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Salvage External Beam Radiotherapy after Incomplete Transarterial Chemoembolization for Hepatocellular Carcinoma: A Meta-Analysis and Systematic Review.

Medicina (Kaunas) 2021 Sep 22;57(10). Epub 2021 Sep 22.

Department of Gastroenterology, Anam Hospital, Korea University Medical College, Seoul 02841, Korea.

: Although transarterial chemoembolization (TACE) has been the commonest local modality for hepatocellular carcinoma (HCC), incomplete repsonse occurs especially for tumors with a large size or difficult tumor accessment. The present meta-analysis assessed the efficacy and feasibility of external beam radiotherapy (EBRT) as a salvage modality after incomplete TACE. : We systematically searched the PubMed, Embase, Medline, and Cochrane databases. Read More

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September 2021

A Case of Intratumoral and Hepatic Portal Venous Gas in Patient with Gastric Cancer Liver Metastases.

Curr Med Imaging 2021 Oct 18. Epub 2021 Oct 18.

Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul. Turkey.

Background: Hepatic portal venous gas [HPVG] is not a common finding in daily practice. It is usually associated with mesenteric ischemia and bowel necrosis in adults. Combination of intratumoral gas in metastatic liver lesions with HPVG is quite rare and thought to be associated with chemotherapy-induced necrosis and infection of the necrotized metastasis. Read More

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October 2021

Association of Obstructive Sleep Apnea with Nocturnal Hypoxemia in Metabolic-Associated Fatty Liver Disease Patients: A Cross-sectional Analysis of Record-based Data.

J Family Med Prim Care 2021 Aug 27;10(8):3105-3110. Epub 2021 Aug 27.

Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, New Delhi, India.

Rationale: Obstructive sleep apnea (OSA) is often seen among obese individuals and the obesity has a linear association with MAFLD. The contribution of chronic intermittent nocturnal hypoxia of OSA and association of MAFLD with OSA is an unmet need. The present study aimed to determine the etiology, impact and association of OSA severity and nocturnal hypoxemia among patients ofChronic liver disease (CLD). Read More

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Venous congestion as a central mechanism of radiculopathies.

Joint Bone Spine 2021 Oct 12:105291. Epub 2021 Oct 12.

Rheumatology Unit, Hôtel-Dieu, Place Alexis Ricordeau, Nantes University Hospital, Nantes, France, 44093, Nantes-Cedex 01, France.

Compression of roots/nerves can disrupt some of their functions, but does not necessarily cause pain. This is illustrated by the frequency of nearly asymptomatic spinal stenosis or disc herniations. In fact, pain of radiculopathies (and nerve entrapments) may mostly be the consequence of intraneural oedema induced by microscopical venous stasis around roots/spinal ganglia (or nerves) not or poorly shown by imaging. Read More

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October 2021

To the Editor: Pathophysiology of splenic arteriovenous fistula.

Ann Vasc Surg 2021 Oct 11. Epub 2021 Oct 11.

Cardiology, University of Modena and Reggio Emilia; Italy.

A splenic arteriovenous fistula causes a 'pre-hepatic' hypertension in the portal venous system with the double mechanism of an increased blood amount and mainly its high pressure inflow. It aggravates for a secondary fibrosis of the portal vein branches and 'capillarization' of the hepatic sinusoids, adding a further 'intra-hepatic' component. The subsequent development of porto-systemic collaterals induces the risk of gastrointestinal hemorrhages All this suggests to perform a close monitoring of every case of splanchnic aneurysm or pseudo-aneurysm, through the current cross-section imaging tools, for their possible evolution in an arteriovenous fistula, and to consider an early therapy, also endovascular, before any secondary damage of the liver parenchyma. Read More

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October 2021

Prevalence of bleeding and thrombosis in critically ill patients with chronic liver disease.

Thromb Haemost 2021 Oct 12. Epub 2021 Oct 12.

Institute of Liver Studies, King's College Hospital NHS Foundation Trust, London, United Kingdom of Great Britain and Northern Ireland.

Introduction: Haemorrhage and venous thromboembolism (VTE) are recognised complications of chronic liver disease (CLD), but their prevalence and risk factors in critically ill patients is uncertain.

