Coagulation and fibrosis: A potential non-negligible target of statins in chronic hepatitis

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Is non-alcoholic fatty liver disease a prothrombotic risk factor?

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Is non-alcoholic fatty liver disease a prothrombotic risk factor?

Not availabl

Polymorphisms of the melatonin receptor 1A (MTNR1A) gene affect the sexual performance of Rasa Aragonesa rams without changing their social dominance

This study aimed to investigate whether a specific genotype of the MTNR1A gene influences social dominance and reproductive performance in rams. Thirty-one rams were genotyped for Rsal and Mnll polymorphism of the gene: CC (n=19), CT (n=5), and TT (n=7), and GG (n=20), GA (n=6), or AA (n=5), respectively. Maintenance (standing still, lying down, drinking, feeding, walking, or stereotyping) and social behavior (agonistic and antagonistic interactions among rams) were recorded by direct observations involving instantaneous scan sampling and continuous behavior sampling. For each animal, his Index of Success (IS) and Displacement (ID) were calculated. One week after the social-behavioral observations, rams were tested in individual serving-capacity tests involving three ewes that were synchronized into estrus in a 15-m2 pen for 20 min. The genotypes did not differ in the number of aggressions they performed (CC: 88.95±12.85; CT: 106.20±21.00; TT: 70.43±8.50; GG: 76.05±8.72; GA: 119.00±16.16; AA: 95.80±36.39) or received (CC:75.79±5.82; CT:92.40±8.68; TT: 86.14±15.05; GG: 79.25±6.58; GA: 86.83±11.51; AA: 79.80±12.74), and their active and passive behaviors were similar. The genotypes did not differ significantly in IS or ID, and the proportion of rams in each success category was similar among groups. For the Rsal and Mnll polymorphism, TT and GG rams were responsible for 54% and 56% of recorded sexual events (P < 0.05), respectively. Results of this study confirm that the best sexual performance of rams was among those that carried certain genotypes of the MTNR1A gene. Still, it was not correlated with differences in social dominance

A new prognostic algorithm based on stage of cirrhosis and HVPG to improve risk-stratification after variceal bleeding

Background & Aims: HVPG decrease ≥20% or ≤12mmHg (“responders”) indicates good prognosis during propranolol/nadolol treatment but requires two HVPG measurements. We aimed at simplifying risk‐stratification after variceal bleeding using clinical data and HVPG. Methods: 193 cirrhotic patients (62% with ascites and/or hepatic encephalopathy, HE) included within 7‐days of bleeding had HVPG measured before and at 1‐3 months of treatment with propranolol/nadolol plus endoscopic band ligation. End‐points: Rebleeding and rebleeding/transplantation‐free survival for 4‐years. Another cohort (n=231) served as validation set. Results: During follow‐up 45 patients had variceal bleeding and 61 died. HVPG‐responders (n=71) had lower rebleeding‐risk (10% vs 34%, p=0.001) and better survival than 122 non‐responders (61% vs 39%, p=0.001). Patients with/HE (n=120) had lower survival than patients without (40% vs 63%, p=0.005). Among patients with ascites/HE, those with baseline HVPG≤16mmHg (n=16) had low rebleeding‐risk (13%). By contrast, among patients with ascites/HE and baseline HVPG>16mmHg, only HVPG‐responders (n=32) had good prognosis, with lower rebleeding‐risk and better survival than non‐responders (n=72) (respective proportions: 7% vs 39%,p=0.018; 56% vs 30% p=0.010). These findings allowed developing a new algorithm for risk‐stratification in which HVPG‐response was only measured in patients with ascites and/or HE and baseline HVPG>16mmHg. This algorithm reduced the grey‐zone (high‐risk patients not dying on follow‐up) from 46% to 35% and decreased by 42% the HVPG measurements required. The validation cohort confirmed these results. Conclusion: Restricting HVPG measurements to patients with ascites/HE and measuring HVPG‐response only if baseline HVPG>16mmHg improves detection of high‐risk patients while markedly reducing the number of HVPG measurements required

Virtual colonoscopy in stenosing colorectal cancer

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

A severe case of hemobilia and biliary fistula following an open urgent cholecystectomy

