Portal System Research Articles

Updated results of the PATH study: Adjuvant therapy with donafenib plus a PD-1 inhibitor for patients with hepatocellular carcinoma at high risk of recurrence after resection.

571 Background: There is no universally accepted standard treatment option or strategy for post-surgery adjuvant therapy in hepatocellular carcinoma (HCC). Among BCLC A/B patients (pts) with MVI, adjuvant transarterial chemoembolization has been reported to provide a 1-year recurrence-free survival (RFS) rate of around 60-70%. We conducted a pilot study to explore the utility of donafenib combined with a PD-1 inhibitor as adjuvant therapy for pts at high risk of recurrence. Herein, we present the updated results with a median follow-up of 11.6 months. Methods: It was planned to enroll 30 HCC pts who had undergone radical surgery and presented with at least one of the following risk factors: a) Presence of microvascular invasion (MVI); b) Presence of satellite nodule(s); c) More than three tumor nodules; d) Portal vein tumor thrombus. Pts with invasion of the main portal venous system were excluded. Donafenib combined with a PD-1 inhibitor (i.e., toripalimab) was initiated at 4 to 8 weeks post-resection and was to be continued for up to six months, unless recurrence occurred or there was an intolerable adverse reaction. No other adjuvant therapies were permitted before enrollment and during the study, except for anti-virus treatment. The primary endpoint was the cumulative 1-year RFS rate. The secondary endpoints included overall survival, quality of life (QoL) measured with the FACT- Hepatobiliary questionnaire, and safety. Results: From June 2020 to November 2023, a total of 30 pts were recruited. 27 pts were included in the efficacy analysis. The median time from surgery to enrollment was 1.4 months. MVI was the most common risk factor (n=25, 92.6%). The majority of the pts had only one risk factor (n=23, 85.2%). As of the data cutoff on August 13, 2024, relapse had occurred in four pts and the median RFS was not reached. The 1-year RFS rate was 81.6% (90% CI, 67.8%-95.4%) in all evaluable pts. QoL showed a mild increase from baseline while on adjuvant therapy. No deaths were observed. In the 30 pts who had received at least one dose, the incidence of any grade and grade 3 treatment-related adverse events (TRAEs) were 90.0% (27/30) and 40.0% (12/30), respectively. No grade 4 or 5 TRAEs were reported. The grade 3 TRAEs occurring in at least two pts were palmar-plantar erythrodysesthesia syndrome (13.3%), rash (13.3%), increased alanine aminotransferase (10.0%), and increased aspartate aminotransferase (6.7%). Conclusions: The study's duration exceeded expectations due to slow recruitment. Nonetheless, it showed a promising outcome with a regimen of 6 months of adjuvant therapy with donafenib plus toripalimab in BCLC A/B pts at high risk of recurrence. An improvement in QoL was observed among patients during the adjuvant therapy. No new safety issues were identified. Clinical trial information: NCT04418401 .

Bacterial components-driven intrahepatic CXCR5hi B cells are important population for MASH progression through inducing inflammation.

Metabolic dysfunction-associated steatohepatitis (MASH) is characterized by severe liver inflammation and fibrosis due to an imbalanced immune response caused by enhanced bacterial components. The progression of MASH is closely linked to increased permeability of intestinal mucosal barrier facilitating enter of bacterial components into hepatic portal venous system. B cells are important immune cells for adaptive responses and enhance hepatic inflammation through cytokine production and T cell activation. B cells are influenced by gut microbiota, but the specific B cell populations in MASH and their pathologic mechanism remain obscure. Here, we found that the numbers of B cells highly expressing CXCR5, the receptor of CXCL13 chemokine, were increased in the livers of MASH. CXCR5 high B cells are non-proliferating naive B cells with inflammatory features mainly residing in hepatic parenchyma to affect liver pathology. Importantly, we revealed that CXCR5 high B cells were induced by bacterial components stimulating TLRs. These bacterial stimulator-induced CXCR5hi B cells highly express TNFα, CD80, and MHC class II, leading to T cell activation. Consistently, we confirmed that intravenous injection of CXCR5 high B cells enhanced hepatic inflammation in MASH model. Ultimately, this study elucidates the role and mechanisms of CXCR5 high B cells in advancing MASH progression.

