Small Liver Research Articles

Subcapital Femoral Neck Fracture in a Professionally Active Patient Undergoing Palliative Treatment for Endothelial Cell-Derived Epithelioid Haemangioendothelioma (EHE)

Background and Clinical Significance: Femoral neck fracture frequently occurs in the elderly population but may also present in patients diagnosed with primary cancer or bone metastases. A pathological, oligosymptomatic fracture associated with epithelioid haemangioendothelioma (EHE), a rare endothelial cell-derived sarcoma, is uncommon. Case Presentation: A 44-year-old patient underwent biopsy procedures three times (2010, 2012, 2013) for a focal lesion of the left ischium, none confirming its malignant nature. The last biopsy revealed a neoplastic tissue with features of discrete dysplasia. The lesion did not undergo medical follow-up for seven consecutive years. In August 2020, the patient presented with right lower limb pain. A CT scan, PET/CT scan, and biopsy confirmed EHE with spindle/sarcomatous features. In November 2020, chemotherapy (5xADIC) started (PET/CT confirmed a partial response). After its completion in July 2021, bone progression occurred and sirolimus-based therapy was started. After 3 months, a small liver metastasis was visualized on PET/CT, which did not result in the termination of treatment. In December 2021, pamidronate-based antiresorptive therapy was started. Liver metastasis remained stable in follow-up CT scans. Due to pelvic and spinal lesions, the patient was assisted by elbow crutches and underwent radiotherapy, remaining professionally active. The patient did not report any trauma, but in August 2023, a subsequent CT scan revealed a subcapital fracture of the left femoral neck in the fusion phase. Due to pelvic changes and the stable nature of the fracture, surgical treatment was abandoned. Conclusions: An oligosymptomatic femoral neck fracture, not requiring medical intervention is considered a rare complication of bone cancer.

NiCo identifies extrinsic drivers of cell state modulation by niche covariation analysis

Cell states are modulated by intrinsic driving forces such as gene expression noise and extrinsic signals from the tissue microenvironment. The distinction between intrinsic and extrinsic cell state determinants is essential for understanding the regulation of cell fate in tissues during development, homeostasis and disease. The rapidly growing availability of single-cell resolution spatial transcriptomics makes it possible to meet this challenge. However, available computational methods to infer topological tissue domains, spatially variable genes, or ligand-receptor interactions are limited in their capacity to capture cell state changes driven by crosstalk between individual cell types within the same niche. We present NiCo, a computational framework for integrating single-cell resolution spatial transcriptomics with matched single-cell RNA-sequencing reference data to infer the influence of the spatial niche on the cell state. By applying NiCo to mouse embryogenesis, adult small intestine and liver data, we demonstrate the ability to predict novel niche interactions that govern cell state variation underlying tissue development and homeostasis. In particular, NiCo predicts a feedback mechanism between Kupffer cells and neighboring stellate cells dampening stellate cell activation in the normal liver. NiCo provides a powerful tool to elucidate tissue architecture and to identify drivers of cellular states in local niches.

PET/MRI evaluation of hepatobiliary tumors.

Positron-emission tomography magnetic resonance imaging (PET/MRI) has emerged as a powerful hybrid molecular imaging technique in clinical practice, overcoming initial technical challenges to provide comprehensive anatomic and metabolic information. This advanced modality combines the superior soft tissue contrast of MRI with the metabolic insights of PET, offering advantages in hepatobiliary imaging, including improved detection of small liver metastases and reduced radiation exposure. The evolution of PET/MRI technology has been marked by significant advancements, such as the development of MRI-compatible PET detectors and sophisticated motion compensation techniques. These innovations have enhanced image quality and co-registration accuracy, crucial for hepatobiliary imaging. The integration of time-of-flight capability and silicon photomultipliers has further improved spatial resolution and sensitivity. PET/MRI protocols for liver imaging typically involve a whole-body scan followed by a targeted liver examination, utilizing radiotracers like FDG and DOTATATE. This approach allows for comprehensive staging and detailed liver assessment in a single session, potentially altering management decisions in up to 30% of patients with intrahepatic cholangiocarcinoma. While PET/MRI excels in characterizing various hepatobiliary lesions, including hepatocellular carcinoma and cholangiocarcinoma, challenges remain in differentiating certain benign entities like small hemangiomas from metastases. Ongoing research and clinical experience continue to refine the role of PET/MRI in hepatobiliary imaging, promising improved diagnostic accuracy and patient care.