Patients And Methods: We studied a retrospective cohort of patients with CLD non-electively admitted to a specialist intensive care unit determining the prevalence and timing of major bleeding and VTE (early, present on admission/diagnosed within 48h; later diagnosed >48h post ICU admission). Associations with baseline clinical and laboratory characteristics, multi-organ failure (MOF), blood product administration and mortality were explored. Read More

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October 2021

Intrahepatic venous collaterals in dogs with congenital intrahepatic portosystemic shunts are associated with focal shunt or hepatic vein narrowing.

Vet Radiol Ultrasound 2021 Oct 12. Epub 2021 Oct 12.

The Animal Medical Center, New York, New York, USA.

Dogs with congenital intrahepatic portosystemic shunts (IHPSS) occasionally have multiple smaller intrahepatic, tortuous blood vessels surrounding the primary shunt. This study was a retrospective, observational design that was also descriptive and anatomic in nature. Objectives were to characterize vascular morphology in IHPSS dogs presenting with intrahepatic venous collaterals (IVCs) relative to IHPSS dogs without IVCs, and to propose reasons for IVC development. Read More

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October 2021

Examination of Social Determinants of Health, District Health Needs, School Nurse Caseload, and Academic Outcomes in Washington State.

J Sch Nurs 2021 Oct 12:10598405211047849. Epub 2021 Oct 12.

University of Washington, Seattle, WA, USA.

The purpose of this study was to examine associations between caseload, social determinants, health needs, students meeting grade-level English and Math standards, and attendance. Data from the Washington State Open Data Portal and Report Card were combined with District Health Assessment data from 264 school districts. Analyses of variance and linear stepwise regression analyses were conducted. Read More

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October 2021

Secondary Hyperparathyroidism, Bone Density, and Bone Turnover After Bariatric Surgery: Differences Between Roux-en-Y Gastric Bypass and Sleeve Gastrectomy.

Obes Surg 2021 Oct 12. Epub 2021 Oct 12.

Post-Graduated Program in Health Sciences, University of Pernambuco Medical School, Recife, Brazil.

Purpose: Bariatric surgery may lead to metabolic bone disease.

Materials And Methods: In this cross-sectional study, we compared the prevalence of secondary hyperparathyroidism (SHPT), impact on bone mass and turnover markers, and serum leptin after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) in 117 patients (91% female, 51% RYGB, age 41.8 ± 6. Read More

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October 2021

A prospective, randomized, single-blinded, crossover trial to investigate the effect of a wearable device in addition to a daily symptom diary for the Remote Early Detection of SARS-CoV-2 infections (COVID-RED): a structured summary of a study protocol for a randomized controlled trial.

Trials 2021 Oct 11;22(1):694. Epub 2021 Oct 11.

Julius Clinical, Zeist, the Netherlands.

Objectives: It is currently thought that most-but not all-individuals infected with SARS-CoV-2 develop symptoms, but the infectious period starts on average 2 days before the first overt symptoms appear. It is estimated that pre- and asymptomatic individuals are responsible for more than half of all transmissions. By detecting infected individuals before they have overt symptoms, wearable devices could potentially and significantly reduce the proportion of transmissions by pre-symptomatic individuals. Read More

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October 2021

Integrative traditional Chinese medicine for lumbar disc herniation after surgery: A protocol for systematic review and meta-analysis.

Medicine (Baltimore) 2021 Oct;100(40):e27519

Department of Clinical Korean Medicine Graduate School, Kyung Hee University, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, Korea.

Background: Patients with lumbar disc herniation, who undergo spine surgery, occasionally complain of pain and functional disability. Fortunately, the concept of enhanced recovery after surgery has emerged recently. As a result, patients seek traditional Chinese medicine after spine surgery. Read More

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October 2021

[Effect of splenectomy on the risk of hepatocellular carcinoma development among patients with liver cirrhosis and portal hypertension: a multi-institutional cohort study].

Zhonghua Wai Ke Za Zhi 2021 Oct;59(10):821-828

Department of Hepatobiliary Surgery,the First Affiliated Hospital of Xi'an Jiaotong University;Institute of Advanced Surgical Technology and Engineering,Xi'an Jiaotong University;National-Local Joint Engineering Research Center for Precision Surgery and Regenerative Medicine,Xi'an 710061,China.