Development of Three-Dimensional Anatomical Models of Dogs with Congenital Extrahepatic Portosystemic Shunts

The aim of this study was to develop three-dimensional anatomical models of dogs with congenital extrahepatic portosystemic shunts (CEPSs) using 3D printing, as well as to detail their development process and compare the final models to volume rendering (VR) derived from computed tomography (CT) scans. CT scans in the Digital Imaging and Communications in Medicine (DICOM) format of two canine patients were used—one with splenocaval deviation and the other with right gastrocaval deviation. The images were segmented using 3DSlicer software, generating 3D files in Standard Tessellation Language (STL) format, which were then subjected to refinement and mesh adjustment using Blender software. The models were printed on a J750™ Digital Anatomy™ printer, followed by post-processing in a 2% sodium hydroxide solution for 72 h, with subsequent rinsing to remove support resin residues. The printed models showed colored anatomical structures, including the liver; spleen; kidneys; part of the arterial, venous, and portal circulations; and CEPSs. For comparison purposes, VR of the scans was recreated in the RadiAnt DICOM Viewer software. Despite some limitations of the segmentation software, the 3D-printed models effectively represented the anatomy of the patients and the CEPSs, demonstrating good equivalence to the VR.

P0243 Evaluation of liver fibrosis and steatohepatitis associated with metabolic dysfunction (MASH) in patients with inflammatory bowel disease (IBD) and steatotic liver disease associated with metabolic dysfunction (MASLD)

Abstract Background Inflammatory bowel disease (IBD) is associated with a systemic inflammatory state and dysbiosis, which may increase the risk of metabolic dysfunction-associated steatotic liver disease (MASLD). This occurs through intestinal bacterial translocation and the increased entry of lipopolysaccharides, free fatty acids, and other toxins into the liver via the portal circulation. One significant complication of MASLD is metabolic dysfunction-associated steatohepatitis (MASH), which can progress to cirrhosis. This study aimed to evaluate the prevalence of MASLD in IBD patients and assess the frequency of complications, such as MASH and liver fibrosis. Methods The presence of MASLD was based on the presence of NAFLD associated with the metabolic criterion in outpatients with IBD. The presence of NAFLD was confirmed using liver ultrasound. Noninvasive estimate of liver fibrosis (FIB-4) Index and NAFLD Fibrosis Score (NFS) were used as indirect scores of liver fibrosis. Patients with scores greater than NFS > 0.675 and/or FIB-4 > 2.67; and patients with indeterminate or discordant scores were indicated for liver biopsy to quantify liver fibrosis and evaluate MASH. Liver elastography was not performed due to unavailability in our center. Results A total of 179 patients underwent liver ultrasound, with 72 (40.2%) diagnosed with MASLD, including 33 with Crohn’s disease (CD) and 39 with ulcerative colitis (UC). Regarding disease activity, 36.11% were clinically active and 50% were endoscopically active. Biological therapy was used by 54.2% of patients. The degree of steatosis was mild (41.67%), moderate (44.4%) and intense (13.89%). According to the FIB-4 Index, patients were classified as low risk of fibrosis (72.22%), intermediate risk (26.32%) and high risk (1.39%). According to the NFS, the risks for fibrosis were low (53.52%), undetermined (38.08%) and high (8.45%). Sixteen (22.22%) patients underwent liver biopsy, and the presence of fibrosis was observed in 11 (68.75%) patients. The histological stage of fibrosis was F1 (n=6, 54.5%), F2 (n=3, 27,3%), F3 (n=1, 9.1%) and F4 (n=1, 9.1%) according to Kleiner's classification. 4 patients (25%) met criteria for MASH. Conclusion A high prevalence of MASLD was observed in patients with IBD. Among patients with MASLD, we must be aware of the risk of liver fibrosis and MASH. Routine monitoring of liver function and fibrosis, including liver biopsy or elastography when appropriate, is crucial for early detection and management of complications. Due to the lack of routine elastography in our center in Brazil, liver biopsy remains essential for accurate assessment in those patients.

Intrahepatic portosystemic shunt: salvage mechanism for oligohydramnios complicating fetal growth restriction.