Application of multiple inflammatory markers combined with PIVKA-II in differential diagnosis of AFP-NHCC

Alpha-fetoprotein (AFP) is a proven blood biomarker widely used in clinical detection of liver cancer, and its concentration increases immediately after liver injury, with high diagnostic specificity and low sensitivity. However, in patients with AFP-negative hepatocellular carcinoma (AFP-NHCC), also known as small liver cancer, their early stage of AFP expression is usually low or close to the normal range. Compared with AFP-positive HCC, AFP-NHCC is more likely to be subjected to missed diagnosis due to solely dependence on the measurement of blood AFP. Therefore, it is necessary to find a reliable, effective, and economical detection method for the early diagnosis of AFP-NHCC. PIVKA-II is closely related to the occurrence, development, invasion, and metastasis of liver cancer, and is also a new hematological marker widely used in the diagnosis of liver cancer in recent years. PIVKA-II effectively makes up for the limitation of negative AFP. 63.2% – 76.3% of patients with negative AFP showed positive PIVKA-II, and if only PIVKA-II detection was relied on, there would still be missed diagnosis in early patients with AFP-NHCC. In this retrospective study, we selected several commonly used inflammatory indicators to explore the diagnostic efficacy of PIVKA-II, an abnormal form of prothrombin, combined with inflammatory indicators in patients with early-stage AFP-NHCC and analyzed the relationship between some clinical features and hematological indicators in patients with AFP-NHCC. Serum levels of high-sensitivity C-reactive protein (hs-CRP), prealbumin (PA), neutrophil/lymphocyte ratio (NLR), and PIVKA-II were compared among three groups (AFP-NHCC group, benign lesion group, and healthy subjects). The diagnostic efficacy of PIVKA-II alone for AFP-NHCC and the diagnostic efficacy of three inflammatory indicators combined with PIVKA-II for AFP-NHCC were calculated, and their diagnostic specificity and sensitivity were compared. Compared with the other two groups, the AFP-NHCC group showed significant changes in three inflammatory markers and PIVKA-II, which may be related to the inflammatory progression of the tumor. Therefore, we recommend the establishment of a laboratory-based detection approach for diagnosing early-stage AFP-NHCC by combining PIVKA-II with inflammatory indicators hs-CRP, PA, and NLR, to facilitate diagnosis, treatment, and prognosis of AFP-NHCC.

Utilizing a domain-specific large language model for LI-RADS v2018 categorization of free-text MRI reports: a feasibility study

ObjectiveTo develop a domain-specific large language model (LLM) for LI-RADS v2018 categorization of hepatic observations based on free-text descriptions extracted from MRI reports.Material and methodsThis retrospective study included 291 small liver observations, divided into training (n = 141), validation (n = 30), and test (n = 120) datasets. Of these, 120 were fictitious, and 171 were extracted from 175 MRI reports from a single institution. The algorithm’s performance was compared to two independent radiologists and one hepatologist in a human replacement scenario, and considering two combined strategies (double reading with arbitration and triage). Agreement on LI-RADS category and dichotomic malignancy (LR-4, LR-5, and LR-M) were estimated using linear-weighted κ statistics and Cohen’s κ, respectively. Sensitivity and specificity for LR-5 were calculated. The consensus agreement of three other radiologists served as the ground truth.ResultsThe model showed moderate agreement against the ground truth for both LI-RADS categorization (κ = 0.54 [95% CI: 0.42–0.65]) and the dichotomized approach (κ = 0.58 [95% CI: 0.42–0.73]). Sensitivity and specificity for LR-5 were 0.76 (95% CI: 0.69–0.86) and 0.96 (95% CI: 0.91–1.00), respectively. When the chatbot was used as a triage tool, performance improved for LI-RADS categorization (κ = 0.86/0.87 for the two independent radiologists and κ = 0.76 for the hepatologist), dichotomized malignancy (κ = 0.94/0.91 and κ = 0.87) and LR-5 identification (1.00/0.98 and 0.85 sensitivity, 0.96/0.92 and 0.92 specificity), with no statistical significance compared to the human readers’ individual performance. Through this strategy, the workload decreased by 45%.ConclusionLI-RADS v2018 categorization from unlabelled MRI reports is feasible using our LLM, and it enhances the efficiency of data curation.Critical relevance statementOur proof-of-concept study provides novel insights into the potential applications of LLMs, offering a real-world example of how these tools could be integrated into a local workflow to optimize data curation for research purposes.Key PointsAutomatic LI-RADS categorization from free-text reports would be beneficial to workflow and data mining.LiverAI, a GPT-4-based model, supported various strategies improving data curation efficiency by up to 60%.LLMs can integrate into workflows, significantly reducing radiologists’ workload.Graphical

Abstract C050: Leveraging ECM deposition by CAF-like Ewing sarcoma tumor cells to target micrometastases with matrix-binding VHHs

