Changes In Hepatic Hemodynamics Research Articles

Membranoproliferative glomerulonephritis in a child with congenital portosystemic shunt.

Congenital portosystemic shunts (CPSS) are rare congenital vascular anomalies characterized by abnormal connections between the portal vein and systemic circulation, bypassing the liver. They can lead to complications such as recurrent encephalopathy, liver nodules, portopulmonary hypertension, and neurocognitive issues due to hyperammonemia and rarely kidney involvement. Hepatic hemodynamic changes can lead to liver nodules and hepatocellular carcinoma, particularly in extrahepatic shunts. We describe here an 11-year-old girl with type 1 intrahepatic portosystemic shunt with focal nodular hyperplasia in the liver, presenting with nephrotic syndrome that was diagnosed as membranoproliferative glomerulonephritis on kidney biopsy and that responded partially to therapy with immunosuppressants.

EGFR-mediated crosstalk between vascular endothelial cells and hepatocytes promotes Piezo1-dependent liver regeneration

Hepatocyte proliferation is essential for recovering liver function after injury. In liver surgery, the mechanical stimulation induced by hemodynamic changes triggers vascular endothelial cells (VECs) to secrete large amounts of cytokines that enhance hepatocyte proliferation and play a pivotal role in liver regeneration. Piezo1, a critical mechanosensory ion channel, can detect and convert mechanical forces into chemical signals, importing external stimuli into cells and triggering downstream biological effects. However, the precise role of Piezo1 in VECs, especially in terms of mediating liver regeneration, remains unclear. Here, we report on a potential mechanism by which early changes in hepatic portal hemodynamics activate Piezo1 in VECs to promote hepatocyte proliferation during the process of liver regeneration induced by portal vein ligation in rats. In this liver regeneration model, hepatocyte proliferation is mainly distributed in zone 1 and zone 2 of liver lobules at 24–48 h after surgery, while only a small number of Ki67-positive hepatocytes were observed in zone 3. Activation of Piezo1 promotes increased secretion of epiregulin and amphiregulin from VECs via the PKC/ERK1/2 axis, further activating epidermal growth factor receptor (EGFR) and ERK1/2 signals in hepatocytes and promoting proliferation. In addition, cytokines secreted by Piezo1-activated VECs can induce hepatocytes to undergo epithelial–mesenchymal transition. In the liver lobules, the expression of EGFR in hepatocytes of zone 1 and zone 2 is significantly higher than that in zone 3. The EGFR inhibitor gefitinib inhibits liver regeneration by suppressing the proliferation of hepatocytes in the middle zone. Thus, activation of Piezo1 in VECs promotes hepatocyte proliferation, suggesting mechanical stimulation regulates hepatocyte proliferation in zone 1 and zone 2 during portal vein ligation-induced liver regeneration. These data provide a theoretical basis for the regulation of liver regeneration through chemical signals mediated by mechanical stimulation.

Liver cirrhosis: relationship between fibrosis-associated hepatic morphological changes and portal hemodynamics using four-dimensional flow magnetic resonance imaging

PurposeThe mechanisms underlying the morphological changes in liver cirrhosis remain unknown. This study aimed to clarify the relationship between fibrotic hepatic morphology and portal hemodynamic changes using four-dimensional flow magnetic resonance imaging (MRI).Materials and methodsOverall, 100 patients with suspected liver disease who underwent 3-T MRI were evaluated in this retrospective study. Liver fibrosis was assessed using a combination of visual assessment of the hepatic morphology and quantitative measures, including the fibrosis-4 index and aspartate transaminase-to-platelet ratio. It was classified into three groups according to the severity of fibrosis as follows: A (normal), B (mild-to-moderate), and C (severe). Quantitative indices, including area (mm2), net flow (mL/s), and average velocity (cm/s), were measured in the right portal vein (RPV) and left portal vein (LPV), and were compared across the groups using the Kruskal–Wallis and Mann–Whitney U tests.ResultsAmong the 100 patients (69.1 ± 12.1 years; 59 men), 45, 35, and 20 were categorized into groups A, B, and C, respectively. The RPV area significantly differed among the groups (from p < 0.001 to p = 0.001), showing a gradual decrease with fibrosis progression. Moreover, the net flow significantly differed between groups A and B and between groups A and C (p < 0.001 and p < 0.001, respectively), showing a decrease during the early stage of fibrosis. In the LPV, the net flow significantly differed among the groups (from p = 0.001 to p = 0.030), revealing a gradual increase with fibrosis progression.ConclusionThe atrophy–hypertrophy complex, which is a characteristic imaging finding in advanced cirrhosis, was closely associated with decreased RPV flow in the early stage of fibrosis and a gradual increase in LPV flow across all stages of fibrosis progression.