Portosystemic shunts in growth-restricted fetuses are more common than previously thought. We aimed to describe fetuses with growth restriction and transient oligohydramnios in which a congenital intrahepatic portosystemic shunt (CIPSS) was noted during follow-up. This was a retrospective study of all fetuses diagnosed with growth restriction and transient oligohydramnios during a 5-year period in a large tertiary referral center. Our routine evaluation of growth-restricted fetuses includes monitoring of estimated fetal weight, assessment of biophysical profile, Doppler imaging, thorough examination of the umbilical-portal system and evaluation of cardiac function using fetal tricuspid annular plane systolic excursion (f-TAPSE). We compared these parameters before and after the resolution of the oligohydramnios using descriptive statistics and the Wilcoxon signed-rank test for paired non-parametric variables. During the surveillance of fetuses with transient oligohydramnios, we noted the appearance of a CIPSS and followed up such cases after birth. A total of 2144 women with a singleton pregnancy with suspected fetal growth restriction were referred to our center between January 2018 and December 2022. In 12 fetuses, oligohydramnios was evident upon initial assessment, and a CIPSS was diagnosed with normalization of amniotic fluid level. The median gestational age at diagnosis of growth restriction and oligohydramnios was 25 (range, 21-30) weeks. The estimated fetal weight was at the 1st percentile in10/12 fetuses. The median amniotic fluid index was 5 (range, 2-5) cm at the initial appointment and improved significantly to 13 (range, 11-20) cm following the shunt diagnosis (P = 0.002). Among fetuses with f-TAPSE data available, the f-TAPSE increased significantly from 4.0 (range, 3.0-5.0) mm before the diagnosis of CIPSS to 8.0 (range, 5.0-9.4) mm following the diagnosis (P = 0.043). The median gestational age at delivery was 36.3 (range, 30.8-38.4) weeks. In nine (75%) fetuses, the diagnosed shunt was left portal to left hepatic vein. Neonatal follow-up revealed spontaneous shunt resolution within 30 months in all newborns. One newborn required embolization owing to suspected shunt, however, no shunt was detected during the procedure. The development of CIPSS in growth-restricted fetuses with oligohydramnios appears to improve hemodynamic status as evidenced by normalization of amniotic fluid index and increase in f-TAPSE. Evaluation of the liver portal system in fetuses with growth restriction offers an understanding of the shunt salvage phenomenon. © 2025 International Society of Ultrasound in Obstetrics and Gynecology.

Fetal Extrahepatic Porto systemic Venous Shunts: prenatal diagnosis management and therapy: 21 years of evolving insights.

Introduction Fetal extrahepatic portosystemic Venous Shunt (FEPSVS) are vascular malformations that divert placental and bowel blood from the liver into the systemic circulation. When uncorrected, it can lead to severe pathologic consequences after birth. Objective To report our method of prenatal diagnosis, the developing insight regarding prenatal counseling, and postnatal treatment. Method Retrospective review of fetuses diagnosed with FEPSVS, classified into Abernethy type I or II based on the absence or existence of intrahepatic portal venous system (IHPVS) flow. Two different counseling periods were compared regarding pregnancy management and postnatal outcome. Results In the first period (2000-2010), 5 cases were diagnosed; 4 were type I with an 80% termination rate. In the second period (2011-2021), 6 cases were diagnosed; with only a 16% termination rate in type I cases. Two type II cases were reclassified to type I postnatally and corrected successfully. Of the six born alive, five had early surgical/endovascular corrections, and one experienced spontaneous closure. All the cases resulted in a successful rescue of the IHPVS with good outcomes. Conclusions During our developing insights we realized that: 1) the adult classification according to the IHPSVS is not relevant for prenatal prognostic counseling. 2) Prenatal diagnosis of FEPSVS is essential in promoting early postnatal investigation and corrective intervention, which might prevent the appearance of postnatal complications.

Activation of the Contact System and Intrinsic Pathway in Peripheral and Portal Venous Circulations in Liver Cirrhosis.