Abstract Ewing sarcoma (EwS) is an aggressive bone and soft tissue tumor and EwS patients often succumb to their disease years after initial treatment due to relapses at metastatic sites. Novel therapeutic strategies are needed that can successfully eliminate microscopic residual disease foci that persist at the end of primary therapy. Extracellular matrix (ECM) proteins in the tumor microenvironment (TME) provide critical pro-survival and pro-invasion signals to tumor cells. Our published and unpublished data show that the glycoprotein tenascin-C (TNC) is enriched in EwS metastases and that TNC and other pro-tumorigenic ECM proteins are deposited by subpopulations of CAF-like tumor cells that are activated in response to tumor and TME-derived TGF-beta ligands. TNC is abundantly produced by multiple human tumors of epithelial and non-epithelial lineage but is otherwise rarely expressed outside of development and wound healing. Importantly, TNC is specifically enriched in metastatic lesions where it has been implicated as a mediator of metastatic competence and treatment resistance. In the current work we have tested whether the TNC-rich TME of disseminated EwS tumor foci could be leveraged to direct therapies to sites of residual micrometastatic disease. To achieve this, we generated monovalent and bivalent anti-human TNC VHHs (hTNC-VHH) using a mammalian expression platform. Camelid-derived hTNC-VHH sequences were sourced from published literature. VHHs are single domain heavy chain only antibody fragments with higher stability and tissue penetration than conventional monoclonal antibodies. Using EwS tumor spheroids in collagen-rich 3D culture, hTNC-VHH penetrated dense ECM matrices and bound through multiple cell layers in under 10 minutes. hTNC-VHH accumulated in TNC-positive but not TNC-knockout EwS spheroids and were retained beyond 96 hours. To assess their potential to drive protein and immune therapies to TNC-rich TMEs, we fused hTNC-VHH to immune modulating CD3- and CD28-activating VHHs. These hTNC-VHH-CD3/CD28-conjugates promoted immune cell activation and tumor cell death in PBMC-tumor co-culture assays as determined by CD25 flow cytometry and fluorescence microscopy, respectively. To assess in vivo localization, fluorescently-tagged hTNC-VHH were intravenously injected into mice that had been xenografted with EwS cells. Tissue microscopy confirmed selective binding of hTNC-VHH to small lung and liver EwS micrometastases in less than 4 hours. VHHs were not retained in non-tumor bearing organs including the brain and heart or in tumor-free lung and liver regions. Experiments are ongoing to assess anti-tumor efficacy and pharmacodynamics of hTNC-VHH conjugates in EwS xenografts. Together these findings suggest that the ECM-remodeling properties of CAF-like EwS cells can be exploited to recruit novel ECM-targeting protein therapeutics to micrometastases. If successful, this innovative approach could eradicate microscopic residual disease and prevent metastatic EwS recurrence. Citation Format: Emma D. Wrenn, Jason P. Price, Raymond O. Ruff, Nicolas M. Garcia, James M. Olson, Elizabeth R. Lawlor. Leveraging ECM deposition by CAF-like Ewing sarcoma tumor cells to target micrometastases with matrix-binding VHHs [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Tumor-body Interactions: The Roles of Micro- and Macroenvironment in Cancer; 2024 Nov 17-20; Boston, MA. Philadelphia (PA): AACR; Cancer Res 2024;84(22_Suppl):Abstract nr C050.

The Effect of Ketoconazole and Quinestrol Combination on Reproductive Physiology in Male Mice.

This study investigates whether ketoconazole, a CYP3A4 inhibitor, can enhance the suppressive effects of quinestrol on reproductive capacity, potentially allowing for a reduced quinestrol dosage while maintaining its efficacy. A total of 104 healthy adult male mice were divided into two groups, assessed at 10 and 30 days. Within each group, six treatment categories were tested: the control (CK), quinestrol alone (Q1, Q5), and quinestrol combined with varying doses of ketoconazole (Q1 + K0.4, Q1 + K2, Q5 + K0.4). The key parameters measured included internal and reproductive organ weights, sperm density, sperm motility, sperm abnormalities, and CYP3A4 enzyme content in intestinal and liver tissues. After 10 days, the combination of a low dose of quinestrol with ketoconazole (Q1 + K0.4) showed the most significant pronounced effects in reducing reproductive potential, with notable reductions in epididymal weight, sperm density, sperm abnormality rate and vitality, serum hormone levels, and CYP3A4 content in the small intestine and liver. Although some reproductive parameters returned to near-baseline levels after 30 days, the Q1 + K0.4 regimen continued to exhibit reduced seminal vesicle weight and testosterone levels. Importantly, the combination did not significantly increase CYP3A4 enzyme content, indicating effective metabolic inhibition. The combination of quinestrol and ketoconazole, especially the Q1 + K0.4 regimen, demonstrated the most noticeable impact on reducing reproductive capacity. This regimen significantly reduced key reproductive parameters and showed strong metabolic inhibition, suggesting that ketoconazole substantially enhances the efficacy of quinestrol in fertility control.

