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Medicina (Kaunas, Lithuania) Apr 2024: Serum alpha-fetoprotein (AFP) is a recognized affordable oncological marker in patients with hepatocellular carcinoma (HCC). However, AFP's prognostic role has been...
: Serum alpha-fetoprotein (AFP) is a recognized affordable oncological marker in patients with hepatocellular carcinoma (HCC). However, AFP's prognostic role has been assessed mainly after specific treatments, and no unanimously recognized cut-offs have been identified. The aim of this study is to investigate the prognostic role of different basal AFP cut-offs on survival and HCC course. : In this single-center, retrospective study, all patients newly diagnosed with HCC between January 2009 and December 2021 were prospectively enrolled. Only patients suitable for curative HCC treatments were included in the analyses. Patients were stratified according to AFP cut-offs of 20, 200, 400, and 1000 ng/mL, which were correlated with survival outcomes and clinical parameters. : A total of 266 patients were analyzed, with a median follow-up time of 41.5 months. Median overall survival (OS) of all cohort was 43 months. At the multivariate Cox-regression analysis, AFP value ≥ 1000 ng/mL correlated with impaired OS (1-year OS: 67% vs. 88%, 5-year OS: 1% vs. 43%; = 0.005); other risk factors were tumor dimension ≥ 5 cm (HR 1.73; = 0.002), Child-Pugh class B-C (HR 1.72; = 0.002), BCLC stage A (vs. 0) (HR 2.4; = 0.011), and malignant portal vein thrombosis (HR 2.57; = 0.007). AFP ≥ 1000 ng/mL was also associated with a reduced recurrence-free survival (HR 2.0; = 0.038), while starting from AFP ≥ 20 ng/mL, a correlation with development of HCC metastases over time (HR 3.5; = 0.002) was seen. AFP values ≥ 20 ng/mL significantly correlated with tumor size and higher histological grading; starting from AFP values ≥ 400 ng/mL, a significant correlation with Child-Pugh class B-C and female gender was also observed. : Basal AFP correlates with relevant outcomes in patients with HCC. It could help identify patients at a higher risk of worse prognosis who might benefit from personalized surveillance and treatment programs. Prospective studies are needed to confirm these results.
Topics: Humans; Carcinoma, Hepatocellular; alpha-Fetoproteins; Liver Neoplasms; Male; Female; Middle Aged; Retrospective Studies; Prognosis; Aged; Biomarkers, Tumor; Adult; Proportional Hazards Models; Survival Analysis
PubMed: 38792876
DOI: 10.3390/medicina60050692 -
Journal of Clinical Medicine May 2024Treatment of established portal vein narrowing after living donor hepatectomy is challenging. We aimed to present a new approach termed the "elbow patch reconstruction...
Treatment of established portal vein narrowing after living donor hepatectomy is challenging. We aimed to present a new approach termed the "elbow patch reconstruction technique" to correct the narrowed remnant portal vein just or late after right lobe living donor hepatectomy. Demographic and clinical data of 12 living liver donors with narrowed remnant portal veins and treated with the "elbow patch reconstruction technique" were prospectively collected and retrospectively evaluated. Anatomic variation of the portal vein was defined in accordance with the Nakamura classification; six of the living liver donors had type A, three had type B, and the remaining three had type C. In eight of the living liver donors with a narrowed remnant portal vein, diagnosis was detected by intraoperative Doppler ultrasonography and visual inspection by experienced transplant surgeons in the living donor hepatectomy procedure. In the remaining four living liver donors, diagnosis was performed postoperatively when elevation of liver enzymes was noticed during the routine liver function test and Doppler US. The diagnosis was confirmed by multidetector computed tomography. Data from nine males and three females aged 18 to 54 years were analyzed. All of the living liver donors were followed up for a median of 1710 days (min-max: 1178-4447 days; IQR: 1516 days), and none of the living liver donors had any structural or functional complications in the portal vein. Narrowing remnant portal veins are rare, but they are a life-threatening complication in living liver donors, and this condition requires urgent management. Image guided interventions and narrowed segment resection with end-to-end anastomosis using a vascular graft carried a potential risk for thrombosis and restenosis. To avoid these complications, we shared a technique named "elbow patch reconstruction technique". This technique can be very effective in relieving the narrowing of the remnant portal vein after right lobe living donor hepatectomy.