Hepatic perfusion as a new predictor of prognosis and mortality in critical care patients with acute-on-chronic liver failure.

Background and aimsLiver diseases are frequent causes of morbidity and mortality worldwide. Liver diseases can lead to cirrhosis, with the risk of acute-on-chronic liver failure (ACLF). For the detection of changes in hepatic hemodynamics, Doppler ultrasonography is a well-established method. We investigated hepatic hemodynamics via serial Doppler ultrasonography to determine the predictive value of changes in hepatic perfusion for the outcome in patients with severe liver diseases compared to established prognostic models such as the MELD (Model for End-Stage Liver Disease) or CLIF-C (Chronic Liver Failure-Consortium) ACLF score.MethodsIn this prospective cohort study, hepatic perfusion was quantified at baseline before the initiation of treatment and every third day by means of serial measurements of the hepatic artery resistance index (HARI) and the maximum portal vein velocity (PVv) using Doppler ultrasonography in 50 consecutive patients with severe liver diseases admitted to a medical intensive care unit (MICU). The recorded hemodynamic parameters were compared to the MELD score, and the CLIF-C ACLF score to analyze their utility for the prediction of the outcome of patients with severe liver diseases, liver cirrhosis, and ACLF.ResultsThe changes (delta) obtained by serial measurements of the MELD score, HARI, and PVv were analyzed through scatter plots. Bivariate correlation analysis yielded a new positive linear correlation between the delta-HARI and the delta-MELD score (r = 0.469; p < 0.001). In addition, our data revealed a new negative linear correlation between delta-PVv and the delta-MELD score (r = −0.279, p = 0.001). The leading cause of MICU mortality was acute-on-chronic liver failure (ACLF). A subgroup analysis of patients with liver cirrhosis revealed a positive linear correlation between the delta-HARI and the delta-CLIF-C-ACLF score (r = 0.252, p = 0.005). Of clinical relevance, non-survivors of ACLF exhibited a significantly higher mean value for the delta-HARI (0.010 vs. −0.005; p = 0.015) and a lower mean value for the delta-PVv (−0.7 vs. 1.9 cm/s; p = 0.037) in comparison to survivors of ACLF.ConclusionThis study shows the prognostic value of the assessment of hepatic perfusion in critical care patients with severe liver diseases by bedside Doppler ultrasound examination and its utility as an accurate predictor of the outcome in patients with ACLF. Increasing HARI and a decreasing PVv are predictors of an adverse outcome. Delta-HARI and delta-PVv are new biomarkers of prognosis and ACLF-related mortality in patients with liver diseases. Delta-HARI and delta-PVv may be helpful in guiding clinical decision-making, especially in catecholamine and fluid management.

Graft Inflow Modulation in Living-Donor Liver Transplantation: Hepatic Hemodynamic Changes in Splenic Artery Ligation and Splenectomy.

BackgroundExcessive portal flow to an allograft was a key mechanism for small-for-size syndrome in living-donor liver transplantation (LDLT). Good outcomes in LDLT by graft inflow modulation (GIM) using a small graft were reported, but the effect on hepatic hemodynamics is undefined. This report summarizes our experience with GIM and compares the effects of splenic artery ligation (SAL) and splenectomy on hepatic hemodynamic changes.Material/MethodsNinety-nine patients who underwent adult-to-adult LDLT from June 2014 to December 2020 were included in this study. GIM was performed in 36 patients (17 patients with SAL and 19 with splenectomy).ResultsThe GIM group had lower graft-to-recipient weight compared to the no-modulation group (median, 0.91% versus 1.04%, P=0.022). Initial portal venous flow (PVF) was higher in the GIM group (median, 311 versus 156 ml/min/100 g, P<0.001). After GIM, PVF decreased to 224 ml/min/100 g. One-year graft survival with GIM was 89.9%, and for the no-modulation group it was 86.6% (P=0.945). In the subgroup analysis, the efficacy of decompressing PVF was higher in the splenectomy subgroup (median, 14.3% versus 41.8%, P=0.002).ConclusionsGIM was useful for grafts with high PVF. Splenectomy modulated excessive PVF more effectively than did SAL. Perioperative hepatic hemodynamic changes could assist surgeons in selecting different GIM strategies.

