Features of metabolic pathology of the liver under the influence of industrial aerosols

Ntroduction. The article is devoted to the study of the features of the metabolic pathology of the liver under the influence of harmful industrial factors. The relevance of the study of nonalcoholic fatty liver disease of workers in contact with industrial aerosols is due to the high prevalence of the disease among the working-age population, the polyethological nature of the pathology, including the pathogenetic relationship with external household and occupational toxic effects. Materials and methods. The were examined two hundred four industrial production workers, divided into four groups according to the composition of the affected aerosol: copper-nickel ore dust, welding aerosol, quartz-containing dust, carbon-based dust. The survey was conducted using the AUDIT questionnaire, examination of patients, anthropometry, ultrasound examination of the abdominal organs, biochemical blood analysis, determination of viral hepatitis B and C markers, and serum immunoglobulins. Results. The frequency of detection of ultrasonic signs of liver damage in the examined patients who came into contact with copper-nickel aerosol dust significantly exceeds the same indicator of the studied patients who came into contact with quartz-containing dust (p<0.05) and also exceeds the frequency of detection in the group working under the influence of carbon-based and welding aerosol (p>0.05). Most often, an increase in the activity of liver enzymes was noted among those working in contact with copper-nickel ore dust. Significant differences were found between groups 1 and 3; 1 and 4 (p<0.05). There were no significant differences between the groups in the frequency of lipid and carbohydrate metabolism disorders and biliary tract pathology. Discussion. The results of the study may be related to the toxic effects of the copper-nickel aerosol but may also be associated with the climatogeographic features of the workers ‘ habitat. Conclusion. The prevalence of liver diseases in the group that came into contact with copper-nickel dust was established. The revealed changes do not depend on lipid and carbohydrate metabolism features, pathology of the biliary tract. For a detailed study of liver damage in industrial workers, it is necessary to conduct an in-depth study.

Mitochondria Load Degree in Hepatocytes of the Classical Hepatic Lobules in Chinchilla (Chinchilla lanigera)

Hepatocytes represent the majority of the liver cell population and are arranged in the form of cords placed in intimate contact with the sinusoidal capillaries. The functional complexity corroborated with the intensity of the activity of hepatocytes requires large amounts of energy. The organelles involved in the production of chemical energy used in the activity of hepatocytes are the mitochondria. The purpose of this study was to verify the mitochondrial load of hepatocytes in all areas of the classical hepatic lobules, in order to indirectly assess the intensity of hepatocyte activity in each area. Materials and Methods Five fresh corpses of chinchilla (Chinchilla lanigera) from an independent breeder from Bistrița-Năsăud county were used. Liver fragments were harvested and fixated in Kolster’s solution for 24 hours, stained with Heidenhain ferric hematoxylin, and assessed using Olympus BX41 microscope. Fixation with Kolster's solution and the staining with Heidenhain's iron hematoxylin clearly shows the hepatocytic mitochondria in shades from gray to black. The liver lobules displayed an uneven distribution of mitochondria depending on the area. In zone 1 of the classical hepatic lobule, the degree of loading of hepatocytes with mitochondria is larger than in zone 2 and much larger than in zone 3. Morphological features of the hepatocytes, including the number and distribution of mitochondria in the hepatic lobules, should improve the understanding of the physiology and pathology of the liver.

Pathology of the Liver and Gallbladder in Patients with Inflammatory Bowel Diseases