PubMed: 38792466
DOI: 10.3390/jcm13102924 -
Animals : An Open Access Journal From... May 2024The ecosystem of ruminal microbiota profoundly affects the health and milk production of dairy cows. High-concentrate diets are widely used in dairy farms and evoke a...
The ecosystem of ruminal microbiota profoundly affects the health and milk production of dairy cows. High-concentrate diets are widely used in dairy farms and evoke a series of metabolic disorders. Several studies have reported the effects of high-concentrate diets on the ruminal microbiome, while the effect of changes in ruminal microbial flora, induced by high-concentrate diet feeding, on the liver of dairy cows has not been studied before. In this study, 12 mid-lactating Holstein Friesian cows (weight of 455 ± 28 kg; parities of 2.5 ± 0.5; starting milk yield of 31.59 ± 3.2 kg/d; DMI of 21.7 ± 1.1 kg/d; and a DIM at the start of the experiment of 135 ± 28 d) were fitted with ruminal fistulas, as well as with portal and hepatic vein catheters. All cows were randomly divided into 2 groups; then, they fed with low-concentrate diets (LC, concentrate: forage = 40:60) and high-concentrate diets (HC, concentrate: forage = 60:40) for 18 weeks. The forage sources were corn silage and alfalfa hay. After the cows of two groups were euthanized over two consecutive days, ruminal microbiota; the concentration of LPS in the rumen content; cecum content; the levels of blood and histamine in rumen fluid, blood, and the liver; the histopathological status of the rumen and cecum; and the inflammatory response of the liver were assessed in dairy cows under conditions of subacute ruminal acidosis (SARA). These conditions were caused by high-concentrate diet feeding. All data were analyzed using the independent -test in SPSS. The results showed that high-concentrate diet feeding increased the concentration of LPS and histamine in the rumen and plasma of veins ( < 0.05). The abundance of at the phylum level, and of both and at the genus level, was decreased, while the abundance of at the phylum level and at the genus level was increased by high-concentrate diet feeding. The decreased pH values of ruminal contents (LC = 6.02, HC = 5.90, < 0.05) and the increased level of LPS in the rumen (LC = 4.921 × 10, HC = 7.855 × 10 EU/mL, < 0.05) and cecum (LC = 11.960 × 10, HC = 13.115 × 10 EU/mL, < 0.01) induced the histopathological destruction of the rumen and cecum, combined with the increased mRNA expression of IL-1β ( < 0.05). The histamine receptor H1R and the NF-κB signaling pathway were activated in the liver samples taken from the HC group. In conclusion, the elevated concentrations of LPS and histamine in the gut may be related to changes in the ruminal microbiota. LPS and histamine induced the inflammatory response in the ruminal epithelium, cecum epithelium, and liver. However, the cause-effect mechanism needs to be proved in future research. Our study offers a novel therapeutic strategy by manipulating ruminal microbiota and metabolism to decrease LPS and histamine release and to improve the health of dairy cows.
PubMed: 38791713
DOI: 10.3390/ani14101495 -
Current Oncology (Toronto, Ont.) May 2024While the importance of conversion surgery has increased with the development of systemic chemotherapy for gastric cancer (GC), reports of conversion surgery for...