Responses in organs, sperm, steroid hormones and CYP450 enzyme in male mice treated by quinestrol only or in conjunction with clarithromycin

Pest rodents persistently undermine crop yields and food security. Fertility control could be a viable alternative for managing rodent populations. This study investigates the antifertility effects of various concentrations of clarithromycin combined with 1.0 mg/kg quinestrol on male rodents to determine an effective contraceptive dose that minimizes quinestrol usage, addressing key concerns such as potential environmental residue, which may impact ecological balance, and poor palatability, which could reduce ingestion and limit the sterilant’s effectiveness. Male mice were divided into five groups and administered different doses of clarithromycin or clarithromycin and quinestrol for three consecutive days, while the control group received sunflower seed oil only. After seven days, organ weights, reproductive organ weights, sperm density, serum hormone levels, and CYP3A4 content in small intestinal and liver tissues were measured to assess persistent effects. Compared with the control group, all treatment groups had significant reductions in epididymal weight, seminal vesicle weight, and serum T and LH levels. Higher concentrations of clarithromycin (2 mg/kg and 10 mg/kg) significantly impacted reproductive metrics, including sperm density, organ weights, and serum LH and testosterone levels, though complete sterilization was not achieved, with more than 60 million cauda epididymal spermatozoa remaining. However, the combination demonstrated potential as an effective strategy for male fertility control. The combination of 2.0 mg/kg clarithromycin and quinestrol can mitigate organ enlargement seen with quinestrol alone. This combination also decreased total enzyme content, thereby diminishing quinestrol’s induction of CYP3A4, which may increase the sterilization effectiveness of the treatment.

Green tea (Camellia sinensis L.) potential to liver of hyperuricemia rats (Rattus norvegicus) fed with high purine diet

Uric acid is produced in tissues containing xanthine oxidases, like the small intestine and liver, as involved in the purine metabolism of adenine and guanine. High uric acid levels cause damage to cell membranes due to the lipid peroxidase chain reaction. Foods containing high purines will activate the xanthine oxidase (XOD), causing an increase in free radicals. Free radicals attack polyunsaturated fatty acids (PUFA) by forming lipid peroxides. PUFA molecules contain multiple double bonds, which make them susceptible to oxidation by reactive oxygen species (ROS), such as free radicals. PUFA will be broken into simple compounds such as pentane, ethane, and aldehydes, leading to malondialdehyde (MDA) formation. High MDA levels illustrate the process of cell membrane oxidation leading to cell membrane damage. Hyperuricemia is often treated using synthetic drugs such as allopurinol; however, it can cause side effects. Some people will choose medicinal plants with minimal side effects. Green tea (Camellia sinensis L.) contains many polyphenol antioxidants, especially flavonoids, which also have a strong antioxidant effect by exerting multiple mechanisms such as inhibiting several enzymes, including antiphospholipid peroxidase, free radical scavengers, metal bonds, and xanthine oxidase (XOD). Statistical analysis results proved that green tea with a dose of 600 mg/kg BW could decrease the level of MDA in the liver by 84.87% (p 0.01) and reduce the activity of XOD by 35.36% (p 0.01). Taken together, green tea can improve liver histopathology.

The outcomes of endoscopic ultrasound-guided tissue acquisition for small focal liver lesions measuring ≤2 cm.

Endoscopic ultrasound-guided tissue acquisition (EUS-TA) for focal liver lesions has gained attention as an alternative to percutaneous biopsy. Although the outcomes of EUS-TA for focal liver lesions have been reported to be favorable, no studies have focused on small focal liver lesions (≤2 cm). The aim of this study was to evaluate the outcomes of EUS-TA for small focal liver lesions (≤2 cm). The details of EUS-TA performed for focal liver lesions between 2016 and 2022 were retrospectively reviewed. The outcomes were compared between cases involving ≤2 cm lesions and those involving >2 cm lesions. The primary outcomes were diagnostic ability and adverse events. EUS-TA for focal liver lesions was performed in 109 cases. Of the 109 cases, 32 (29.3%) involved ≤2 cm lesions and 77 (70.6%) involved >2 cm lesions. Right lobe lesions and transduodenal puncture were significantly fewer in the ≤2 cm group. There were no significant differences in needle gauge, needle type, or number of punctures between the groups. The sensitivity, specificity, and accuracy rates were 96.8%, 100%, and 96.8%, respectively, in the ≤2 cm group and 97.4%, 100%, and 97.4%, respectively, in the >2 cm group, with no significant differences between the groups. There was no difference in adverse events between the groups (0% in the ≤2 cm group and 2.3% in the >2 cm group). EUS-TA for small focal liver lesions measuring ≤2 cm has favorable outcomes, which are similar to those for lesions measuring >2 cm.

