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Yan F, Zhang Q, Mutembei BM, Wang C, Alhajeri ZA, Pandit K, Zhang F, Zhang K, Yu Z, Fung KM, Elgenaid SN, Parrack P, Ali W, Hostetler CA, Milam AN, Nave B, Squires R, Martins PN, Battula NR, Potter S, Pan C, Chen Y, Tang Q. Comprehensive Evaluation of Human Donor Liver Viability with Polarization-Sensitive Optical Coherence Tomography. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.03.31.25321497. [PMID: 40236439 PMCID: PMC11998830 DOI: 10.1101/2025.03.31.25321497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2025]
Abstract
Human liver transplantation is severely constrained by a critical shortage of donor livers, with approximately one quarter of patients on the waiting list dying due to the scarcity of viable organs. Current liver viability assessments, which rely on invasive pathological methods, are hampered by limited sampling from biopsies, particularly in marginal livers from extended criteria donors (ECD) intended to expand the donor pool. Consequently, there is a pressing need for more comprehensive and non-invasive evaluation techniques to meet the escalating demand for liver transplants. In this study, we propose the use of polarization-sensitive optical coherence tomography (PS-OCT) to perform a thorough viability evaluation across the entire surface of donor livers. PS-OCT imaging was conducted on multiple regions, achieving near-complete coverage of the liver surface, and the findings were cross-validated with histopathological evaluations. The analysis of hepatic parameters derived from pathology highlighted tissue heterogeneity. Leveraging machine learning and texture analysis, we quantified hepatic steatosis, fibrosis, inflammation, and necrosis, and established strong correlations (≥ 80%) between PS-OCT quantifications and pathological assessments. PS-OCT offers a non-invasive assessment of liver viability by quantifying hepatic parenchymal parameters across the entire donor liver, significantly complementing current pathological analysis. These results suggest that PS-OCT provides a robust, non-invasive approach to assessing donor liver viability, which could potentially decrease the discard rate of higher risk livers, thereby expanding the donor pool and reducing the inadvertent use of those livers unsuitable for transplantation.
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Pavan Sai Kumar Rao D, Patro S, Sharma V, Choudhary A, Desale S, Nath P. Diagnostic Accuracy of Red Cell Distribution Width to Platelet Ratio for the Prediction of Liver Fibrosis in Patients With Chronic Liver Disease From Eastern India. Cureus 2025; 17:e82014. [PMID: 40352011 PMCID: PMC12065511 DOI: 10.7759/cureus.82014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2025] [Accepted: 04/10/2025] [Indexed: 05/14/2025] Open
Abstract
Background Early diagnosis of liver cirrhosis in patients with chronic liver disease (CLD) can help delay/prevent complications and thereby improve survival. The currently available diagnostic modalities for the non-invasive assessment of hepatic fibrosis, especially FibroScan, are costly and not widely available, whereas various non-invasive scores for the assessment of fibrosis are cumbersome. Hence, we aimed to develop an easy and simple score for predicting cirrhosis in patients from Eastern India suffering from CLD with a better diagnostic accuracy. Methodology This cross-sectional, observational study was conducted between September 2019 and September 2021 in East India. Our study participants were patients who had CLD of etiologies such as alcohol-related liver disease, non-alcoholic fatty liver disease, chronic viral hepatitis B, chronic viral hepatitis C, primary biliary cholangitis, and autoimmune hepatitis, who had undergone FibroScan of the liver. All demographic details were noted, and the patients were subjected to physical examination, followed by hematological as well as biochemical investigations, including liver function tests. Non-invasive scores (such as aspartate aminotransferase (AST) to platelet ratio index (APRI) and Fibrosis-4 score (FIB-4) and red cell distribution width (RDW) to platelet ratio (RPR)) were computed, and their diagnostic accuracy for prediction of advanced fibrosis and cirrhosis were evaluated by receiver operating characteristic curve (ROC curve) analysis with comparison of area under the ROC curves. Pearson correlation and logistic regression analysis were also performed to study the association of these scores with advanced fibrosis and cirrhosis. Results The area under the ROC (AUROC) curve of the APRI score, FIB-4 score, RPR, and RPR × AST for prediction of advanced liver fibrosis was 0.817, 0.799, 0.706, and 0.811, respectively. Similarly, the AUROC of the above scores for the prediction of cirrhosis was 0.889, 0.858, 0.797, and 0.898. However, the product of RPR and AST was superior than APRI and FIB-4 for predicting cirrhosis. An RPR × AST value above the cut-off of 4.818 can help predict liver cirrhosis with 85.7% sensitivity and 85.5% specificity. Pearson correlation and logistic regression analysis also proved the association of these scores with liver fibrosis. Conclusions RPR is a simple, inexpensive, and easily available marker for predicting liver cirrhosis. Nevertheless, the variable RPR × AST can predict liver cirrhosis in patients with CLD with even greater diagnostic accuracy.
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Affiliation(s)
- D Pavan Sai Kumar Rao
- Department of Medical Gastroenterology, Gleneagles BGS Global Hospitals, Bengaluru, IND
| | - Shubhransu Patro
- General Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Vibha Sharma
- General Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Arushi Choudhary
- General Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Shubham Desale
- General Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
| | - Preetam Nath
- Gastroenterology and Hepatology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND
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Takase K, Ueno T, Matsumoto S, Uga N, Deguchi K, Nomura M, Watanabe M, Kamiyama M, Tazuke Y, Kimura T, Okuyama H. Impact of follow-up liver biopsy on long-term outcomes post-Kasai procedure in patients with biliary atresia. Pediatr Surg Int 2025; 41:88. [PMID: 40019581 PMCID: PMC11870969 DOI: 10.1007/s00383-025-05979-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/26/2025] [Indexed: 03/01/2025]
Abstract
PURPOSE Patients with biliary atresia (BA) suffer from progressive liver damage, even after successful Kasai portoenterostomy (KPE). The purpose of this study is to analyze the relevance of follow-up percutaneous liver biopsy (LBx) and long-term prognosis of patients with BA. METHODS This study included patients with BA who were born between 1983 and 2005 and survived with their native liver until 10 years of age. Patient characteristics, laboratory data and Child-Pugh score at the time of LBx, and native-liver survival (NLS) and complication-free survival (CFS) in patients with mild (F0-F2) or severe fibrosis (F3, F4) on follow-up LBx were retrospectively analyzed. RESULTS Forty-three patients were gathered in this study and the most recent LBx was performed at age 21.1 ± 2.9 years. Thirty-three patients had mild fibrosis and ten patients had severe fibrosis on follow-up LBx. Long-term NLS and CFS were significantly worse in patients with severe fibrosis. Among those patients, 18 patients had follow-up LBx between the ages of 6 and 12 years, and CFS were significantly worse in patients with severe fibrosis. CONCLUSIONS We found that patients with BA with severe liver fibrosis on follow-up LBx had worse long-term survival and a higher rate of progression of complications of BA.
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Affiliation(s)
- Koki Takase
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takehisa Ueno
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Sayaka Matsumoto
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Naoko Uga
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Koichi Deguchi
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Motonari Nomura
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Miho Watanabe
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Masafumi Kamiyama
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuko Tazuke
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takeshi Kimura
- Department of Pediatrics, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroomi Okuyama
- Department of Pediatric Surgery, Osaka University of Graduation School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Riescher-Tuczkiewicz A, Rautou PE. Prediction and prevention of post-procedural bleedings in patients with cirrhosis. Clin Mol Hepatol 2025; 31:S205-S227. [PMID: 39962975 PMCID: PMC11925446 DOI: 10.3350/cmh.2024.0928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Revised: 01/28/2025] [Accepted: 02/17/2025] [Indexed: 03/20/2025] Open
Abstract
Although post-procedural bleedings are infrequent in patients with cirrhosis, they are associated with significant morbidity and mortality. Therefore, predicting and preventing such bleedings is important. Established predictors of post-procedural bleeding include high-bleeding risk procedure, severe cirrhosis and high body mass index; prognostic value of anemia, acute kidney injury and bacterial infection is more uncertain. While prothrombin time and international normalized ratio do not predict post-procedural bleeding, some evidence suggests that platelet count, whole blood thrombin generation assay and viscoelastic tests may be helpful in this context. Prevention of postprocedural bleeding involves careful management of antithrombotic drugs during the periprocedural period. Patients with cirrhosis present unique challenges due to altered pharmacokinetics and pharmacodynamics of antithrombotic drugs, but there is a lack of dedicated studies specifically focused on this patient population. Guidelines for periprocedural management of antithrombotic drugs developed for patients without liver disease are thus applied to those with cirrhosis. Some technical aspects may decrease the risk of post-procedural bleeding, namely ultrasoundguidance, opting for transjugular route rather than percutaneous route, and the level of expertise of the operator. The effectiveness of platelet transfusions or thrombopoietin-receptor agonists remains uncertain. Transfusion of fresh-frozen plasma, of fibrinogen, and administration of tranexamic acid are not recommended for reducing post-procedural bleeding in patients with cirrhosis. In conclusion, prediction of post-procedural requires a global approach taking into account the patients characteristics, the risk of the procedure, and the platelet count. There is little data to support prophylactic correction of hemostasis, and dedicated studies are needed.
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Affiliation(s)
| | - Pierre-Emmanuel Rautou
- Paris City University, Inserm, Inflammatory Research Center, UMR 1149, Paris, France
- AP-HP, Beaujon Hospital, Hepatology Department, DMU DIGEST, Reference Center for Vascular Diseases of the Liver, FILFOIE, ERN RARE-LIVER, Clichy, France
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Nian L, Liu Z, Cai X, Wang B, Zhang Q, Lei J, Xiao J. A Single-Chain Peptide Probe Targeting Pathological Collagen for Precise Staging of Hepatic Fibrosis by MR Imaging. Anal Chem 2025; 97:1117-1124. [PMID: 39772523 DOI: 10.1021/acs.analchem.4c03601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
Hepatic fibrosis, a chronic liver response to injury with potential severe outcomes like cirrhosis and liver cancer, necessitates urgent noninvasive diagnostic techniques to halt disease progression. We herein for the first time developed a single-chain peptide probe targeting pathological collagen for in vivo magnetic resonance imaging (MRI) of hepatic fibrosis. The novel (GhypO)10 probe, distinguished by its unique monomeric conformation achieved through Pro to (2S,4S)-hydroxyproline (hyp) substitution and subsequent disruption of hydrogen bonding, exhibits selectivity for pathological collagen over its intact counterpart in connective tissues. Fluorescence imaging of liver specimens from fibrotic models displayed a discernible relationship between pathological collagen levels and fibrosis stage. Moreover, T1-weighted MR images post Gd-GhypO administration revealed progressive signal enhancement congruent with fibrosis severity, corroborated by a corresponding increase in the contrast-to-noise ratio (ΔCNR). Biodistribution analysis indicates that Gd-GhypO has low Gd retention in the main organs 24 h postinjection, ensuring the probe's safety for molecular imaging. The Gd-GhypO probe therefore emerges as a potent tool for the precise, noninvasive delineation of hepatic fibrosis stages, offering significant implications for the diagnosis and management of liver fibrosis.
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Affiliation(s)
- Linge Nian
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou 730000, P. R. China
| | - Zhao Liu
- The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China
| | - Xiangdong Cai
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou 730000, P. R. China
| | - Bo Wang
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou 730000, P. R. China
| | - Qianqian Zhang
- School of Pharmacy, Lanzhou University, Lanzhou 730000, P. R. China
| | - Junqiang Lei
- The First Hospital of Lanzhou University, Lanzhou 730000, P. R. China
| | - Jianxi Xiao
- State Key Laboratory of Applied Organic Chemistry, College of Chemistry and Chemical Engineering, Lanzhou University, Lanzhou 730000, P. R. China
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Marinho DS, Rocha Filho JA, Figueira ERR, Fernandes CR, Detsch Junior RC, Garcia JHP, Andraus W, D'Albuquerque LAC. INTERNATIONAL NORMALIZED RATIO AND ACTIVATED PARTIAL THROMBOPLASTIN TIME DO NOT PREDICT PLASMA TRANSFUSION IN LIVER TRANSPLANTATION. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2025; 37:e1855. [PMID: 39813557 PMCID: PMC11729538 DOI: 10.1590/0102-6720202400061e1855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 10/21/2024] [Indexed: 01/18/2025]
Abstract
BACKGROUND Blood loss during liver transplantation (LT) remains a major concern associated with increased morbidity and reduced patient and graft survival. The high complexity of the procedure associated with the multifaceted origin of the bleeding urges early identification of high-risk patients and proper monitoring of hemostasis disorders in order to improve results. The accuracy of international normalized ratio (INR) and activated partial thromboplastin time (aPTT) to evaluate coagulation status in cirrhotic patients has been doubted. AIMS The aim of this study was to investigate the applicability of these coagulation tests to indicate fresh frozen plasma transfusion in LT. METHODS This retrospective cohort study analyzed 297 cirrhotic patients submitted to LT. INR and aPTT were measured preoperatively and in each surgical phase. Hemostatic blood components were transfused only for coagulopathy indication. Patients were divided according to intraoperative plasma transfusion into transfused and non-transfused groups. The accuracy of INR and aPTT to predict plasma transfusions was investigated. The alert values of INR and aPTT unassociated with coagulopathy in each phase of surgery were identified. RESULTS Multivariate analysis showed that preoperative hematocrit (odds ratio [OR]=0.90, p<0.001), preoperative fibrinogen (OR=0.99, p<0.001), and absence of hepatocellular carcinoma (OR=3.57, p=0.004) were significant predictors of plasma transfusions. CONCLUSIONS INR and aPTT demonstrated poor accuracy in predicting plasma transfusions, irrespective of the cutoff adopted, highlighting the need for a more comprehensive approach to guide hemostatic therapy in LT to improve the outcome.
