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Correlation Between Clinical and Pathological Findings of Liver Injury in 27 Patients With Lethal COVID-19 Infections in Brazil.

Hepatol Commun 2021 Aug 31. Epub 2021 Aug 31.

Department of Pathological Anatomy and Forensic Medicine, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.

Liver test abnormalities are frequently observed in patients with coronavirus disease 2019 (COVID-19) and are associated with worse prognosis. However, information is limited about pathological changes in the liver in this infection, so the mechanism of liver injury is unclear. Here we describe liver histopathology and clinical correlates of 27 patients who died of COVID-19 in Manaus, Brazil. Read More

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Non-pharmacological interventions for preventing clotting of extracorporeal circuits during continuous renal replacement therapy.

Cochrane Database Syst Rev 2021 Sep 14;9:CD013330. Epub 2021 Sep 14.

Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan.

Background: Acute kidney injury (AKI) is a common complication amongst people who are critically ill, and it is associated with an increased risk of death. For people with severe AKI, continuous kidney replacement therapy (CKRT), which is delivered over 24 hours, is needed when they become haemodynamically unstable. When CKRT is interrupted due to clotting of the extracorporeal circuit, the delivered dose is decreased and thus leading to undertreatment. Read More

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September 2021

[Analysis of the short-and medium-term curative effect of TIPS approach combined with AngioJet thrombus aspiration technology treatment in acute portal vein thrombosis].

Zhonghua Gan Zang Bing Za Zhi 2021 Aug;29(8):754-758

Department of Vascular Surgery, Henan Provincial People's Hospital; Department of Vascular Surgery, People's Hospital of Zhengzhou University; Henan Provincial Intervention Treatment Center, Zhengzhou 450003, China.

To evaluate the short- and medium-term clinical efficacy of TIPS approach combined with AngioJet thrombus aspiration technology treatment in acute portal vein thrombosis. 63 cases with acute portal vein thrombosis treated in our center from May 2017 to July 2019 were studied retrospectively, including 49 males and 14 females, aged 35-61 (46 ± 5) years. TIPS approach (with/without) combined with Angiojet thrombus aspiration and gastroesophageal varices embolization was performed simultaneously according to the patient's condition. Read More

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Midodrine Improves the Tolerability of Diuretics in Patients with Acute-on-Chronic Liver Failure-A Pilot Study.

J Clin Exp Hepatol 2021 Sep-Oct;11(5):573-578. Epub 2020 Dec 17.

Department of Hepatology, Asian Institute of Gastroenterology, Hyderabad, India.

Background: Acute-on-chronic liver failure (ACLF) is a syndrome of acute portal hypertension with high short-term mortality. ACLF patients have low mean arterial pressure (MAP), systemic vascular resistance, and high cardiac output. This, in turn, leads to an increased incidence of ascites, acute kidney injury, and hyponatremia. Read More

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December 2020

Hepatic Adenosine Triphosphate Reduction Through the Short-Chain Fatty Acids-Peroxisome Proliferator-Activated Receptor γ-Uncoupling Protein 2 Axis Alleviates Immune-Mediated Acute Hepatitis in Inulin-Supplemented Mice.

Hepatol Commun 2021 Sep 2;5(9):1555-1570. Epub 2021 Jun 2.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan.

How liver tolerance is disrupted in immune-mediated liver injury is currently unclear. There is also insufficient information available regarding susceptibility, precipitation, escalation, and perpetuation of autoimmune hepatitis. To explore how dietary fiber influences hepatic damage, we applied the concanavalin A (ConA)-induced acute immune-mediated liver injury model in mice fed a diet supplemented with 6. Read More

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September 2021

Tailored versus fixed scan delay in contrast-enhanced abdominal multi-detector CT: An intra-patient comparison of image quality.

Eur J Radiol 2021 Sep 4;143:109914. Epub 2021 Sep 4.

Department of Advanced Biomedical Sciences - Section of Diagnostic Imaging, University "Federico II", Naples, Italy(1).

Purpose: To perform anintra-patient comparison betweena single-pass protocol (SP) and a portal venous phase (PVP) by means ofboth quantitative and qualitative analysis of image quality.