To identify whether splenectomy for treatment of hypersplenism has any impact on development of hepatocellular carcinoma(HCC) among patients with liver cirrhosis and hepatitis. Patients who underwent splenectomy for hypersplenism secondary to liver cirrhosis and portal hypertension between January 2008 and December 2012 were included from seven hospitals in China, whereas patients receiving medication treatments for liver cirrhosis and portal hypertension (non-splenectomy) at the same time period among the seven hospitals were included as control groups. In the splenectomy group, all the patients received open or laparoscopic splenectomy with or without pericardial devascularization. Read More

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October 2021

Combination of yttrium-90 radioembolization with stereotactic body radiation therapy in the treatment of portal vein tumor thrombosis.

Radiat Oncol J 2021 Jun 18;39(2):113-121. Epub 2021 Jun 18.

Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA, USA.

Purpose: Portal vein tumor thrombosis (PVTT) from cancer involving the liver carries a dismal prognosis, with median overall survival (OS) ranging from 2 to 5 months. While treatment with yttrium-90 (90Y) radioembolization alone may improve outcomes, overall prognosis remains poor. We hypothesize that the combination of 90Y radioembolization to the parenchymal component of the tumor and stereotactic body radiation therapy (SBRT) to the vascular component is a safe and effective means of improving outcomes. Read More

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Unhappy Triad: Infection with spp. and Associated with an Unusual Manifestation of Portal Vein Thrombosis.

Case Rep Gastroenterol 2021 May-Aug;15(2):598-602. Epub 2021 Jul 6.

Department of Infectious Diseases, Tropical Medicine, Nephrology and Rheumatology, St. Georg Hospital, Leipzig, Germany.

Portal vein thrombosis (PVT) is a rare disease with an incidence of 0.7/100,000 inhabitants per year. Septic PVT (pylephlebitis) usually occurs secondary to infection in the anatomic region drained by the portal venous system. Read More

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Upper GI Bleeding Secondary to Radiation Gastritis in a Patient with Preexisting Portal Hypertensive Gastropathy.

Case Rep Gastroenterol 2021 May-Aug;15(2):513-518. Epub 2021 Jun 11.

Department of Gastroenterology, Staten Island University Hospital, New York, New York, USA.

We commonly see patients presenting with either portal hypertensive gastropathy (PHG) or radiation gastritis. Radiation-induced hemorrhagic gastritis is an unusual lethal complication postradiation. Patients with preexisting PHG have very friable mucosa that can easily bleed after radiation for cancer treatment. Read More

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Evaluation of Family Caregivers' Use of Their Adult Care Recipient's Patient Portal From the 2019 Health Information National Trends Survey: Secondary Analysis.

JMIR Aging 2021 Oct 4;4(4):e29074. Epub 2021 Oct 4.

Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, United States.

Background: Patient engagement is critical for realizing the value of telehealth modalities such as the patient portal. Family caregiver engagement may also be critical for facilitating the use of the patient portal among adult patients, including older adults.

Objective: This study aims to analyze the 2019 Health Information National Trends Survey to characterize family caregivers' use of their care recipient's patient portal in terms of sociodemographic, health, and caregiving characteristics and caregivers' use of their own portal. Read More

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October 2021

Amyloidosis: A Rare Cause of Severe Cholestasis and Acute Liver Failure.

ACG Case Rep J 2020 Dec 4;7(12):e00479. Epub 2020 Dec 4.

Department of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.

Although hepatic involvement in light chain-associated amyloidosis is common, clinical manifestations of hepatic amyloidosis are rare. In most cases, hepatomegaly serves as a clue to diagnosis. We report a unique case of a 48-year-old man from China with jaundice and noncirrhotic portal hypertension, with rapidly progressive liver failure, in the absence of hepatomegaly, secondary to systemic light chain-associated amyloidosis associated with multiple myeloma. Read More

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December 2020

Percutaneous Transhepatic Embolization of Ectopic Varices in a Patient With Portal Hypertension Presenting With Hemorrhagic Shock.

Cureus 2021 Sep 23;13(9):e18209. Epub 2021 Sep 23.

Interventional Radiology, Detroit Medical Center, Detroit, USA.

Varices secondary to portal hypertension in the setting of liver cirrhosis typically occur in the gastroesophageal region. Management guidelines for bleeding gastroesophageal varices are well established in the literature. Ectopic varices that occur outside of this typical location are an uncommon complication of portal hypertension. Read More

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September 2021

Safety and efficacy of endoscopic cyanoacrylate injection in the management of gastric varices: A systematic review and meta-analysis.