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Affiliation(s)
- David Silveira Marinho
- Department of Anesthesiology, Faculty of Medicine, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | - Joel Avancini Rocha Filho
- Anesthesiology Unit, Hospital das Clinicas, Faculty of Medicine - Universidade de São Paulo, São Paulo (SP), Brazil
| | - Estela Regina Ramos Figueira
- Department of Gastroenterology, Hospital das Clinicas, Faculty of Medicine, Universidade de São Paulo - São Paulo (SP), Brazil
| | - Claudia Regina Fernandes
- Department of Anesthesiology, Faculty of Medicine, Universidade Federal do Ceará - Fortaleza (CE), Brazil
| | - Rui Carlos Detsch Junior
- Anesthesiology Unit, Hospital das Clinicas, Faculty of Medicine - Universidade de São Paulo, São Paulo (SP), Brazil
| | | | - Wellington Andraus
- Department of Gastroenterology, Hospital das Clinicas, Faculty of Medicine, Universidade de São Paulo - São Paulo (SP), Brazil
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Jo K, Linh VTN, Yang JY, Heo B, Kim JY, Mun NE, Im JH, Kim KS, Park SG, Lee MY, Yoo SW, Jung HS. Machine learning-assisted label-free colorectal cancer diagnosis using plasmonic needle-endoscopy system. Biosens Bioelectron 2024; 264:116633. [PMID: 39126906 DOI: 10.1016/j.bios.2024.116633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 07/29/2024] [Accepted: 08/02/2024] [Indexed: 08/12/2024]
Abstract
Early and accurate detection of colorectal cancer (CRC) is critical for improving patient outcomes. Existing diagnostic techniques are often invasive and carry risks of complications. Herein, we introduce a plasmonic gold nanopolyhedron (AuNH)-coated needle-based surface-enhanced Raman scattering (SERS) sensor, integrated with endoscopy, for direct mucus sampling and label-free detection of CRC. The thin and flexible stainless-steel needle is coated with polymerized dopamine, which serves as an adhesive layer and simultaneously initiates the nucleation of gold nanoparticle (AuNP) seeds on the needle surface. The AuNP seeds are further grown through a surface-directed reduction using Au ions-hydroxylamine hydrochloride solution, resulting in the formation of dense AuNHs. The formation mechanism of AuNHs and the layered structure of the plasmonic needle-based SERS (PNS) sensor are thoroughly analyzed. Furthermore, a strong field enhancement of the PNS sensor is observed, amplified around the edges of the polyhedral shapes and at nanogap sites between AuNHs. The feasibility of the PNS sensor combined with endoscopy system is further investigated using mouse models for direct colonic mucus sampling and verifying noninvasive label-free classification of CRC from normal controls. A logistic regression-based machine learning method is employed and successfully differentiates CRC and normal mice, achieving 100% sensitivity, 93.33% specificity, and 96.67% accuracy. Moreover, Raman profiling of metabolites and their correlations with Raman signals of mucus samples are analyzed using the Pearson correlation coefficient, offering insights for identifying potential cancer biomarkers. The developed PNS-assisted endoscopy technology is expected to advance the early screening and diagnosis approach of CRC in the future.
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Affiliation(s)
- Kangseok Jo
- Advanced Bio and Healthcare Materials Research Division, Korea Institute of Materials Science (KIMS), Changwon, 51508, South Korea; School of Chemical Engineering, Pusan National University, Busan, 46241, South Korea
| | - Vo Thi Nhat Linh
- Advanced Bio and Healthcare Materials Research Division, Korea Institute of Materials Science (KIMS), Changwon, 51508, South Korea
| | - Jun-Yeong Yang
- Advanced Bio and Healthcare Materials Research Division, Korea Institute of Materials Science (KIMS), Changwon, 51508, South Korea
| | - Boyou Heo
- Advanced Bio and Healthcare Materials Research Division, Korea Institute of Materials Science (KIMS), Changwon, 51508, South Korea
| | - Jun Young Kim
- Advanced Bio and Healthcare Materials Research Division, Korea Institute of Materials Science (KIMS), Changwon, 51508, South Korea
| | - Na Eun Mun
- Biomedical Science Graduate Program, Chonnam National University, Hwasun, 58128, South Korea; Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, 58128, South Korea; Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun, 58128, South Korea
| | - Jin Hee Im
- Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, 58128, South Korea; Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun, 58128, South Korea
| | - Ki Su Kim
- School of Chemical Engineering, Pusan National University, Busan, 46241, South Korea
| | - Sung-Gyu Park
- Advanced Bio and Healthcare Materials Research Division, Korea Institute of Materials Science (KIMS), Changwon, 51508, South Korea
| | - Min-Young Lee
- Advanced Bio and Healthcare Materials Research Division, Korea Institute of Materials Science (KIMS), Changwon, 51508, South Korea
| | - Su Woong Yoo
- Biomedical Science Graduate Program, Chonnam National University, Hwasun, 58128, South Korea; Department of Nuclear Medicine, Chonnam National University Medical School and Hwasun Hospital, Hwasun, 58128, South Korea; Institute for Molecular Imaging and Theranostics, Chonnam National University Medical School, Hwasun, 58128, South Korea.
| | - Ho Sang Jung
- Advanced Bio and Healthcare Materials Research Division, Korea Institute of Materials Science (KIMS), Changwon, 51508, South Korea; Advanced Materials Engineering Division, University of Science and Technology (UST), Daejeon, 34113, South Korea; School of Convergence Science and Technology, Medical Science and Engineering, Pohang University of Science and Technology (POSTECH), Pohang, 37673, South Korea.
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Sehgal K, Taylor F, Van Wees M, Li K, De Boo DW, Slater LA. What is the Safe Observation Period for Image-Guided Percutaneous Liver Biopsies? Cardiovasc Intervent Radiol 2024; 47:1327-1334. [PMID: 39078495 DOI: 10.1007/s00270-024-03800-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 06/24/2024] [Indexed: 07/31/2024]
Abstract
PURPOSE Current observation period post-liver biopsy is typically 4 h. This study investigates the safety of reducing the observation period after percutaneous liver biopsy. METHODS Patients who underwent percutaneous liver biopsy between 2017 and 2022 in the Radiology Department of a tertiary centre were included in this retrospective, institutional review board-approved study. Patient demographics, procedure details and complication data were collected from the electronic medical records. Complications were graded according to the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) classification. Conditional survival probabilities were calculated for the 4-h observation period. RESULTS Among 1125 patients, 275 complications were seen; 255 grade 1, 15 grade 2 and five grade 3. Post-procedural pain represented 93% (256) of complications, whereas post-procedural haemorrhage occurred in 17 (6%) patients: 13 were of grade 2 severity requiring prolonged observation, and 4 were of grade 3 severity. Of these grade 3 complications, two required blood transfusion whereas two required embolization. A total of 215 (78%) complications occurred within 1 h, 244 (89%) within 2 h of observation. 16 (94%) of 17 post-procedural haemorrhages occurred within 2 h post-biopsy. If complication-free after 2 h, the probability of experiencing a complication within the next 2 h was 4%. CONCLUSION The majority of complications were identified within 2 h of observation. Complications recognised after this period were largely pain-related, with only one grade 3 complication seen (post-procedural haemorrhage).Our findings suggest 2 h of post-procedural observation may be safe. LEVEL OF EVIDENCE Level 2B, Retrospective Cohort Study.
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Affiliation(s)
- Kunal Sehgal
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia.
| | - Fergus Taylor
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia
| | - Matthew Van Wees
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia
| | - Kenny Li
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia
| | - Diederick Willem De Boo
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia
- Department of Radiology and Radiological Sciences, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Lee Anne Slater
- Department of Radiology, Monash Medical Centre, Monash Health, 246 Clayton Rd, Melbourne, Clayton, VIC, 3168, Australia
- Department of Radiology and Radiological Sciences, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
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Yoon JK, Lee CK, Yoon H, Choi HJ, Kim SS. Ultrasound-Guided Percutaneous Biopsy With Needle Track Plugging in Patients With Focal Liver Lesions on an Outpatient Basis: A Randomized Controlled Trial. Korean J Radiol 2024; 25:902-912. [PMID: 39344547 PMCID: PMC11444846 DOI: 10.3348/kjr.2024.0536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/16/2024] [Accepted: 08/02/2024] [Indexed: 10/01/2024] Open
Abstract
OBJECTIVE The increasing utilization of various molecular tests for diagnosing and selecting treatments for patients with malignancies has led to a rising trend in both the frequency of biopsies and the required tissue volume. We aimed to compare the safety of outpatient ultrasound (US)-guided percutaneous liver biopsy (PLB) between the coaxial method with needle track plugging (NTP) and the conventional method. MATERIALS AND METHODS This single-center, prospective, randomized controlled study was conducted from October 2022 to May 2023. Patients referred for US-guided PLB with target liver lesions measuring ≥1 cm and requiring ≥3 tissue cores were enrolled. Patients with severe coagulopathy or a substantial volume of ascites were excluded. Patients were randomly assigned to undergo PLB using either the coaxial method with NTP or the conventional method, in a 1:1 ratio, and were subsequently discharged after 2 hours. The primary endpoint was the presence of a patent track sign, defined as a linear color flow along the biopsy track on Doppler US, as an indication of bleeding. The secondary endpoints included clinically significant bleeding, delayed bleeding after discharge, and diagnostic yield. The incidences of these endpoints were compared between the two methods. RESULTS A total of 107 patients completed the study protocol. Patent track signs were observed significantly less frequently in the coaxial method with NTP group than in the conventional method group: 16.7% (9/54) vs. 35.8% (19/53; P = 0.042). Clinically significant bleeding and delayed bleeding did not occur in either group, and both methods achieved a high diagnostic yield: 94.4% (51/54) vs. 98.1% (52/53; P = 0.624). CONCLUSION Compared with the conventional method, the coaxial method with NTP may potentially be safer, with a reduced risk of overall bleeding complications after PLB when retrieving ≥3 tissue cores. The coaxial method with NTP could be considered a viable option for acquiring multiple liver tissues on an outpatient basis.
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Affiliation(s)
- Ja Kyung Yoon
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Choong-Kun Lee
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
| | - Hongjeong Yoon
- Songdang Institute for Cancer Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hye Jin Choi
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Seung-Seob Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Fierro-Angulo OM, González-Regueiro JA, Pereira-García A, Ruiz-Margáin A, Solis-Huerta F, Macías-Rodríguez RU. Hematological abnormalities in liver cirrhosis. World J Hepatol 2024; 16:1229-1244. [PMID: 39351511 PMCID: PMC11438588 DOI: 10.4254/wjh.v16.i9.1229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 08/09/2024] [Accepted: 08/22/2024] [Indexed: 09/23/2024] Open
Abstract
Hematological abnormalities are common in cirrhosis and are associated with various pathophysiological mechanisms. Studies have documented a prevalence of thrombocytopenia, leukopenia, and anemia in patients with compensated cirrhosis of 77.9%, 23.5%, and 21.1%, respectively. These abnormalities carry significant clinical implications, including considerations for invasive procedures, infection risk, bleeding risk, and prognosis. Previously, cirrhosis was believed to predispose patients to bleeding due to alterations observed in classical coagulation tests such as prothrombin time, partial thromboplastin time, international normalized ratio, and thrombocytopenia. However, this understanding has evolved, and cirrhosis patients are now also acknowledged as being at a high risk for thrombotic events. Hemostasis in cirrhosis patients presents a complex phenotype, with procoagulant and anticoagulant abnormalities offsetting each other. This multifactorial phenomenon is inadequately reflected by routine laboratory tests. Thrombotic complications are more prevalent in decompensated cirrhosis and may correlate with disease severity. Bleeding is primarily associated with portal hypertension, endothelial dysfunction, mechanical vessel injury, disseminated intravascular coagulation, endotoxemia, and renal injury. This review comprehensively outlines hematologic index abnormalities, mechanisms of hemostasis, coagulation, and fibrinolysis abnormalities, limitations of laboratory testing, and clinical manifestations of bleeding and thrombosis in patients with liver cirrhosis.
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Affiliation(s)
- Oscar Manuel Fierro-Angulo
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Mexico
| | - José Alberto González-Regueiro
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Mexico
| | - Ariana Pereira-García
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Mexico
| | - Astrid Ruiz-Margáin
- Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Mexico
| | - Fernando Solis-Huerta
- Department of Hematology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico 14080, Mexico
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Kang YW, Baek YH, Lee JH, Roh YH, Kwon HJ, Moon SY, Son MK, Jeong JS. Assessing the Utility of Acoustic Radiation Force Impulse in the Evaluation of Non-Alcoholic Fatty Liver Disease with Severe Obesity or Steatosis. Diagnostics (Basel) 2024; 14:1083. [PMID: 38893610 PMCID: PMC11171891 DOI: 10.3390/diagnostics14111083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/16/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Non-alcoholic fatty liver disease (NAFLD) encompasses a heterogeneous spectrum ranging from simple steatosis to fibrosis and cirrhosis. Fibrosis, associated with long-term overall mortality and liver-related events, requires evaluation. Traditionally, liver biopsy has been the gold standard for diagnosing fibrosis. However, its invasive nature, potential complications, and sampling variability limit widespread use. Consequently, various non-invasive tests have been developed as alternatives for diagnosing fibrosis in NAFLD patients. AIM This study aimed to compare the accuracy of non-invasive tests (NITs) and evaluate the diagnostic accuracy of acoustic radiation force impulse (ARFI), one of the point shear wave techniques, compared to conventional methods, assessing its effective role in diagnosis. METHODS This is a retrospective study; a total of 136 patients diagnosed with fatty liver disease through ultrasonography were enrolled. The anthropometric data of the patients were collected on the day of admission and blood tests, measurements of ARFI, and a point shear test were conducted using abdominal ultrasound; a biopsy was performed the following day. In addition, we calculated the aspartate aminotransferase-to-platelet ratio index (APRI) index based on four factors (FIB-4) and the NAFLD fibrosis score (NFS). Subsequently, we assessed the diagnostic accuracy of NITs within various subgroups based on the extent of obesity, steatosis, or NAFLD activity score. RESULTS ARFI has been shown to have the highest diagnostic value among various NITs, with AUROC values of 0.832, 0.794, 0.767, and 0.696 for ARFI, APRI, FIB-4, and NFS, respectively. In the morbidly obese subgroup, the AUROC values of ARFI, APRI, FIB-4, and NFS were 0.805, 0.769, 0.736, and 0.674. In the group with severe steatosis or non-alcoholic steatohepatitis (NASH), the AUROC values were 0.679, 0.596, 0.661, and 0.612, respectively, for severe steatosis and 0.789, 0.696, 0.751, and 0.691, respectively, for NASH. CONCLUSIONS In conclusion, ARFI is not affected by various factors and maintains diagnostic accuracy compared to serum NITs. Therefore, we can recommend ARFI as a valuable diagnostic test to screen for advanced fibrosis in patients with NAFLD.