Portal vein system-specific risk factors contributing to portal vein thrombosis in cirrhosis are poorly investigated. This study aimed to quantify contact system and intrinsic pathway activation in the peripheral compared to portal venous blood in patients with decompensated cirrhosis. Adult patients with cirrhosis undergoing transjugular intrahepatic portosystemic shunt underwent simultaneous blood sampling from a peripheral vein and the portal vein. Complexes of serine proteases with their respective inhibitors were measured by ELISA to quantify contact system (PKa:C1-INH [plasma kallikrein:C1-esterase inhibitor] and FXIIa:C1-INH) and intrinsic pathway activation (FXIa:C1-INH, FXIa:α1at [α-1 antitrypsin], FXIa:AT [antithrombin], and FIXa:AT). Twenty patients with cirrhosis (mean age 55 ± 7 years, M = 58%, Child-Pugh A/B/C 6/11/3) and 25 healthy controls (mean age 45 ± 12 years, M = 60%) were enrolled. The etiology of cirrhosis was primarily alcohol abuse, followed by chronic viral infection. Log-transformed peripheral levels of all the complexes were significantly higher in patients compared with controls. While levels of PKa:C1-INH, FXIIa:C1-INH, FXIa:C1-INH and FXIa:α1at were similar in peripheral and portal venous blood in cirrhotic patients, FXIa:AT and FIXa:AT levels were significantly higher in portal blood (p = 0.013 and 0.011, respectively). FXIa:C1-INH significantly correlated with both contact system complexes (FXIIa:C1-INH and PKa:C1-INH) and with FIX:AT. Markers of contact system and intrinsic pathway activation in the systemic circulation were significantly higher in cirrhosis versus controls. Complexes of FXIa and FIXa with AT were significantly higher in the portal than in peripheral plasma in cirrhosis, possibly indicating a unique heparin-like effect in portal venous blood.

Relationship Between Pituitary Gland and Stem Cell in the Aspect of Hormone Production and Disease Prevention: A Narrative Review.

In the last two decades, scientists have gained a better understanding of several aspects of pituitary development. The signaling pathways that govern pituitary morphology and development have been identified, and the compensatory relationships among them are now known. This paper aims to emphasize the wide variety of relationships between Pituitary Gland and Stem cells in hormone Production and disease prevention. Based on many case reports and several types of research, a wide variety of relationships between the Pituitary Gland and Stem cells in the aspect of hormone Production and disease prevention are reviewed in this literature. In this paper, we focus on various roles and functions of the pituitary gland, the responsibilities of stem cells as a mode of hormone production, and disease prevention. Within this period, more was discovered concerning the contributions made to the transcription factors within the pituitary development, with factors such as Prop1, Pitx1, and Sox2 being defined as important in the development and action of hormone-secreting cells. They are also required in the appropriate specification of the cell types in the pituitary gland and the persistence of the progenitors. Manipulation of these factors causes developmental defects as well as tumors, thus the necessity of knowing the precise function and interaction of these factors. A closer look at these transcription factors could help expand treatment options for structural defect development or give rise to pituitary adenomas. It has been established that signaling pathways such as Sonic Hedgehog (Shh), Wnt, and Notch play a part in modulating pituitary development. These pathways are involved in regulating important processes such as cellular proliferation, differentiation, and organization of the pituitary gland tissues. Breaching any of these pathways has been correlated with the development of various pituitary-related conditions including adenomas and congenital hypopituitarism. Moving forward, further studies of these pathways and their associations with stem cells could provide a better understanding of disease processes and approaches to manage them. This way, there is a possibility of developing new approaches aimed at treating the cause of the dysfunction of the pituitary gland by modulating its specific signaling activities. Promising directions for the stimulation of hormone synthesis and restoration of normal pituitary function upon its disorders via tissue regrowth could be found in stem cell application. The fact that one can generate functional pituitary cells from iPSCs for instance provides new avenues both for the understanding of pituitary disease mechanisms as well as for personalized medicine. It is possible to utilize these stem cell- derived cells for modeling disease, drug discovery or even transplantation to restore the function of the damaged pituitary gland. In the future, however, the focus ought to be on the effective application of stem cell therapies that have been research during the development of better differentiation processes. The recent understanding of the system that carries the hypothalamic hormones to the pituitary gland, i.e., the hypophyseal portal vasculature, has had its implications too. This factorial consideration emphasizes the role of the vascular component in the control of pituitary activity - the release of hormones by the pituitary gland. Exploring stem cell-hypophyseal portal system interactions may open new avenues of treatment for diseases associated with deficient hormone transportation and/or pituitary dysfunction.

Capillary connections between sensory circumventricular organs and adjacent parenchyma enable local volume transmission.

