Morphofunctional changes in the rat's liver of different ages after L-methionine administration

Background: Literature data on the effect of methionine on functional activity and, especially, on morphological changes in the liver parenchyma in animals of different ages are sporadic, and research results are often ambiguous. Aim: The purpose of this work was to study and compare the morphofunctional changes in the liver of rats of different ages on prolonged administration of L-methionine. Material and Methods: The experiment was performed on 48 male Wistar rats of 3 and 15 months of age. Animals of the experimental group received L-methionine at a dose of 250 mg/kg body weight in addition to the standard diet, daily for 21 days. Histological preparations were prepared from liver tissue by a standard technique. Morphometry was performed on digital images using the computer program «Image J». Succinate dehydrogenase activity and protein concentration were determined in the suspension of hepatocyte mitochondria. Results: It was revealed that 21-day administration of L-methionine to rats led to hypertrophy of the hepatocyte nucleus, an increase in the nuclear-cytoplasmic ratio, the number of binuclear hepatocytes, and the nucleolus in the cell nucleus. The relative area of ​​the sinusoids network increased by 50% in 3-month-old animals. This indicated a better blood filling of the liver parenchyma. The increase in succinate dehydrogenase activity and protein concentration was revealed in the suspension of hepatocyte mitochondria of the experimental rats. This indicated an increase in the mitochondria energy potential and protein-synthetic activity. Conclusions: The administration of prophylactic doses of methionine to healthy rats leads to the appearance of pronounced morphological and functional signs of increased activity of hepatocytes. The severity of this effect has a distinct age-dependent character. In young rats, it is more pronounced than in mature rats. The results of the study are important for practical medicine when using methionine for therapeutic and prophylactic purposes.

Bleeding hepatico-cutaneous fistula: Unusual complication of the percutaneous liver biopsy

Introduction. Arteriovenous fistula is one of the complications that can occur during percutaneous liver biopsy. Hepatic arterio-venous fistula with chronic bleeding from the puncture site on the skin is extremly rare complication following percutaneous liver biopsy. Case report. The case represents a 35-year-old woman with secondary anemia caused by chronic bleeding at the site of a granuloma caused by a previous liver biopsy done 7 years ago. The patient was examined and treated for several years due to anemic syndrome. The pathological communication between the right hepatic vein, the anterior sectional branch of the portal vein and the posterior arterial sectional branch was detected on a CT scan, and proven by fistulography. Due to the failed embolization, a laparotomy was performed, where a tumor mass was found in the VI and VII segment of the liver, which communicates with the skin. Tumor mass was removed by atypical resection of VI and VII liver segments. Due to hemorrhage, re-exploration was performed, where bleeding was found from the surface of the resected liver parenchyma. Two weeks after the last operation, the patient was released for home treatment. Conclusion. Although percutaneous liver biopsy is a safe procedure, the complication in the form of bleeding occurs in less than 25% of cases and with spontaneous cessation. In our presentation, there was a complicated intrahepatic arteriovenous-portal fistula with the formation of communication with the puncture site on the skin. This is the first case of complications of this type after percutaneous liver biopsy.

Antibiotics and Liver Cirrhosis: What the Physicians Need to Know

The liver is the primary site of drug metabolism, which can be altered by a variety of diseases affecting the liver parenchyma, especially in patients with liver cirrhosis. The use of antibiotics in patients with cirrhosis is usually a matter of concern for physicians, given the lack of practical knowledge for drug choice and eventual dose adjustments in several clinical scenarios. The aim of the current narrative review is to report, as broadly as possible, basic, and practical knowledge that any physician should have when approaching a patient with liver cirrhosis and an ongoing infection to efficiently choose the best antibiotic therapy.

Early Diagnosis of Liver Metastases from Colorectal Cancer through CT Radiomics and Formal Methods: A Pilot Study

Background: Liver metastases are a leading cause of cancer-associated deaths in patients affected by colorectal cancer (CRC). The multidisciplinary strategy to treat CRC is more effective when the radiological diagnosis is accurate and early. Despite the evolving technologies in radiological accuracy, the radiological diagnosis of Colorectal Cancer Liver Metastases (CRCLM) is still a key point. The aim of our study was to define a new patient representation different by Artificial Intelligence models, using Formal Methods (FMs), to help clinicians to predict the presence of liver metastasis when still undetectable using the standard protocols. Methods: We retrospectively reviewed from 2013 to 2020 the CT scan of nine patients affected by CRC who would develop liver lesions within 4 months and 8 years. Seven patients developed liver metastases after primary staging before any liver surgery, and two patients were enrolled after R0 liver resection. Twenty-one patients were enrolled as the case control group (CCG). Regions of Interest (ROIs) were identified through manual segmentation on the medical images including only liver parenchyma and eventual benign lesions, avoiding major vessels and biliary ducts. Our predictive model was built based on formally verified radiomic features. Results: The precision of our methods is 100%, scheduling patients as positive only if they will be affected by CRCLM, showing a 93.3% overall accuracy. Recall was 77.8%. Conclusion: FMs can provide an effective early detection of CRCLM before clinical diagnosis only through non-invasive radiomic features even in very heterogeneous and small clinical samples.

