Recent controversies in liver transplantation

The chronicle backdrop of liver transplantation (LT) is an intricate story to reveal- it is an adventure of extraordinary achievement and catastrophic disappointments. Historically, controversies and LT seems to be synonymous. Despite the improvements in results, LT is still facing lots of challenges and controversies, whereby demand is high but the resources, primarily concerned to donor, are very limited.  We have focused our perspective on LT for HCV-related cirrhosis and nutritional support for cachectic patients awaiting LT

Membrane expression and significance of TRAIL death receptors DR4 and DR5 in Pancreatic cancer

Introduction: Tumor necrosis factor related-apoptosis-inducing ligand (TRAIL) is a powerful and selective activator of apoptosis in many cancer cells. We aim to investigate the expression and significance of TRAIL death receptor DR4 and DR5 in pancreatic cancer (PC) tissues. Method: Twenty-eight histologically verified samples of PC tissue were collected between 2018 and 2019. TRAIL death receptor expression profiles were determined by immunohistochemistry. Result: Death receptor DR4 and DR5 were expressed in the PC tissue and the adjacent non-cancerous pancreatic tissues, the expression of DR4 and DR5 in the PC tissue was significantly higher than that of the adjacent non-cancerous pancreatic tissues (p<0.05). Additionally, in both the tissue group, the expression of DR4 was significantly stronger than the DR5 (p<0.05). To assess the relationship between DR4 and DR5 expression, differentiation, and tumor staging of PC, the result reveals that the expression of DR4 and DR5 was significantly higher in stage I tumors than the stage II, III, IV tumors (p<0.05). In contrast, the expression of DR4 and DR5 was decreased with a decrease in the degree of differentiation of tumors. However, the difference was not statistically significant. Conclusion: The membrane expression of TRAIL death receptor DR4 and DR5 is greater in PC than in the adjacent non-cancerous pancreatic tissues. Furthermore, increased membrane expression of TRAIL death receptor DR4 and DR5 in stage I PC and well-differentiated PC may predict the prognosis and feasibility of using TRAIL gene therapy as a treatment option for early PC.&nbsp

Effect of Rhizobium leguminosarum Inoculation and Mulching on Growth and Yield of Chinese Long Bean (Vigna unguiculata subsp. sesquipedalis)

An experiment was conducted to evaluate the influence of Rhizobium leguminosarum inoculation and mulching on the growth and yield of Chinese long bean (Vigna unguiculata subsp. sesquipedalis) in Palungtar, Nepal. A split-plot design was used for the experiment, which was replicated four times. Plastic, straw, and no-mulch conditions constituted the main plot factor, while seeds with or without Rhizobium inoculation constituted the sub-plot elements. Growth parameters and yield-related traits of Chinese long beans were recorded at 15-day intervals. Transparent plastic mulching resulted in earlier flowering (46 days), while seed inoculation with Rhizobium resulted in a higher mean number of nodules (106.92) than non-inoculated treatments, with transparent plastic mulching resulting in the highest mean number of nodules (108.21). At 60 days after showing (DAS), plant height was greater in the inoculated treatment (69.23 cm), while at 30 DAS, the non-inoculated treatment had a higher number of leaves (22.28 cm). Similarly, pod length (49.98 cm), pod yield per plant (348.01 g), and total yield per hectare (16.07 t/ha) were all significantly higher with both plastic mulch and seed inoculation with Rhizobium than with the other treatments alone. A positive correlation was observed between plant height (0.81), number of branches (0.44), number of leaves (0.81), number of nodules per plant (0.6), and pod yield. This supports the potential benefits of using seed inoculation with Rhizobium in combination with mulching to improve Chinese long bean growth and increase yield as demonstrated by the results of this study

Evaluating the Impact of Various Seed Priming Agents (SPAs) on Germination and Development Parameters of Okra (Abelmoschus esculentus L. Moench)