Triplex Sonographic Evaluation of Portal Vein Indices Among Adults in Port Harcourt, Nigeria.

Chronic liver disease is characterized by progressive hepatic fibrosis and changes in hepatic vascular hemodynamics. Sonography is a readily available tool in the assessment of the hepatic hemodynamic alterations that occur in chronic liver diseases. This study was aimed at sonographically determining the portal vein indices in apparently healthy adults by estimating the portal vein diameter, cross-sectional area, and portal vein velocity. This was a prospective, cross-sectional study carried out among 62 apparently healthy individuals. The participants underwent gray scale and Doppler ultrasonographic examinations of the portal vein. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) IBM Corp. version 23.0 (Armonk, NY: USA). The comparison of means of two groups was with the unpaired t-test, and level of significance was set at 5% (P < 0.05). Forty-six (74.2%) of the 62 participants recruited were male and 16 (25.8%) were female. Participants were aged 18-65 years with a mean age of 39.90 ± 10.34 years. The means of portal vein diameter, cross-sectional area, and portal vein velocity are 1.15 ± 0.12 cm, 0.88 ± 0.18 cm2, and 18.37 ± 2.04 cm/s, respectively. There was no statistically significant difference of all portal vein ultrasound parameters between males and females, except portal vein flow velocity which was higher in males, t-test = 2.273 and P = 0.027 (>0.05). There was no significant correlation between age and ultrasound parameters P > 0.05. The normal values of portal vein diameter, cross-sectional area, and portal vein velocity were established.

Cardiac-induced liver deformation as a measure of liver stiffness using dynamic imaging without magnetization tagging-preclinical proof-of-concept, clinical translation, reproducibility and feasibility in patients with cirrhosis.

MR elastography and magnetization-tagging use liver stiffness (LS) measurements to diagnose fibrosis but require physical drivers, specialist sequences and post-processing. Here we evaluate non-rigid registration of dynamic two-dimensional cine MRI images to measure cardiac-induced liver deformation (LD) as a measure of LS by (i) assessing preclinical proof-of-concept, (ii) clinical reproducibility and inter-reader variability, (iii) the effects of hepatic hemodynamic changes and (iv) feasibility in patients with cirrhosis. Sprague-Dawley rats (n = 21 bile duct ligated (BDL), n = 17 sham-operated controls) and fasted patients with liver cirrhosis (n = 11) and healthy volunteers (HVs, n = 10) underwent spoiled gradient-echo short-axis cardiac cine MRI studies at 9.4T (rodents) and 3.0T (humans). LD measurements were obtained from intrahepatic sub-cardiac regions-of-interest close to the diaphragmatic margin. One-week reproducibility and prandial stress induced hemodynamic changes were assessed in healthy volunteers. Normalized LD was higher in BDL (1.304 ± 0.062) compared with sham-operated rats (1.058 ± 0.045, P = 0.0031). HV seven-day reproducibility Bland-Altman (BA) limits-of-agreement (LoAs) were ± 0.028 a.u. and inter-reader variability BA LoAs were ± 0.030 a.u. Post-prandial LD increases were non-significant (+ 0.0083 ± 0.0076 a.u., P = 0.3028) and uncorrelated with PV flow changes (r = 0.42, p = 0.2219). LD measurements successfully obtained from all patients were not significantly higher in cirrhotics (0.102 ± 0.0099 a.u.) compared with HVs (0.080 ± 0.0063 a.u., P = 0.0847). Cardiac-induced LD is a conceptually reasonable approach from preclinical studies, measurements demonstrate good reproducibility and inter-reader variability, are less likely to be affected by hepatic hemodynamic changes and are feasible in patients with cirrhosis.

Short-term Effects of Hepatic Arterial Buffer Responses Induced by Partial Splenic Embolization on the Hepatic Function of Patients with Cirrhosis According to the Child-Pugh Classification.