Pathology of the liver and gallbladder is one of the extra-intestinal manifestations of inflammatory bowel diseases (IBD). Targeted examination indicates clinical, laboratory, and structural changes in the liver and gallbladder in 30% of patients with IBD. However, information about the state of the hepatobiliary zone in comparison with the IBD phenotype, the features of the course, and the nature of therapy are few, and their results are contradictory. The aim − to study the frequency of occurrence, to analyze the structural and functional features of the liver and gallbladder in relation to the phenotype, clinical and endoscopic activity of the process, the nature of the course, and the effectiveness of IBD therapy. Material and methods. A simple, open, single-stage, non-randomized study involved 157 patients with ulcerative colitis (UC) and 37 patients with Crohn's disease (CD) who were treated in the Gastroenterology Department of the City Clinical Hospital No. 5 in Saratov in the period of 2016−2019. Complex clinical, biochemical, and instrumental studies were performed (ultrasound examination of the abdominal organs, fibrogastroduodenoscopy and colonoscopy, general morphological examination of colonobioptates). Results. Non-alcoholic fatty liver disease (NAFLD) was verified in 10.8% of patients with UC (3.8% had non-alcoholic steаthohepatitis (NASH), 7% − liver steatosis) and in 27% of patients with CD (NASH – 5.4% of cases, liver steatosis – 21.6%). Dysfunctional disorders and structural changes of the gallbladder were detected in 14.3% of patients with UC and 20.8% with CD. Of these, cholelithiasis was found in 9.5% of patients with UC and 10.8% with CD. When analyzing the association of risk factors for hepatobiliary pathology with a variant of IBD, NAFLD was associated with the type of IBD course (recurrent course for CD), localization of the process (in UC – with left-sided colitis, in CD – with terminal ileitis), an operational history on the intestine in CD, the duration of CD for more than five years, overweight in UC, and the effects of basic therapy (steroid resistance). The pathology of the gallbladder is associated with the duration of IBD for more than three years, the continuous course of UC, and surgical interventions on the intestine in CD. When analyzing laboratory and structural markers of steatosis, it was noted that high values of the steatosis index prevailed in UC (according to J.H. Lee). Abdominal ultrasound revealed mild (41% in UC, 40% in CD) and moderate (47.1% in UC, 50% in CD) liver steatosis more often. When analyzing the clinical features of the hepatobiliary system, it was found that liver pathology was detected by instrumental and laboratory criteria, and gallbladder pathology was characterized clinically by symptoms of biliary dyspepsia in the absence of biliary colic attacks. Conclusion. The features of liver and gallbladder pathology identified during the study can be used to optimize the management of patients with IBD

Abstract 16533: Heterogeneity of Fibrosis in Patients Undergoing Combined Heart-Liver Transplant

Introduction: Combined heart-liver transplant (CHLT) is indicated for patients with end-stage heart failure and concomitant irreversible liver injury. Given that liver dysfunction from congestive hepatopathy is common in patients with end-stage heart failure, it can be difficult to determine reversible from irreversible liver injury. Transjugular liver biopsy (TJLB) is frequently used to evaluate the severity of parenchymal injury, but is limited by heterogeneity of fibrosis across biopsy specimens. We sought to compare the fibrosis evaluation of the TJLB specimens as compared to the pathology of the liver explant at the time of CHLT. Methods: All CHLT cases at CSMC between 2007 and 2017 were included. Demographic and liver ultrasound (US) or abdominal computed tomography (CT) imaging was retrieved by chart review. TJLB was performed prior to transplant to determine the severity of liver fibrosis and was compared to the pathology of the liver explant. A biopsy was considered to show heterogenous fibrosis if there was at least a 2 stage difference between the predominant and secondary patterns. Results: Thirteen CHLTs were performed at our center during the study period. The median follow-up was 59 months (IQR 48-67). Mean age at transplant was 53 years (SD +/- 14.9) and 77% of patients were male. Indications for CHLT included cardiac cirrhosis (7), amyloidosis (2), HCV cirrhosis (2), and congenital heart disease (2). By imaging, 3/7 patients (43%) had US and CT evidence, 2/7 (29%) had US or CT evidence, and 2/7 (29%) had no evidence of liver nodularity US or CT. All patients diagnosed with cardiac cirrhosis had both TJLB and explant pathology for review. All TJLBs were graded as stage 4 fibrosis. Fibrosis on analysis of the liver explant was variable: stage 4 (2), stage 3-4 (3), stage 2-4 (1), and stage 1-4 (1). Thus, 2/7 patients (29%) showed heterogeneity of fibrosis in their explant as compared to their TJLB. Conclusions: We found heterogeneity of fibrosis in liver explants of patients that had stage 4 fibrosis (cirrhosis) by TJLB and underwent CHLT. Further work is needed to identify which heart transplant candidates will most benefit from CHLT.

Utilization of Laparoscopic Surgery in Cirrhosis of the Liver

Surgery in patients with cirrhosis of the liver is dangerous and risky due to abnormalities in their physiology. However these patients do present with conditions that may require surgical intervention. Laparoscopic surgery is safer for these patients as it mitigates the dangers and complications associated with open surgery, offers shorter operation time and subserves a diagnostic value in its safe use to determine and confirm the pathology of the liver. The aim of this study is to determine if laparoscopic surgery is dangerous or safe for patients with cirrhosis of the liver. A literature review was done using search engines viz Hinari, goggle, high wire press and overview of our experiences in patients in university of medical science teaching hospital Ondo. References to our experiences during our subspecialty training at world laparoscopy hospital New-Delhi were also beneficial in the course of this study. The results show that the technique of laparoscopy in all index cases is more favourable than open surgery in cirrhotic patients. We conclude that cirrhosis of the liver does not contraindicate the procedure of laparoscopy.

