD; 85.85 (46.27-129.31) in AGC; 83.90 (40.12-121.28) in EGC. P1FI of AGC and EGC were significantly higher than that in NGD group (Mann-Whitney U test, AGC vs. NGD or EGC Deforolimus vs. NGD, all P < 0.001). The areas under the receiver operating characteristic curves for the detection of AGC and EGC were 0.740 (95% confidence interval [CI] 0.657 – 0.823, P < 0.001) and 0.725 (0.631 – 0.819, P < 0.001). With P1FI of ≥ 47.7, the sensitivity, specificity and accuracy for detection of EGC were 73.5%, 64.3% and 68.1%. A multiple logistic regression analysis showed that increased P1FI of gastric juice was associated with EGC (adjusted β coefficients 1.627, 95%CI 0.768-2.486, P < 0.001). Conclusion: The enhancement P1FI of gastric juice starts to occur in early-stage gastric cancer and can be used to indicate EGC. Fluorescence spectrum of gastric juice may an efficient method for detection of EGC in mass screening. Key Word(s): 1. gastric cancer; 2. fluorescence ; 3. early detection; 4. gastric juice;

Presenting Author: YUWEN LI Additional Authors: LIYA ZHOU, SANREN LIN, YINGCHUN WANG, ZHU JIN, RONGLI CUI, Loperamide CHEN HUANG, LING LI, KANG DENG Corresponding Author: LIYA ZHOU Affiliations: Peking University Third Hospital, Department of Gastroenterology; Peking University Third Hospital, Department of Gastroenterology Objective: Gastric cancer patients usually have a higher incidence of hypergastrinemia compared to healthy people. Moreover, gastrin plays a role in malignant progression. But whether hypergastrinemia alone can induce gastric cancer is still unknown. This study examined whether hypergastrinemia alone can induce malignant changes and promote the tumor progression in a rat model of gastric carcinogenesis induced by N-methyl-N’-nitro-N-nitrosoguanidine (MNNG).

However, in response to the rapid advances in treatment and emerging therapeutic advances on the horizon it will also require fresh approaches and MLN0128 price renewed strategic thinking. Each year we have moved one step closer to achieving our collective vision of Treatment for All. Over the past five decades of the WFH’s history, there has been tremendous progress in our understanding of bleeding disorders, improvement of treatment, and enhancement of access bringing hope to patients and their families throughout the world. Nonetheless, despite our progress to date in closing the

global gap in care, our work is not complete. Too many patients remain undiagnosed and too few receive adequate treatment. The WFH remains committed to its vision of achieving Treatment for All. This paper will discuss some the historical, present and future challenges and opportunities Napabucasin datasheet to close the gap in care and achieve Treatment for All. Over the past 50 years, we have seen enormous advances in treatment and therapies for bleeding disorders. Although access and availability vary widely

around the world, our understanding of coagulation mechanisms, prevention and treatment of bleeding disorders is far different than in 1963, the year the WFH was founded. It is now well established that, with proper treatment, people with haemophilia can live perfectly healthy lives. Without treatment, the reality

is that many will die young or, if they survive, suffer joint damage that leaves them with permanent disabilities. The journey to improve treatment globally began in June 1963 when Frank Schnabel, our founder and a man with severe hemophilia, convened a global meeting to establish an international haemophilia organization. There were many others involved in the early and formative years of the WFH who served either as the interim (1963) or first (1964) officers or led the medical 3-mercaptopyruvate sulfurtransferase advisory board including: Sir Weldon Balrymple-Champneys (UK), Prof. Kenneth Brinkhous (US), Henri Chaigneau (France), Dr. Cecil Harris (Canada), Dr. E. Neumark (UK), Dr. Knut-Eric Sjolin (Denmark), Prof. J.P. Soulier (France), John Walsh (US), Dr. S. Van Creveld (The Netherlands). Mr. Schnabel’s opening words to those assembled still ring true. “The threat to the life of just one haemophiliac would be sufficient reason for us to travel to this meeting. We are here however to help the hundreds of thousands of haemophiliacs by adding another organization which can be instrumental, in liaison with national societies” [1]. What began with a meeting of representatives from 12 countries (Argentina, Australia, Belgium, Canada, Denmark, France, Germany, Japan, Netherlands, Sweden, United Kingdom and the United States) [2] has grown to become a truly global organization.