The present study has been conducted to study the effect of various primer treatments i.e., PEG (5%), PEG (10%), NaCl (2%), KCl (2%), CuSO4•5H2O (2%), NaOH (2%) and control on germination and growth of two okra (Abelmoschus esculentus) varieties (var. Arka Anamika and Clemson). Growth parameters were measured at 10, 20, and 30 DAS, while germination parameters were recorded over a period of seven days. Compared to Arka Anamika, Clemson showed better germination and growth metrics, which also showed significant differences in seed priming treatments. The use of different concentrations of PEG solution for seed priming proved to be particularly effective as evidenced by the highest germination percentage (79%), speed (95.95%), energy (76%), and Vigor index (2037.94 cm). Growth parameters also showed significant differences with these treatments. Similarly, seed priming with 2% NaOH and 2% CuSO4•5H2O had the lowest results for growth and germination metrics. The results highlight how priming can significantly improve the germination and growth of okra seedlings; the Clemson and PEG solution treatments stand out as particularly successful techniques. This highlights the potential for improved okra production through the use of these priming methods

Acute Decompensated Liver: When to Transplant?

Currently, liver transplant (LT) is only the effective treatment for an acute decompensated liver. Yet, a result of LT in the background of acute decompensated liver largely depends upon the cause of decompensation. Acute-on-chronic liver failure (ACLF) should not be confused with acute liver failure (ALF), where a patient with ACLF presents with a distinct clinical feature than ALF and often requires LT as the only definitive treatment option. However, ACLF patients are generally not listed for the emergency LT due to advanced age, ongoing sepsis, multiple organ failures and active alcoholism. Then again, about 40% of the patients with ALF recover spontaneously with medical care and hence do not need LT. In between these all perplexities and contentions, it’s critical to comprehend the clinical course of liver failure. In addition, physicians should also understand when it is necessary to enlist a patient for LT and which patient are likely to get benefit from LT. Thus, utilizing a “golden window” time for LT before the development of multi-organ failure. In this chapter, we focus on the current situation of LT for ALF and ACLF and further discuss the current decision making strategies used to indicate LT in this difficult clinical scenario

Dermatological Disorders following Liver Transplantation: An Update

Patients undergoing liver transplantation (LT) are at a high risk of dermatological complications compared to the general population as a result of long-term use of immunosuppressant. However, the risk is not as high as other solid organ transplantations (SOT), particularly for skin cancer. The liver is considered as an immune privileged organ since it has a low prevalence of humoral rejection in contrast to other SOT, and thus, LT requires a minimal amount of immunosuppressants compared to other SOT recipients. However, because of the large volume of the liver, patients with LT have higher donor lymphocytes that sometimes may trigger graft-versus-host-disease, yet it is rare. On the other hand, the vast majority of the nonspecific dermatological lesions linked with cirrhosis improve after removal of diseased liver or due to the immunosuppressant used after LT. Nevertheless, dermatological infections related to bacteria, viruses, and fungus after LT are not uncommon. Additionally, the incidence of IgE-mediated food allergies develops in 12.2% of LT patients and may present as life-threatening conditions such as urticaria and/or angioedema and hypersensitivity. Moreover, skin malignancies after LT are a matter of concern. Thus, posttransplant dermatological care should be provided to all LT patients for any suspicious dermatological lesions. Our goal is to give an outline of the dermatological manifestation associated with LT for the clinicians by collecting the published data from all archived case reports

COVID-19 is associated with a high prevalence of Liver Damage: A Systematic Review and Meta-Analysis : COVID-19 and liver damage