CHARACTERISTICS OF AUTOPSY MATERIAL IN CASES OF CHRONIC DIFFUSE PATHOLOGY OF THE LIVER PARENCHYMA DIAGNOSED DURING PATIENT’S LIFETIME USING THE ULTRASOUND METHOD

The aim: Of the study is to analyze autopsy cases where chronic diffuse pathology of the liver parenchyma was diagnosed during patient’s lifetime using the ultrasound method. Material and methods: In this study archival material (autopsy protocols and microspecimens of these cases) of the pathological anatomy department of the Communal Nonprofit Enterprise «Regional Clinical Hospital» (Kharkiv) was used for the period from 2012 to 2018. The cases diagnosed with a chronic diffuse pathology of the liver parenchyma according to ultrasound data were selected among all cases. Microspecimens stained with hematoxylin and eosin, picrofuxin according to van Gieson were examined using an Olympus BX-41 microscope (Japan). The obtained digital indicators were statistically processed using the programs Statistica 6.0, Microsoft Excel 2003. To compare the parameters, parametric and nonparametric methods were used (Student’s t-test, χ2 criterion, Mann-Whitney U-test). Differences were considered significant at p<0.05. Results: According to the analysis of archival material for the period from 2012 to 2018, there was no change in the relative number of cases with fatty hepatosis, fibrosis or cirrhosis of the liver, chronic hepatitis, malignant tumors of the liver, metastatic liver damage and liver infiltration by leukemic cells, liver abscesses. Among all cases with revealed liver pathology, both separately by year and as a whole for the entire studied period, a predominance of the relative number of cases with fatty hepatosis, fibrosis or cirrhosis of the liver was noted. Conclusions: The term «chronic diffuse pathology of the liver parenchyma», which is widely used in ultrasound diagnostics, is morphologically a collective term that combines pathological conditions such as fatty hepatosis, fibrosis or cirrhosis of the liver, chronic hepatitis, malignant tumors of the liver, metastatic liver damage and liver infiltration by leukemic cells, liver abscesses. The ultrasound term «chronic diffuse pathology of the liver parenchyma» needs to be improved as well as additional diagnostic criteria should be developed in order to correctly use it in practice and avoid diagnostic errors.

Case study: HCV micro-elimination in prison

The presentation will explore the concept of HCV micro-elimination in prison settings end its application in the context of French prisons. Hepatitis C is a chronic pathology of the liver and can significantly affect quality of life, with significant mortality rates. Hepatitis C is of great relevance for prison population due to the overlap of risk factors for both incarceration and HCV infection, including substance use disorders. Historically, HCV interferon-based therapy has not always been offered to people in prison due to various factors, including homelessness, active injecting drug use, and liver disease. With the advent of direct-acting antivirals, almost 100% of patients are experiencing successful HCV treatment, with no medical contra-indication for incarcerated individuals, drug users and/or individuals on opioid substitution treatment. Approaches based on HCV test and treat have proven to be successful in prison settings to achieve micro-elimination and to offer HCV appropriate care to individuals belonging to socially-deprived groups and characterised by limited access to care when in the community. The elimination of hepatitis C in prison, among people who use drugs, also requires effective Harm Reduction programmes, an important tool to prevent re-infections.

DISEASES OF THE LIVER AND INTESTINAL MICROBIOME

The review presents data on the effect of the intestinal microbiota on the regulation of the synthesis and metabolism of bile acids. Violations of the bile acid pool have been shown to be accompanied by an imbalance of the intestinal microbiota, which can determine the dynamics of the formation of cholestatic liver diseases and their progression up to cirrhosis of the liver. Impaired bile acid synthesis is often caused by an imbalance in the intestinal microbiome. Changes in the complex connections of the intestinal microbiome and the metabolism of bile acids influence the formation of liver and intestinal diseases. More and more research has been noted to be devoted to the problem of the axis of the liver and intestines and its significance in the pathogenesis of various forms of the pathology of the liver and intestines.