Among contributors to diffusible signaling are portal systems which join two capillary beds through connecting veins. Portal systems allow diffusible signals to be transported in high concentrations directly from one capillary bed to the other without dilution in the systemic circulation. Two portal systems have been identified in the brain. The first was discovered almost a century ago and connects the median eminence to the anterior pituitary gland. The second was discovered a few years ago and links the suprachiasmatic nucleus to the organum vasculosum of the lamina terminalis, a sensory circumventricular organ (CVO). Sensory CVOs bear neuronal receptors for sensing signals in the fluid milieu. They line the surface of brain ventricles and bear fenestrated capillaries thereby lacking blood-brain barriers. It is not known whether the other sensory CVOs, namely the subfornical organ (SFO), and area postrema (AP) form portal neurovascular connections with nearby parenchymal tissue. To preserve the integrity of the vasculature of CVOs and their adjacent neuropil, we combined iDISCO clearing and light-sheet microscopy to acquire volumetric images of blood vessels and traced the vasculature in two experiments. In the first, the whole brain vasculature was registered to the Allen Brain Atlas in order to identify the nuclei to which the SFO and AP are attached. In the second study, regionally specified immunolabeling was used to identify the attachment sites and vascular connections between the AP, and the SFO to their respective parenchymal attachment sites. There are venous portal pathways linking the capillary vessels of the SFO and the posterior septal nuclei, namely the septofimbrial nucleus and the triangular nucleus of the septum. Unlike the arrangement of portal vessels, the AP and the nucleus of the solitary tract share a common capillary bed. Taken together, the results reveal that all three sensory CVOs bear direct capillary connections to adjacent neuropil, providing a direct route for diffusible signals to travel from their source to their targets.

IgA-codominant Post-streptococcal Glomerulonephritis in a Patient with Type 1b Abernethy Malformation: A New Insight into the Pathogenesis

ABSTRACT Post-streptococcal glomerulonephritis is an immune complex-mediated glomerulonephritis as a result of transient dysregulation of alternate complement pathway along with in situ immune complex formation. Here is a case of a young boy who developed acute nephritic syndrome following traumatic wound over his lower limb. Computed tomography (CT) abdomen is suggestive of Abernethy malformation. He underwent renal biopsy in view of rapidly worsening renal failure showing diffuse proliferative glomerulonephritis with predominant neutrophils, IgG (3+), IgA (3+), C3(3+), kappa (2+), and lambda (2+) on immunofluorescence, suggestive of immune complex glomerulonephritis favoring infection-related glomerulonephritis. He was treated accordingly and showed signs of improvement with normalization of complements within 4 weeks of insult. As the genesis of infection-related glomerulonephritis here in this case is complex due to the hepatic malformation where there is mixing of blood between the systemic and portal systems, the narrative is that congenital anomaly too has a say in the pathogenesis of infection-related glomerulonephritis as it happened in our case.

Hepatobiliary and pancreatic manifestations in inflammatory bowel disease: an umbrella review of meta-analyses.

Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), can affect the hepatobiliary system and pancreas, substantially impacting the life quality of patients. To evaluate the quality of evidence and comprehensively assess the validity of associations of IBD with hepatobiliary and pancreatic diseases. We performed an umbrella review of existing meta-analyses in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) recommendations. We systematically searched PubMed, Embase, and Web of Science from inception to April 2024, to identify and appraise meta-analyses examining IBD and risk of hepatobiliary and pancreatic manifestations. Methodologic quality was assessed with A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) and the strength of evidence was graded according to prespecified criteria. A total of 14 meta-analyses of observational studies were included. The strongest-validity evidence suggested the significant associations between IBD and risk of gallstones (odds ratio (OR) = 1.72; 95% confidence interval (CI) = 1.40-2.12) and acute pancreatitis (OR = 3.11; 95% CI = 2.93-3.30). Highly suggestive evidence indicated a significantly increased risk of hepatobiliary cancer in UC (incidence rate ratio (IRR) = 2.05; 95% CI = 1.52-2.76) and CD (IRR = 2.31; 95% CI = 1.25-4.28). In addition, highly suggestive evidence indicated that IBD was associated with portal venous system thrombosis. Suggestive evidence showed a significantly higher prevalence of primary sclerosing cholangitis, non-alcoholic fatty liver disease, autoimmune hepatitis, and autoimmune pancreatitis in IBD patients than in the general population. The associations between IBD and multiple hepatobiliary and pancreatic disorders showed varying levels of evidence and magnitude of risk. Further high-quality primary studies are needed to identify IBD patients who are more at risk and would benefit the most from screening and prevention programs. CRD42023451461.