Methods: Forty patients (31 M; 9F; aged 20-77 years; BMI 23 ± 4 Kg/m) underwent both a SP and a PVP using a 64-rows multi-detector CT with a median interval time of 56 days (range5-903). All patients underwent i. Read More

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September 2021

Role of Eyes and Eyes Protection Amidst SARS-CoV-2 Infection.

Authors:
Bibechan Thapa

JNMA J Nepal Med Assoc 2021 Jan 31;59(233):108-110. Epub 2021 Jan 31.

KIST Medical College and Teaching Hospital, Lalitpur, Nepal.

Severe Acute Respiratory Syndrome Coronavirus 2 pandemic has infected millions of people. The conjunctival epithelium is easily exposed to infectious droplets and body fluids making eyes a potential route and reservoir of the infection. The CD147 and ACE2 receptor has been demonstrated in ocular surface cells, which implies that these cells may facilitate as a portal of entry for transmission of Severe Acute Respiratory Syndrome Coronavirus 2. Read More

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January 2021

Long-term morbidity and mortality in 2-year hepatoblastoma survivors treated with SIOPEL risk-adapted strategies.

Hepatol Int 2021 Sep 10. Epub 2021 Sep 10.

Department of Pediatric Oncology, Gustave Roussy, Université Paris-Saclay, 114 rue Edouard Vaillant, 94805, Villejuif, France.

Background And Aims: Prognosis of hepatoblastoma patients has increased with cisplatin-based chemotherapy and high-quality resection including liver transplant. Consequently current risk-adapted therapeutic strategy aims to reduce long-term side effects in patients with standard risk disease.

Methods: We report long-term mortality and morbidity data concerning 151 2-year hepatoblastoma survivors treated with SIOPEL risk-adapted strategies (sex-ratio M/F = 1. Read More

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September 2021

Combining APR-246 and HDAC-Inhibitors: A Novel Targeted Treatment Option for Neuroblastoma.

Cancers (Basel) 2021 Sep 5;13(17). Epub 2021 Sep 5.

Hopp Children's Cancer Center Heidelberg (KiTZ), 69120 Heidelberg, Germany.

APR-246 (Eprenetapopt/PRIMA-1) is a very potent anti-cancer drug in clinical trials and was initially developed as a p53 refolding agent. As an alternative mode of action, the elevation of reactive oxygen species (ROS) has been proposed. Through an in silico analysis, we investigated the responses of approximately 800 cancer cell lines (50 entities; Cancer Therapeutics Response Portal, CTRP) to APR-246 treatment. Read More

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September 2021

Recent Advances in the Management of Acute Variceal Hemorrhage.

J Clin Med 2021 Aug 25;10(17). Epub 2021 Aug 25.

Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy.

Gastrointestinal bleeding is one of the most relevant causes of death in patients with cirrhosis and clinically significant portal hypertension, with gastroesophageal varices being the most frequent source of hemorrhage. Despite survival has improved thanks to the standardization on medical treatment aiming to decrease portal hypertension and prevent infections, mortality remains significant. In this review, our goal is to discuss the most recent advances in the management of variceal hemorrhage in cirrhosis with specific attention to the treatment algorithms involving the use of indirect measurement of portal pressure (HVPG) and transjugular intrahepatic portosystemic shunt (TIPS), which aim to further reduce mortality in high-risk patients after acute variceal hemorrhage and in the setting of secondary prophylaxis. Read More

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Hypothermic Oxygenated Machine Perfusion of Liver Grafts: Preliminary Experience in a Single Center.

Chirurgia (Bucur) 2021 Aug;116(4):451-465

The need to maximize the use of donor organs and the issue of ischemia-reperfusion injury led to the use of thermoregulated oxygenated machine perfusion that improves the function of liver graft prior to transplantation. Among these methods, the HOPE (hypothermic oxygenated perfusion) protocol shows significant benefits. The aim of the paper is to analyze the early experience in using such procedure in a high-volume liver transplantation center. Read More

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A novel, simplified, and reproducible porcine model of acute ischemic liver failure with portal vein preservation.