Photon-counting computed tomography versus energy-integrating computed tomography for detection of small liver lesions: comparison using a virtual framework imaging.

Photon-counting computed tomography (PCCT) has the potential to provide superior image quality to energy-integrating CT (EICT). We objectively compare PCCT to EICT for liver lesion detection. Fifty anthropomorphic, computational phantoms with inserted liver lesions were generated. Contrast-enhanced scans of each phantom were simulated at the portal venous phase. The acquisitions were done using DukeSim, a validated CT simulation platform. Scans were simulated at two dose levels ( 1.5 to 6.0mGy) modeling PCCT (NAEOTOM Alpha, Siemens, Erlangen, Germany) and EICT (SOMATOM Flash, Siemens). Images were reconstructed with varying levels of kernel sharpness (soft, medium, sharp). To provide a quantitative estimate of image quality, the modulation transfer function (MTF), frequency at 50% of the MTF ( ), noise magnitude, contrast-to-noise ratio (CNR, per lesion), and detectability index ( , per lesion) were measured. Across all studied conditions, the best detection performance, measured by , was for PCCT images with the highest dose level and softest kernel. With soft kernel reconstruction, PCCT demonstrated improved lesion CNR and compared with EICT, with a mean increase in CNR of 35.0% ( ) and 21% ( ) and a mean increase in of 41.0% ( ) and 23.3% ( ) for the 1.5 and 6.0mGy acquisitions, respectively. The improvements were greatest for larger phantoms, low-contrast lesions, and low-dose scans. PCCT demonstrated objective improvement in liver lesion detection and image quality metrics compared with EICT. These advances may lead to earlier and more accurate liver lesion detection, thus improving patient care.

6728 Bilateral Adrenal Hemorrhage: Cause Or Consequence?

Abstract Disclosure: M.N. Rayan: None. R. Horner: None. A. Valenciaga: None. L.E. Ryan: None. Introduction: Before the advent of the CT scan, bilateral adrenal hemorrhage was primarily discovered post-mortem in patients who had succumbed to sepsis, burns, or anticoagulant therapy. Today, non-traumatic hemorrhage is recognized as an infrequent, yet potentially lethal diagnosis causing clinical deterioration in acutely ill patients. Clinical Case: Our patient is a 64-year-old-male with a medical history of Myelodysplastic Syndrome initially presented to an external ED with abdominal pain. CT abdomen revealed hepatomegaly, splenomegaly, and new bilateral adrenal masses—absent in an MRI conducted a year earlier. He was treated conservatively and subsequently discharged. Two weeks later, he returned to the hospital with severe right sided flank pain. His hemoglobin and platelet counts dropped from 11.5 g/dL and 309 K/uL during the previous ED visit to 7.7 g/dL and 80 K/uL, respectively. Additionally, his PT/INR, PTT, fibrinogen, and D-Dimer levels were elevated. A repeat CT scan indicated a significant enlargement of the right adrenal mass, raising suspicion of adrenal hemorrhage. He was appropriately transfused, and a BM biopsy was performed to evaluate for acute transformation of underlying MDS. Cortisol levels were monitored daily for adrenal insufficiency. A complicated hospital course ensued marked by worsening anemia, thrombocytopenia, and coagulopathy, accompanied by high fevers and new-onset atrial fibrillation. Mixing studies showed absence of a factor inhibitor ruling out acquired forms of Hemophilia. Infectious workup including fungal and viral serologies returned negative. A PET scan revealed several small hypermetabolic hypodense liver lesions, and hypermetabolic activity diffusely in the spleen, and adrenal glands leading to suspicion of metastasis. Results of the BM biopsy returned revealing hypercellularity, with aggregates of hemosiderin-laden macrophages replacing the bone marrow space with associated necrosis. Worsening abdominal pain with hematochezia prompted an endoscopy, confirming a diagnosis of metastatic melanoma. Concurrently, seizure activity and altered mentation led to a head CT, revealing new metastatic lesions that confirmed the rapid progression of the disease. Subsequently, the patient was transitioned to comfort care and passed away. Clinical Lesson: It is crucial to review the various causes of adrenal hemorrhage, understand the challenges associated with interpreting adrenal imaging, emphasize the need to monitor adrenal function, and consider the occasional necessity for tissue sampling. In this clinical scenario, metastases with hemorrhage were the most likely etiology. The causes of adrenal hemorrhage are not always apparent; in this presentation, the consequence of the underlying disease state ultimately led to the initial presenting symptom of abdominal pain. Presentation: 6/2/2024

Pregnancy Management and Outcomes in a Small Bowel, Pancreas, and Liver Transplant Recipient: A Case Report and Literature Review.

