Acute coronary syndrome after liver transplantation in a young primary biliary cholangitis recipient with dyslipidemia: a case report

BACKGROUND: Primary biliary cholangitis (PBC) is a chronic, progressive liver disease associated with dyslipidemia. There is a consensus that PBC does not accelerate coronary artery disease despite high cholesterol levels, so the screening test for the coronary artery is not routinely performed before liver transplantation (LT). To date, no report has described the potential risk of PBC-related dyslipidemia for developing acute coronary syndrome (ACS) after LT. CASE PRESENTATION: A 40-year-old Asian female with a known history of PBC underwent ABO-incompatible living-donor LT, with her husband as the donor. Although she had high cholesterol and triglyceride levels that were refractory to medications, she passed all routine preoperative examinations, including cardiopulmonary function tests and infection screenings. One week after LT, she developed ACS with 90% stenosis of both the left anterior descending artery and left circumflex artery. Emergent stent implantation was successfully performed followed by dual antiplatelet therapy. The long history of PBC and associated severe dyslipidemia for 10 years would have accelerated the atherosclerosis, causing latent stenosis in the coronary artery. Inapparent stenosis might have become apparent due to unstable hemodynamics during the acute phase after LT. CONCLUSIONS: PBC-related dyslipidemia potentially brings a risk for developing ACS after LT. This experience suggests that the preoperative evaluation of the coronary artery should be considered for high-risk patients, especially those who have drug-resistant dyslipidemia

Bile Duct Regeneration with an Artificial Bile Duct Made of Gelatin Hydrogel Nonwoven Fabrics

Although choledochojejunostomy is the standard technique for biliary reconstruction, there are various associated problems that need to be solved such as reflux cholangitis. Interposition with an artificial bile duct (ABD) to replace the resected bile duct maintains a physiological conduit for bile and may solve this problem. This study investigated the usefulness of an ABD made of gelatin hydrogel nonwoven fabric (GHNF). GHNF was prepared by the solution blow spinning method. The migration and activity of murine fibroblast L929 cells were examined in GHNF sheets. L929 cells migrated into GHNF sheets, where they proliferated and synthesized collagen, suggesting GHNF is a promising scaffold for bile duct regeneration. ABDs made of GHNF were implanted in place of resected bile duct segments in rats. The rats were killed at 2, 6, and 12 weeks postimplantation. The implantation site was histologically evaluated for bile duct regeneration. At postoperative 2 weeks, migrating cells were observed in the ABD pores. The implanted ABD was mostly degraded and replaced by collagen fibers at 6 weeks. Ki67-positive bile duct epithelial cells appeared within the implanted ABD. These were most abundant within the central part of the ABD after 6 weeks. The percentages of Ki67-positive cells were 31.7 ± 9.1% in the experimental group and 0.8 ± 0.6% in the sham operation group at 6 weeks (p < 0.05), indicating that mature biliary epithelial cells at the stump proliferated to regenerate the biliary epithelium. Biliary epithelial cells had almost completely covered the bile duct lumen at 12 weeks (epithelialization ratios: 10.4 ± 6.9% at 2 weeks, 93.1 ± 5.1% at 6 weeks, 99.2 ± 1.6% at 12 weeks). The regenerated epithelium was positive for the bile duct epithelium marker cytokeratin 19. Bile duct regeneration was accompanied by angiogenesis, as evidenced by the appearance of CD31-positive vascular structures. Capillaries were induced 2 weeks after implantation. The number of capillaries reached a maximum at 6 weeks and decreased to the same level as that of normal bile ducts at 12 weeks. These results showed that an ABD of GHNF contributed to successful bile duct regeneration in rats by facilitating the cell migration required for extracellular matrix synthesis, angiogenesis, and epithelialization. Impact Statement Development of an artificial bile duct (ABD) enables physiological biliary reconstruction and may solve clinical problems associated with choledochojejunostomy. In this study, we created ABDs with gelatin hydrogel nonwoven fabric and implanted them in place of resected bile duct in rats. We evaluated the process of bile duct regeneration as well as decomposition of the ABD and demonstrated successful regeneration of resected bile duct, highlighting the possibility of this novel biliary reconstruction method to replace choledochojejunostomy