Objective This study primarily aimed to investigate the short-term effects of partial splenic embolization (PSE) on the Child-Pugh score and identify predictive factors for changes in the score caused by PSE. The secondary aim was to analyze changes in various parameters at one month postoperatively using these identified factors. Methods Between September 2007 and December 2019, 118 patients with cirrhosis and hypersplenism underwent PSE at our hospital. Testing was conducted preoperatively and at one month after PSE. Results Overall, the Child-Pugh score was not significantly changed postoperatively. The Child-Pugh score before PSE was identified as the strongest independent predictor of ameliorated and deteriorated Child-Pugh scores after PSE. Higher pretreatment Child-Pugh scores were correlated with higher posttreatment amelioration rates of the score. A significant decrease in the portal vein diameter and a significant increase in the common hepatic artery diameter were evident at the same level postoperatively in 64 patients with Child-Pugh class A (group A) and in 54 patients with Child-Pugh class B or C (group B/C) preoperatively. According to Murray's Law, PSE resulted in decreased portal venous flow and increased hepatic arterial flow, suggesting a hepatic arterial buffer response (HABR) induced by the procedure. Despite equivalent splenic infarction rates and similar posttreatment changes in hepatic hemodynamics, PSE significantly increased the Child-Pugh score of group A; however, the procedure significantly decreased the score of group B/C. Conclusion Considering original portal venous-hepatic arterial hemodynamics, PSE is expected to produce HABR-mediated hepatic functional improvements in cirrhosis patients with Child-Pugh class B/C.

Dopplerfluxometria das veias hepáticas em pacientes com esteatose hepática não-alcoólica

Objetivo: Avaliar as alterações hemodinâmicas do fígado em pacientes diagnosticados com esteatose hepática não alcoólica pela ultrassonografia. Métodos: Estudo clínico e prospectivo com abordagem quantitativa. A amostra foi composta de pacientes de ambos os sexos, de 18 a 70 anos. Através da ultrassonografia, eles foram diagnósticos como portadores ou não de esteatose hepática não alcoólica, e submetidos a uma avaliação hemodinâmica pela dopplerfluxometria. Os dados foram analisados pelo software IBM SPSS 22.0 para Windows e o nível de significância foi p &lt;0,05. Resultados: Foram avaliados 145 pacientes pela ultrassonografia abdominal. Destes, 33 foram diagnosticados com esteatose hepática não alcoólica grau 1, 35 com grau 2, e 07 com grau 3. Houve modificação do padrão de onda da veia hepática, de trifásico para bifásico ou monofásico, de acordo com o aumento dos graus de esteatose hepática. Os resultados foram estatisticamente significativos para as velocidades máxima, mínima e média da veia porta, quando uma comparação entre o grupo não portador e o grupo portador de fígado gorduroso foi realizada. Conclusão: A Doença Hepática Gordurosa Não Alcoólica causa modificações na hemodinâmica hepática, diminuindo as velocidades máxima, mínima e média da veia porta, além de alterações no padrão de onda da veia hepática.

Correlation of clinical features with inferior right hepatic vein incidence: a three-dimensional reconstruction-based study.

The correlation between right hepatic vein (RHV) diameter and inferior RHV (IRHV) incidence and that between IRHV incidence and other clinical features remain unclear. We investigated factors correlated with IRHV incidence as well as provide a simple and reliable method for predicting IRHV presence preoperatively. We obtained computed tomography (CT) imaging data of 1980 patients from the Department of Radiology, Qingdao Municipal Hospital, from July 1, 2016, to July 1, 2017. We excluded patients with heart disease, inferior vena cava (IVC) disease, history of liver surgery or trauma, space-occupying lesions in the liver, and other diseases, which can cause hepatic hemodynamic changes. CT images of patients were three-dimensionally reconstructed. We measured RHV and IRHV diameter as well as the angle between the RHV and the IVC. Data on 299 patients were included in this study; the incidence of IRHV was 34.44%. Sex, age, and the angle between the RHV and IVC did not correlate with IRHV incidence. RHV diameter negatively correlated with IRHV incidence (P < 0.05). The area under the receiver-operating characteristic curve for IRHV incidence was 0.878. The diagnostic threshold value of RHV diameter was 8.86mm. A negative correlation was found between RHV diameter and IRHV incidence, suggesting that IRHV is absent with RHV diameter > 8.86mm, but is present with RHV diameter < 8.86mm. This suggests that measuring only RHV diameter can predict the presence of an IRHV when IRHV-related hepatectomy and IRHV preserved living donor liver transplantation are needed.