BACKGROUND Small bowel transplantation (SBT) is a rare but life-saving surgery. However, successful full-term pregnancies in individuals with SBT are exceedingly rare due to the nutritional and immunosuppression challenges this transplant poses for pregnancy. Therefore, clear guidelines for treating pregnant SBT recipients are unavailable. Here, we report the second case of a successful pregnancy in an individual with a triple organ transplant, including SBT, highlighting the need for careful immunosuppressive management and multidisciplinary care. CASE REPORT A 20-year-old woman in the third trimester of pregnancy with a history of small bowel, liver, and pancreas transplantation at age 1 year presented with elevated liver function test results. She had been taking tacrolimus, sirolimus, and prednisone before pregnancy, with no signs of organ rejection. While sirolimus and prednisone was discontinued upon conception, laboratory test results at presentation revealed low serum tacrolimus levels. The patient had an acute kidney injury and pulmonary edema during her hospitalization and received a diagnosis of preeclampsia. She underwent a successful cesarean delivery, due to labor induction complications; however, about 1 month after hospital discharge, the patient experienced elevated liver enzymes, which was treated with high-dose steroids and adjusted tacrolimus. Sirolimus was restarted, and the patient's liver enzymes have been normalized to date. CONCLUSIONS Comprehensive multidisciplinary care, as well as monitoring and optimizing immunosuppression, are essential for pregnant SBT recipients throughout the prenatal, perinatal, and postpartum periods to mitigate risks, prevent graft rejection, and ensure positive maternal and fetal health outcomes.

S4823 Pregnancy Outcomes Following Triple Organ (Small Bowel, Liver, and Pancreas) Transplantation

S4823 Pregnancy Outcomes Following Triple Organ (Small Bowel, Liver, and Pancreas) Transplantation

Assessing the Impact of Clove (Syzygium Aromaticum) Extract on Intestinal and Hepatic Histological Alterations in Broiler Chickens Infected with Salmonella typhimurium

This study investigated effects of aqueous and ethanolic clove extracts in small intestine and liver of chickens exposed to Salmonella typhimurium. Two hundred fifty-day-old chicks were divided into five groups. Group 1 served as the control and received a basic diet.Group 2 was orally infected with Salmonella typhimurium. Group 3 received same infection but was treated with Ciprofloxacin. Groups 4 and 5 were infected but received treatments of aqueous and ethanolic clove extracts, respectively. The findings revealed that Group 1 exhibited normal small intestine, while Group 2 displayed severe abnormalities, including flattened mucosa, damaged villi, and inflammation. Group 3 showed improvements, increased cell growth and goblet cells in the small intestine. Group 4 displayed nearly normal intestinal features. Group 5 had fully restored intestinal health. In the liver, Group 1 showed typical hepatic structure, whereas Group 2 exhibited signs of inflammation and hepatocyte necrosis. Group 3 displayed severe hepatocyte damage, while Group 4 demonstrated restored liver structure with slight sinusoidal dilation. Group 5 had a well-preserved hepatic architecture with minor inflammation. Administration of 2 mg/kg of aqueous and ethanolic clove extracts demonstrated alleviate histological alterations in small intestine and liver caused by Salmonella typhimurium infection. Notably, the aqueous extract is more effective than ethanolic extract in reducing liver and intestine damage.