CT radiomics models are unable to predict new liver metastasis after successful thermal ablation of colorectal liver metastases

Background Patients with colorectal liver metastases (CRLM) who undergo thermal ablation are at risk of developing new CRLM after ablation. Identification of these patients might enable individualized treatment. Purpose To investigate whether an existing machine-learning model with radiomics features based on pre-ablation computed tomography (CT) images of patients with colorectal cancer can predict development of new CRLM. Material and Methods In total, 94 patients with CRLM who were treated with thermal ablation were analyzed. Radiomics features were extracted from the healthy liver parenchyma of CT images in the portal venous phase, before thermal ablation. First, a previously developed radiomics model (Original model) was applied to the entire cohort to predict new CRLM after 6 and 24 months of follow-up. Next, new machine-learning models were developed (Radiomics, Clinical, and Combined), based on radiomics features, clinical features, or a combination of both. Results The external validation of the Original model reached an area under the curve (AUC) of 0.57 (95% confidence interval [CI]=0.56–0.58) and 0.52 (95% CI=0.51–0.53) for 6 and 24 months of follow-up. The new predictive radiomics models yielded a higher performance at 6 months compared to 24 months. For the prediction of CRLM at 6 months, the Combined model had slightly better performance (AUC=0.60; 95% CI=0.59–0.61) compared to the Radiomics and Clinical models (AUC=0.55–0.57), while all three models had a low performance for the prediction at 24 months (AUC=0.52–0.53). Conclusion Both the Original and newly developed radiomics models were unable to predict new CLRM based on healthy liver parenchyma in patients who will undergo ablation for CRLM.

Transjugular Intrahepatic Portosystemic Shunt Reduction for Medically Refractory Hepatic Encephalopathy

Background: Transjugular intrahepatic portosystemic shunt (TIPS) is an established intervention for symptomatic portal hypertension. Following TIPS creation, 22-50% of patients experience hepatic encephalopathy (HE), with symptoms ranging from mild confusion to coma. While HE can be medically managed, refractory cases may require downsizing of the TIPS which can be accomplished by deploying a smaller caliber stent within the original shunt. Decreasing shunt diameter redirects blood flow back through liver parenchyma. The purpose of this study was to evaluate the efficacy of TIPS downsizing for the treatment of medically refractory post-TIPS HE. Methods: An IRB-approved, HIPAA compliant retrospective review was performed. A search of an institutional radiology database yielded 45 patients who underwent TIPS downsizing between 2011-2021. Four patients were excluded due to lack of post-TIPS HE, and a total 41 patients were included in the study. Clinical and serologic data were obtained for all 41 patients. The primary objective was to determine the efficacy of TIPS downsizing for reduction of HE as measured by the West Haven criteria. Secondary endpoints included post-downsize recurrence of ascites or gastrointestinal bleeding, procedural complications, and thirty-day mortality. Results: TIPS downsizing was performed in all 41 patients with a 9.8% thirty-day mortality rate. No deaths were attributable to the procedure itself. Of the remaining patients, twenty-seven patients (65.9%) had improvement in HE and 10 patients (24.4%) proceeded to TIPS occlusion due to refractory HE. The average pre-downsize and post-downsize West Haven grades were 2.9 ± 0.5 and 1.9 ± 1.2, respectively. One patient (2.4%) had spontaneous TIPS thrombosis after downsizing and developed gastrointestinal bleeding requiring embolization; 15 patients (36.6%) experienced recurrent ascites. Conclusion: In this population, TIPS downsizing improved medically refractory HE in 65.9% of patients with a 2.4% risk of recurrent gastrointestinal bleeding, 36.6% risk of recurrent ascites, and 9.8% thirty-day mortality.