A preliminary report of the gravity survey in Ross Island, Antarctica

Gravity surveys were carried out on Ross Island during the austral summer of 1982-1983. Twenty-one gravity stations were established in the summit area of Mount Erebus and eleven stations in the other area of Ross Island. The Bouguer gravity anomaly distribution shows a possibility of the maximum positive anomaly in the northeast side of the Erebus main crater, though the gravity stations are sparse there. This might be due to the fact that the structure of Mount Erebus is not a caldera type but nearly of the same type as the Kilauea Volcano of Hawaii Island and the O Sima Volcano of Japan

Seismic activity of Mount Erebus, Antarctica in 1983-1984

Mount Erebus is one of the active volcanoes in antarctica, and seismic observations of it have been made since December 1980 using a radiotelemetered network and several temporary stations. In the 1983-1984 field season, the number of the network stations was increased to eight by adding two new radio-telemetered stations. Volcanic earthquakes in and around Mount Erebus occurred at a rate of 20-160 events per day, which was almost the same rate as in the previous season. No intense earthquake swarm occurred in the 1983-1984 season. The earthquakes in this season are located wide around Mount Erebus. The clustered earthquakes have a dike-like distribution beneath the northern area of the central cone. An aseismic zone is recognized beneath the southwest area of the Erebus summit. This aseismic zone may correspond to a magma reservoir. The earthquakes which were not associated with the eruptions of Mount Erebus can be divided into several types according to their seismograms and spectra of the seismic waves. The seismic waves which may pass through the aseismic zone seem to be strongly attenuated as compared with those which may not pass through the zone

Seismic activity of Mount Erebus, Antarctica in 1982-1983

Mount Erebus is an active volcano with a persistent convecting lava lake at the summit crater, located on Ross Island, Antarctica. Since December 1980 the seismic activity of Mount Erebus has been continuously monitored using a radio-telemetered network of six seismic stations. A 50-day temporary seismic observation was also carried out in the 1982-1983 Antarctic field season. The following seismic activities were observed during this field season : 1) Explosion earthquakes accompanied with Strombolian eruptions from the lava lake occurred at a rate of 0-4 times per day which is slightly lower than the rate in the previous season; 2) an intense earthquake swarm, which is possibly related to the underground movement of magma, occurred in October 1982 near Abbott Peak, 10km northwest of the summit; 3) there were other source regions of seismicity in Ross Island, fairly distant from Mount Erebus to the east

GRAVITY SURVEY IN ROSS ISLAND, ANTARCTICA

Gravity surveys have been carried out in Ross Island every summer since 1982/83 in order to investigate the subsurface structure of the active volcano in Antarctica, Mount Erebus. The Bouguer anomaly has been calculated at each station. The pattern of anomaly distribution on this island can be summarized that the anomaly is high in the whole island except the western and southwestern coasts, where anomalies are about zero or negative, and that a higher anomaly exists in the summit area of Mount Erebus. The structure of Mount Erebus might be classified as a type similar to the Kilauea Volcano of Hawaii Island or the Osima Volcano of Japan

Current status of preoperative risk assessment for posthepatectomy liver failure in patients with hepatocellular carcinoma

Abstract Liver resection is an effective therapeutic option for patients with hepatocellular carcinoma. However, posthepatectomy liver failure (PHLF) remains a major cause of hepatectomy‐related mortality, and the accurate prediction of PHLF based on preoperative assessment of liver functional reserve is a critical issue. The definition of PHLF proposed by the International Study Group for Liver Surgery has gained acceptance as a standard grading criterion. Liver function can be estimated using a variety of parameters, including routine blood biochemical examinations, clinical scoring systems, dynamic liver function tests, liver stiffness and fibrosis markers, and imaging studies. The Child–Pugh score and model for end‐stage liver disease scores are conventionally used for estimating liver decompensation, although the alternatively developed albumin‐bilirubin score shows superior performance for predicting hepatic dysfunction. Indocyanine green clearance, a dynamic liver function test mostly used in Japan and other Asian countries, serves as a quantitative estimation of liver function reserve and helps determine indications for surgical procedures according to the estimated risk of PHLF. In an attempt to improve predictive accuracy, specific evaluation of liver fibrosis and portal hypertension has gained popularity, including liver stiffness measurements using ultrasonography or magnetic resonance elastography, as well as noninvasive fibrosis markers. Imaging modalities, including Tc‐99m‐labeled galactosyl serum albumin scintigraphy and gadolinium‐enhanced magnetic resonance imaging, are used for preoperative evaluation in combination with liver volume. This review aims to provide an overview of the usefulness of current options for the preoperative assessment of liver function in predicting PHLF