Cryptosporidiosis in puppies: clinical and epizootical characteristics

Gastrointestinal diseases of puppies aged 2–6 months account for 62% of all pathologies of these animals registered in the clinic. The lifestyle of dogs is associated with close tactile contact with the environment. The presence of protozoa in the digestive tract causes the inclusion of its representatives in the pathological process, which leads to the complication of disorders that have arisen due to various etiological factors. The study aimed to determine the role of the ubiquitous protozoa Cryptosporidium spp. in the pathogenesis of digestive tract diseases in puppies. General clinical, laboratory tests of blood (haematological, biochemical), faeces (coprogram, parasitological), statistical processing were performed. It was found that protozoa were detected in 52 % of sick animals with digestive disorders. The protozoan fauna included Cryptosporidium spp. (100 %), Isospora spp. (29 %), Giardia lamblia (21 %). Animals with cryptosporidium were examined without associations. The manifestation of the disease was noted most often in puppies with weak immune system functions, especially in the age group of 4–5 months, which is associated with the period of tooth change and a decrease in the overall immunological reactivity of the body. Clinically, the disease is characterized by enteritis development with accompanying symptoms. A characteristic clinical sign that should guide further diagnostic search is watery diarrhoea with an unpleasant odour, foamy, mucus, sometimes blood streaks. Laboratory findings include hypoalbuminemia with a decrease in the albumin-globulin ratio, hyperbilirubinaemia due to conjugated bilirubin, hyperfermentation of indicator enzymes of the liver and pancreas, and uremia. Such indicators indicate concomitant insufficiency of the digestive glands – the liver and pancreas, and a general inflammatory reaction. In coprological diagnostics, the qualitative data of the coprogramme confirm the lesions of the small intestine, liver and pancreas. Examination of fecal smears stained by the Ziehl-Nielsen method revealed cryptosporidium oocysts. The average intensity of invasion was 786.4 ± 23.1 oocysts per gram of feces.

Efficacy and safety of B-ultrasound-guided radiofrequency ablation in the treatment of primary liver cancer: Systematic review and meta-analysis.

Primary liver cancer is one of the most lethal malignancies in the world. Traditional treatment methods have limitations in terms of efficacy and safety. Radiofrequency ablation (RFA) guided by B-ultrasound, as a minimally invasive treatment, has attracted increasing attention in the treatment of primary liver cancer in recent years. To study the efficacy and safety of RFA were compared with those of traditional surgery (TS) for treating small liver cancer. At least 2 people were required to search domestic and foreign public databases, including foreign databases such as EMBASE, PubMed and the Cochrane Library, and Chinese databases such as the China National Knowledge Infrastructure database, China Biomedical Literature database, Wanfang database and VIP database. Controlled trials of RFA vs conventional surgery for small liver cancer were retrieved from January 2008 to January 2023. They were screened and evaluated according to the quality evaluation criteria in the Cochrane Handbook of Systematic Reviews. The meta-analysis was performed using RevMan 5.3 software. A total of 10 studies were included in this study, including 1503 patients in the RFA group and 1657 patients in the surgery group. The results of the meta-analysis showed that there was no significant difference in 1-year overall survival between the two groups (P > 0.05), while the 3-year and 5-year overall survival rates and 1-year, 3-year and 5-year tumor-free survival rates in the surgery group were greater than those in the RFA group (P < 0.05). In terms of complications, the incidence of complications in the RFA group was lower than that in the surgery group (P < 0.05). In terms of long-term survival, TS is better than RFA for small liver cancer patients. However, RFA has fewer complications and is safer.

Relevance of lesion size in navigator-triggered and free-breathing diffusion-weighted liver MRI.

The purpose of this study was to investigate the relevance of focal liver lesions (FLL) size for lesion detection comparing navigator triggering (TRIG) to free breathing (FB) liver Diffusion-weighted magnetic resonance imaging (DWI). Patients with known or suspected FLL were prospectively (registry number 276_19 B) included from October to December 2019 in this study, out of which 32 had liver lesions. Echo planar spin-echo DWI data both with TRIG and FB were with approximately constant acquisition times acquired at 1.5 T. Lesions were segmented in the b = 800 s/mm² images in both the TRIG and FB images. The lesion size, location (liver segment), liver lesion visibility, as well as contrast-to-noise ratio (CNR) were recorded. The CNR was assessed with the Wilcoxon-Mann-Whitney test and the number of visible lesions with the Fisher test. Data from 43 patients (22 female) were analyzed. The mean patient age was 58 ± 14 years. A total of 885 FLL (Ntotal) were segmented. Among these, 811 lesions (Nboth) were detected with TRIG and FB, 65 lesions exclusively with TRIG (NTRIG_Only), and nine exclusively in FB (NFB_Only). The largest additional lesion in TRIG/FB had a diameter of 10.4 mm/7.6 mm. The number of additional lesions detected with TRIG decreased with size. Among all lesions ≤ 4.7 mm, the relative number of additional lesions was 15.6%. Additional lesions were found in all liver segments with TRIG. In the left liver lobe, the relative proportion was 9.2%, and in the right liver lobe 5.4%. CNR and visibility were significantly higher in TRIG than in FB (p < 0.001). In relation to size, the difference is significant in terms of visibility and CNR for lesion diameters ≤ 8 mm. Respiration triggering can improve the detection of small liver lesions with diameters up to approx. 1 cm in the whole liver. Question Can respiration triggering (TRIG) improve the detection of small FLL compared to FB diffusion-weighted imaging? Findings Among 885 segmented FLL, TRIG was superior to FB for lesions smaller than 8 mm and had improved CNR and visibility. Clinical relevance Diffusion-weighted magnetic resonance imaging is used for the detection of focal liver lesions and image quality is influenced by breathing motion. Navigator triggering becomes more important for smaller lesions, and seems recommendable for the detection of small focal liver lesions.

