Current treatment options of refractory ascites in liver cirrhosis - A systematic review and meta-analysis.

BACKGROUND Refractory ascites is a severe complication of liver cirrhosis and treatment options consist in large volume paracentesis, transjugular intrahepatic portosystemic shunt, alfapump®, peritoneovenous shunt and permanent indwelling peritoneal catheter. AIM Our aim was to assess the efficacy, mortality and complications of each treatment. METHODS We performed a systematic review using Pubmed and Embase. Frequencies were summarized with Comprehensive Meta-Analysis Software. RESULTS Seventy-seven studies were included. In patients with transjugular intrahepatic portosystemic shunt, 1-year mortality was 33% (95% CI 0.29-0.39, I2=82.1; τ2 = 0.37; p<0.001) with lower mortality in newer studies (26% vs. 44%). At 6 months, mortality in patients with alfapump® was 24% (95% CI 0.16-0.33, I2=0.00; τ2 = 0.00; p = 0.83), 31% developed acute kidney injury (95% CI 0.18-0.48, I2=44.0; τ2 = 0.22; p = 0.15). Mortality at 12 months was 44% (95% CI 32%-58%, I2=76.7, τ2 = 0.44, p<0.001) in peritoneovenous shunts and 45% (95% CI 38%-53%, I2=61.4, τ2 = 0.18, p = 0.003) in large volume paracentesis, respectively. Overall mortality in patients with permanent indwelling catheters was 66% (95% CI 33%-89%, I2=82.5, τ2 = 1.57, p = 0.001). DISCUSSION Mortality in patients with transjugular intrahepatic portosystemic shunt was lower in newer studies, probably due to a better patient selection. Acute kidney injury was frequent in patients with alfapump®. Permanent indwelling catheters seemed to be a good option in a palliative setting

Noninvasive Detection of Clinically Significant Portal Hypertension in Compensated Advanced Chronic Liver Disease.

Patients with compensated advanced chronic liver disease have different prognoses depending on the presence of portal hypertension. Current non-invasive diagnostic methods allow identification of clinically significant portal hypertension. Portosystemic collaterals on imaging or liver stiffness of more than 20 to 25 kPa by using transient elastography identifies patients with clinically significant portal hypertension. Patients with liver stiffness of less than 20 kPa and platelet count of greater than 150 g/L can avoid endoscopy. This rule could be expanded using spleen stiffness. Methods to risk stratify for portal hypertension in compensated advanced chronic liver disease and successfully treated chronic hepatitis C and B are subject of research

Transjugular intrahepatic portosystemic shunt in patients with hepatocellular carcinoma: A systematic review.

BACKGROUND/AIMS Transjugular intrahepatic portosystemic shunts (TIPS) in patients with hepatocellular carcinoma (HCC) may improve access to curative therapies, treat portal hypertension (PH)-related complications without worsening liver function, and increase overall survival. Data on the efficacy and safety of TIPS to treat PH complications in HCC patients, as well as the HCC treatment response, were evaluated. METHODS Studies reporting efficacy in controlling bleeding/ascites or response to HCC therapy, safety, and survival in patients with HCC and TIPS were searched systematically on PubMed and Embase. An extraction of articles using predefined data fields and quality indicators was used. RESULTS We selected 19 studies and found 937 patients treated for ascites/bleeding and 177 evaluating HCC treatment response. Over half were under 5 cm and solitary lesions, and most studies included tumours with portal vein thrombosis. Regarding PH studies, TIPS resolved bleeding/ascites in >60% of patients, more effective for bleeding. There were no lethal complications reported and procedural bleeding occurred in 40% rate in half of the studies. CONCLUSIONS In the published studies, TIPS is effective in treating PH complications in patients with HCC. Prospective studies on TIPS placement in patients with HCC are urgently needed to evaluate the efficacy and safety of TIPS in this setting

Severity classification in cases of Collagen VI-related myopathy with Convolutional Neural Networks and handcrafted texture features