Hemodynamic comparisons of different shunt positions and geometrical model simplification strategies in the simulation of transjugular intrahepatic portosystemic shunt (TIPS)

Transjugular intrahepatic portosystemic shunt (TIPS) is a widely used surgery for portal hypertensive patients, whose potential postoperative complications are closely related to the hemodynamic condition of the portal venous system. The selection of shunt position in the surgery may affect the postoperative hemodynamics; however, it is difficult for clinical studies to investigate the influence. Therefore, this study aims to employ the computational model simulating TIPS to compare the hemodynamic differences resulting from different shunt positions, and also to investigate the influences of different geometrical model simplification strategies used in the TIPS simulation. For this purpose, the clinical data of two representative patients were retrospectively collected, based on which, the computational hemodynamic models of the portal venous systems after TIPS were constructed, incorporating three typical shunt positions (i.e. shunt at the left/main/right portal vein) and three types of geometrical model simplification. Results showed that among the models with different shunt positions, the area-averaged flow velocity magnitudes in the shunts were very similar, while the model with shunt at the main portal vein showed the lowest postoperative portal pressure and the smallest area of high wall shear stress near the portal venous bifurcation. Among the models using different geometrical model simplification strategies, the simulated blood pressures at the main portal veins were very similar, but showed marked differences near the shunt inlets. Moreover, the area-averaged flow velocity magnitudes in the shunts were almost the same, while the velocity distributions differed a lot, leading to the different spatial distributions of wall shear stress near the portal venous bifurcations and shunt walls. These results on one hand suggested that placing the shunt at the main portal vein is more beneficial for the patient; on the other hand, they proved the feasibility of utilizing simplified model to save computational cost without losing the accuracy when the pressure at the main portal vein is mainly focused on. These findings would assist clinical decision-making and promote more accurate and efficient TIPS simulations.

Robotic pancreaticoduodenectomy for portal annular pancreas: how to do it.

Portal annular pancreas (PAP) is an uncommon anomaly in which the pancreatic parenchyma surrounds the portal or superior mesenteric vein. An adequate operative approach is necessary to prevent clinically relevant postoperative pancreatic fistula after pancreaticoduodenectomy for PAP. We herein report a case of robotic pancreaticoduodenectomy for PAP. In PAP, dissection of the retroportal parenchyma is the most important aspect of surgery. Adequate retraction of the portal system using vessel loops allows for a safe dissection and transection of the retroportal parenchyma. The robotic approach has some advantages for dissecting the retroportal parenchyma. The magnified three-dimensional view helps the surgeon distinguish the nerve plexus from the pancreatic parenchyma. The caudal view allows for direct dissection of the retroportal parenchyma from the superior mesenteric artery. Dissection can easily be performed using articulated forceps. Owing to these advantages, robotic pancreaticoduodenectomy can be safely performed for PAP.

Comparison of Apixaban and Aspirin in Preventing Portal Vein Thrombosis after Laparoscopic Splenectomy for Cirrhotic Hypersplenism.

Portal vein system thrombosis (PVST) is a frequent and possibly fatal concurrent disorder following splenectomy. The optimal anticoagulant to prevent PVST following splenectomy remains unclear. The purpose of this study was to compare the safety and efficacy of apixaban versus aspirin in preventing PVST after laparoscopic splenectomy (LS) for cirrhotic hypersplenism. In this single-center randomized controlled trial, 80 patients with liver cirrhosis who received LS were randomly allocated to two treatment arms that were treated with apixaban or aspirin for 6 months. The primary effectiveness outcome was PVST formation after LS. We excluded four patients who withdrew from the study. The dynamic incidence of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in the 6 postoperative months were all significantly lower in the apixaban treatment arm compared to the aspirin treatment arm (all P <0.001). Significantly lower incidences of PVST, main and intrahepatic branches of PVST, and splenic vein thrombosis in apixaban treatment arm started from postoperative day 7, month 1, and day 7 compared to the aspirin treatment arm respectively (all P <0.05). Multiple logistic regression analysis revealed that apixaban was an independent protective factor for PVST at postoperative month 3, as compared with aspirin (relative risk, 0.057; 95% confidence interval, 0.013-0.248; P <0.001). Compared with aspirin, apixaban could earlier and more effectively prevent PVST following LS for cirrhotic hypersplenism. Apixaban can be chosen as a priority treatment option versus aspirin, contributing to a lower risk of PVST.