JGH Open 2021 Sep 30;5(9):1047-1055. Epub 2021 Jul 30.

Division of Gastroenterology and Hepatology, Department of Medicine Phramongkutklao Hospital, College of Medicine, Royal Thai Army Bangkok Thailand.

Background And Aim: Bleeding from gastric varices is a catastrophic event and poses difficulty in management. The efficacy and safety of cyanoacrylate injection remain unclear. We performed a systematic review and meta-analysis to evaluate the effect of endoscopic cyanoacrylate injection in the management of gastric varices. Read More

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September 2021

Potential Role of in a Fatal Systemic Disease in a Puppy.

Pathogens 2021 Sep 14;10(9). Epub 2021 Sep 14.

Faculty of Veterinary Medicine, University of Teramo, 64100 Teramo, Italy.

Canine hepatozoonosis caused by   is an emerging disease in Europe. Clinical pictures vary from subclinical to life-threatening and non-specific clinical signs are predominantly reported. A 2-month-old female puppy originating from Southern Italy was adopted and moved to Northern Italy. Read More

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September 2021

Diagnostic Value of Contrast-Enhanced Ultrasound for Evaluation of Transjugular Intrahepatic Portosystemic Shunt Perfusion.

Diagnostics (Basel) 2021 Sep 1;11(9). Epub 2021 Sep 1.

Department of Radiology, University Hospital, LMU Munich, 81377 Munich, Germany.

Background: In patients with liver cirrhosis, transjugular intrahepatic portosystemic shunt (TIPS) displays an effective method for treating portal hypertension. Main indications include refractory ascites and secondary prevention of esophageal bleeding. Color Doppler ultrasound (CDUS) plays a leading role in the follow-up management, whereas contrast-enhanced ultrasound (CEUS) is not routinely considered. Read More

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September 2021

Packaging of a Pediatric Weight Management Intervention and Implementation Blueprint for Rural and Micropolitan Communities: The Nebraska CORD 3.0 Project.

Child Obes 2021 09;17(S1):S62-S69

Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, USA.

Pediatric weight management interventions (PWMIs) have resulted in positive changes among family members and, if widely disseminated, could have an impact on pediatric weight management in rural communities. The purpose of this article is to describe a backward design approach taken to create an online packaged program and implementation blueprint for building healthy families (BHF), an effective PWMI for implementation in rural communities. The backward design process included the identification of end users: primary (facilitators to be trained through the packaged program and implementation blueprint), secondary (researchers and evaluators), terminal (caregivers and children impacted by PWMI participation), tertiary (community support organizations, funding agency promoting widespread PWMI, and payors), as well as, key outcomes for respective end user groups based on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. Read More

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September 2021

Effect of Ashwagandha (Withania somnifera) extract on sleep: A systematic review and meta-analysis.

PLoS One 2021 24;16(9):e0257843. Epub 2021 Sep 24.

Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.

Objective: To determine the effect of Ashwagandha extract on sleep.

Methods: A comprehensive search was conducted in CENTRAL, MEDLINE, SCOPUS, Google Scholars, World Health Organization Trials Portal, ClinicalTrials.gov, Clinical Trial Registry of India, and AYUSH Research Portal for all appropriate trials. Read More

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September 2021

Efficacy of erzhu jiedu recipe on hepatitis B cirrhosis with hyperalphafetoproteinemia: A randomized, double-blind, placebo-controlled clinical trial.

Medicine (Baltimore) 2021 Sep;100(38):e27231

Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, No.528 Zhangheng Road, Pudong District, Shanghai, China.

Background: Hepatitis B cirrhosis with hyperalphafetoproteinemia is the intermediate stage of liver cirrhosis progressing to hepatocellular carcinoma (HCC), there is no effective way to treat precancerous lesions of liver in modern medicine. In recent decades, clinical and experimental evidence shows that Chinese medicine (CM) has a certain beneficial effect on Hepatitis B Cirrhosis. Therefore, this trial aims to evaluate the efficacy and safety of a CM erzhu jiedu recipe (EZJDR) for the treatment of Hepatitis B Cirrhosis with Hyperalphafetoproteinemia. Read More

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September 2021

[Unstable RAMP Lesions of the Medial Meniscus in ACL-Deficient Knee: Comparing the Outcomes of Outside-in versus All-inside Surgical Repair - a Retrospective Study].