(C) 2022 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.Magnetic Resonance Imaging (MRI) is a non-invasive tool for the clinical assessment of low-prevalence neuromuscular disorders. Automated diagnosis methods might reduce the need for biopsies and provide valuable information on disease follow-up. In this paper, three methods are proposed to classify target muscles in Collagen VI-related myopathy cases, based on their degree of involvement, notably a Convolutional Neural Network, a Fully Connected Network to classify texture features, and a hybrid method combining the two feature sets. The proposed methods were evaluated on axial T1-weighted Turbo Spin-Echo MRI from 26 subjects, including Ullrich Congenital Muscular Dystrophy and Bethlem Myopathy patients at different evolution stages. The hybrid model achieved the best cross-validation results, with a global accuracy of 93.8%, and F-scores of 0.99, 0.82, and 0.95, for healthy, mild and moderate/severe cases, respectively.info:eu-repo/semantics/acceptedVersio

Severity classification in cases of Collagen VI-related myopathy with Convolutional Neural Networks and handcrafted texture features

© 2022 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes, creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.Magnetic Resonance Imaging (MRI) is a non-invasive tool for the clinical assessment of low-prevalence neuromuscular disorders. Automated diagnosis methods might reduce the need for biopsies and provide valuable information on disease follow-up. In this paper, three methods are proposed to classify target muscles in Collagen VI-related myopathy cases, based on their degree of involvement, notably a Convolutional Neural Network, a Fully Connected Network to classify texture features, and a hybrid method combining the two feature sets. The proposed methods were evaluated on axial T1-weighted Turbo Spin-Echo MRI from 26 subjects, including Ullrich Congenital Muscular Dystrophy and Bethlem Myopathy patients at different evolution stages. The hybrid model achieved the best cross-validation results, with a global accuracy of 93.8%, and F-scores of 0.99, 0.82, and 0.95, for healthy, mild and moderate/severe cases, respectively.info:eu-repo/semantics/acceptedVersio

Non-invasive tools for compensated advanced chronic liver disease and portal hypertension after Baveno VII - an update.

Non-invasive tests (NITs) and liver stiffness measurement (LSM) in particular, have entered clinical practice over 20 years ago as point-of-care tests to diagnose liver fibrosis in patients with compensated chronic liver disease. Since then, NITs use has evolved thanks to a large number of studies in all major etiologies of liver disease, and they have become important tools to stratify the risk of portal hypertension and liver-related events. The Baveno VII consensus workshop provided several novel recommendations regarding the use of well-established and novel NITs in the specific setting of portal hypertension screening, diagnosis and follow-up. The Baveno VII expert panels paid special attention to summarizing the existing data into simple clinical rules able to guide clinicians in their practice. The "rule of five" for LSM is a tool to stratify the risk of liver-related events, and LSM alone or in combination with platelet count, can be used now to rule-in and rule-out compensated advanced chronic liver disease (cACLD) and clinically significant portal hypertension, as well as to rule-out high-risk varices. Use of NITs in obese subjects with non-alcoholic fatty liver disease (NAFLD) and patients with viral hepatitis C that has been successfully treated, require specific knowledge. This review will update the reader on these aspects

Iodine Intake and Related Cognitive Function Impairments in Elementary Schoolchildren

Iodine deficiency, the most common cause of preventable mental impairment worldwide, has been linked to poorer intellectual function in several studies. However, to our knowledge, no studies have been performed in moderate iodine-deficient schoolchildren using the complete form of Wechsler Intelligence Scale for Children (WISC-III; Portuguese version). The main purpose of this study was to ascertain whether moderate iodine deficiency would affect the cognitive function of schoolchildren (7–11 years old; 3rd and 4th grades). Raven’s Colored Progressive Matrices (CPM; Portuguese version) were used for measuring the intelligence quotient (IQ) of the total population (n = 256; median UIC = 66.2 μg/L), and the WISC-III was used to study two selected subgroups: one moderately iodine-deficient (n = 30) and the other with adequate iodine intake (n = 30). WISC-III was shown to be the prime instrument for cognitive function assessment among moderate iodine-deficient schoolchildren; this subgroup had a Full-Scale IQ 15.13 points lower than the adequate iodine intake subgroup, with a magnitude effect of d = 0.7 (p = 0.013). Significant differences were also registered in 6 of the 13 Verbal-Performance IQ subtests. Moderate iodine deficiency has a substantial impact on mental development and cognitive functioning of schoolchildren, with significant impairment in both Performance IQ and Verbal IQ spectrum, adversely impacting their educational performance.Diana Linhares was supported by a post-doc fellowship from the Fundo Regional da Ciencia (Regional Government of the Azores) (M3.1.a/F/004/2018). This work was supported by FCT-Fundacao para a Ciencia e a Tecnologia, within the project UIDP/00643/2020.info:eu-repo/semantics/publishedVersio