Introduction: The Coronavirus Disease 2019 (COVID-19) outbreak is a serious threat to humans, and the impact of COVID-19 on the liver remains unexplored. At present, no meta-analysis has summarized available findings of COVID-19 patients with liver injury in depth. Thus, we aimed to scrutinize the association of the liver in COVID-19 patients and approximate the prognosis of COVID-19 patients with liver injury thoroughly.   Method: We searched different databases for qualified studies between December 2019 to May 2021. Finally, meta-analysis was carried out using fixed-effect or random-effect models based on the heterogeneity.   Result: Our Meta-analysis includes 32 studies with a total of 6,933 COVID-19 patients. The pooled prevalence of chronic liver disease (CLD) was 3.5%. Overall, the rates of severity and mortality in COVID-19 patients with underlying CLD were 4.6% and 19.2%, respectively. Additionally, the incidence of acute on chronic failure (ACLF) among COVID-19 patients with CLD was 25.1%. The prevalence of an increase in serum ALT, AST, TBil, and LDH levels was 39.5%, 28.6%, 26.5%, and 55.5%, respectively. Similarly, PT was prolonged in 8.3% of cases, and albumin was decreased in 66.8% of cases. The pooled prevalence of liver injury among COVID-19 patients was 28.2%. Strikingly, the patients with liver injury had significantly more severe disease (42.3%) and a higher incidence of mortality (18.5%) than the patients without liver injury.   Conclusion: In conclusion, more than one in five of the COVID-19 patients is at risk of developing a liver injury. Further, patients with liver injury have significantly more severe disease and a higher incidence of mortality than patients without liver injury. Thus, careful monitoring of liver function is advisable while treating COVID-19 patients

Laparoscopic Spleen-Preserving Distal Pancreatectomy (LSPDP) with Preservation of Splenic Vessels: An Inferior-Posterior Approach

Objective. To summarize the operation experience of laparoscopic spleen-preserving distal pancreatectomy (LSPDP) with preservation of splenic vessels by an inferior-posterior dissection of the pancreatic body and evaluate its feasibility. Methods. Patients undergoing LSPDS at Ningbo Li Huili Hospital and Ningbo Li Huili Eastern Hospital from January 2014 to April 2017 were recruited in this study and were analyzed retrospectively. They were divided into two groups based on the surgical approach: the inferior-posterior approach group and the other approach group. We sought to compare outcomes of the two groups. Results. The LSPDP procedure was completed successfully in 49 cases, and 48 patients had their splenic artery and vein preserved, including 26 cases in the inferior-posterior approach group and 22 cases in the other approach group. There were no significant differences between the two groups with respect to age (p=0.18), sex (p=0.56), preoperative diabetes (p=1.00), ASA grading (p=1.00), tumor size (p=0.91), intraoperative blood loss (t=−0.01, p=0.99), hospital stay (t=−0.02, p=0.98), and pancreatic fistula rates (p=1.00). Patients undergoing LSPDP by the inferior-posterior approach had a shorter operative time (t=−4.13, p<0.001) than the other approach group. Conclusions. LSPDS by the inferior-posterior approach associated with shorter operative time is safe and feasible

Evaluation of Different Okra (Abelmoschus esculentus L.) Cultivars for Yield and Biomass Production

In a field experiment conducted at Girija Prasad Koirala College of Agriculture and Research Center, Morang, Nepal, spanning from April to August 2022, the study aimed to assess the yield and biomass production of various okra (Abelmoschus esculentus L.) varieties, including Arka Anamika, Chandani, Chiranjeevi F1, F1 Glory, Gunjan, JK1666, OH-940, Punjab Selection, R35 Selection, and Swastik-2. Results unveiled significant variability among the varieties, with F1 Glory (0.91 Kg/m2) and Punjab Selection (0.96 Kg/m2) emerging as top performers in average yield per m2. Conversely, Arka Anamika, Gunjan, and JK1666 exhibited the lowest yields. Notably, Punjab Selection (4.17 Kg/m2), OH-940 (4.28 Kg/m2), and Swastik-2 (3.86 Kg/m2) showed the highest fresh biomass, while Gunjan had the lowest biomass. F1 Glory demonstrated the highest harvest index (1.14), followed by Chandani and Punjab Selection (both 0.88). These findings underscore the significant impact of varietal selection on okra productivity, highlighting the potential of Punjab Selection and F1 Glory for further exploration in vegetable cultivation and biomass production. The study underscores the importance of varietal selection in enhancing okra productivity and biomass production. Farmers should consider planting high-yielding varieties such as Punjab Selection and F1 Glory to maximize their yields and biomass. Additionally, further research is needed to explore optimal cultivation practices and management techniques tailored to these high-performing varieties. This study provides actionable recommendations for farmers to improve okra cultivation practices, ultimately enhancing agricultural productivity in Nepal and comparable agro-ecological conditions