PSLBI-5 Ruminal papillae morphology of beef on dairy heifers with abscessed or non-abscessed livers

Abstract The ruminal papillae morphology characteristics of feedlot beef on dairy non-spayed heifers with liver abscess to those with non-abscessed liver were evaluated. Heifers were sourced from 27 lots which were harvested on six dates between November 2022 and February 2023. Upon harvest, a total of 94 rumen tissue samples from animals presenting liver abscesses and 110 rumen tissue samples from animals with non-abscessed livers were collected in pairs, as abscesses were identified within the harvesting facility viscera inspection line, following a randomized complete block design (block = lot within harvest date). Individual fragments (6 cm2) from the cranial sac epithelium of the rumen were collected, rinsed with deionized water, immersed in 70% alcohol, and preserved under refrigeration (4 oC) until analysis. Ruminal tissues were trimmed (1 cm2), in which the number of papillae was counted by three trained personnel, followed by the removal of 12 representative papillae specimens for further area electronic scanning (The University of Texas Health Science Center of San Antonio, Image Tool) to determine average papillae area, number per cm2 (AVP), average papillae area in cm2 (APA), absorptive surface area in cm2/fragment cm2 (ASA), and papillae absorptive surface area, % (ASA). Data were analyzed using the GLIMMIX procedures of SAS, with individual animal ruminal tissue used as the experimental unit, the fixed effect of ruminal condition, and the random effect of lot within the harvesting date. Average papillae number (P = 0.27), average papillae area (P = 0.74), absorptive surface area (P = 0.48), and papillae absorptive surface area (P = 0.43) were not affected by the presence of liver abscess. Severity of liver abscess distinguished as A -, A, or A+ scores compared with non-abscessed liver showed no difference on papillae number (P = 0.34), papillae area (P = 0.89), and absorptive area (P = 0.62). The presence of small or large liver abscesses did not affect the papillae area, size, or absorptive area (P ≥ 0.41). The liver lobe location of abscesses (cranial, caudal, both) did not affect (P ≥ 0.17) any of the ruminal morphological variables measured. The presence of liver abscesses, whether diffuse or localized, in beef on dairy heifers, did not affect (P ≥ 0.58) the development of ruminal papillae. The presence, severity, or location of liver abscess was not connected with ruminal papillae number, area, or absorptive surface area of beef on dairy heifers measured upon harvest time. The absence of ruminal papillae morphological changes in animals committed with liver abscesses may be further investigated with the characterization of potential cellular physical changes of the ruminal tissue and the integrity of the primary barrier in the digestive tract.

Transfemoral hepatic vein access in double vein embolization – initial experience and feasibility

BackgroundHepatic vein embolization in double vein embolization (DVE) can be performed with transhepatic, transjugular or transfemoral access. This study evaluates the feasibility and technical success of using a transfemoral access for the hepatic vein embolization in patients undergoing preoperative to induce hypertrophy of the future liver remnant (FLR).Material and methodsRetrospective analysis of single center cohort including 17 consecutive patients. The baseline standardized FLR was 18.2% (range 14.7–24.9). Portal vein embolization was performed with vascular plugs and glue through an ipsilateral transhepatic access. Hepatic vein embolization was performed using vascular plugs. Access for the hepatic vein was either transhepatic, transjugular or transfemoral. Technical success, number of hepatic veins embolized and complications were registered. In addition, volumetric data including degree of hypertrophy (DH) and kinetic growth rate (KGR), and resection data were registered.R: Seven of the 17 patients had transfemoral hepatic vein embolization, with 100% technical success. No severe complications were registered. In the whole cohort, the median number of hepatic veins embolized was 2 (1–6). DH was 8.6% (3.0–19.4) and KGR was 3.6%/week (1.4–7.4), without significant differences between the patients having transfemoral versus transhepatic /transjugular access (p = 0.48 and 0.54 respectively). Time from DVE to surgery was median 4.8 weeks (2.6–33.9) for the whole cohort, with one patient declining surgery, two having explorative laparotomy and one patient having change of surgical strategy due to insufficient growth.ConclusionTransfemoral access is a feasible option with a high degree of technical success for hepatic vein embolization in patients with small future liver remnants needing DVE.