While the importance of conversion surgery has increased with the development of systemic chemotherapy for gastric cancer (GC), reports of conversion surgery for patients with GC with distant metastasis and tumor thrombus are extremely scarce, and a definitive surgical strategy has yet to be established. Herein, we report a 67-year-old man with left abdominal pain referred to our hospital following a diagnosis of unresectable GC. Esophagogastroduodenoscopy and contrast-enhanced abdominal computed tomography (CT) revealed advanced GC with splenic metastasis. A splenic vein tumor thrombus (SVTT) and a continuous thrombus to the main trunk of the portal vein were detected. The patient was treated with anticoagulation therapy and systemic chemotherapy comprising S-1 and oxaliplatin. One year following chemotherapy initiation, a CT scan revealed progressive disease (PD); therefore, the chemotherapy regimen was switched to ramucirumab with paclitaxel. After 10 courses of chemotherapy resulting in primary tumor and SVTT shrinkage, the patient underwent laparoscopic total gastrectomy (LTG) and distal pancreaticosplenectomy (DPS). He was discharged without complications and remained alive 6 months postoperatively without recurrence. In summary, the wait-and-see approach was effective in a patient with GC with splenic metastasis and SVTT, ultimately leading to an R0 resection performed via LTG and DPS.
Topics: Humans; Stomach Neoplasms; Male; Aged; Splenic Vein; Splenic Neoplasms; Minimally Invasive Surgical Procedures; Venous Thrombosis; Gastrectomy
PubMed: 38785482
DOI: 10.3390/curroncol31050201 -
Briefings in Bioinformatics May 2024
PubMed: 38783707
DOI: 10.1093/bib/bbae252 -
Cirugia Y Cirujanos 2024Hilar cavernous transformation is the formation of venous structures rich in collateral around the portal vein. Portal vein thrombosis is a rare entity. Although there...
Hilar cavernous transformation is the formation of venous structures rich in collateral around the portal vein. Portal vein thrombosis is a rare entity. Although there are many reasons for its etiology, few cases have been reported secondary to hydatid cysts in the liver. Here, we present a 24-year-old patient with complaints of abdominal pain and swelling. Her CT and MRI scans show cholelithiasis with portal vein thrombosis and hilar cavernous transformation due to giant hydatid cyst compression in the lateral liver sector.
Topics: Humans; Echinococcosis, Hepatic; Female; Portal Vein; Young Adult; Tomography, X-Ray Computed; Venous Thrombosis; Cholelithiasis; Magnetic Resonance Imaging; Abdominal Pain; Liver
PubMed: 38782397
DOI: 10.24875/CIRU.21000728 -
Annals of Gastroenterology 2024Endoscopic ultrasound-guided portal pressure gradient measurement (EUS-PPG) is a new modality where the portal pressure is measured by directly introducing a needle into...
BACKGROUND
Endoscopic ultrasound-guided portal pressure gradient measurement (EUS-PPG) is a new modality where the portal pressure is measured by directly introducing a needle into the hepatic vein and portal vein. This is the first systematic review and meta-analysis to evaluate the efficacy and safety of EUS-PPG.
METHODS
A comprehensive literature search was performed to identify pertinent studies. The primary outcomes assessed were the technical and clinical success of EUS-PPG. Technical success was defined as successful introduction of the needle into the desired vessel, while clinical success was defined as the correlation of the stage of fibrosis on the liver biopsy to EUS-PPG, or concordance of HVPG and EUS-PPG. The secondary outcomes were pooled rates for total and individual adverse events related to EUS-PPG. Pooled estimates were calculated using random-effects models with a 95% confidence interval (CI).
RESULTS
Eight cohort studies with a total of 178 patients were included in our analysis. The calculated pooled rates of technical success and clinical success were 94.6% (95%CI 88.5-97.6%; P=<0.001; =0) and 85.4% (95%CI 51.5-97.0%; P=0.042; =70), respectively. The rate of total adverse events was 10.9% (95%CI 6.5-17.7%; P=<0.001; =4), and 93.7% of them were mild, as defined by the American Society for Gastrointestinal Endoscopy. Abdominal pain (11%) was the most common adverse event, followed by bleeding (3.6%). There were no cases of perforation or death reported in our study.