<p>Abstract</p> <p>Background</p> <p>Cholecystectomy has been the treatment of choice for symptomatic gallstones, but remains the greatest source of post-operative biliary injuries. Laparoscopic approach has been recently preferred because of short hospitalisation and low morbidity but has an higher incidence of biliary leakages and bile duct injuries than open one due to a technical error or misinterpretation of the anatomy. Even open cholecystectomy presents a small number of complications especially if it was performed in urgency. Hemobilia is one of the most common cause of upper gastrointestinal bleeding from the biliary ducts into the gastrointestinal tract due to trauma, advent of invasive procedures such as percutaneous liver biopsy, transhepatic cholangiography, and biliary drainage.</p> <p>Methods</p> <p>We report here a case of massive hemobilia in a 60-year-old man who underwent an urgent open cholecystectomy and a subsequent placement of a transhepatic biliary drainage.</p> <p>Conclusion</p> <p>The management of these complications enclose endoscopic, percutaneous and surgical therapies. After a diagnosis of biliary fistula, it's most important to assess the adequacy of bile drainage to determine a controlled fistula and to avoid bile collection and peritonitis. Transarterial embolization is the first line of intervention to stop hemobilia while surgical intervention should be considered if embolization fails or is contraindicated.</p

Assessing spleen stiffness by point shear‐wave elastography: Is it feasible and reproducible in patients with chronic liver disease? Is it useful to predict portal hypertension?

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Surgical site infection after caesarean section. Space for post-discharge surveillance improvements and reliable comparisons

Surgical site infections (SSI) after caesarean section (CS) represent a substantial health system concern. Surveying SSI has been associated with a reduction in SSI incidence. We report the findings of three (2008, 2011 and 2013) regional active SSI surveillances after CS in community hospital of the Latium region determining the incidence of SSI. Each CS was surveyed for SSI occurrence by trained staff up to 30 post-operative days, and association of SSI with relevant characteristics was assessed using binomial logistic regression. A total of 3,685 CS were included in the study. A complete 30 day post-operation follow-up was achieved in over 94% of procedures. Overall 145 SSI were observed (3.9% cumulative incidence) of which 131 (90.3%) were superficial and 14 (9.7%) complex (deep or organ/space) SSI; overall 129 SSI (of which 89.9% superficial) were diagnosed post-discharge. Only higher NNIS score was significantly associated with SSI occurrence in the regression analysis. Our work provides the first regional data on CS-associated SSI incidence, highlighting the need for a post-discharge surveillance which should assure 30 days post-operation to not miss data on complex SSI, as well as being less labour intensive

Prevalence, features and predictive factors of liver nodules in Fontan surgery patients: The VALDIG Fonliver prospective cohort

Background & Aims: Fontan surgery is used to treat a variety of congenital heart malformations, and may lead to advanced chronic liver disease in the long-term. This study examines the prevalence, characteristics and predictors of liver nodules in patients following Fontan surgery. Methods: This was a prospective, cross-sectional, observational study conducted at 8 European centres. Consecutive patients who had undergone Fontan surgery underwent blood tests, abdominal ultrasonography (US), transient elastography (Fibroscan®), echocardiography, haemodynamic assessments, and abdominal MRI/CT scan. The primary outcome measure was liver nodules detected in the MRI/CT scan. Predictors of liver nodules were identified by multivariate logistic regression. Results: One hundred and fifty-two patients were enrolled (mean age 27.3 years). The mean time elapsed from surgery to inclusion was 18.3 years. Liver nodule prevalences were 29.6% (95% CI 23–37%) on US and 47.7% (95% CI 39–56%) on MRI/CT. Nodules were usually hyperechoic (76.5%), round-shaped (>80%), hyperenhancing in the arterial phase (92%) and located in the liver periphery (75%). The sensitivity and specificity of US were 50% (95% CI 38–62%) and 85.3% (95% CI 75–92%), respectively. Inter-imaging test agreement was low (adjusted kappa: 0.34). In the multivariate analysis, time since surgery >10 years was the single independent predictor of liver nodules (odds ratio 4.18; p = 0.040). Hepatocellular carcinoma was histologically diagnosed in 2 of the 8 patients with hypervascular liver nodules displaying washout. Conclusion: While liver nodules are frequent in Fontan patients, they may go unnoticed in US. Liver nodules are usually hyperechoic, hypervascular and predominantly peripheral. This population is at risk of hepatocellular carcinoma, the diagnosis of which requires confirmatory biopsy