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Affiliation(s)
- Yeo Wool Kang
- Department of Internal Medicine, Dong-A University College of Medicine, 32 Daeshingongwonro, Seo-gu, Busan 49201, Republic of Korea; (Y.W.K.); (J.H.L.); (S.Y.M.)
| | - Yang Hyun Baek
- Department of Internal Medicine, Dong-A University College of Medicine, 32 Daeshingongwonro, Seo-gu, Busan 49201, Republic of Korea; (Y.W.K.); (J.H.L.); (S.Y.M.)
| | - Jong Hoon Lee
- Department of Internal Medicine, Dong-A University College of Medicine, 32 Daeshingongwonro, Seo-gu, Busan 49201, Republic of Korea; (Y.W.K.); (J.H.L.); (S.Y.M.)
| | - Young Hoon Roh
- Department of General Surgery, Dong-A University College of Medicine, 32 Daeshingongwonro, Seo-gu, Busan 49201, Republic of Korea;
| | - Hee Jin Kwon
- Department of Radiology, Dong-A University College of Medicine, 1,3-ga Dongdaesindong, Seo-gu, Busan 49201, Republic of Korea;
| | - Sang Yi Moon
- Department of Internal Medicine, Dong-A University College of Medicine, 32 Daeshingongwonro, Seo-gu, Busan 49201, Republic of Korea; (Y.W.K.); (J.H.L.); (S.Y.M.)
| | - Min Kook Son
- Department of Physiology, Dong-A University College of Medicine, 32 Daeshingongwonro, Seo-gu, Busan 49201, Republic of Korea;
| | - Jin Sook Jeong
- Department of Pathology, Dong-A University College of Medicine, 32 Daeshingongwonro, Seo-gu, Busan 49201, Republic of Korea;
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12
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Choudhary NS, Dhampalwar S, Sud S, Sharma ZD, Sahu B, Saraf N, Sud R. Endoscopic Ultrasound-guided Liver Biopsy: Missing the Limitations in the Hype. J Clin Exp Hepatol 2024; 14:101273. [PMID: 38076374 PMCID: PMC10709297 DOI: 10.1016/j.jceh.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/23/2023] [Indexed: 01/05/2025] Open
Abstract
Endoscopic ultrasound-guided liver biopsy is increasingly being performed at several centers. It is also being promoted at endoscopy conferences. The currently available literature does not support the routine use of endoscopic ultrasound-guided liver biopsy as results are either inferior or comparable to percutaneous liver biopsy. We discuss the technical limitations of endoscopic ultrasound-guided liver biopsy when compared to percutaneous liver biopsy and the comparative studies in the current review. The routine use of endoscopic ultrasound-guided liver biopsy should be discouraged as it may get less tissue, the complication rate is similar and it is more costly.
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Affiliation(s)
- Narendra S. Choudhary
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurugram, Haryana, India
| | - Swapnil Dhampalwar
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurugram, Haryana, India
| | - Sukrit Sud
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurugram, Haryana, India
| | - Zubin D. Sharma
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurugram, Haryana, India
| | - Bimal Sahu
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurugram, Haryana, India
| | - Neeraj Saraf
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurugram, Haryana, India
| | - Randhir Sud
- Institute of Digestive and Hepatobiliary Sciences, Medanta The Medicity, Gurugram, Haryana, India
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Chen MY, Yang AY, Hu YF, Yang YF, Xiong QF, Zhong YD, Liu DX. Transjugular liver biopsy: enlarge the indications for liver biopsy with reliable diagnostic quality. BMC Gastroenterol 2023; 23:282. [PMID: 37580680 PMCID: PMC10426161 DOI: 10.1186/s12876-023-02917-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Complications and diagnostic efficiency for liver biopsy are main concerns for clinicians. This study aimed to assess the safety and efficacy of transjugular liver biopsy (TJLB) compared with percutaneous liver biopsy (PLB) when patients had equal level of liver function and number of passes, using propensity score matching (PSM). METHODS The clinical and pathological data of patients who received TJLB or PLB between January 2012 and October 2022 were collected. Matching factors included age, gender, cirrhosis, portal hypertension, liver function, creatinine, number of passes, hemodialysis, history of anti-coagulation and anti-platelet, and comorbidities. Coagulation indexes were not considered as matching factors due to different indications of the two techniques. RESULTS 2711 PLBs and 30 TJLBs were evaluated. By PSM, 75 patients (50 PLBs, 25 TJLBs) were matched. The complication rates for TJLB and PLB were 4.0% (1/25) and 10.0% (5/50) (P > 0.05). Two PLBs had hepatic hemorrhage, one of which required only close monitoring (Grade 1) and the other needed hemostasis and rehydration therapy (Grade 2). The other 3 cases presented with mild abdominal pain (Grade 1). And only one TJLB presented with mild pain. The median number of complete portal tracts were 6.0 and 10.0 for TJLBs and PLBs (P < 0.05). Moreover, the median length of sample for TJLBs and PLBs were 10.0 and 16.5 mm (P < 0.05). The diagnostic efficiency of hepatopathy of unknown etiology of TJLB versus PLB groups before and after matching were 96.4% vs. 94.1% and 95.7% vs. 93.2%, respectively (P > 0.05). CONCLUSION TJLB is an effective invasive diagnostic procedure that expands indications for liver biopsy with reliable diagnostic quality.
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Affiliation(s)
- Miao-Yang Chen
- Department of liver diseases, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No.1 Zhongfu Road, Gulou District, Nanjing, 210003 China
| | - An-Yin Yang
- Department of liver diseases, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No.1 Zhongfu Road, Gulou District, Nanjing, 210003 China
| | - Yi-Fan Hu
- Department of liver diseases, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No.1 Zhongfu Road, Gulou District, Nanjing, 210003 China
| | - Yong-Feng Yang
- Department of liver diseases, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No.1 Zhongfu Road, Gulou District, Nanjing, 210003 China
| | - Qing-Fang Xiong
- Department of liver diseases, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No.1 Zhongfu Road, Gulou District, Nanjing, 210003 China
| | - Yan-Dan Zhong
- Department of liver diseases, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No.1 Zhongfu Road, Gulou District, Nanjing, 210003 China
| | - Du-Xian Liu
- Department of pathology, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, No.1 Zhongfu Road, Gulou District, Nanjing, 210003 China
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14
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Bao J, Lv Y, Wang K, Wang Q, Chen Y, Dong Y, Zhu Y, Wang W. A Comparative Study of Ultrasound Attenuation Imaging, Controlled Attenuation Parameters, and Magnetic Resonance Spectroscopy for the Detection of Hepatic Steatosis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:1481-1489. [PMID: 36583414 DOI: 10.1002/jum.16158] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES To investigate the methodology and clinical application of ultrasound attenuation imaging (ATI) and comparative analyze the diagnostic performance of ATI and controlled attenuation parameters (CAP) for detecting and grading hepatic steatosis. METHODS A total of 159 patients with NAFLD were prospectively enrolled. CAP and ATI examinations were performed within a week before proton magnetic resonance spectroscopy (1 H-MRS). Ten liver attenuation coefficient (AC) measurements by ATI were obtained in each patient. The interclass correlation coefficients (ICCs) of the intraobserver consistencies and the ICCs between the median of the first two through the first nine measurements and all 10 measurements were calculated. The correlations between 1 H-MRS, CAP, biological data, and ATI were evaluated. The significant factors associated with ATI and the diagnostic performance of ATI and CAP for detecting hepatic steatosis was evaluated. RESULTS The median value of AC for detecting hepatic steatosis was 0.831 dB/cm/MHz. For the intraobserver consistency of ATI, the ICC was 0.931. Compared with 10 measurements, a minimum of four ATI measurements was required. The correlation of AC with hepatic fat fraction (HFF) was significantly higher than that of CAP (0.603 vs 0.326, P = .0015). The HFF and triglyceride (TG) were the significant factors for the ATI. The area under the receiver operating characteristics (ROC) curves of ATI and CAP were 0.939 and 0.788 for detecting ≥10% hepatic steatosis; 0.751 and 0.572 for detecting >33% hepatic steatosis. The cutoff values of ATI and CAP were 0.697 dB/cm/MHz and 310 dB/m for detecting ≥10% hepatic steatosis; 0.793 dB/cm/MHz and 328 dB/m for detecting >33% hepatic steatosis. The sensitivity of ATI and CAP were 85.92% and 52.11% for detecting ≥10% hepatic steatosis; 87.50% and 82.14% for detecting >33% hepatic steatosis. The specificity of ATI and CAP were 94.12% and 100% for detecting ≥10% hepatic steatosis; 54.37% and 43.69% for detecting >33% hepatic steatosis. CONCLUSIONS ATI technology showed excellent intraobserver consistency and the optimal minimum number of ATI measurements was 4. ATI is a promising noninvasive, quantitative and convenient tool for assessing hepatic steatosis.
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Affiliation(s)
- Jingwen Bao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
- School of Medical Science, Hexi University, Zhangye, China
| | - Yueming Lv
- Department of General Surgery, Zhangye Second People's Hospital, Zhangye, China
| | - Kun Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Quanwen Wang
- School of Medical Science, Hexi University, Zhangye, China
| | - Yanling Chen
- Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yuli Zhu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Wenping Wang
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai, China
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Reis J, Koo KSH, Shivaram GM, Shaw DW, Monroe EJ. Safety of Periprocedural Antithrombotics during Pediatric Transplant Liver Biopsies. J Vasc Interv Radiol 2023; 34:460-465. [PMID: 36521790 DOI: 10.1016/j.jvir.2022.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 11/16/2022] [Accepted: 12/02/2022] [Indexed: 12/14/2022] Open
Abstract
The purpose of this study was to compare the adverse event (AE) rates of percutaneous pediatric transplant liver biopsies in patients receiving periprocedural antithrombotic agents with those in patients not receiving them. A 19-year retrospective single-center study of ultrasound-guided transplant liver biopsies was conducted. Patients who received aspirin for <5 days (n = 51) or heparin <4 hours (n = 15) before biopsy were separately grouped. AEs were reported using the Society of Interventional Radiology classification. In 276 biopsy samples from patients with a mean age of 6.75 years ± 5.80, the overall AE (P = .72) and moderate AE (P = .78) rates for control and antithrombotic groups were not significantly different. No severe AEs or deaths occurred. In conclusion, aspirin continuation during percutaneous pediatric transplant liver biopsies may be safe, but more studies are necessary to confirm the safety of periprocedural heparin.
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Affiliation(s)
- Joseph Reis
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington.
| | - Kevin S H Koo
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Giri M Shivaram
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Dennis W Shaw
- Department of Radiology, Seattle Children's Hospital, Seattle, Washington
| | - Eric J Monroe
- University of Wisconsin Health Services, Madison, Wisconsin
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16
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Brehm TT, Ndzedzeka-Völz N, Wehmeyer M, Christner M, Clauditz TS, Hübener P, Addo MM, Lohse AW, Schmiedel S. Mini-laparoscopy as a diagnostic tool for abdominal tuberculosis: a retrospective series of 29 cases. Surg Endosc 2023; 37:1830-1837. [PMID: 36229559 PMCID: PMC9560738 DOI: 10.1007/s00464-022-09703-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 10/02/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Abdominal tuberculosis (TB) is a "great mimic," and diagnosis remains challenging even for experienced clinicians. While mini-laparoscopy has already been demonstrated to be an efficient diagnostic tool for a variety of diseases, we aimed to demonstrate the feasibility of this technique in diagnosing abdominal TB. METHODS We retrospectively included patients who underwent mini-laparoscopy at the University Medical Center Hamburg-Eppendorf between April 2010 and January 2022 for suspected abdominal TB. Demographic, clinical, and laboratory data, radiological findings as well as macroscopic, histopathologic, and microbiologic results were analyzed by chart review. RESULTS Out of 49 consecutive patients who underwent mini-laparoscopy for suspected abdominal TB, the diagnosis was subsequently confirmed in 29 patients (59%). Among those, the median age was 30 years (range 18-86 years) and the majority were male (n = 22, 76%). Microbiological diagnosis was established in a total of 16 patients. The remaining patients were diagnosed with abdominal TB either by histopathological detection of caseating granulomas (n = 3), or clinically by a combination of typical presentation, mini-laparoscopic findings, and good response to anti-tuberculous treatment (n = 10). Bleeding from the respective puncture site occurred in 19 patients (66%) and either resolved spontaneously or was arrested with argon plasma coagulation alone (n = 10) or in combination with fibrin glue (n = 1). Minor intestinal perforation occurred in 2 patients and was treated conservatively. CONCLUSIONS Mini-laparoscopy is a useful and safe modality for the diagnosis of abdominal TB.
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Affiliation(s)
- Thomas Theo Brehm
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany.
| | - Natascha Ndzedzeka-Völz
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Malte Wehmeyer
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Martin Christner
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Till Sebastian Clauditz
- Department of Pathology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Peter Hübener
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Marylyn M Addo
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
- Institute for Infection Research and Vaccine Development (IIRVD), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Ansgar W Lohse
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
| | - Stefan Schmiedel
- I. Department of Internal Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Hamburg, Germany
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Huang H, Xie Y, Wang G, Zhang L, Zhou W. DLNLF-net: Denoised local and non-local deep features fusion network for malignancy characterization of hepatocellular carcinoma. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 227:107201. [PMID: 36335751 DOI: 10.1016/j.cmpb.2022.107201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 10/17/2022] [Accepted: 10/23/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is a primary liver cancer with high mortality rate. The degree of HCC malignancy is an important prognostic factor for predicting recurrence and survival after surgical resection or liver transplantation in clinical practice. Currently, deep features obtained from data-driven machine learning algorithms have demonstrated superior performance in characterising lesion features in medical imaging processing. However, previous convolutional neural network (CNN)-based studies on HCC lesion characterisation were based on traditional local deep features. The aim of this study was to propose a denoised local and non-local deep features fusion network (DLNLF-net) for grading HCC. METHODS Gadolinium-diethylenetriaminepentaacetic-acid-enhanced magnetic resonance imaging data of 117 histopathologically proven HCCs were collected from 112 patients with resected HCC between October 2012 and October 2018. The proposed DLNLF-net primarily consists of three modules: feature denoising, non-local feature extraction, and bilinear kernel fusion. First, local feature maps were extracted from the original tumour images using convolution operations, followed by a feature denoising block to generate denoised local features. Simultaneously, a non-local feature extraction block was employed on the local feature maps to generate non-local features. Finally, the two generated features were fused using a bilinear kernel model to output the classification results. The dataset was divided into a training set (77 HCC images) and an independent test set (40 HCC images). Training and independent testing were repeated five times to reduce measurement errors. Accuracy, sensitivity, specificity, and area under the curve (AUC) values in the five repetitive tests were calculated to evaluate the performance of the proposed method. RESULTS Denoised local features (AUC 89.19%) and non-local features (AUC 88.28%) showed better performance than local features (AUC 86.21%) and global average pooling features (AUC 87.1%) that were derived from a CNN for malignancy characterisation of HCC. Furthermore, the proposed DLNFL-net yielded superior performance (AUC 94.89%) than a typical 3D CNN (AUC 86.21%), bilinear CNN (AUC 90.46%), recently proposed local and global diffusion method (AUC 93.94%), and convolutional block attention module method (AUC 93.62%) for malignancy characterisation of HCC. CONCLUSION The non-local operation demonstrated a better capability of yielding global representation, and feature denoising based on the non-local operation achieved performance gains for lesion characterisation. The proposed DLNLF-net, which integrates denoised local and non-local deep features, evidently outperforms conventional CNN-based methods in the malignancy characterisation of HCC.