Systemic lupus erythematosus complicated by portal vein thrombosis: A case report

A 24-year-old female got admitted in a remote hospital with one and half month previous history of gradually increasing swelling of the abdomen followed by swelling of the both legs and face without any discernable etiology. Later she is diagnosed as a case systemic lupus erythematosus (SLE) based on clinical features and serology. She had neither any history of having pro-thrombotic risk factor nor any history of deep vein thrombosis. Her Anti-β2 Glycoprotein 1 (Ab IgM &amp; IgG) was marginally positive. Her ultra-sonogram of abdomen showed moderate ascites, gross thrombosis &amp; stenosis in portal system (main trunk of portal vein, both proximal branches of portal vein, splenic vein at pancreatic area, superior mesenteric vein at confluence) that were 100% blocked that also supported by CT scan of abdomen and Doppler ultra-sonogram. Her Doppler ultra-sonogram of lower limbs were normal. She was treated initially with albumin infusion, enoxaparin, warfarin, aspirin, hydroxychloroquine and medium dose prednisolone. Bangladesh Med J. 2023 Sept; 52(3): 47-51

Development of a Data Portal System for Governance in Berau

The development of a Data Portal System for Berau Governance addresses the need for an integrated platform to effectively manage and disseminate government data. This system aims to enhance transparency, accountability, and public access to diverse datasets in alignment with the One Data Indonesia initiative. The portal consolidates various data categories, including news, announcements, agendas, publications, downloads, infographics, and visualizations, into a single platform, streamlining data access for both government agencies and the public. The system was developed using the Rapid Application Development (RAD) methodology, enabling iterative prototyping and quick adjustments based on feedback from key stakeholders. This approach ensured the system could meet the dynamic requirements of the government while remaining adaptable to future needs. The Laravel framework was chosen for its flexibility, scalability, and security features, allowing the system to provide a responsive, user-friendly experience while maintaining high levels of data integrity.The Data Portal System significantly improves the local government’s ability to manage and share information, fostering greater civic engagement and enhancing public trust in governance processes. Furthermore, the system facilitates more efficient public service delivery by making key data accessible in a structured and intuitive format. Regular assessments and updates are recommended to ensure the system continues to align with evolving user needs and governmental policies, further advancing data governance in Berau Regency.

ADDITIVE TECHNOLOGIES IN CONSTRUCTION: TECHNICAL, ECONOMIC AND MANAGEMENT ANALYSIS

The study is devoted to a comprehensive analysis of the introduction of additive technologies into modern construction production, revealing the technical, economic, and managerial aspects of concrete 3D-printing of architectural structures. The work systematically analyzes the evolution of additive manufacturing technologies and identifies the main structural types of 3D-printers (an additive machine for layer-by-layer construction of objects), including portal, robotic, mobile, and hybrid systems. A detailed study of the technological parameters of concrete 3D-printing with concrete mixtures is presented, in particular, optimal printing speed modes, layer parameters, criteria for shaping and quality of building structures. A comparative analysis of the technological capabilities of leading world equipment manufacturers, such as ICON, COBOD International, Apis Cor, and WinSun, is conducted. The economic analysis demonstrates significant advantages of additive technologies: reduction of construction time by 2-6 times, reduction of construction cost by 20-35%, and increase in the load-bearing capacity of structures. The study comprehensively explores the structure of capital and operational expenses associated with technology implementation. Special emphasis is placed on the management aspects of introducing additive technologies, highlighting the critical need for an interdisciplinary approach and knowledge integration across architecture, engineering, management, and computer modeling. The study determines the prospects for the development of concrete 3D-printing technology in the construction industry and outlines the main directions of further scientific research and practical implementation of innovative solutions. This study was developed between the Department of "Integrated Technologies of Mechanical Engineering" named after M. Semko of NTU "KhPI" and "Geopolimer" LTD to implement innovative technologies in the construction industry.

Residual Ultrasound-Enhancing Agents Mimicking Portal Venous Gas.

