Elective percutaneous liver biopsy and use of aspirin.

OBJECTIVES Percutaneous liver biopsy is an essential diagnostic investigation in hepatology. Among complications, which are rare, bleeding is the most feared. Many patients scheduled for a liver biopsy are taking aspirin. Surprisingly no information is available in the literature on this frequent clinical situation. The American Association for the Study of Liver Diseases (AASLD) position paper on percutaneous liver biopsy does not specifically recommend stopping low dose aspirin prior to an elective percutaneous liver biopsy. The European Association for the Study of the Liver also remains unspecific without giving clear recommendation on stopping or not low dose aspirin before the procedure. The aim of this study is to document current practice concerning the management of patients scheduled for an elective percutaneous biopsy and taking low dose aspirin. DESIGN An online questionnaire was designed to gather data on current practice on the perioperative management of percutaneous liver biopsy and use of aspirin. SETTINGS The questionnaire was emailed to AASLD members in September 2018. PARTICIPANTS Four hundred sixty six responses were collected. RESULTS Seventy eight percent postpone elective percutaneous liver biopsy if International Normalised Ratio is ≥1.5 or Quick ≤50%. Ninety five percent postpone biopsy if platelet count is ≤50,000 × 106 /L. Seventy five percent stop low dose aspirin, on average, 6 days prior to the percutaneous liver biopsy. This choice of management does not seem to be related to previous complications since 86% report not having experienced any bleeding in patients taking low dose aspirin. Nevertheless, this practice has logistic consequences since 61% of the respondents postponed a liver biopsy due to intake of low dose aspirin. CONCLUSIONS Despite the lack of clear statement in guidelines and evidence supporting this practice, three quarters of physicians practicing in hepatology stop low dose aspirin before elective percutaneous liver biopsy

Correlates of at-risk gambling behaviors of homeless youth

Objective: This exploratory study aims to describe the gambling behaviors of 419 homeless youth. Methods: Participants were divided into two groups: 1) those whose gambling behaviors did not present a risk (n=366); and 2) those whose gambling behaviors presented a risk (n=53). Results: In this homeless youth cohort, 12.6% exhibited gambling behaviors that could be considered at-risk. Compared to youth not having at-risk gambling behavior, youth with at-risk gambling behaviors were more likely to be male and be born outside of Canada. The at-risk participants were three times more likely to have a diagnosis of mental health disorder and two times more likely to report criminal activities as their main source of income. Conclusions: These findings underline the importance of addressing all at-risk behaviors engaged in by homeless youth

Effects of Home Care on patients with hepatocellular carcinoma treated with sorafenib.

Background and Aim Treatment with sorafenib causes diverse side effects, which limits adherence. This work assesses whether Home Care, a psychosocial nursing intervention, prolongs the duration of treatment in patients with advanced hepatocellular carcinoma (HCC) and if it influences health-related quality of life (HRQL). Methods and Results This is a cohort study using data from patients receiving sorafenib in the prospective Bern HCC Cohort at the University Hospital. Duration of treatment, overall survival, and HRQL using the Functional Assessment of Cancer Therapy-Hepatobiliary questionnaire were compared in the two groups. A total of 173 patients were eligible for the analysis. Among them, 141 were in the Home Care program, and 32 were not. Patients with Home Care had a significantly longer duration of treatment (265 days vs 152 days, P = 0.003) and a better functional well-being (17.7 vs 12.5, P = 0.015). Conclusion Psychosocial interventions such as Home Care are a valid method in improving adherence to sorafenib and can therefore be recommended

PPAR-Targeted Therapies in the Treatment of Non-Alcoholic Fatty Liver Disease in Diabetic Patients.

Peroxisome proliferator-activated receptors (PPAR), ligand-activated transcription factors of the nuclear hormone receptor superfamily, have been identified as key metabolic regulators in the liver, skeletal muscle, and adipose tissue, among others. As a leading cause of liver disease worldwide, non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) cause a significant burden worldwide and therapeutic strategies are needed. This review provides an overview of the evidence on PPAR-targeted treatment of NAFLD and NASH in individuals with type 2 diabetes mellitus. We considered current evidence from clinical trials and observational studies as well as the impact of treatment on comorbid metabolic conditions such as obesity, dyslipidemia, and cardiovascular disease. Future areas of research, such as possible sexually dimorphic effects of PPAR-targeted therapies, are briefly reviewed

Herpes simplex virus hepatitis 4 years after liver transplantation

If not promptly recognized and treated, herpes simplex virus (HSV) hepatitis is associated with a high mortality. A patient transplanted for primary sclerosing cholangitis required, 4 years later, a colectomy for a steroid-resistant flare of ulcerative colitis. He subsequently developed fever, with genital and oral ulcerations. He was hospitalized for diabetic decompensation with massive elevation of serum aminotransferases. Examination revealed vesicles on the hands. Liver biopsy showed Cowdry type B inclusions. Therapy with acyclovir was immediately initiated and the patient recovered. This case illustrates the diagnostic importance of mucocutaneous lesions in the assessment of complications after liver transplantatio

COVID-19 in Liver Transplant Recipients: A Systematic Review.