Quantitative study of liver hemodynamic changes in rats with small-for-size syndrome by the 4D-CT perfusion technique.

The microcirculatory hemodynamic changes of small-for-size syndrome (SFSS) are still unclear. In this study, they were investigated by four-dimensional CT perfusion (4D-CTP) technique. The sham group, 50, 60, 70 and 80 % partial hepatectomy (PH) rat groups were established. At 1 hour (1 h), 1 day (1 d), 3 days (3 d) and 7 days (7 d) post-operation, serological examination, 4D-CTP scan and histopathological examination were performed. One-way analysis of variance and the Kruskal-Wallis test were used for the comparison. Based on the diagnostic criteria of SFSS, the 80 % group was considered to be a successful model. In all the PH groups, portal vein perfusion and total liver perfusion peaked at 1 h and declined at 1d and 3d. Both portal vein perfusion and total liver perfusion were significantly higher in the 80 % group than the sham group, 50 and 60% groups at 1 h (p < 0.05), and 80 % group at 3d and 7d (p < 0.05). In the 50 and 60 % groups, hepatic artery perfusion decreased at 1 h and maintained at a lower level until at 7 d; whereas, in the 70 and 80% groups, it increased at 1 h, then decreased and reached the lowest level at 7 d. No significant difference appeared in hepatic artery perfusion between any two groups at any time points. At all time points, hepatic perfusion index was lower in all the PH groups than the sham group. Significant differences in hepatic perfusion index appeared between the 80% group and the sham group at 1 h and 1 d (p < 0.05). The CTP parameters quantitatively revealed the microcirculatory hemodynamic changes in SFSS, which were further confirmed to be associated with histopathological injury. It is suggested that the hemodynamic changes in SFSS remnant liver can provide useful information for further revealing the mechanism of SFSS and may help for guiding the treatments. By using the 4D-CTP technique, the hepatic microcirculatory hemodynamic changes could be quantitatively measured in vivo for small animal research.

Systemic and hepatic hemodynamic changes in acute-on- chronic liver failure

Systemic and hepatic hemodynamic changes in acute-on- chronic liver failure

Maternal hepatic venous hemodynamics and cardiac output in normal and fetal growth restricted pregnancies

To evaluate relationship of maternal hepatic vein Doppler flow parameters and cardiac output (CO) with neonatal birth weight in uncomplicated pregnancies (UP) and pregnancies complicated by fetal growth restriction (FGR) . Methods: Hepatic vein impedance index (HVI), venous pulse transit time (VPTT), and CO were measured in women with UP at the 14th-37th weeks and complicated by FGR at the 26th-37th weeks who underwent maternal hepatic hemodynamic and echocardiographic examination during the ultrasonography. After delivery, the birth weight and the birth weight percentile of each neonate in this study were recorded. Correlations among HVI, VPTT, and CO were analyzed. Results: In the UP group, HVI, VPTT, and CO changed with the increase of gestation. In the FGR group, HVI was higher, VPTT was shorter, CO and neonatal birth weight were obviously lower than those in the UP at the 26th-37th weeks (P<0.05). Conclusion: There is a series of adaptive changes in hepatic venous hemodynamics and CO in UP with the increase of gestation to meet the demand of fetal growth, while the maladaptive changes in hepatic venous hemodynamics and CO in pregnant woman may contribute to FGR.