CONCLUSIONS
EUS-PPG is a safe and effective modality for diagnosing portal hypertension. Further randomized controlled trials are needed to validate our findings.
PubMed: 38779643
DOI: 10.20524/aog.2024.0882 -
CVIR Endovascular May 2024Double vein embolization with simultaneous embolization of the portal and hepatic vein aims to grow the future liver remnant in preparation for major hepatectomy....
BACKGROUND
Double vein embolization with simultaneous embolization of the portal and hepatic vein aims to grow the future liver remnant in preparation for major hepatectomy. Transvenous hepatic vein embolization is usually done via a transjugular access. The purpose of this study is to describe the transfemoral approach as an alternative option and to discuss potential advantages.
RESULTS
Twenty-three patients undergoing hepatic vein embolization via a transjugular (n = 10) or transfemoral access (n = 13) were evaluated retrospectively. In all cases the portal vein embolization was done first. All procedures were technically successful. There were no peri-interventional complications. Only two patients were not able to proceed to surgery. Standardized future liver remnant hypertrophy was non-inferior with the transfemoral approach compared to the transjugular route. Procedure time was significantly shorter in the transfemoral access group (40 ± 13 min) compared to the transjugular group (67 ± 13 min, p < 0.001).
CONCLUSION
Transfemoral hepatic vein embolization is feasible, safe, and faster due to easier catheterization, improved stability, and simpler patient preparation. These findings will need to be validated in larger studies.
PubMed: 38776033
DOI: 10.1186/s42155-024-00463-5 -
Clinical and Experimental Hepatology Dec 2023Porto-sinusoidal vascular disease (PSVD) is defined as a vascular liver disease characterized by the absence of cirrhosis and the presence of characteristic histological... (Review)
Review
Porto-sinusoidal vascular disease (PSVD) is defined as a vascular liver disease characterized by the absence of cirrhosis and the presence of characteristic histological features, with or without the presence of portal hypertension (PH). Half of the patients with PSVD also have associated disease that may contribute to the development of PSVD. Patients usually remain asymptomatic until complications of PH arise. Variceal bleeding and portal vein thrombosis are major complications associated with PSVD. The treatment is focused on managing complications of PH, mainly through primary prophylaxis of variceal bleeding and treatment of portal vein thrombosis. Currently, there is insufficient evidence to support the use of anticoagulants for thrombosis prevention in these patients. Despite the increase of recognition of PSVD, further research is needed to enable early disease diagnosis, establish optimal screening methods, and develop strategies to slow down disease progression.
PubMed: 38774199
DOI: 10.5114/ceh.2023.133107 -
JBJS Essential Surgical Techniques 2024This video article describes the technique for arthroscopic reduction and fixation of Pipkin type-I fractures.
BACKGROUND
This video article describes the technique for arthroscopic reduction and fixation of Pipkin type-I fractures.
DESCRIPTION
Surgery is performed with the patient in a supine position, with free lower limbs, on a radiolucent table. Arthroscopic superior and anterolateral portals are made similarly to the portals created to evaluate the peripheral compartment during an outside-in (ballooning) technique. An additional medial portal is subsequently created in order to aid in reduction and screw placement. The medial portal is created in abduction and external rotation of the hip (i.e., the figure-4 position). The adductor tendon is identified, and the portal is then safely positioned posteriorly to its margin, approximately 4 to 5 cm distal to the inguinal fold, avoiding the saphenous vein (usually identified with an ultrasound scan). The fragment is mobilized, debrided, and then reduced with use of a microfracture awl or a large Kirschner wire (used as a joystick). Following reduction, temporary fixation is performed with use of long Kirschner wires under direct visualization and fluoroscopic guidance. If reduction is satisfactory, definitive fixation can be performed with use of 4.5-mm headless screws through the medial portal. All steps of fragment reduction and fixation are performed through the medial portal, with the patient in the figure-4 position. Once the screws are placed, a final dynamic arthroscopic and fluoroscopic check is performed.