Exp Anim 2021 Sep 8. Epub 2021 Sep 8.

General Surgery Center, Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital, Southern Medical University.

The current ischemic models of liver failure are difficult and usually time-consuming to produce. The aim of this study was to develop a simplified and reproducible porcine model of acute liver failure for use in preclinical research. Eighteen Bama miniature pigs were randomly divided into Groups A, B, and C. Read More

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September 2021

Extrahepatic Surgery in Cirrhosis Significantly Increases Portal Pressure in Preclinical Animal Models.

Front Physiol 2021 20;12:720898. Epub 2021 Aug 20.

Department of Internal Medicine 1, Center for Cirrhosis and Portal Hypertension Bonn (CCB), University Hospital Bonn, Bonn, Germany.

Liver cirrhosis is a relevant comorbidity with increasing prevalence. Postoperative decompensation and development of complications in patients with cirrhosis remains a frequent clinical problem. Surgery has been discussed as a precipitating event for decompensation and complications of cirrhosis, but the underlying pathomechanisms are still obscure. Read More

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Splenic arteriovenous fistula accompanied by splenic artery aneurysm associated with acute-onset portal hypertension and gastrointestinal bleeding: case report and literature review.

Ann Vasc Surg 2021 Sep 3. Epub 2021 Sep 3.

Department of Vascular Surgery, 301 General Hospital of PLA, Beijing, 100853, China. Electronic address:

Splenic arteriovenous fistula is an uncommon aetiology of portal hypertension, which has definitive treatment effectiveness and good prognosis. We report a case of portal hypertension and gastrointestinal bleeding in the absence of hepatic parenchymal disease in a 50-year-old woman with multiple pregnancies. Abdominal computed tomography and transabdominal arteriography recorded the presence of tortuous and aneurysmal splenic arteries and the premature filling of enlarged splenic veins, which are highly suggestive of splenic arteriovenous fistula. Read More

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September 2021

Restriction of congenital portosystemic shunt using the modified microvascular plug.

Catheter Cardiovasc Interv 2021 Sep 6. Epub 2021 Sep 6.

Department of Pediatric Cardiology, Valley Children's Healthcare, 9300 Valley Children's, Pl, Madera, CA, USA.

Congenital portosystemic shunts (CPSS) may produce a variety of severe, clinically detrimental presentations. When indicated, closure is recommended; however, if the intrahepatic portal venous system (IPVS) is underdeveloped complete closure may not be possible and may result in severe acute portal hypertension. Staged restriction of CPSS flow by both surgical and complex transcatheter interventions has been successful in augmenting development of the IPVS such that complete occlusion of the CPSS can be performed. Read More

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September 2021

Management of Acute Portal Vein Thrombosis With Serial Mechanical Thrombectomy and tPA in a Pediatric Liver Transplant Recipient: A Case Report.

Transplant Proc 2021 Sep 2. Epub 2021 Sep 2.

Baylor College of Medicine, Michael E. DeBakey Department of Surgery, Division of Abdominal Transplantation, Houston, Texas.

Background: Acute portal vein thrombosis is a major cause of fulminant allograft failure in pediatric liver transplantation. Timely intervention is critical to save the graft and patient. Serial interventional radiologic management of this condition is scarcely reported in the literature. Read More

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September 2021

Spleno-aortic radiodensity ratio - A distinctive imaging feature to predict short-term outcome in critical care unit.

Eur J Radiol 2021 Aug 28;143:109939. Epub 2021 Aug 28.

Dresden University Hospital, Department of Radiology, Fetscherstr. 74, 01307 Dresden, Germany. Electronic address:

Introduction: To investigate the value of contrast-enhanced CT findings - splenic and aortic radiodensities and their ratios (spleno-aortic ratio) - in predicting the prognosis of critical care unit patients (CCU).

Methods: One hundred thirteen continuous CCU patients with an acute deterioration (Group A: 37 women, age: 67.2 ± 14. Read More

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Assessing Patient Needs During Natural Disasters: Mixed Methods Analysis of Portal Messages Sent During Hurricane Harvey.

J Med Internet Res 2021 Sep 1;23(9):e31264. Epub 2021 Sep 1.