Mycophenolate mofetil as second line treatment in autoimmune hepatitis – A retrospective single center analysis

Background: Most patients with autoimmune hepatitis respond to standard treatment with steroids and azathioprine. While the disease is usually fatal if untreated, patients who respond well to therapy have an excellent prognosis. Nevertheless, second-line treatment is necessary in approximately 20% of patients, due to either intolerance or insufficient response to first line treatment.While data for mycophenolate mofetil (MMF) in patients intolerant to azathioprine is encouraging, MMF seems of less benefit in patients with insufficient response to first line treatment, but analyzed data on this issue is limited. Aim: To evaluate the efficacy and safety of MMF as a second-line therapy in patients with AIH. Methods: Retrospective analysis of a monocentric database of AIH patients who received medical care from 2000 to 2022. Clinical, immunological and biochemical parameters were assessed at different time points including last follow-up. Results: Overall, 144 patients with AIH were identified. Fifty out of 144 (35%) AIH patients received MMF. Forty (80%) received MMF due to first line treatment intolerance, while ten (20%) due to insufficient response to first line treatment.Remission with MMF monotherapy was 81.5% in the intolerance group versus 30% in the insufficient response group. Patients switched to MMF because of an insufficient response, more often needed additional prednisolone doses higher than 5 mg/day, a switch to third-line treatment or combination regiments, to achieve disease control. Conclusions: Patients treated with MMF because of intolerance to first line treatment show a good disease control under MMF in the majority of cases. Efficacy is considerably lower in the patients switched to MMF because of an insufficient response to first line treatment

Synthesis and evaluation of heterocyclic pyrrolidene imines as optical chemosensors

Imine derivatives are an important class of compounds due their biological and optical properties making them suitable for several applications such as chemosensors, photochromic compounds, among others. In recent years the search for new colorimetric chemosensors for anions has been of great interest because of the role that ions play in chemical and biological processes. In this context and as part of an on-going research to develop efficient heterocyclic systems for photochromic and chemosensory applications, we report the synthesis, the photophysical characterization and the chemosensory ability of pyrrolidene heterocyclic imines functionalized with aryl or naphthyl moieties. Keywords: Imines,FCTFEDERQRE

Bioproducts from seaweeds: a review with special focus on the Iberian Peninsula

Seaweeds, i.e. macroalgae that occupy the littoral zone, are a great source of compounds with diverse applications; their types and content greatly determine the potential applications and commercial values. Algal polysaccharides, namely the hydrocolloids: agar, alginate and carrageenan, as well as other non-jellifying polysaccharides and oligosaccharides, are valuable bioproducts. Likewise, pigments, proteins, amino acids and phenolic compounds are also important, exploitable compounds. For the longest time the dominant market for macroalgae has been the food industry. More recently, several other industries have increased their interest in algal-derived products, e.g. cosmetics, pharmaceuticals and more recently, as a source of feedstock for biorefinery applications. This manuscript reviews the chemical composition of dominant macroalgae, as well as their potential added-value products and applications. Particular attention is devoted to the macroalgal species from the Iberian Peninsula. This is located in the Southwest of Europe and is influenced by the distinct climates of the Mediterranean Sea and the Atlantic Ocean, representing a rich spot of marine floral biodiversity