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Affiliation(s)
- Haoyuan Huang
- School of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Yanyan Xie
- School of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou 510006, China
| | - Guangyi Wang
- Department of Radiology, Guangdong Provincial People's Hospital, Guangzhou 510080, China
| | - Lijuan Zhang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen 518055, China
| | - Wu Zhou
- School of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou 510006, China.
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Preprocedural prophylaxis with blood products in patients with cirrhosis: Results from a survey of the Italian Association for the Study of the Liver (AISF). Dig Liver Dis 2022; 54:1520-1526. [PMID: 35474168 DOI: 10.1016/j.dld.2022.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The concept of rebalanced hemostasis in cirrhosis challenges the policy of transfusing plasma or platelets before invasive procedures in patients with prolonged PT or severe thrombocytopenia. Recent guidelines recommend against plasma transfusion and suggest avoiding/minimizing platelet transfusions. AIM We assessed how hepato-gastroenterologists manage prolonged PT/INR or severe thrombocytopenia before invasive procedures. METHODS On May 2021, AISF members were sent a questionnaire addressing the PT/INR and platelet thresholds required before invasive procedures, the use of other markers of bleeding risk or other hemostatic treatments and the burden of pre-emptive plasma and platelet transfusions. RESULTS Of 62 respondents, 94% and 100% use PT/INR and platelet count to assess bleeding risk, respectively. Only 37% and 32% require less conservative PT/INR or platelet counts thresholds for low-risk procedures, respectively. As for those applying single thresholds, 68% require PT/INR <1,5 and 86% require platelet counts ≥50 × 109/L. Half respondents use additional indicators of bleeding risk and 63% other hemostatic treatments. Low-risk procedures account for 70% of procedures, and for 50% and 59% of plasma and platelets units transfused, respectively. CONCLUSIONS the survey indicates lack of compliance with guidelines that advise against plasma and platelet transfusions before invasive procedures and the need for prospective studies and inter-society consensus workshops.
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The Use of the Transfemoral Transcaval Liver Biopsy Technique for Biopsies of Hepatic Masses. J Vasc Interv Radiol 2022; 33:1230-1233. [PMID: 36182256 DOI: 10.1016/j.jvir.2022.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 03/28/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022] Open
Abstract
The purpose of this study was to investigate the safety and effectiveness of the transfemoral transcaval (TFTC) liver biopsy technique in patients with hepatic masses with relative contraindications to percutaneous biopsy and/or mass location abutting the inferior vena cava. The medical records of 16 patients (56% men; age range, 21-88 years) who underwent TFTC biopsy of hepatic masses (ranging in diameter from 2.1 to 13.2 cm) from September 2015 to August 2021 were reviewed. Histopathologic diagnoses were made in 15 of 17 (88%) procedures. Two adverse events were noted: worsened preexisting hemobilia requiring embolization in 1 patient, and a decrease in hematocrit level in another patient, requiring only observation. In conclusion, this report showed that the TFTC technique is a relatively safe and effective method for sampling hepatic masses in select cases.
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Kurakawa KI, Okada A, Bessho K, Jo T, Ono S, Michihata N, Kumazawa R, Matsui H, Fushimi K, Yamaguchi S, Yamauchi T, Nangaku M, Kadowaki T, Yasunaga H. Major complications after percutaneous biopsy of native or transplanted liver in pediatric patients: a nationwide inpatient database study in Japan. BMC Gastroenterol 2022; 22:395. [PMID: 36002811 PMCID: PMC9404589 DOI: 10.1186/s12876-022-02476-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 08/03/2022] [Indexed: 11/12/2022] Open
Abstract
Aim Although major complication rates following percutaneous liver biopsy (PLB) have been reported to be higher in children than in adults, scarce data are available regarding pediatric patients stratified by native and transplanted liver. We aimed to assess the factors associated with major complications after percutaneous biopsy of native or transplanted liver using a nationwide inpatient database.
Methods Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified pediatric patients who underwent PLB between 2010 and 2018. We described major complication rates and analyzed factors associated with major complications following PLB, stratified by native and transplanted liver. Results We identified 3584 pediatric PLBs among 1732 patients from 239 hospitals throughout Japan during the study period, including 1310 in the native liver and 2274 in the transplanted liver. Major complications following PLB were observed in 0.5% (n = 18) of the total cases; PLB in the transplanted liver had major complications less frequently than those in the native liver (0.2% vs. 1.0%, p = 0.002). The occurrence of major complications was associated with younger age, liver cancers, unscheduled admission, anemia or coagulation disorders in cases with native liver, while it was associated with younger age alone in cases with transplanted liver. Conclusions The present study, using a nationwide database, found that major complications occurred more frequently in pediatric cases with native liver and identified several factors associated with its major complications.
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Affiliation(s)
- Kayo Ikeda Kurakawa
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.,Department of Pediatrics, National Rehabilitation Center for Persons With Disabilities, Saitama, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kazuhiko Bessho
- Department of Pediatrics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sachiko Ono
- Department of Eat-Loss Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ryosuke Kumazawa
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Satoko Yamaguchi
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolism, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaomi Nangaku
- Department of Nephrology and Endocrinology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Kadowaki
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. .,Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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21
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NAFLD: Mechanisms, Treatments, and Biomarkers. Biomolecules 2022; 12:biom12060824. [PMID: 35740949 PMCID: PMC9221336 DOI: 10.3390/biom12060824] [Citation(s) in RCA: 202] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 02/07/2023] Open
Abstract
Nonalcoholic fatty liver disease (NAFLD), recently renamed metabolic-associated fatty liver disease (MAFLD), is one of the most common causes of liver diseases worldwide. NAFLD is growing in parallel with the obesity epidemic. No pharmacological treatment is available to treat NAFLD, specifically. The reason might be that NAFLD is a multi-factorial disease with an incomplete understanding of the mechanisms involved, an absence of accurate and inexpensive imaging tools, and lack of adequate non-invasive biomarkers. NAFLD consists of the accumulation of excess lipids in the liver, causing lipotoxicity that might progress to metabolic-associated steatohepatitis (NASH), liver fibrosis, and hepatocellular carcinoma. The mechanisms for the pathogenesis of NAFLD, current interventions in the management of the disease, and the role of sirtuins as potential targets for treatment are discussed here. In addition, the current diagnostic tools, and the role of non-coding RNAs as emerging diagnostic biomarkers are summarized. The availability of non-invasive biomarkers, and accurate and inexpensive non-invasive diagnosis tools are crucial in the detection of the early signs in the progression of NAFLD. This will expedite clinical trials and the validation of the emerging therapeutic treatments.
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22
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Hsu PK, Wu LS, Su WW, Su PY, Chen YY, Hsu YC, Yen HH, Wu CL. Comparing the controlled attenuation parameter using FibroScan and attenuation imaging with ultrasound as a novel measurement for liver steatosis. PLoS One 2021; 16:e0254892. [PMID: 34653177 PMCID: PMC8519468 DOI: 10.1371/journal.pone.0254892] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 07/06/2021] [Indexed: 12/19/2022] Open
Abstract
Background/Aims In a recent study, attenuation imaging (ATI) with ultrasound was used as a new approach for detecting liver steatosis. However, although there are many studies on ATI and controlled attenuation parameter (CAP) that prove their practicability, there are few studies comparing these two methods. As such, this study compared CAP and ATI for the detection and evaluation of liver steatosis. Methods A prospective analysis of 28 chronic liver disease patients who underwent liver biopsy, FibroScan® imaging, and ATI with ultrasound was conducted. The presence and degree of steatosis, as measured with the FibroScan® device and ATI, were compared with the pathological results obtained using liver biopsy. Results The areas under the receiver operating characteristic curve (AUROC) of ATI and CAP for differentiating between normal and hepatic steatosis were 0.97 (95% confidence interval [CI] 0.83–1.00) and 0.96 (95% CI 0.81–0.99), respectively. ATI has a higher AUROC than CAP does in liver steatosis, at 0.99 (95% CI, 0.86–1.00) versus 0.91 (95% CI, 0.74–0.98) in grade ≥ 2 and 0.97 (95% CI, 0.82–1.00) versus 0.88 (95% CI, 0.70–0.97) in grade = 3, respectively. Conclusion The ATI and CAP results showed good consistency and accuracy for the steatosis grading when compared with the liver biopsy results. Moreover, ATI is even better than CAP in patients with moderate or severe steatosis. Therefore, ATI represents a non-invasive and novel diagnostic tool with which to support the diagnosis of liver steatosis in clinical practice.
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Affiliation(s)
- Po-Ke Hsu
- Department of Gastroenterology, Changhua Christian Hospital, Changhua County, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Li-Sha Wu
- Department of Ultrasound, Changhua Christian Hospital, Changhua County, Taiwan
| | - Wei-Wen Su
- Department of Gastroenterology, Changhua Christian Hospital, Changhua County, Taiwan
| | - Pei-Yuan Su
- Department of Gastroenterology, Changhua Christian Hospital, Changhua County, Taiwan
| | - Yang-Yuan Chen
- Department of Gastroenterology, Changhua Christian Hospital, Changhua County, Taiwan
| | - Yu-Chun Hsu
- Department of Gastroenterology, Changhua Christian Hospital, Changhua County, Taiwan
| | - Hsu-Heng Yen
- Department of Gastroenterology, Changhua Christian Hospital, Changhua County, Taiwan
| | - Chia-Lin Wu
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Nephrology, Changhua Christian Hospital, Changhua County, Taiwan
- * E-mail:
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23
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Jing H, Yi Z, He E, Xu R, Shi X, Li L, Sun L, Liu Y, Zhang L, Qian L. Evaluation of Risk Factors for Bleeding After Ultrasound-Guided Liver Biopsy. Int J Gen Med 2021; 14:5563-5571. [PMID: 34539186 PMCID: PMC8444981 DOI: 10.2147/ijgm.s328205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 08/17/2021] [Indexed: 12/18/2022] Open
Abstract
Purpose This study was performed to analyze the risk factors for hemorrhagic complications after ultrasound-guided liver biopsies. Patients and Methods In this retrospective study, we reviewed 1193 ultrasound-guided percutaneous liver biopsies performed in our hospital from January 2018 to December 2020. Relevant patient characteristics, indications for biopsy, laboratory findings, biopsy technique, hemorrhagic complications, and pathologic outcomes were collected. Results We analyzed 834 procedures performed on 807 patients with complete data. The bleeding group comprised 45 patients with post-procedure bleeding, and non-bleeding group comprising the remaining 789 patients. Univariate analysis showed that age (p < 0.001), number of needle passes (p = 0.009), platelet count (p = 0.002), prothrombin time (p < 0.001), and international normalized ratio (p < 0.001) were associated with post-procedure bleeding. Multivariable regression analysis showed that age under 18 years (p < 0.001), low platelet count (p = 0.001), and increased needle passes (p = 0.025) were independent risk factors for bleeding complications. Conclusion Sex and focal liver lesions did not affect the risk of post-procedure bleeding. The international normalized ratio and prothrombin time were associated with an increased incidence of bleeding; however, they had no predictive value. Age, number of needle passes, and platelet count were identified as reliable predictors of bleeding.
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Affiliation(s)
- Haoyu Jing
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Zhanxiong Yi
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Enhui He
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Ruifang Xu
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Xianquan Shi
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Li Li
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Liying Sun
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Ying Liu
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Liang Zhang
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Linxue Qian
- Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
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Huang C, Seah JJ, Tan CK, Kam JW, Tan J, Teo EK, Kwek A, Wong YJ, Tan M, Ang TL, Kumar R. Modified AST to platelet ratio index improves APRI and better predicts advanced fibrosis and liver cirrhosis in patients with non-alcoholic fatty liver disease. Clin Res Hepatol Gastroenterol 2021; 45:101528. [PMID: 33268036 DOI: 10.1016/j.clinre.2020.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/13/2020] [Accepted: 08/24/2020] [Indexed: 02/08/2023]
Abstract
AIMS Advanced fibrosis (AF) and liver cirrhosis (LC) are important milestones in non-alcoholic fatty liver disease (NAFLD). FIB-4, NFS and BARD are validated scores with good accuracy in detecting AF and LC. APRI does not have similar predictive accuracy. While a modification (m-APRI) improves its use in viral hepatitis, this has yet to be evaluated in NAFLD. This study compares diagnostic performance of aforementioned scores in predicting AF and LC in NAFLD. METHODS Consecutive NAFLD patients undergoing Transient Elastography (TE) using Echosens® Fibroscan® for fibrosis staging were included. Cut-off liver stiffness measurements for AF and LC were 7.9 kPa and 11.5 kPa respectively. Anthropometric and laboratory tests done within 3 months were used. Diagnostic performances of scores were analyzed by standard statistical tests. RESULTS 161 patients qualified for the study. Mean age was 60.2 ± 14 years, BMI 26.8 ± 4.6 kg/m2. M-probe was used in 113, XL in 48. Optimal cut-offs of m-APRI for AF and LC were 5.84 and 9 respectively. Area under receiver operator characteristic curves (AUROC) for prediction of AF at optimal cut-off points were m-APRI 0.84, APRI 0.80, FIB-4: 0.77, NFS 0.77 and BARD 0.65. For prediction of LC, AUROC were m-APRI: 0.83, APRI: 0.76, FIB-4: 0.81, NFS: 0.77 and BARD: 0.66. m-APRI was significantly superior to all scores compared in detecting AF (p < 0.05 for all) and superior to APRI (p = 0.008) and BARD (p = 0.007) in predicting LC. There was no significant difference between m-APRI and FIB-4 or NFS in prediction of LC. CONCLUSIONS For prediction of AF in NAFLD, m-APRI outperforms BARD, APRI, NFS and FIB-4, while for the prediction of cirrhosis, m-APRI is superior to APRI and BARD but comparable to NFS and FIB-4.