Center for Outcomes Research, Houston Methodist, Houston, TX, United States.

Background: Patient portals play an important role in connecting patients with their medical care team, which improves patient engagement in treatment plans, decreases unnecessary visits, and reduces costs. During natural disasters, patients' needs increase, whereas available resources, specifically access to care, become limited.

Objective: This study aims to examine patients' health needs during a natural crisis by analyzing the electronic messages sent during Hurricane Harvey to guide future disaster planning efforts. Read More

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September 2021

Challenging anticoagulation cases: Acute extensive portal vein thrombosis in a patient without cirrhosis - Evidence-based management of a rare clinical entity.

Thromb Res 2021 Aug 18;206:133-136. Epub 2021 Aug 18.

Department of Medicine, McGill University, Canada; Research Institute, McGill University Health Centre, Canada.

Acute non-cirrhotic and non-malignant portal vein thrombosis (aPVT) is a rare and heterogenous condition. Current guidelines recommend early initiation of therapeutic anticoagulation to prevent extension of thrombosis, and favor recanalization. Although not formally defined, a poor outcome in the acute setting would include thrombosis extension with progression to intestinal infarction. Read More

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Pylephlebitis - a rare complication of a fish bone migration mimicking metastatic pancreatic cancer: A case report.

World J Clin Cases 2021 Aug;9(23):6768-6774

Department of Surgery, Centro Hospitalar do Médio Tejo, Tomar 2304-909, Portugal.

Background: Pylephlebitis is a rare condition, poorly recognized by clinicians and with few references. In this case, the clinical appearance resembled the clinical course of a pancreatic cancer and was originated by the ingestion of a fish bone, making the case more interesting and rare.

Case Summary: A 79-year-old female presented to the emergency department with fever, loss of appetite and jaundice. Read More

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Critically Ill COVID-19 Patient with Chronic Liver Disease - Insights into a Comprehensive Liver Intensive Care.

J Clin Transl Hepatol 2021 Aug 28;9(4):576-586. Epub 2021 Apr 28.

Gastroenterology and Advanced G.I Endoscopy, Center of Excellence in GI Sciences, Rajagiri Hospital, Chunangamvely, Aluva, Ernakulam, Kerala, India.

The novel coronavirus-related coronavirus disease 2019 (COVID-19) pandemic has been relentless in disrupting and overwhelming healthcare the world over. Clinical outcomes of COVID-19 in patients with chronic comorbidities, especially in those with metabolic syndrome, are well documented. Chronic liver disease and cirrhosis patients are a special sub-group, among whom the management of COVID-19 is challenging. Read More

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Duodenal Diverticulitis Accompanied by Portal Vein Thrombosis Treated with Endoscopic Therapy.

Korean J Gastroenterol 2021 08;78(2):129-133

Department of Internal Medicine, Dankook University Hospital, Dankook University College of Medicine, Cheonan, Korea.

A 44-year-old woman presented with right upper abdominal pain and nausea with a 4-day duration. An abdominopelvic CT scan revealed a 2.3-cm sized cystic lesion in the duodenum with inflammatory changes and partial thrombosis in the distal main portal vein. Read More

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Liver transplantation for post-COVID-19 sclerosing cholangitis.

BMJ Case Rep 2021 Aug 26;14(8). Epub 2021 Aug 26.

Section of Abdominal Organ Transplant, Department of Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA.

Since identified in December 2019, COVID-19 has remained a pandemic across the globe. Although primarily a respiratory illness, the impact of COVID-19 on other end organs has been increasingly identified. The effect of COVID-19 on the liver has yet to be completely understood. Read More

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Multiple-Organ Complement Deposition on Vascular Endothelium in COVID-19 Patients.

Biomedicines 2021 Aug 12;9(8). Epub 2021 Aug 12.

Laboratory of Immuno-Rheumatology, Istituto Auxologico Italiano, IRCCS, 20095 Milan, Italy.

