Portal vein thrombosis in cirrhotic and non cirrhotic patients: from diagnosis to treatment

<p><b>Introduction</b>: Portal vein thrombosis (PVT) may occur in non-cirrhotic and cirrhotic patients. It can be classified as acute (if a recent thrombus is present) and chronic (if portal cavernoma has developed). Patients can be symptomatic or may present signs and symptoms related to the development of portal hypertension. In rare cases bowel infarction may occur.</p> <p><b>Areas covered</b>: This review provides an overview of the clinical presentation, complications, diagnostic challenges and available treatments for PVT in non-cirrhotic and cirrhotic patients (NCPVT).</p> <p><b>Expert opinion</b>: Treatment of acute NCPVT aims at recanalizing the thrombosed veins and preventing intestinal infarction and portal hypertension. Anticoagulation should be started promptly and maintained for at least 6 months. Long-term anticoagulation should be implemented in the presence of underlying persistent thrombotic state. In chronic NCPVT, treatment aims at managing portal hypertension and portal cavernoma cholangiopathy and preventing new thrombotic events. In this setting, the indication for anticoagulation should be individualized. No formal recommendations can be given for PVT in cirrhosis, since there are no randomized controlled trials, prospective studies, or <i>ad hoc</i> guidelines. High quality studies, including randomized controlled trials, will be needed to provide robust evidence on the best treatment strategy.</p

Bio‑electrochemical production of hydrogen and electricity from organic waste: preliminary assessment

This study investigated the performance of a novel integrated bio-electrochemical system for synergistic hydrogen production from a process combining a dark fermentation reactor and a galvanic cell. The operating principle of the system is based on the electrochemical conversion of protons released upon dissociation of the acid metabolites of the biological process and is mediated by the electron flow from the galvanic cell, coupling biochemical and electrochemical hydrogen production. Accordingly, the galvanic compartment also generates electricity. Four different experimental setups were designed to provide a preliminary assessment of the integrated bio-electrochemical process and identify the optimal configuration for further tests. Subsequently, dark fermentation of cheese whey was implemented both in a stand-alone biochemical reactor and in the integrated bio-electrochemical process. The integrated system achieved a hydrogen yield in the range 75.5–78.8 N LH2/kg TOC, showing a 3 times improvement over the biochemical process

Distinguishing features between patients with acute diverticulitis and diverticular bleeding: Results from the REMAD registry

Background: Pathogenesis of acute diverticulitis and diverticular bleeding remains poorly defined, and few data compare directly risk factors for these complications. Aims: to assess differences in clinical features, lifestyles factors and concurrent drug use in patients with acute diverticulitis and those with diverticular bleeding. Methods: Data were obtained from the REMAD Registry, an ongoing 5-year prospective, observational, multicenter, cohort study conducted on 1,217 patients. Patient- and clinical- related factors were compared among patients with uncomplicated diverticular disease, patients with previous acute diverticulitis, and patients with previous diverticular bleeding. Results: Age was significantly lower (OR 0.48, 95% CI: 0.34-0.67) and family history of diverticular disease was significantly higher (OR 1.60, 95% CI: 1.11-2.31) in patients with previous diverticulitis than in patients with uncomplicated diverticular disease, respectively. Chronic obstructive pulmonary disease was significantly higher in patients with previous diverticular bleeding as compared with both uncomplicated diverticular disease (OR 8.37, 95% CI: 2.60-27.0) and diverticulitis (OR 4.23, 95% CI: 1.11-16.1). Conclusion: This ancillary study from a nationwide Registry showed that some distinctive features identify patients with acute diverticulitis and diverticular bleeding. These information might improve the assessment of risk factors for diverticular complications