Hemodynamic and clinical effects of shunt diameter in portacaval shunt: a systematic review

Introduction: Portacaval shunts (PCS) were used to decrease the portal vein flow (PVF) and pressure (PVP). However, the proper shunt diameter to optimize PVF and PVP is still controversial. Our aim was to systematically review the effects of different PCS diameters reported, to determine the efficient shunt with lower complication rates. Methods: A systematic literature search was performed to find studies reporting diameter of H-Graft PCS in patients with cirrhosis, portal hypertension and gastrointestinal varices. Articles reporting hepatic hemodynamic changes and outcomes with specified PCS diameters were included and reviewed. Results: Our search results identified 360 articles. After screening, 12 studies with 440 patients were included in the study. Mean postoperative PVP was 19.3±5.5 in 8mm diameter and 16.7±3.8 in 10mm (p=0.0022). PVP decreased 33.9% after 8mm PCS and 44.3% after 10mm (p=0.1242). PVF was prograde in 92.0% of patients with 8mm and 74.9% with 10mm PCS (p=0.0002). Variceal rebleeding occurred in 3.1% of 8mm and 4.5% of 10mm PCS (p=0.5759). Shunt thrombosis occurred in 6.5% of 8mm group and 6.3% of 10mm (p=0.9502). Chronic encephalopathy was diagnosed in 3.6% of 8mm PCS and 13.4% of 10mm PCS (p=0.0060). Conclusion: Diameter of a shunt plays an important role on its efficacy. In patients with cirrhosis, portal hypertension and variceal bleeding, 8mm PCS comparing to 10mm PCS was associated with higher prograde PVF, more efficient decrease in PVP, lower variceal rehemorrhage, and chronic encephalopathy. Further studies are necessary to compare the role of shunt diameter on its efficacy.

Simvastatin Prevents Progression of Acute on Chronic Liver Failure in Rats With Cirrhosis and Portal Hypertension

Cirrhosis and its clinical consequences can be aggravated by bacterial infections, ultimately leading to the development of acute on chronic liver failure (ACLF), characterized by acute decompensation, organ failure, and high mortality within 28 days. Little is known about cellular and molecular mechanisms of ACLF in patients with cirrhosis, so no therapeutic options are available. We developed a sepsis-associated preclinical model of ACLF to facilitate studies of pathogenesis and evaluate the protective effects of simvastatin. Male Wistar rats inhaled CCl4 until they developed cirrhosis (at 10 weeks) or cirrhosis with ascites (at 15-16 weeks). Male Sprague-Dawley rats received bile-duct ligation for 28 days or intraperitoneal thioacetamide for 10 weeks to induce cirrhosis. After induction of cirrhosis, some rats received a single injection of lipopolysaccharide (LPS) to induce ACLF; some were given simvastatin or vehicle (control) 4 hours or 24 hours before induction of ACLF. We collected data on changes in hepatic and systemic hemodynamics, hepatic microvascular phenotype and function, and survival times. Liver tissues and plasma were collected and analyzed by immunoblots, quantitative polymerase chain reaction, immuno(fluoro)histochemistry and immunoassays. Administration of LPS aggravated portal hypertension in rats with cirrhosis by increasing the severity of intrahepatic microvascular dysfunction, exacerbating hepatic inflammation, increasing oxidative stress, and recruiting hepatic stellate cells and neutrophils. Rats with cirrhosis given LPS had significantly shorter survival times than rats with cirrhosis given the control. Simvastatin prevented most of ACLF-derived complications and increased survival times. Simvastatin appeared to increase hepatic sinusoidal function and reduce portal hypertension and markers of inflammation and oxidation. The drug significantly reduced levels of transaminases, total bilirubin, and ammonia, as well as LPS-mediated activation of hepatic stellate cells in liver tissues of rats with cirrhosis. In studies of rats with cirrhosis, we found administration of LPS to promote development of ACLF, aggravating the complications of chronic liver disease and decreasing survival times. Simvastatin reduced LPS-induced inflammation and liver damage in rats with ACLF, supporting its use in treatment of patients with advanced chronic liver disease.

The Portosystemic Shunt Syndrome and Role of Shunt Embolization in the Management of Hepatic Encephalopathy

Portosystemic shunting (PSS) is a result of changes in hepatic hemodynamics where portal flow diverts away from the liver due to increased intrahepatic resistance from cirrhosis and is associated with hepatic encephalopathy (HE). Over time, increased PSS may directly lead to worsening liver failure because of severely decreased loss of effective portal inflow towards the liver and result in recurrent or persistent HE. This clinical scenario has been recently defined as “portosystemic shunt syndrome” and has been associated with poor clinical outcomes. The presence of PSS is common in patients with cirrhosis and increased PSS size appears to correlate with recurrent or persistent HE. Recent studies have shown that patients with Model for End-Stage Liver Disease (MELD) score < 11 have demonstrated high clinical benefit in recurrent or persistent HE when treated with shunt embolization. There is a growing literature that demonstrates potential clinical benefit using PSS embolization for selected patients, particularly with MELD under 11, with recurrent or persistent HE. Further investigation into improved risk stratification in order to determine effective treatments is necessary as well as heightened detection of the portosystemic shunt syndrome in its earlier and possibly reversible stages.