Liver transplant (LT) recipients are considered a vulnerable population amidst the COVID-19 pandemic. To date, available data have been heterogeneous and scarce. Therefore, we conducted a systematic literature review identifying English-language articles published in PubMed between November 2019 and 30 May 2021. We aimed to explore three areas: (1) outcome and clinical course; (2) immunological response after COVID-19 in LT recipients; and (3) vaccination response. After systematic selection, 35, 4, and 5 articles, respectively, were considered suitable for each area of analysis. Despite the heterogeneity of the reports included in this study, we found that gastrointestinal symptoms were common in LT recipients. The outcome of the LT population was not per se worse compared to the general population, although careful management of immunosuppressive therapy is required. While a complete therapy discontinuation is not encouraged, caution needs to be taken with use of mycophenolate mofetil (MMF), favoring tacrolimus (TAC) use. Although data conflicted about acquired immunity after SARS-CoV-2 infection, vaccine immunogenicity appeared to be low, suggesting that the level of surveillance should be kept high in this population

What Is the Role of Body Composition Assessment in HCC Management?

In the last decade, body composition (BC) assessment has emerged as an innovative tool that can offer valuable data concerning nutritional status in addition to the information provided by the classical parameters (i.e., body mass index, albumin). Furthermore, published data have revealed that different types of body composition are associated with different outcomes. For example, abnormalities of skeletal muscle, a common finding in cirrhotic and oncologic patients, are associated with poor outcome (i.e., high morbidity and high mortality). The disposition (visceral/subcutaneous adipose tissue) and radiodensity of adipose tissue proved to also be determinant factors for HCC outcome. Despite all the advantages, BC assessment is not part of the standard pre-therapeutic workup. The main reasons are the high heterogeneity of data, the paucity of prospective studies, the lack of a standard assessment method, and the interpopulation variation of BC. This paper aims to review the available evidence regarding the role of BC as a prognostic tool in the HCC population undergoing various therapies

Diffuse Primary Angiosarcoma of the Pleura: A Case Report and Review of the Literature

Primary pleural angiosarcoma is an extremely rare tumor. We report the case of a patient who presented with recurrent massive bilateral hemothoraxes. Although thoracoscopy was performed, biopsy samples of the pleura were inconclusive. The delayed onset of skin metastases led to the diagnosis of angiosarcoma, however the patient died from pleuropulmonary progression before treatment could be started. We review the literature of primary pleuropulmonary angiosarcoma and discuss its treatment modalities

In-Plane Forces Prediction and Analysis in High-Speed Conditions on a Contra-Rotating Open Roto

Due to the growing interest from engine and aircraft manufacturers for contra-rotating open rotors (CROR), much effort is presently devoted to the development of reliable computational fluid dynamics (CFD) methodologies for the prediction of performance, aerodynamic loads, and acoustics. Forces transverse to the rotation axis of the propellers, commonly called in-plane forces (or sometimes 1P forces), are a major concern for the structural sizing of the aircraft and for vibrations. In-plane forces impact strongly the stability and the balancing of the aircraft and, consequently, the horizontal tail plane (HTP) and the vertical tail plane (VTP) sizing. Also, in-plane forces can initiate a flutter phe- nomenon on the blades or on the whole engine system. Finally, these forces are unsteady and may lead to vibrations on the whole aircraft, which may degrade the comfort of the passengers and lead to structural fatigue. These forces can be predicted by numerical methods and wind tunnel measurements. However, a reliable estimation of in-plane forces requires validated prediction approaches. To reach this objective, comparisons between several numerical methods and wind tunnel data campaigns are necessary. The primary objective of the paper is to provide a physical analysis of the aerodynamics of in-plane forces for a CROR in high speed at nonzero angle of attack using unsteady simulations. Confidence in the numerical results is built through a code-to-code comparison, which is a first step in the verification process of in-plane forces prediction. Thus, two computa- tional processes for unsteady Reynolds-averaged Navier–Stokes (URANS) simulations of an isolated open rotor at nonzero angle of attack are compared: computational strategy, open rotor meshing, aerodynamic results (rotor forces, blades thrust, and pressure distributions). In a second step, the paper focuses on the understanding of the key aerodynamic mechanisms behind the physics of in-plane forces. For the front rotor, two effects are predominant: the first is due to the orientation of the freestream velocity, and the second is due to the distribution of the induced velocity. For the rear rotor, the freestream velocity effect is reduced but is still dominant. The swirl generated by the front rotor also plays a major role in the modulus and the direction of the in-plane force. Finally, aerodynamic interactions are found to have a minor effect