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Affiliation(s)
- Cheryl Huang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore; NUS Yong Loo Lin School of Medicine, Singapore
| | - Jun Jie Seah
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore; NUS Yong Loo Lin School of Medicine, Singapore
| | - Chin Kimg Tan
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Jia Wen Kam
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore; Clinical Trials and Research Unit, Changi General Hospital, Singapore
| | - Jessica Tan
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Eng Kiong Teo
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Andrew Kwek
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Yu Jun Wong
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Malcolm Tan
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Rahul Kumar
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore.
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Cao W, Cheng Z, Wang L, Zhao X, Li J, Zhou S. Analysis of Risk Factors of Bleeding Complications in Percutaneous Needle Biopsy of Liver Occupying Lesions. Int J Gen Med 2021; 14:2893-2899. [PMID: 34234519 PMCID: PMC8254094 DOI: 10.2147/ijgm.s313407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 06/10/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To search for risk factors for bleeding complications after percutaneous biopsy of primary or secondary space-occupying lesions of liver guided by imaging. METHODS Consecutive 555 patients with liver space-occupying lesions who underwent ultrasound or CT-guided percutaneous biopsy in our hospital from January 2015 to January 2021 were retrospectively analyzed. Those who cannot cooperate with breath-holding and cannot successfully complete the operation, cytology, and incomplete clinical data. After screening, a total of 502 patients were enrolled, including 313 males and 189 females. Abdominal cavity or liver subcapsular hemorrhage after procedure was used as the dependent variable, and patient's gender, age, pathological results, tumor size, preoperative platelets and international normalized ratio (INR) and hemoglobin as independent variables. All independent variables were analyzed by a single factor logistic regression analysis. The independent variables with P<0.05 were included in the regression model and analyzed by multivariate logistic regression analysis to search for the risk factors for bleeding complications of liver space-occupying lesions. RESULTS A total of 502 patients with liver space-occupying lesions undergoing percutaneous liver biopsy guided by imaging equipment were included. Twenty-six of 502 (5.2%) patients occurred abdominal cavity or liver sub-capsule bleeding after procedure. Univariate logistic regression analysis observed that liver cirrhosis, the number of punctured tissues and the depth of puncture were related to bleeding complications after puncturing. Multivariate logistic regression analysis showed that liver cirrhosis and puncture depth were risk factors for bleeding complications (P<0.05). The ROC curve for predicting bleeding complications after needle biopsy in patients with liver cirrhosis has a sensitivity of 94.3% and a specificity of 46.2%. CONCLUSION Liver cirrhosis and puncture depth are risk factors for bleeding complications during percutaneous biopsy of liver occupying lesions.
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Affiliation(s)
- Wei Cao
- School of Medical Imaging of Guizhou Medical University, Guiyang, 550002, People’s Republic of China
| | - Zhimei Cheng
- School of Medical Imaging of Guizhou Medical University, Guiyang, 550002, People’s Republic of China
| | - Lizhou Wang
- School of Medical Imaging of Guizhou Medical University, Guiyang, 550002, People’s Republic of China
| | - Xuya Zhao
- Department of Interventional Radiology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550005, People’s Republic of China
| | - Junxiang Li
- Department of Interventional Radiology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550005, People’s Republic of China
| | - Shi Zhou
- School of Medical Imaging of Guizhou Medical University, Guiyang, 550002, People’s Republic of China
- Department of Interventional Radiology, The Affiliated Cancer Hospital of Guizhou Medical University, Guiyang, 550005, People’s Republic of China
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Shamseddeen H, Patidar KR, Ghabril M, Desai AP, Nephew L, Kuehl S, Chalasani N, Orman ES. Features of Blood Clotting on Thromboelastography in Hospitalized Patients With Cirrhosis. Am J Med 2020; 133:1479-1487.e2. [PMID: 32473871 PMCID: PMC7704808 DOI: 10.1016/j.amjmed.2020.04.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Thromboelastography (TEG) provides a global assessment of hemostasis and may have value for patients with cirrhosis who have multiple hemostatic defects. We sought to examine the characteristics of TEG in hospitalized patients with cirrhosis and its relationship with outcomes. METHODS We performed a cohort study of all adults with cirrhosis hospitalized at Indiana University Hospital between November 2015 and October 2018 with a TEG. We examined the relationships among TEG, traditional measures of hemostasis, liver disease severity, and outcomes, including mortality, discharge to hospice, length of stay, and 30-day readmission. RESULTS A total of 344 patients met inclusion and exclusion criteria. R-value was elevated (≥10 min) in 4.5%, alpha angle was low (<45°) in 9.3%, and maximum amplitude (maximum amplitude) was low (<55 mm) in 72.1%. K-value, alpha angle, and maximum amplitude were all correlated with both platelet count and fibrinogen (absolute rho range 0.52-0.67); R-value and international normalized ratio (INR) were not strongly correlated with traditional measures or TEG, respectively. Patients with bleeding had hypercoagulable profiles, and patients with infection had increased R-value and decreased alpha angle. A total of 35.8% died or were discharged to hospice, and these patients had a greater R-value and smaller alpha angle. However, after adjustment for model for end-stage liver disease (MELD), neither R-value nor alpha angle were associated with discharge outcomes. CONCLUSIONS TEG provides insight into the hemostatic state of patients with cirrhosis beyond that of standard measures of hemostasis. It is associated with liver disease severity and outcomes and may play a role complementary to standard measures of hemostasis in this population.
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Affiliation(s)
- Hani Shamseddeen
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis
| | - Kavish R Patidar
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis
| | - Marwan Ghabril
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis
| | - Archita P Desai
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis
| | - Lauren Nephew
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis
| | - Sandra Kuehl
- Pharmacy, Indiana University Health University Hospital, Indianapolis
| | - Naga Chalasani
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis
| | - Eric S Orman
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis.
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Reece J, Pavlick M, Penninck DG, Webster CRL. Hemorrhage and complications associated with percutaneous ultrasound guided liver biopsy in dogs. J Vet Intern Med 2020; 34:2398-2404. [PMID: 33125175 PMCID: PMC7694835 DOI: 10.1111/jvim.15942] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 10/02/2020] [Accepted: 10/09/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Liver biopsy is often necessary to obtain a diagnosis in dogs with hepatobiliary disease. Hemorrhage after biopsy is a concern. OBJECTIVE To describe the extent of hemorrhage and incidence of complications after percutaneous ultrasound guided liver biopsy (PUGLB) in dogs and to examine risk factors for hemorrhage or complications. ANIMALS One hundred two client owned dogs with suspected hepatobiliary disease that underwent PUGLB. METHODS Medical records were retrospectively reviewed. Using human guidelines, major hemorrhage was defined as an absolute decrease in the PCV (ΔPCV) ≥ 6%. Complications were defined separately as clinically relevant physiologic compromise that necessitated intervention or death. The relationship between ΔPCV and the occurrence of complications and the initial PCV, coagulation variables, serum activity of liver-derived enzymes, serum bilirubin concentration, number of biopsies, biopsy needle gauge, radiologist experience, histological diagnosis, and ultrasound variables were compared. RESULTS Before PUGLB, most aberrations in coagulation variables were mild. After biopsy a decrease in PCV occurred in 87/102 (85.3%) dogs. The mean ΔPCV was -7.2% ± 4.5%. Major hemorrhage occurred in 43/102 (42.2%) dogs and complications in 2/102 (1.9%). ΔPCV was significantly positively correlated with PCV before biopsy (r = .47, P = .004). There was no correlation between ΔPCV or complications with any of the variables examined. CONCLUSION AND CLINICAL IMPORTANCE Percutaneous ultrasound guided liver biopsy in the population of dogs in the current study, with normal or mild abnormalities in coagulation, results in a high incidence of clinically silent, major hemorrhage (42.5%), but few complications (1.9%).
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Affiliation(s)
- Jonjo Reece
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Michelle Pavlick
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Dominique G Penninck
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
| | - Cynthia R L Webster
- Cummings School of Veterinary Medicine at Tufts University, Grafton, Massachusetts, USA
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Sittl R, Bäumler P, Stumvoll AM, Irnich D, Zwißler B. [Considerations concerning the perioperative use of metamizole]. Anaesthesist 2020; 68:530-537. [PMID: 31435718 DOI: 10.1007/s00101-019-00637-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND The non-opioid analgesic metamizole (dipyrone) is approved for the treatment of severe pain and is often used in the perioperative period. As it can cause agranulocytosis, a severe adverse event, its perioperative administration is controversially discussed. OBJECTIVE Is there enough evidence for a high risk of metamizol-induced agranulocytosis (MIA)? What are the consequences of its perioperative use with respect to the risk profiles of alternative analgesics? MATERIAL AND METHODS Rapid review of the literature on the risk of MIA and adverse effects of non-opioid analgesics. RESULTS The incidence of MIA is estimated to be one case per million inhabitants per year. The risk seems low compared to other drugs associated with a risk of agranulocytosis, such as antithyroid drugs and ticlopidine. The risk profile of metamizole concerning hepatotoxicity, nephrotoxicity, bleeding and cardiovascular adverse effects is favorable compared to other non-opioid analgesics. None of the non-opioid analgesics are licensed to be administered intraoperatively. CONCLUSION The perioperative use of metamizole is possible after a thorough evaluation of the indications as it provides good analgesia with a generally favorable side effect profile and is administered intravenously. The risk of agranulocytosis is small but needs to be mentioned during patient informed consent in order to optimize early recognition. Intraoperative administration aims at reducing the expected severe postoperative pain. A documentation and justification for the evaluation of the indications are recommended.
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Affiliation(s)
- R Sittl
- Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland
| | - P Bäumler
- Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland
| | - A-M Stumvoll
- Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland
| | - D Irnich
- Interdisziplinäre Schmerzambulanz, Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Pettenkoferstr. 8a, 80336, München, Deutschland.
| | - B Zwißler
- Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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Jiang B, Su R, Ren D, Zheng X, Cao Y, Mi Y, Wang F, Ma P. Evaluation of HBV serological markers in treatment-naïve HBV mono-infected patients and HBV-HIV co-infected patients. Virus Res 2020; 290:198117. [PMID: 32800804 DOI: 10.1016/j.virusres.2020.198117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/28/2020] [Accepted: 08/06/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES Many studies have investigated the utility of hepatitis B virus (HBV) serological markers in HBV-infected patients. However, only a few studies have examined HBV serological markers in HBV-human immunodeficiency virus (HIV) co-infected patients. Here, we conducted a cross-sectional study to evaluate correlations of HBV serological markers in treatment-naïve HBV mono-infected patients and HBV-HIV co-infected patients. METHODS HBsAg, HBV DNA, HBV RNA, and HBcrAg were quantified in 51 HBV mono-infected patients and 33 HBV-HIV co-infected patients recruited at Tianjin Second People's Hospital from 2016 to 2019. RESULTS There was no significant difference in serum levels of HBV DNA (P = 0.056), HBV RNA (P = 0.387), HBcrAg (P = 0.714) and HBsAg (P = 0.165) between the patient groups. In HBV mono-infected patients, strong positive correlations were confirmed between HBV RNA and HBV DNA (r=0.620, P < 0.01), HBcrAg and HBV DNA (r=0.802, P < 0.001), and HBcrAg and HBV RNA (r=0.727, P < 0.01). In HBV-HIV co-infected patients, serum HBsAg was very strongly correlated with HBcrAg (r=0.838, P < 0.001). In HBeAg-positive HBV mono-infected patients, all HBV serological markers correlated with each other, whereas only HBV RNA correlated with HBcrAg in HBeAg-negative HBV mono-infected patients (r=0.688, P = 0.007). In HBeAg-positive HBV-HIV co-infected patients, only HBsAg correlated with HBcrAg (r=0.725, P<0.001), whereas HBcrAg and HBV RNA correlated with each other in HBeAg-negative patients (r = 0.683, P=0.010). Moreover, CD4 T-cell counts were not significantly associated with HBsAg, HBV DNA, HBV RNA, and HBcrAg levels. CONCLUSION Compared with HBsAg and HBV DNA, which are widely used in clinical settings, our study confirmed that new HBV serological markers, such as HBV RNA and HBcrAg, have some utility in HBV mono-infected patients and HBV-HIV co-infected patients for monitoring the progression of liver disease.
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Affiliation(s)
- Bei Jiang
- Tianjin Second People's Hospital, Tianjin, 300192, PR China; Tianjin Institute of Hepatology, Tianjin, 300192, PR China
| | - Rui Su
- Tianjin Second People's Hospital, Tianjin, 300192, PR China; Tianjin Institute of Hepatology, Tianjin, 300192, PR China
| | - Doudou Ren
- School of Medicine, Nankai University, Tianjin, 300071, PR China
| | - Xiaoya Zheng
- Tianjin Second People's Hospital, Tianjin, 300192, PR China; Tianjin Institute of Hepatology, Tianjin, 300192, PR China
| | - Yu Cao
- Tianjin Second People's Hospital, Tianjin, 300192, PR China; Tianjin Institute of Hepatology, Tianjin, 300192, PR China
| | - Yuqiang Mi
- Tianjin Second People's Hospital, Tianjin, 300192, PR China; Tianjin Institute of Hepatology, Tianjin, 300192, PR China
| | - Fengmei Wang
- Tianjin Second People's Hospital, Tianjin, 300192, PR China; Tianjin Institute of Hepatology, Tianjin, 300192, PR China.
| | - Ping Ma
- Tianjin Second People's Hospital, Tianjin, 300192, PR China; Tianjin Institute of Hepatology, Tianjin, 300192, PR China.