Sonographic detection of mobile echogenic foci within the main portal vein and its branches or within the liver parenchyma extending along the portal triads to the periphery of the liver is an alarming finding that has been associated with portal venous gas in the setting of bowel ischemia. Ultrasound-enhancing agents (UEAs) have been widely utilized in abdominal ultrasound for evaluation of organ neoplasms and vascular patency as well as in echocardiography for the evaluation of cardiac function. The appearance of UEAs on abdominal ultrasound can resemble gas like that seen in the portal venous system and liver in patients with bowel ischemia; therefore, UEA residuals should always be a part of the differential diagnosis of echogenic foci when seen on abdominal ultrasounds with preceding recent UEA administration. In this observational study, we present a series of cases with suspected portal venous gas suspicious for bowel ischemia that turned out to be a result of residual or persistent UEA from the recent contrast-enhanced echocardiography. Discussion of this phenomenon and its potential explanation is provided.

The natural history of portal venous system aneurysms.

Portal venous system aneurysms (PVAs) are increasingly diagnosed on cross-sectional computed tomography imaging. However, the natural history of these aneurysms is poorly understood, and reports are limited to small case series. Terms relevant to PVAs were searched in radiology reports (2010-2022), with PVA presence confirmed by manual review. PVA were defined as a diameter greater than 1.5cm in patients without cirrhosis and 1.9cm in those with cirrhosis. Aneurysm growth was defined as greater than 20% increase in size, whereas aneurysm regression was defined as greater than 20% decrease in size. Patient demographics, comorbid conditions, and PVA outcomes were abstracted. Univariate statistics were used to compare groups. Thirty-eight aneurysms with radiographic follow up were identified in 35 patients, involving the portal vein (n= 18; 47.4%), splenic vein (n= 10; 26.3%), superior mesenteric vein (n= 3; 7.9%), and portal confluence (n= 7; 18.4%). Although 12 (31.6%) were idiopathic, the remaining 26 (68.4%) were associated with portal hypertension (n= 20; 52.6%) and prior liver transplant (n= 4; 10.5%). The median growth was 0.2cm (range,-2.6 to 2.4cm) over median follow up over 5.0years (range, 0.3-16.6 years). Five PVAs (13.2%) regressed and were largely idiopathic (80.0%; P= .03). Thirteen PVAs (34.2%) grew and were associated with portal hypertension (n= 11; 84.6%; P= .003) and thrombosis (n= 6; 46.2%; P= .05). Nine PVAs (23.7%) thrombosed, predominantly in males (n=7; 77.8%). The median growth was 1.0cm (range,-0.7 to 1.9cm). Three patients (33.3%) were symptomatic from PVA thrombosis including abdominal pain (n= 2; 22.2%), intestinal ischemia (n= 1; 11.1%), and variceal bleeding (n= 2; 22.2%). Four patients (44.4%) were treated with anticoagulation. No aneurysms ruptured. Of the 58 PVAs initially identified with and without radiographic follow up, five (8.6%) underwent intervention with a median diameter of 4.0cm (range, 3.4-5cm). Intervention included vein ligation (n= 1; 20.0%), aneurysmorrhaphy (n= 1; 20.0%), and aneurysmectomy (n= 3; 60.0%). There was one case of aneurysm recurrence 20years following resection and one postoperative mortality. Two-thirds of PVAa, including those with size greater than 3cm, remain stable on surveillance. Although annual surveillance is initially recommended to confirm PVA stability, interval imaging can be subsequently extended given low growth rates. Over 20% of PVAs thrombosed, but none ruptured. Although we did not observe any cases of rupture, the devastating consequences of rupture necessitate consideration of surgical intervention for large symptomatic PVAs.

Increasing the Effectiveness and Efficiency of Local MSME Consignment Cooperation with the Portal Vendor System

MSMEs have an important role in the Indonesian economy, but they face challenges in adapting to the digital era and establishing effective collaborations with retail companies. This study aims to develop and evaluate a vendor portal system that can overcome this challenge by increasing the effectiveness and efficiency of consignment cooperation between local MSMEs and retail companies. Using a qualitative descriptive method, this study analyzes the impact of the implementation of the vendor portal system on the consignment business process, including operational efficiency, transparency, and collaboration between the two parties. The results show that the vendor portal system has succeeded in improving operational efficiency, providing real-time transparency of sales and inventory data, and facilitating better communication between MSMEs and retail companies. In addition, this system also supports the government's program in encouraging MSMEs to "Go Digital" and "Upgrade Class".