Acta Chir Orthop Traumatol Cech 2021 ;88(4):273-283

Klinika dětské a dospělé ortopedie a traumatologie, 2. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice v Motole, Praha.

PURPOSE OF THE STUDY We present the results of the retrospective study comparing the clinical outcomes of outside-in versus all-inside suture techniques of unstable RAMP lesions (RL) of the medial meniscus in patients with simultaneous ACL lesion with a minimum two-year follow-up. MATERIAL AND METHODS The retrospective evaluation covered two groups of patients who underwent the arthroscopic repair of unstable RL in combination with anterior cruciate ligament reconstruction (ACLR). Group 1 included 42 patients (28 men/24 women). Read More

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September 2021

Gut-liver axis-mediated mechanism of liver cancer: A special focus on the role of gut microbiota.

Cancer Sci 2021 Sep 17. Epub 2021 Sep 17.

Research Institute for Microbial Diseases, Osaka University, Suita, Japan.

Gut microbiota and the mammalian host share a symbiotic relationship, in which the host provides a suitable ecosystem for the gut bacteria to digest indigestible nutrients and produce useful metabolites. Although gut microbiota primarily reside in and influence the intestine, they also regulate liver function via absorption and subsequent transfer of microbial components and metabolites through the portal vein to the liver. Due to this transfer, the liver may be continuously exposed to gut-derived metabolites and components. Read More

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September 2021

[Microwave ablation of the spleen: An easy and gentle method for treatment of secondary splenomegaly in children. A case report].

Lakartidningen 2021 09 16;118. Epub 2021 Sep 16.

docent, överläkare, enheten för pediatrik, CLINTEC, Karolinska institutet; Barngastroenterologi, hepatologi och nutrition, ME högspecialiserad barnmedicin, Karolinska universitetetssjukhuset, Stockholm.

Portal hypertension (PHT) in children may be caused by many different liver and vascular diseases and can lead to life threatening complications such as splenomegaly with thrombocytopenia. The treatment of choice for symptomatic splenomegaly is Partial Splenic Embolization (PSE) which is effective but painful, and therefore not offered to children younger than 10 years of age at the Karolinska University Hospital in Stockholm.  Percutaneous microwave ablation (MWA) is a well-established method in adults for the treatment of tumors in the liver and other organs. Read More

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September 2021

Adaptations to a Secondary School-Based Citizen Science Project to Engage Students in Monitoring Well Water for Arsenic during the COVID-19 Pandemic.

J STEM Outreach 2021 Jul 19;4(2). Epub 2021 Jul 19.

MDI Biological Laboratory, Salisbury Cove, ME.

Secondary schools in Maine and New Hampshire have been involved in a citizen science program called "All About Arsenic" aimed at addressing arsenic contamination of well water, one of the most pressing public health issues in both states. Nearly half of the population of Maine and New Hampshire derive their drinking water from private wells which often have arsenic levels above the EPA limit of 10 ppb. Arsenic exposure can cause cancer, adverse cardiovascular effects, and other health problems. Read More

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Sarcopenia predicts reduced liver growth and reduced resectability in patients undergoing portal vein embolization before liver resection - A DRAGON collaborative analysis of 306 patients.

HPB (Oxford) 2021 Aug 16. Epub 2021 Aug 16.

Institute of Physiology, University of Zurich, Zurich, Switzerland; Department of Surgery, Cantonal Hospital Winterthur, Zurich, Switzerland; Department of Surgery, Division of Transplant Surgery, Rush University Medical Center, Chicago, IL, USA. Electronic address:

Background: After portal vein embolization (PVE) 30% fail to achieve liver resection. Malnutrition is a modifiable risk factor and can be assessed by radiological indices. This study investigates, if sarcopenia affects resectability and kinetic growth rate (KGR) after PVE. Read More

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Histopathological examination of the impact of sodium hypochlorite on the hepatobiliary system. An experimental study.

Ann Ital Chir 2021 ;92:412-418

Background: The liver is the most common organ for settlement of hydatic cyst disease. All acknowledged protoscolicidals that are used for echinococcus degeneration have a risk of caustic secondary sclerosing cholangitis. The sodium hypochlorite is an effective protoscolicidal agent for treatment of hydatid liver cysts in vitro. Read More

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September 2021