Stability of Liver Radiomics across Different 3D ROI Sizes—An MRI In Vivo Study

We aimed to evaluate the stability of radiomic features in the liver of healthy individuals across different three-dimensional regions of interest (3D ROI) sizes in T1-weighted (T1w) and T2-weighted (T2w) images from different MR scanners. We retrospectively included 66 examinations of patients without known diseases or pathological imaging findings acquired on three MRI scanners (3 Tesla I: 25 patients, 3 Tesla II: 19 patients, 1.5 Tesla: 22 patients). 3D ROIs of different diameters (10, 20, 30 mm) were drawn on T1w GRE and T2w TSE images into the liver parenchyma (segment V–VIII). We extracted 93 radiomic features from the different ROIs and tested features for significant differences with the Mann–Whitney-U (MWU)-test. The MWU-test revealed significant differences for most second- and higher-order features, indicating a systematic difference dependent on the ROI size. The features mean, median, root mean squared (RMS), 10th percentile, and 90th percentile were not significantly different. We also assessed feature robustness to ROI size variation with overall concordance correlation coefficients (OCCCs). OCCCs across the different ROI-sizes for mean, median, and RMS were excellent (>0.90) in both sequences on all three scanners. These features, therefore, seem robust to ROI-size variation and suitable for radiomic studies of liver MRI.

Hepatitis E virus cross-contamination on the surface of porcine livers after storage in Euro meat containers in a German pig abattoir

Hepatitis E virus (HEV) is a foodborne zoonotic pathogen and known as the causative agent of hepatitis E in humans. The specific role of porcine liver as a vehicle for human HEV infections has been highlighted in different studies. Nevertheless, gaps of knowledge still exist regarding possible HEV cross-contamination both at consumer and production level. Furthermore, people working in the food production industry, e.g. veterinarians and abattoir employees, are exposed to an increased risk of HEV infection. The aim of the present study was to investigate HEV cross-contamination on the surface of porcine liver in a German abattoir. The sample set included 250 samples of porcine liver parenchyma and the corresponding 250 superficial layer samples of the same livers, which were analyzed for the presence of HEV ribonucleic acid (RNA). Afterwards, the initial status of the tested liver parenchyma was compared with the occurrence of HEV RNA in the corresponding superficial layer. HEV RNA was detectable in 34% (85/250) of superficial layer samples, with 58% (49/85) of the samples originated from initially HEV negative livers. To our knowledge, this is the first study that provides an insight in the potential of HEV cross-contamination at abattoir level in Germany. Furthermore, it could be identified that the joint storage of livers in Euro meat containers has a significant impact on the presence of HEV RNA on the surface of porcine liver.

Morbidity associated with Schistosoma mansoni infection in north-eastern Democratic Republic of the Congo

Background Reducing morbidity is the main target of schistosomiasis control efforts, yet only rarely do control programmes assess morbidity linked to Schistosoma sp. infection. In the Democratic Republic of Congo (DRC), and particularly in north-eastern Ituri Province, little is known about morbidity associated with Schistosoma mansoni infection. For this reason, we aimed to assess intestinal and hepatosplenic morbidity associated with S. mansoni infection in Ituri Province. Methods/Principal findings In 2017, we conducted a cross-sectional study in 13 villages in Ituri Province, DRC. S. mansoni infection was assessed with a Kato-Katz stool test (2 smears) and a point-of-care circulating cathodic antigen (POC-CCA) urine test. A questionnaire was used to obtain demographic data and information about experienced intestinal morbidity. Each participant underwent an abdominal ultrasonography examination to diagnose hepatosplenic morbidity. Of the 586 study participants, 76.6% tested positive for S. mansoni. Intestinal morbidity reported in the two preceding weeks was very frequent, and included abdominal pain (52.7%), diarrhoea (23.4%) and blood in the stool (21.5%). Hepatosplenic morbidity consisted of abnormal liver parenchyma patterns (42.8%), hepatomegaly (26.5%) and splenomegaly (25.3%). Liver pathology (adjusted odds ratio [aOR] 1.20, 95% confidence interval [CI] 1.06–1.37, p = 0.005) was positively and significantly associated with S. mansoni infection. Hepatomegaly (aOR 1.52, 95% CI 0.99–2.32, p = 0.053) and splenomegaly (aOR 1.12, 95% CI 0.73–1.72, p = 0.619) were positively but not significantly associated with S. mansoni infection at the individual level. At the village level, S. mansoni prevalence was positively associated with the prevalence of hepatomegaly and splenomegaly. High-intensity S. mansoni infections were associated with diarrhoea, blood in the stool, hepatomegaly, splenomegaly, and liver parenchyma (C, D, E and F pathology patterns). Four study participants were diagnosed with ascites and five reported hematemesis. Conclusions/Significance Our study documents a high burden of intestinal and hepatosplenic morbidity associated with S. mansoni infection status in Ituri Province. The findings call for targeted interventions to address both S. mansoni infection and related morbidity.