Features of diagnostics of the hepatobiliary system diffuse lesions in children with herpes viral infection caused by Epstein-Barr virus (both isolated and in the form of mixed herpesvirus infection)

Purpose: to improve the treatment quality and prognosis of herpesvirus infection in children caused by the Epstein-Barr virus (both isolated and in the form of mixed herpesvirus infection) based on the study of clinical, biochemical and immunological parameters of the hepatobiliary system. Materials and methods: We examined 95 children aged 3 to 7 years with herpesvirus infection, who were divided into three groups (the I group – children with acute Epstein-Barr infection, the II group – children with Epstein-Barr infection in combination with cytomegalovirus infection, the ІІІ group – children with Epstein-Barr infection and herpesvirus infection type 6). Age-matched healthy control group consisted of 20 children. The diagnosis was verified using a polymerase chain reaction. Biochemical studies included determination of total protein and its fractions, total bilirubin and its fractions, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, thymol index. All patients underwent echosonography of the liver. The level of cytokines (IL-1β, IL-4) and antiviral protection parameters – the content of natural killers (CD16+), T-helper (CD4 +) and/or cytotoxic lymphocytes (CD8 +) were evaluated. Results. In all examined children the disease started acutely from general intoxication syndrome, lesion of the nasopharynx and oropharynx, which were more pronounced in the children of the 1st and 2nd examined groups. Manifestations of the viral exanthema and enanthema were more commonly and pronounced in children of the III group. Most children (61.8 %) with Epstein-Barr infection in combination with herpesvirus infection type 6 had disturbances in the central nervous system. The lesions of lymphoid tissue occurred in 73 (76.7 %) children and were more prevalent in the 1st and 2nd surveyed groups. The constant symptom of the disease was hepatomegaly. Splenomegaly was observed in 82 (86.7 %) patients. We have noted an increase in the levels of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase in the examined children. These changes were more pronounced in children of the 2nd group. Herewith, cytolysis of hepatocytes in most cases among children of all examined groups was not accompanied by hyperbilirubinemia. The jaundice of the skin and mucous membranes occurred only in 18.5% of all examined patients, who were diagnosed with moderate hyperbilirubinemia (60.0 ± 4.6 μmol/l). Proteinogram parameters in the examined patients in the acute period were characterized by a decrease in albumin content, an increase in the content of α1-, α2- and γ-globulins and a decrease in the albumin / globulin ratio. These indicators were significantly changed in the 2nd surveyed group. The majority of examined patients had coagulogram indices on average matched to the age norm. One third of patients showed moderately elevated fibrinogen levels. Immune disorders, that accompany the herpesvirus infection, are characterized by an imbalance of proinflammatory and anti-inflammatory cytokines. Indicators of portal hemodynamics in patients of the I group in the acute period of the disease were characterized by moderate changes such as a decrease in hepatic artery and portal vein blood flow without viscoelasticity and peripheral vascular resistance violations. In the II group the decrease in the diameter of the common hepatic artery and the increase in the diameter of the portal vein, the decrease in the vessels blood flow with a decrease in their viscoelasticity and peripheral vascular resistance was noted. In the III group of patients the hepatic artery and portal vein hemodynamic changes, which had a compensatory character, were identified. Conclusions: Taking into account the revealed clinical changes, it can be noted that lesions of the nasopharynx, more pronounced manifestations of intoxication and hepatolienal syndromes prevailed in infants with herpesvirus infection. Proinflammatory cytokines overactivity in patients with Epstein-Barr viral infection in combination with cytomegalovirus infection causes a longer intoxication period, pronounced liver enlargement, elevation of transaminases and inhibition of liver albumin synthesis. It could be reasonable to prescribe vasoactive therapy for patients with Epstein-Barr virus infection in combination with cytomegalovirus infection both in the acute and reconvalescence period of the disease followed by structural-functional and hemodynamic state of the liver monitoring at the stages of medical rehabilitation.