ALTERNATIVES
In Pipkin type-I fractures, surgery is recommended when the femoral head fragment is large (exceeding 15% to 20% of the femoral head volume) and displaced (by >3 mm). In such cases, if untreated, spontaneous evolution to osteoarthritis may occur. For fragments smaller than 10% to 15% of the femoral head volume, arthroscopic removal is often the best choice. Several approaches (e.g., Smith-Petersen, modified Hueter, Kocher-Langenbeck, and surgical safe dislocation) have been proposed for reduction and fixation, with surgical safe dislocation being the most versatile because of the uniquely complete visualization of the femoral head.
RATIONALE
The arthroscopic reduction and fixation technique for a non-comminuted Pipkin type-I fracture holds the intrinsic advantages of being less invasive than open surgery in terms of surgical exposure, and having less blood loss, infection risks, and wound complications. Arthroscopy allows direct visualization of the fragment and its reduction surface, along with removal of articular loose bodies and debridement. The surgical time is influenced by the surgeon's experience, but often is no longer than with an open procedure. In the few studies assessing the use of this technique, the rates of osteonecrosis and heterotopic ossification are lower than with open techniques. It is worth noting that the studies assessing the use of this procedure are limited both in number and quality; however, the results of these studies have been excellent. It must also be noted that patients undergoing arthroscopic fixation are mostly selected for this treatment because they have less severe injuries.
EXPECTED OUTCOMES
Open reduction and fixation through one of a variety of approaches is the gold standard treatment for Pipkin fractures; however, it is a relatively invasive procedure, prone to increased risks of osteonecrosis of the femoral head and heterotopic ossification (from 4% to 78% of cases). In some cases, arthroscopic reduction and fixation can be as effective as open reduction, and carries with it the intrinsic advantages of a keyhole procedure. The reported 4.6% global complication rate following arthroscopic fixation demonstrates the potential advantages of this technique, with limits due to the low numbers of treated cases.
IMPORTANT TIPS
The operating room should be carefully set up, especially regarding the positions of the C-arm and the arthroscopy tower, which should be double-checked before starting the procedure.The medial portal should be created after identification of the saphenous vein on an ultrasound scan. The anesthesiologist or a radiologist may mark the vein on the skin preoperatively, or the surgeon may extend the arthroscopic portal and perform a superficial dissection to avoid the vessel.Visualization after creation of the portals is usually suboptimal until the hematoma is completely removed. Patience must be maintained in this phase of the procedure.A microfracture awl or a large Kirschner wire can be utilized as a joystick to aid in reduction of the fragment, from either the usual portals or the medial portal. This aid can facilitate rotation of the fragment, which is a key step in the reduction phase.Definitive fixation can be achieved with use of 4.5-mm cannulated headless screws. Large cannulated headless screws have longer and larger Kirschner wires that can also aid in reduction when used as joysticks, reducing the risk of bending or breaking during screw insertion. Additionally, a 4.5-mm screwdriver is longer, allowing easier insertion, especially in patients with a larger thigh. The large diameter should not be a concern because the head is sunk in a non-weight-bearing area of the head.To avoid the risk of misplacement or loss of the screw during its insertion, make use of a cannulated guide handle for 4.5-mm screws, such as the guide utilized in a Latarjet arthroscopic procedure.To prevent screw loss into the joint, utilize a loop-knotted wire around the proximal part of the screw; this wire is cut at the end of the procedure.
ACRONYMS AND ABBREVIATIONS
AAFF = arthroscopic-assisted fracture fixationHO = heterotopic ossificationUS = ultrasound/ultrasonographyAP = anteroposteriorCT = computed tomographyASIS = anterosuperior iliac spineGT = greater trochanterSP = Smith-PetersenIF = internal fixationK-wire = Kirschner wire.
PubMed: 38774022
DOI: 10.2106/JBJS.ST.23.00073