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Nazarova EE, Tereshchenko GV, Kupriyanov DA, Smetanina NS, Novichkova GA. Free-breathing T2* mapping for MR myocardial iron assessment at 3 T. Eur Radiol Exp 2020; 4:25. [PMID: 32303909 PMCID: PMC7165216 DOI: 10.1186/s41747-020-00156-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 03/19/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Timely diagnosis of cardiac iron overload is important for children with transfusion-dependent anaemias and requires modern measure methods. Nowadays, myocardial iron quantification is performed by magnetic resonance (MR) breath-hold techniques, sensitive to respiratory motion and unfeasible in patients who are unable to hold their breath. Free-breathing T2* mapping sequences would allow to scan children who cannot hold their breath for a specified duration. Our aim was to test a free-breathing T2* mapping sequence, based on motion correction by multiple signal accumulation technique. METHODS We used an electrocardiographically gated T2* mapping sequence based on multiple gradient echo at 3-T in 37 paediatric patients with haematologic disorders aged from 2 to 16. We compared T2* values of myocardium and signal-to-noise ratio of this new sequence with standard breath-holding T2* mapping sequence. T2* values were measured in the interventricular septum for both methods in studies with adequate image quality. RESULTS All children were scanned without complications. Five patients were excluded from analysis because of the presence of respiratory artefacts on the T2* images with breath-holding technique due to patient's inability to hold their breath. Breath-holding T2* was 19.5 ± 7.7 ms (mean ± standard deviation), free-breathing T2* was 19.4 ± 7.6 ms, with positive correlation (r = 0.99, R2 = 0.98; p < 0.001). The free-breathing sequence had a higher signal-to-noise ratio (median 212.8, interquartile range 148.5-566.5) than the breath-holding sequence (112.6, 71.1-334.1) (p = 0.03). CONCLUSION A free-breathing sequence provided accurate measurement of myocardial T2* values in children.
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Affiliation(s)
- E E Nazarova
- Radiology department, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samory Mashela st., 1, Moscow, Russia, 117997.
| | - G V Tereshchenko
- Radiology department, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samory Mashela st., 1, Moscow, Russia, 117997
| | - D A Kupriyanov
- Radiology department, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samory Mashela st., 1, Moscow, Russia, 117997
- Philips Healthcare, Moscow, Russia
| | - N S Smetanina
- Radiology department, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samory Mashela st., 1, Moscow, Russia, 117997
- 3Pirogov Russian National Research Medical University, Moscow, Russia
| | - G A Novichkova
- Radiology department, Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Samory Mashela st., 1, Moscow, Russia, 117997
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Kovalic AJ, Khan MA, Malaver D, Whitson MJ, Teperman LW, Bernstein DE, Singal A, Satapathy SK. Thromboelastography versus standard coagulation testing in the assessment and reversal of coagulopathy among cirrhotics: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2020; 32:291-302. [PMID: 32012141 DOI: 10.1097/meg.0000000000001588] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The utility of thromboelastography/thromboelastometry currently has unvalidated clinical benefit in the assessment and reversal of coagulopathy among cirrhotic patients as compared to standard coagulation testing. A novel systematic review and meta-analysis was conducted in order to assess pooled outcome data among patients receiving thromboelastography/thromboelastometry as compared to standard coagulation testing. As compared to standard coagulation testing, there was a significant reduction in the number of patients requiring pRBC, platelet, and fresh frozen plasma transfusions among thromboelastography/thromboelastometry group with pooled OR 0.53 (95% CI 0.32-0.85; P = 0.009), 0.29 (95% CI 0.12-0.74; P = 0.009), and 0.19 (95% CI 0.12-0.31; P < 0.00001), respectively. Similarly, there was a significant reduction in number of pRBC, platelet, and fresh frozen plasma units transfused in the thromboelastography/thromboelastometry group with pooled MD -1.53 (95% CI -2.86 to -0.21; P = 0.02), -0.57 (95% CI -1.06 to -0.09; P = 0.02), and -2.71 (95% CI -4.34 to -1.07; P = 0.001), respectively. There were significantly decreased total bleeding events with pooled OR 0.54 (95% CI 0.31-0.94; P = 0.03) and amount of intraoperative bleeding during liver transplantation with pooled MD -1.46 (95% CI -2.49 to -0.44; P = 0.005) in the thromboelastography/thromboelastometry group. Overall, there was no significant difference in mortality between groups with pooled OR 0.91 (95% CI 0.63-1.30; P = 0.60). As compared to standard coagulation testing, a thromboelastography/thromboelastometry-guided approach to the assessment and reversal of cirrhotic coagulopathy improves overall number of patients exposed to blood product transfusions, quantity of transfusions, and bleeding events.
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Affiliation(s)
- Alexander J Kovalic
- Department of Internal Medicine, Wake Forest Baptist Medical Center, Winston Salem, North Carolina
| | - Muhammad Ali Khan
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Diego Malaver
- Department of Internal Medicine, Section of Cardiology, Wake Forest Baptist Medical Center, Winston Salem, North Carolina
| | - Matthew J Whitson
- Department of Internal Medicine, Division of Gastroenterology, Barbara and Zucker School of Medicine for Hofstra/Northwell Health
| | - Lewis W Teperman
- Department of Internal Medicine, Division of Transplantation, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Barbara and Zucker School of Medicine for Hofstra/Northwell Health
| | - David E Bernstein
- Department of Internal Medicine, Division of Transplantation, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Barbara and Zucker School of Medicine for Hofstra/Northwell Health
- Department of Internal Medicine, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, New York
| | - Ashwani Singal
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, University of South Dakota Sanford School of Medicine and Avera Transplant Institute, Division of Hepatology, Sioux Falls, South Dakota, USA
| | - Sanjaya K Satapathy
- Department of Internal Medicine, Division of Transplantation, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Barbara and Zucker School of Medicine for Hofstra/Northwell Health
- Department of Internal Medicine, Division of Hepatology, Sandra Atlas Bass Center for Liver Diseases and Transplantation, Barbara and Zucker School of Medicine for Hofstra/Northwell Health, Manhasset, New York
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Erkan B, Meier J, Clark TJ, Kaplan J, Lambert JR, Chang S. Non-invasive diagnostic criteria of hepatocellular carcinoma: Comparison of diagnostic accuracy of updated LI-RADS with clinical practice guidelines of OPTN-UNOS, AASLD, NCCN, EASL-EORTC, and KLSCG-NCC. PLoS One 2019; 14:e0226291. [PMID: 31821360 PMCID: PMC6903758 DOI: 10.1371/journal.pone.0226291] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/22/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose To retrospectively compare the diagnostic performance of different noninvasive diagnostic criteria of HCC including LI-RADS, OPTN-UNOS, AASLD, NCCN, EASL-EORTC, KLCSG-NCC. Materials and methods We reviewed the medical records of 3,491 pathologically examined liver lesions from January-2011 to January-2015 in our institution. 195 lesions in 133 patients (M:F = 100:33) with chronic hepatitis B/C and/or cirrhosis for any etiology were finally included in our study, with 98 lesions ≥ 2 cm, 72 lesions between 1–2 cm, and 25 lesions < 1 cm. The main comparison was made with the largest nodules of each patient (n = 133). The lesions were retrospectively evaluated for the diagnosis of HCC on DCE-CT or MR using different noninvasive diagnostic criteria including LI-RADS, OPTN-UNOS, AASLD, NCCN, EASL-EORTC, and KLCSG-NCC. With pathological evaluation serving as a gold-standard, sensitivity, specificity, PPV and NPV as well as accuracy of the diagnostic criteria were calculated. Results There was no statistically significant differences in diagnostic accuracy among noninvasive diagnostic criteria. For 133 lesions of the largest lesion per patient, the overall accuracy was highest with LI-RADS criteria (89.3%) and the overall sensitivity was highest with LI-RADS, AASLD, NCCN criteria (all 89.5%). For 1–2 cm lesions, sensitivity decreased for all criteria in the following order: EASL-EORTC (59.1%), KLCSG-NCC (58.3%), LI-RADS, AASLD, NCCN (all 56.5%), and OPTN-UNOS (22.7%) criteria. OPTN-UNOS had the highest specificity in cirrhotic livers, 91.7%. Conclusions The current noninvasive diagnostic criteria of HCC have no statistically significant difference in diagnostic accuracy. Overall, LI-RADS had the highest sensitivity and accuracy among the guidelines. OPTN had the highest specificity for cirrhotic livers.
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Affiliation(s)
- Burcu Erkan
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Jeffrey Meier
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Toshimasa J. Clark
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Jeffrey Kaplan
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
| | - Jeffrey R. Lambert
- Department of Biostatistics and Informatics, University of Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Samuel Chang
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado, United States of America
- * E-mail:
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Abstract
Purpose of review Hepatocellular carcinoma (HCC) surveillance in patients with cirrhosis is associated with decreased mortality by enabling early tumor detection. However, the benefits of any cancer screening program must be considered in light of potential physical, financial, and psychological harms, as well as the risk of overdiagnosis. Herein, we summarize the potential harms of HCC surveillance. Recent findings To date, two retrospective studies have addressed physical harms of HCC surveillance. Based on these data, 15% to 28% of patients undergoing HCC surveillance experience physical harm including additional cross-sectional imaging or liver biopsy. Although psychological and financial harms have been reported for other cancers, there are currently limited data specific to HCC. An ongoing multi-center prospective study assessing all four types of harms should provide data in near future. Summary HCC screening may prevent death by diagnosing tumors at an early stage, but limited sensitivity and specificity of screening tests can result in unintended harms. There is a need for further quality data evaluating both the benefits and harms of HCC surveillance.
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Zhou W, Wang G, Xie G, Zhang L. Grading of hepatocellular carcinoma based on diffusion weighted images with multiple b-values using convolutional neural networks. Med Phys 2019; 46:3951-3960. [PMID: 31169907 DOI: 10.1002/mp.13642] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/09/2019] [Accepted: 05/29/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE To effectively grade hepatocellular carcinoma (HCC) based on deep features derived from diffusion weighted images (DWI) with multiple b-values using convolutional neural networks (CNN). MATERIALS AND METHODS Ninety-eight subjects with 100 pathologically confirmed HCC lesions from July 2012 to October 2018 were included in this retrospective study, including 47 low-grade and 53 high-grade HCCs. DWI was performed for each subject with a 3.0T MR scanner in a breath-hold routine with three b-values (0,100, and 600 s/mm2 ). First, logarithmic transformation was performed on original DWI images to generate log maps (logb0, logb100, and logb600). Then, a resampling method was performed to extract multiple 2D axial planes of HCCs from the log map to increase the dataset for training. Subsequently, 2D CNN was used to extract deep features of the log map for HCCs. Finally, fusion of deep features derived from three b-value log maps was conducted for HCC malignancy classification. Specifically, a deeply supervised loss function was devised to further improve the performance of lesion characterization. The data set was split into two parts: the training and validation set (60 HCCs) and the fixed test set (40 HCCs). Four-fold cross validation with 10 repetitions was performed to assess the performance of deep features extracted from single b-value images for HCC grading using the training and validation set. Receiver operating characteristic curve (ROC) and area under the curve (AUC) values were used to assess the characterization performance of the proposed deep feature fusion method to differentiate low-grade and high-grade in the fixed test set. RESULTS The proposed fusion of deep features derived from logb0, logb100, and logb600 with deeply supervised loss function generated the highest accuracy for HCC grading (80%), thus outperforming the method of deep feature derived from the ADC map directly (72.5%), the original b0 (65%), b100 (68%), and b600 (70%) images. Furthermore, AUC values of the deep features of the ADC map, the deep feature fusion with concatenation, and the proposed deep feature fusion with deeply supervised loss function were 0.73, 0.78, and 0.83, respectively. CONCLUSION The proposed fusion of deep features derived from the logarithm of the three b-value images yields high performance for HCC grading, thus providing a promising approach for the assessment of DWI in lesion characterization.
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Affiliation(s)
- Wu Zhou
- School of Medical Information Engineering, Guangzhou University of Chinese Medicine, Guangzhou, China, 510006
| | - Guangyi Wang
- Department of Radiology, Guangdong General Hospital, Guangzhou, China, 510080
| | - Guoxi Xie
- School of Basic Medical Sciences, Guangzhou Medical University, Guangzhou, China, 510182
| | - Lijuan Zhang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China, 510085
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Pavlick M, Webster CRL, Penninck DG. Bleeding risk and complications associated with percutaneous ultrasound-guided liver biopsy in cats. J Feline Med Surg 2019; 21:529-536. [PMID: 30099964 PMCID: PMC10814532 DOI: 10.1177/1098612x18788883] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
OBJECTIVES Liver biopsy is necessary for a diagnosis of liver disease; however, post-biopsy bleeding is a concern. The aim of this study was to describe the extent of bleeding and the occurrence of complications after percutaneous ultrasound-guided liver biopsy (PUGLB) in cats. METHODS The medical records of 30 cats that had a PUGLB were retrospectively reviewed. Using human guidelines, bleeding was classified as minor or major when the absolute change in packed cell volume (ΔPCV) was <0 and >-6% or ≤-6%, respectively. Complications were defined as physiologic compromise necessitating an intervention, or death. The relationship between ΔPCV and the occurrence of complications and the signalment, initial PCV, coagulation parameters, serum liver enzymes and bilirubin, number of biopsies, histological diagnosis, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration were assessed using Fisher's exact test, ANOVA and Pearson's correlation coefficient, with a P value <0.05 considered significant. RESULTS All cats had a decrease in PCV after biopsy. The mean ΔPCV was -6.9% ± 4.1%. Minor and major bleeding occurred in 13/30 (43.3%) and 17/30 (56.7%) cats, respectively, and non-lethal bleeding complications occurred in 5/30 (16.7%). Cats with complications had a lower pre-biopsy PCV ( P <0.003). Major bleeding was more likely with a diagnosis of hepatic lipidosis ( P = 0.03). There was no correlation between ΔPCV or complications and signalment, coagulation parameters, serum parameters, number of biopsies, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration. CONCLUSIONS AND RELEVANCE PUGLB is a relatively safe procedure in cats, although many cats have a subclinical decrease in PCV. As conventional coagulation tests did not predict complications or the magnitude of ΔPCV, there is a need for more sensitive indicators of bleeding risk in cats undergoing PUGLB.