In situ splitting after selective partial portal vein ligation or simultaneous hepatic artery ligation promotes liver regeneration

This study seeks to compare the impact of selective partial portal vein ligation (PPVL) or the combination of simultaneous hepatic artery ligation (PPVAL) with in situ splitting (ISS) on liver regeneration and injury. Rats were randomized into three groups; namely: selective PVL, PPVL + ISS and PPVAL + ISS. The changes in hepatic hemodynamics, liver regeneration and hepatocytic injury were examined. Blood flow to the left portal branch and the microcirculation of the left median lobe after PPVL or PPVAL was significantly reduced. Liver regeneration of PPVAL + ISS group was more pronounced than that in the PPVL + ISS and PVL groups at 48 and 72 hours as well as 7 d postoperatively. The serum biochemical markers and histopathological examination demonstrated reduced levels of liver injury in the PPVL + ISS group. Injury to hepatocytes was more pronounced with PPVAL + ISS than PVL. HGF, TNF-α and IL-6 expression in the regenerated lobes in both PPVAL + ISS and PPVL + ISS groups increased significantly when compared to the PVL group. We demonstrated that both PPVL + ISS and PPVAL + ISS were effective and feasible means of inducing remnant liver hypertrophy and could serve as a rapid clinical application for qualified patients.

Experimental study of artery spasm in rat hepatic ischemia-reperfusion injury

Objective Discussion the hepatic artery hemodynamic changes and microcirculation disorders in rat hepatic ischemia-reperfusion injury (H-IRI) through ultrasound imaging. And investigatethe effect of phentolamine pretreatment on H-IRI. Methods Fifty rats were randomly divid into three groups: sham operation group (Sham group, n=10), ischemia-reperfusion group (Control group, n=20), phentolamine treatment before ischemia-reperfusion group (PHT group, n=20). Ultrasonography examinations were performed respectively in thesegroups at 30 mins (n=10) and 90 mins (n=10) after reperfusion. After then, blood samples were taken from portal vein for serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) test and liver tissue specimens were also collected for pathological analysis. Results Hepatic artery resistance index(RI) of Sham group, 30 mins and 90 mins after reperfusion in Control group, 30 mins and 90 mins after reperfusion in PHT group were 0.50±0.09, 0.65±0.09, 0.50±0.08, 0.54±0.09, 0.54±0.05 respectively. Area under the curve (AUC) calculated by the software which reflects hepatic microcirculation status were 1 846.81±376.78, 939.94±452.18, 1 502.24±382.39, 1 709.80±214.36, 1 848.02±374.39 respectively.30 mins after reperfusion in Control grouphas statistical significance with other groups(P 0.05). Compared with 30 mins after reperfusion in Control group, ALT level in 30 mins after reperfusion in PHT grouphas statistical significance (P<0.05), which was (1 041.5±174.0) U/L and (816.3±117.8) U/L respectively. In pathology, smaller hepatic artery diameter and depressed vessel wall were observed at 30 mins after reperfusion in the Control group, which can’t be founded in other groups. Conclusion Hepatic artery underwent transient spasm or narrowing during hepatic ischemia-reperfusion process, which may aggravate the liver damage. Phentolamine could alleviate hepatic artery spasm and improve liver perfusion, which may reduce liver injury by ameliorating hepatic microcirculation. Key words: Rats; Hepatic ischemia-reperfusion injury; Vasospasm; Phentolamine

Change of hepatic arterial systolic/diastolic ratio predicts ischemic type biliary lesion after orthotropic liver transplantation

BackgroundWe conducted this prospective nested case–control study for the hepatic artery and portal vein hemodynamic changes after orthotopic liver transplantation. MethodsA total 128 cases of orthotropic liver transplantation were analyzed, including 25 cases of ischemic type biliary lesions (ITBL). The portal vein and hepatic artery flow velocities were detected by ultrasound on days 28, 42, and 84 after liver transplantation. In the GLM analysis of Lg(S/D), the P values of Group Effect, Time Effect, and Time×Group were 0.014, 0.376, and 0.008, respectively. ConclusionOur results show a relatively reduced hepatic artery S/D in ITBL, especially in extrahepatic ITBL.