Increased levels of circulating complement activation products have been reported in COVID-19 patients, but only limited information is available on complement involvement at the tissue level. The mechanisms and pathways of local complement activation remain unclear. The aim of this study was to investigate the deposition of complement components in the lungs, kidneys, and liver in patients with COVID-19 patients and to determine the pathway/s of complement activation. Read More

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Recipient-Specific Risk Factors Impairing Patient and Graft Outcome after Pediatric Liver Transplantation-Analysis of 858 Transplantations in 38 Years.

Children (Basel) 2021 Jul 27;8(8). Epub 2021 Jul 27.

Pediatric Gastroenterology, Hepatology and Liver Transplantation, Department of Pediatric Kidney, Liver and Metabolic Diseases, Hannover Medical School, 30625 Hannover, Germany.

(1) Background and Aim: Despite excellent long-term results in pediatric liver transplantation (pLTx), mortality and graft loss still are to be diminished. We aim to describe time-dependent changes and long-term outcome of a large single-center pLTx cohort and to identify independent recipient-related risk factors impairing patient and graft survival. (2) Methods: This is a retrospective single-center study analyzing all pediatric liver transplants from 1983-2020. Read More

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Enterically derived high-density lipoprotein restrains liver injury through the portal vein.

Science 2021 07;373(6553)

Department of Pathology, Washington University School of Medicine, St. Louis, MO 63110, USA.

The biogenesis of high-density lipoprotein (HDL) requires apoA1 and the cholesterol transporter ABCA1. Although the liver generates most of the HDL in the blood, HDL synthesis also occurs in the small intestine. Here, we show that intestine-derived HDL traverses the portal vein in the HDL subspecies form, in complex with lipopolysaccharide (LPS)-binding protein (LBP). Read More

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Establishment of a murine model of acute-on-chronic liver failure with multi-organ dysfunction.

Hepatol Int 2021 Aug 25. Epub 2021 Aug 25.

Department of Molecular and Cellular Medicine, Institute of Liver and Biliary Sciences (ILBS), New Delhi, 110 070, India.

Background And Aims: Acute-on-chronic liver failure (ACLF) is a distinct clinical entity with high probability of organ failure and mortality. Since patients generally present late, experimental models are needed to understand the pathophysiology and natural course of the disease.

Methodology: To reproduce the syndrome of ACLF, chronic liver disease was induced in C57BL6 mice (6-8 weeks; approximately 20-24 g weight) by intraperitoneal administration of carbon tetrachloride (CCl) for 10 weeks followed by an acute injury with acetaminophen (APAP) and lipopolysaccharide (LPS). Read More

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Phlegmonous gastritis developed during chemotherapy for acute lymphocytic leukemia: A case report.

World J Clin Cases 2021 Aug;9(22):6493-6500

Department of Cancer Pathology, Hokkaido University, Faculty of Medicine, Sapporo 0608638, Hokkaido, Japan.

Background: Phlegmonous gastritis (PG) is a rare bacterial infectious disease characterized by neutrophil-based purulent inflammation of the gastric wall. The most representative causative bacterium is , followed by , and . Hepatic portal venous gas (HPVG) is considered a potentially fatal condition and is rarely associated with PG. Read More

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Budd-Chiari syndrome computed tomographic imaging: Elucidating the devil in the details.

J Pak Med Assoc 2021 Jul;71(7):1889-1892

Department of Cardiovascular Medicine, Oxford University, Oxford, United Kingdom.

Hepatic venous outflow obstruction, due to hepatic venous thrombosis is the hallmark of Budd-Chiari Syndrome (BCS), a relatively uncommon disorder. The aim of this study was to explore imaging details and causes, and define invasive and non-invasive interventions for achieving successful portosystemic shunting (PSS). The variations in imaging topology and associated risk factors in BCS cases, diagnosed during the past 20 months, were studied. Read More

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Pediatric deceased donor liver transplantation with size reduction for recipient-graft size matching.

Ann Hepatobiliary Pancreat Surg 2021 Aug;25(3):431-435

Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

We present a case of pediatric deceased donor liver transplantation using a reduced whole liver graft in a 25-month-old boy weighing 12.7 kg. After he had undergone Kasai portoenterostomy for biliary atresia, his general condition deteriorated progressively. Read More

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