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Affiliation(s)
- Michelle Pavlick
- Small Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, USA
| | - Cynthia RL Webster
- Department of Clinical Sciences, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA
| | - Dominique G Penninck
- Small Animal Internal Medicine, Cummings School of Veterinary Medicine at Tufts University, Grafton, MA, USA
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Maheux A, Purcell Y, Harguem S, Vilgrain V, Ronot M. Targeted and non-targeted liver biopsies carry the same risk of complication. Eur Radiol 2019; 29:5772-5783. [DOI: 10.1007/s00330-019-06227-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 03/29/2019] [Accepted: 04/05/2019] [Indexed: 12/16/2022]
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Cai Y, Liu D, Cui J, Sha Y, Zhou H, Tang N, Wang N, Huang A, Xia J. Diagnostic accuracy of red blood cell distribution width to platelet ratio for predicting staging liver fibrosis in chronic liver disease patients: A systematic review and meta-analysis. Medicine (Baltimore) 2019; 98:e15096. [PMID: 30946368 PMCID: PMC6455720 DOI: 10.1097/md.0000000000015096] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Red cell volume distribution width to platelet ratio (RPR), as a novel noninvasive assessment, is frequently investigated. However, the utility of RPR to evaluate the diagnostic accuracy of liver fibrosis remains controversial. We performed a meta-analysis to determine the diagnostic performance of RPR for detecting staging liver fibrosis in patients with chronic liver disease. METHODS MEDLINE, EMBASE, and Cochrane Library databases were systematically searched. Summary receiver operating characteristic curves (SROC), diagnostic odds ratios (DOR), pooled estimates of sensitivity, specificity, and likelihood ratios were used to assess the diagnostic accuracy of RPR. Meta-regression and subgroup analyses were also performed to identify factors that contributed to heterogeneity. The Quality Assessment for Studies of Diagnostic Accuracy Studies-2 tool was applied to assess the quality. RESULTS Fifteen studies with a total of 3346 patients were included in the meta-analysis. The area under the curve for SROC to summarize diagnostic accuracy of RPR for prediction of significant fibrosis, advanced fibrosis, and cirrhosis was 0.73 (standard error [SE] = 0.02), 0.83 (SE = 0.03), and 0.85 (SE = 0.04), respectively. Pooled DOR with corresponding 95% confidence interval (CI) was 4.93 (95% CI: 3.78-6.43), 10.27 (95% CI: 6.26-16.84), and 12.16 (95% CI: 5.85-25.28), respectively, using a random effects model. Meta-regression showed that length of liver biopsy specimen potentially contributed to heterogeneity. There was no significant publication bias observed across the eligible studies. CONCLUSIONS In chronic liver disease patients, RPR presented a good performance for prediction of significant fibrosis, advanced fibrosis, and cirrhosis. More future trials are required for prospective validation.
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Affiliation(s)
- Ying Cai
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University
- Department of Intensive Care Medicine, The Second Affiliated Hospital of Chongqing Medical University
| | - Dina Liu
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University
| | - Jing Cui
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University
| | - Yu Sha
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University
| | - Hengyu Zhou
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University
- College of Nursing, Chongqing Medical University, Chongqing
| | - Ni Tang
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University
| | - Na Wang
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University
| | - Ailong Huang
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University, Hangzhou, China
| | - Jie Xia
- Key Laboratory of Molecular Biology for Infectious Diseases (Ministry of Education), Institute for Viral Hepatitis, Department of Infectious Diseases, The Second Affiliated Hospital, Chongqing Medical University
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Kumar R, Teo EK, How CH, Wong TY, Ang TL. A practical clinical approach to liver fibrosis. Singapore Med J 2019; 59:628-633. [PMID: 30631885 DOI: 10.11622/smedj.2018145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Liver fibrosis is a slow, insidious process involving accumulation of extracellular matrix protein in the liver. The stage of liver fibrosis in chronic liver disease (CLD) determines overall morbidity and mortality; the higher the stage, the worse the prognosis. Noninvasive composite scores can be used to determine whether patients with CLD have significant or advanced fibrosis. Patients with low composite scores can be safely followed up in primary care with periodic reassessment. Those with higher scores should be referred to a specialist. As the epidemic of diabetes mellitus, obesity and non-alcoholic fatty liver diseases is rising, CLD is becoming more prevalent. Easy-to-use fibrosis assessment composite scores can identify patients with minimal or advanced fibrosis, and should be an integral part of decision-making. Patients with cirrhosis, high composite scores, chronic hepatitis B with elevated alanine aminotransferase and aspartate aminotransferase, or deranged liver panel of uncertain aetiology should be referred to a specialist.
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Affiliation(s)
- Rahul Kumar
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Eng Kiong Teo
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
| | - Choon How How
- Care and Health Integration, Changi General Hospital, Singapore.,Family Medicine Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
| | - Teck Yee Wong
- Department of Continuing and Community Care, Tan Tock Seng Hospital, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
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Midia M, Odedra D, Shuster A, Midia R, Muir J. Predictors of bleeding complications following percutaneous image-guided liver biopsy: a scoping review. Diagn Interv Radiol 2019; 25:71-80. [PMID: 30644369 PMCID: PMC6339629 DOI: 10.5152/dir.2018.17525] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/08/2018] [Accepted: 07/02/2018] [Indexed: 12/14/2022]
Abstract
PURPOSE Percutaneous tissue biopsy is a mainstay of diagnostic and interventional radiology, providing a minimally invasive method for diagnosing malignant and benign disease. The purpose of this review was to collect and summarize the best available evidence regarding the risk factors associated with bleeding complications in image-guided liver biopsy. METHODS A literature review was performed, searching Medline, EMBASE, CINAHL, the Cochrane Library, the National Institute for Health and Care Excellence (NICE) and Canadian Agency for Drugs and Technology in Health (CADTH) databases for any studies evaluating bleeding complications in image-guided liver biopsy. A total of 68 articles, published between January 1994 and April 2015, were reviewed in full, with 34 ultimately eligible for inclusion in the review. RESULTS Bleeding of any kind occurred in up to 10.9% of image-guided liver biopsies, with major bleeding episodes ranging from 0.1% to 4.6% and minor bleeding events occurring in up to 10.9% of biopsies. The overall rate of bleeding was, however, found to be less than 2%. Several risk factors (patient, operator, and procedure-related) were identified as potentially indicative of an increased risk of post-biopsy bleeding. Patient-related risk factors included patient age (>50 years or <2 years), inpatient status (8/12 vs. 4/12, P < 0.001), comorbidities and/or concurrent diagnoses and coagulation status (rate of bleeding was 3.3% for international normalized ratio [INR] 1.2-1.5 vs. 7.1% for INR >1.5, P < 0.001). There was no consensus on impact of operator experience (>200 biopsies/year vs. <50/year) on post-biopsy bleeding rate. Procedure-related risk factors included needle size (cutting biopsy vs. fine needle aspiration, P < 0.001) and the presence of a patent track on post-biopsy ultrasound (P < 0.001). Lastly there was no difference found between targeted vs. nontargeted biopsies and number of needle passes. CONCLUSION Reported rate of post-biopsy bleeding ranges between 0% and 10.9%, although the vast majority of studies reported bleeding rates under 2%. Several patient, operator, and procedure-related risk factors are associated with a higher risk of bleeding following liver biopsy.
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Affiliation(s)
- Mehran Midia
- From the Department of Radiology (M.M. , D.O.), McMaster University School of Medicine, Hamilton, ON, Canada; Department of Radiology (A.S.), Thunder Bay Health Sciences, Thunder Bay, ON, Canada; St Francis Health (R.M.), Topeka, Kansas, USA; Motion Research (J.M.), Ancaster, ON, Canada
| | - Devang Odedra
- From the Department of Radiology (M.M. , D.O.), McMaster University School of Medicine, Hamilton, ON, Canada; Department of Radiology (A.S.), Thunder Bay Health Sciences, Thunder Bay, ON, Canada; St Francis Health (R.M.), Topeka, Kansas, USA; Motion Research (J.M.), Ancaster, ON, Canada
| | - Anatoly Shuster
- From the Department of Radiology (M.M. , D.O.), McMaster University School of Medicine, Hamilton, ON, Canada; Department of Radiology (A.S.), Thunder Bay Health Sciences, Thunder Bay, ON, Canada; St Francis Health (R.M.), Topeka, Kansas, USA; Motion Research (J.M.), Ancaster, ON, Canada
| | - Ramin Midia
- From the Department of Radiology (M.M. , D.O.), McMaster University School of Medicine, Hamilton, ON, Canada; Department of Radiology (A.S.), Thunder Bay Health Sciences, Thunder Bay, ON, Canada; St Francis Health (R.M.), Topeka, Kansas, USA; Motion Research (J.M.), Ancaster, ON, Canada
| | - Jeffrey Muir
- From the Department of Radiology (M.M. , D.O.), McMaster University School of Medicine, Hamilton, ON, Canada; Department of Radiology (A.S.), Thunder Bay Health Sciences, Thunder Bay, ON, Canada; St Francis Health (R.M.), Topeka, Kansas, USA; Motion Research (J.M.), Ancaster, ON, Canada
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Ghadimi K, Levy JH, Welsby IJ. Perioperative management of the bleeding patient. Br J Anaesth 2018; 117:iii18-iii30. [PMID: 27940453 DOI: 10.1093/bja/aew358] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Perioperative bleeding remains a major complication during and after surgery, resulting in increased morbidity and mortality. The principal causes of non-vascular sources of haemostatic perioperative bleeding are a preexisting undetected bleeding disorder, the nature of the operation itself, or acquired coagulation abnormalities secondary to haemorrhage, haemodilution, or haemostatic factor consumption. In the bleeding patient, standard therapeutic approaches include allogeneic blood product administration, concomitant pharmacologic agents, and increasing application of purified and recombinant haemostatic factors. Multiple haemostatic changes occur perioperatively after trauma and complex surgical procedures including cardiac surgery and liver transplantation. Novel strategies for both prophylaxis and therapy of perioperative bleeding include tranexamic acid, desmopressin, fibrinogen and prothrombin complex concentrates. Point-of-care patient testing using thromboelastography, rotational thromboelastometry, and platelet function assays has allowed for more detailed assessment of specific targeted therapy for haemostasis. Strategic multimodal management is needed to improve management, reduce allogeneic blood product administration, and minimize associated risks related to transfusion.
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Affiliation(s)
- K Ghadimi
- Divisions of Cardiothoracic Anesthesiology & Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - J H Levy
- Divisions of Cardiothoracic Anesthesiology & Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
| | - I J Welsby
- Divisions of Cardiothoracic Anesthesiology & Critical Care Medicine, Duke University Medical Center, Durham, NC, USA
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Kitchin DR, del Rio AM, Woods M, Ludeman L, Hinshaw JL. Percutaneous liver biopsy and revised coagulation guidelines: a 9-year experience. Abdom Radiol (NY) 2018; 43:1494-1501. [PMID: 28929196 DOI: 10.1007/s00261-017-1319-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE To retrospectively review revised pre-procedural coagulation guidelines for percutaneous liver biopsy to determine whether their implementation is associated with increased hemorrhagic complications on a departmental scale. Secondary endpoints were to determine the effect of this change on pre-procedural blood product (FFP and platelet) utilization, to evaluate the impact of administered blood products on hemorrhagic complications, and to determine whether bleeding complications were related to INR and platelet levels. MATERIALS AND METHODS This IRB-approved, HIPAA-compliant, retrospective study reviewed 1846 percutaneous liver biopsies in 1740 patients, comparing biopsies performed, while SIR consensus pre-procedural coagulation guidelines were in place (INR ≤ 1.5, platelets ≥50,000 µL) to those performed after departmental implementation of revised, less stringent guidelines (INR ≤ 2.0, platelets ≥25,000 µL). RESULTS On a departmental scale, there were significantly fewer hemorrhagic complications in the population of patients treated after adoption of less stringent guidelines as compared to those treated under the SIR guidelines (1.6% vs. 3.4%, p = 0.0192) despite a significant decrease in pre-procedural FFP (0.8% vs. 3.9%, p < 0.001) and platelet transfusions (0.3% vs. 1.2%, p = 0.021). Individual patient hemorrhagic complication rates significantly increased as INR increased (p = 0.006) and platelet counts decreased (p = 0.004), but pre-procedural FFP (p = 0.64) and/or platelet transfusion (p = 0.5) did not have a significant impact on hemorrhagic complication rates. CONCLUSION Implementation of less stringent pre-procedural coagulation parameter guidelines for percutaneous liver biopsy (INR ≤ 2.0, platelets ≥25,000 µL) did not result in an increase in departmental hemorrhagic complication rates but did significantly decrease pre-procedural FFP/platelet administration. An individual patient's bleeding risk does increase as INR increases and platelets decrease, but pre-procedural FFP and/or platelet transfusion did not mitigate that increased risk.
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Patel NJ, Bowman AW. Assessment of Appropriate Recovery Time After Liver Biopsy. J Am Coll Radiol 2018; 15:1266-1268. [PMID: 29789231 DOI: 10.1016/j.jacr.2018.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 04/03/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Neema J Patel
- Department of Radiology, Mayo Clinic, Jacksonville, Florida
| | - Andrew W Bowman
- Department of Radiology, Mayo Clinic, Jacksonville, Florida.
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Erstad DJ, Farrar CT, Ghoshal S, Masia R, Ferreira DS, Chen YCI, Choi JK, Wei L, Waghorn PA, Rotile NJ, Tu C, Graham-O'Regan KA, Sojoodi M, Li S, Li Y, Wang G, Corey KE, Or YS, Jiang L, Tanabe KK, Caravan P, Fuchs BC. Molecular magnetic resonance imaging accurately measures the antifibrotic effect of EDP-305, a novel farnesoid X receptor agonist. Hepatol Commun 2018; 2:821-835. [PMID: 30027140 PMCID: PMC6049071 DOI: 10.1002/hep4.1193] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 02/21/2018] [Accepted: 04/04/2018] [Indexed: 12/13/2022] Open
Abstract
We examined a novel farnesoid X receptor agonist, EDP-305, for its antifibrotic effect in bile duct ligation (BDL) and choline-deficient, L-amino acid-defined, high-fat diet (CDAHFD) models of hepatic injury. We used molecular magnetic resonance imaging with the type 1 collagen-binding probe EP-3533 and the oxidized collagen-specific probe gadolinium hydrazide to noninvasively measure treatment response. BDL rats (n = 8 for each group) were treated with either low or high doses of EDP-305 starting on day 4 after BDL and were imaged on day 18. CDAHFD mice (n = 8 for each group) were treated starting at 6 weeks after the diet and were imaged at 12 weeks. Liver tissue was subjected to pathologic and morphometric scoring of fibrosis, hydroxyproline quantitation, and determination of fibrogenic messenger RNA expression. High-dose EDP-305 (30 mg/kg) reduced liver fibrosis in both the BDL and CDAHFD models as measured by collagen proportional area, hydroxyproline analysis, and fibrogenic gene expression (all P < 0.05). Magnetic resonance signal intensity with both EP-3533 in the BDL model and gadolinium hydrazide in the CDAHFD model was reduced with EDP-305 30 mg/kg treatment (P < 0.01). Histologically, EDP-305 30 mg/kg halted fibrosis progression in the CDAHFD model. Conclusion: EDP-305 reduced fibrosis progression in rat BDL and mouse CDAHFD models. Molecular imaging of collagen and oxidized collagen is sensitive to changes in fibrosis and could be used to noninvasively measure treatment response in clinical trials. (Hepatology Communications 2018;2:821-835).
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Affiliation(s)
- Derek J Erstad
- Division of Surgical Oncology, Massachusetts General Hospital Harvard Medical School Boston MA
| | - Christian T Farrar
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School Charlestown MA
| | - Sarani Ghoshal
- Division of Surgical Oncology, Massachusetts General Hospital Harvard Medical School Boston MA
| | - Ricard Masia
- Department of Pathology, Massachusetts General Hospital Harvard Medical School Boston MA
| | - Diego S Ferreira
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School Charlestown MA
| | - Yin-Ching Iris Chen
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School Charlestown MA
| | - Ji-Kyung Choi
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School Charlestown MA
| | - Lan Wei
- Division of Surgical Oncology, Massachusetts General Hospital Harvard Medical School Boston MA
| | - Phillip A Waghorn
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School Charlestown MA
| | - Nicholas J Rotile
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School Charlestown MA
| | - Chuantao Tu
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School Charlestown MA
| | - Katherine A Graham-O'Regan
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School Charlestown MA
| | - Mozhdeh Sojoodi
- Division of Surgical Oncology, Massachusetts General Hospital Harvard Medical School Boston MA
| | - Shen Li
- Division of Surgical Oncology, Massachusetts General Hospital Harvard Medical School Boston MA
| | - Yang Li
- Enanta Pharmaceuticals Watertown MA
| | | | - Kathleen E Corey
- Department of Medicine, Massachusetts General Hospital Harvard Medical School Boston MA
| | | | | | - Kenneth K Tanabe
- Division of Surgical Oncology, Massachusetts General Hospital Harvard Medical School Boston MA
| | - Peter Caravan
- Martinos Center for Biomedical Imaging, Massachusetts General Hospital Harvard Medical School Charlestown MA.,Institute for Innovation in Imaging Massachusetts General Hospital Boston MA
| | - Bryan C Fuchs
- Division of Surgical Oncology, Massachusetts General Hospital Harvard Medical School Boston MA
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Reesink KD, Hendrikx T, van Gorp PJ, Hoeks AP, Shiri-Sverdlov R. Ultrasonic Perfluorohexane-Loaded Monocyte Imaging: Toward a Minimally Invasive Technique for Selective Detection of Liver Inflammation in Fatty Liver Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:921-933. [PMID: 28990215 DOI: 10.1002/jum.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 06/06/2017] [Accepted: 07/13/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To investigate the utility of ultrasonic (US) perfluorohexane (PFH)-loaded monocyte imaging for detection of liver inflammation in fatty liver disease. METHODS C57Bl6 mice were injected intraperitoneally with tumor necrosis factor α and assessed by US PFH-loaded monocyte imaging 3 hours later. Echogenic monocytes were injected intravenously, leading to a transient increase in liver tissue intensity on a US perfusion scan. The contrast wash-out time constant was hypothesized to reflect the degree of inflammation. Next, we evaluated US PFH-loaded monocyte imaging in Ldlr-/- mice fed a 1-week high-fat/high-cholesterol diet as model for early developing nonalcoholic steatohepatitis. Adjunct analyses included tissue markers of liver inflammation. RESULTS Tumor necrosis factor α-injected mice showed a reduced wash-out time constant (mean ± SEM, 0.013 ± 0.003; n = 8) compared to controls (0.054 ± 0.009; n = 7; P = .0006), indicative of increased inflammatory adhesion molecule expression on the endothelium. The Ldlr-/- mice fed the high-fat/high-cholesterol diet showed liver inflammation, as reflected by increased (3- to 4-fold) infiltration of inflammatory cells and increased (3- to 4-fold) gene expression of tumor necrosis factor α, integrin αM, intracellular adhesion molecule, and vascular cell adhesion molecule. However, in these mice, no difference was detected in the wash-out time constant as assessed by US PFH-loaded monocyte imaging (high-fat/high-cholesterol, 0.050 ± 0.017; n = 5; chow, 0.048 ± 0.006; n = 6; P = .91). CONCLUSIONS Our results indicate that US PFH-loaded monocyte imaging is able to detect vascularly expressed inflammatory adhesion molecules in the mouse liver on direct endothelial stimulation. However, in our mouse model of early developing nonalcoholic steatohepatitis, we did not detect inflammation by this method, which may suggest that the time-dependent relationship between parenchymal and endothelial inflammation remains a fundamental issue to be addressed.
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Affiliation(s)
- Koen D Reesink
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht, the Netherlands
| | - Tim Hendrikx
- Department of Molecular Genetics, Nutrition and Toxicology Research Institute Maastricht School for Nutritional Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Patrick J van Gorp
- Department of Molecular Genetics, Nutrition and Toxicology Research Institute Maastricht School for Nutritional Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
| | - Arnold P Hoeks
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht School for Cardiovascular Diseases, Maastricht, the Netherlands
| | - Ronit Shiri-Sverdlov
- Department of Molecular Genetics, Nutrition and Toxicology Research Institute Maastricht School for Nutritional Toxicology and Metabolism, Maastricht University, Maastricht, the Netherlands
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Wadhva RK, Haque MM, Luck NH, Tasneem AA, Abbas Z, Mubarak M. Diagnostic Accuracy of Aspartate Aminotransferase to Platelet Ratio Index and Fibrosis 4 Scores in Predicting Advanced Liver Fibrosis in Patients with End-stage Renal Disease and Chronic Viral Hepatitis: Experience from Pakistan. J Transl Int Med 2018; 6:38-42. [PMID: 29607303 PMCID: PMC5874486 DOI: 10.2478/jtim-2018-0008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVES The aim was to assess the diagnostic accuracy of APRI and FIB-4 in assessing the stage of liver fibrosis in end stage renal disease (ESRD) patients with chronic viral hepatitis and to compare the two tests with standard tru-cut liver biopsy. MATERIAL AND METHODS The study was conducted at Sindh Institute of Urology and Transplantation Karachi (SIUT) from May 2010 to May 2014. All ESRD patients, being considered as candidates for renal transplantation and in whom liver biopsy was performed were included. Fibrosis stage was assessed on liver biopsy using Ishak scoring system. The serum transaminases and platelet counts were used to calculate APRI and FIB-4 scores. RESULTS Out of 109 patients, hepatitis C and B virus infections were present in 104 (95.4%) and 3(2.8%), respectively, while 2 (1.8%) patients had both infections. The mean Ishak fibrosis score was 1.95 ± 2. Advanced fibrosis was noted in 37 (34%) patients. Univariate analysis showed that advanced liver fibrosis was associated with lower platelets counts (P=0.001) and higher aspartate aminotransferase (AST) (P=0.001), alanine aminotransferase (ALT) (P=0.022), APRI score (P=0.001) and FIB-4 score (P=0.001). On logistic regression analysis, only APRI score (P < 0.001) was found to be the independent variable associated with advanced liver fibrosis. APRI score cutoff ≥1 indicating advanced fibrosis showed sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 91.9%, 90.3%, 82.9%, 95.6%, respectively with area under the curve (AUC) of 0.97. Similarly, a FIB-4 score cutoff ≥1.1 had sensitivity, specificity, PPV and NPV of 70.27%, 66.67%, 52% and 81.36%, respectively with AUC of 0.74. CONCLUSION APRI is more accurate noninvasive test for assessing advanced liver fibrosis in ESRD patients as compared to FIB-4. It can be used to obviate the need for liver biopsy in this high risk population.
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Affiliation(s)
| | | | | | | | - Zaigham Abbas
- Ziauddin Medical University Hospital, Sindh, Karachi, Pakistan
| | - Muhammad Mubarak
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Farrar CT, Gale EM, Kennan R, Ramsay I, Masia R, Arora G, Looby K, Wei L, Kalpathy-Cramer J, Bunzel MM, Zhang C, Zhu Y, Akiyama TE, Klimas M, Pinto S, Diyabalanage H, Tanabe KK, Humblet V, Fuchs BC, Caravan P. CM-101: Type I Collagen-targeted MR Imaging Probe for Detection of Liver Fibrosis. Radiology 2017; 287:581-589. [PMID: 29156148 DOI: 10.1148/radiol.2017170595] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Purpose To evaluate the biodistribution, metabolism, and pharmacokinetics of a new type I collagen-targeted magnetic resonance (MR) probe, CM-101, and to assess its ability to help quantify liver fibrosis in animal models. Materials and Methods Biodistribution, pharmacokinetics, and stability of CM-101 in rats were measured with mass spectrometry. Bile duct-ligated (BDL) and sham-treated rats were imaged 19 days after the procedure by using a 1.5-T clinical MR imaging unit. Mice were treated with carbon tetrachloride (CCl4) or with vehicle two times a week for 10 weeks and were imaged with a 7.0-T preclinical MR imaging unit at baseline and 1 week after the last CCl4 treatment. Animals were imaged before and after injection of 10 µmol/kg CM-101. Change in contrast-to-noise ratio (ΔCNR) between liver and muscle tissue after CM-101 injection was used to quantify liver fibrosis. Liver tissue was analyzed for Sirius Red staining and hydroxyproline content. The institutional subcommittee for research animal care approved all in vivo procedures. Results CM-101 demonstrated rapid blood clearance (half-life = 6.8 minutes ± 2.4) and predominately renal elimination in rats. Biodistribution showed low tissue gadolinium levels at 24 hours (<3.9% injected dose [ID]/g ± 0.6) and 10-fold lower levels at 14 days (<0.33% ID/g ± 12) after CM-101 injection with negligible accumulation in bone (0.07% ID/g ± 0.02 and 0.010% ID/g ± 0.004 at 1 and 14 days, respectively). ΔCNR was significantly (P < .001) higher in BDL rats (13.6 ± 3.2) than in sham-treated rats (5.7 ± 4.2) and in the CCl4-treated mice (18.3 ± 6.5) compared with baseline values (5.2 ± 1.0). Conclusion CM-101 demonstrated fast blood clearance and whole-body elimination, negligible accumulation of gadolinium in bone or tissue, and robust detection of fibrosis in rat BDL and mouse CCl4 models of liver fibrosis. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Christian T Farrar
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Eric M Gale
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Richard Kennan
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Ian Ramsay
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Ricard Masia
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Gunisha Arora
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Kailyn Looby
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Lan Wei
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Jayashree Kalpathy-Cramer
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Michelle M Bunzel
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Chunlian Zhang
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Yonghua Zhu
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Taro E Akiyama
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Michael Klimas
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Shirly Pinto
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Himashinie Diyabalanage
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Kenneth K Tanabe
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Valerie Humblet
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Bryan C Fuchs
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
| | - Peter Caravan
- From the Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth St, Suite 2301, Charlestown, MA 02129 (C.T.F., E.M.G., I.R., J.K., P.C.); Merck Research Laboratories, Kenilworth, NJ (R.K., M.M.B., C.Z., Y.Z., T.E.A., M.K., S.P.); Collagen Medical, Belmont, Mass (I.R., H.D., V.H.); Departments of Pathology (R.M.) and Surgical Oncology (G.A., K.L., L.W., K.K.T., B.C.F.), Massachusetts General Hospital Cancer Center and Harvard Medical School, Boston, Mass; and Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Mass (P.C.)
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Arslanow A, Baum C, Lammert F, Stokes CS. Nichtinvasive Früherkennung von Lebererkrankungen im Rahmen der betrieblichen Gesundheitsförderung. ZENTRALBLATT FUR ARBEITSMEDIZIN ARBEITSSCHUTZ UND ERGONOMIE 2017. [DOI: 10.1007/s40664-017-0187-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Yang ZX, Liang HY, Hu XX, Huang YQ, Ding Y, Yang S, Zeng MS, Rao SX. Feasibility of histogram analysis of susceptibility-weighted MRI for staging of liver fibrosis. Diagn Interv Radiol 2017; 22:301-7. [PMID: 27113421 DOI: 10.5152/dir.2016.15284] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE We aimed to evaluate whether histogram analysis of susceptibility-weighted imaging (SWI) could quantify liver fibrosis grade in patients with chronic liver disease (CLD). METHODS Fifty-three patients with CLD who underwent multi-echo SWI (TEs of 2.5, 5, and 10 ms) were included. Histogram analysis of SWI images were performed and mean, variance, skewness, kurtosis, and the 1st, 10th, 50th, 90th, and 99th percentiles were derived. Quantitative histogram parameters were compared. For significant parameters, further receiver operating characteristic (ROC) analyses were performed to evaluate the potential diagnostic performance for differentiating liver fibrosis stages. RESULTS The number of patients in each pathologic fibrosis grade was 7, 3, 5, 5, and 33 for F0, F1, F2, F3, and F4, respectively. The results of variance (TE: 10 ms), 90th percentile (TE: 10 ms), and 99th percentile (TE: 10 and 5 ms) in F0-F3 group were significantly lower than in F4 group, with areas under the ROC curves (AUCs) of 0.84 for variance and 0.70-0.73 for the 90th and 99th percentiles, respectively. The results of variance (TE: 10 and 5 ms), 99th percentile (TE: 10 ms), and skewness (TE: 2.5 and 5 ms) in F0-F2 group were smaller than those of F3/F4 group, with AUCs of 0.88 and 0.69 for variance (TE: 10 and 5 ms, respectively), 0.68 for 99th percentile (TE: 10 ms), and 0.73 and 0.68 for skewness (TE: 2.5 and 5 ms, respectively). CONCLUSION Magnetic resonance histogram analysis of SWI, particularly the variance, is promising for predicting advanced liver fibrosis and cirrhosis.
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Affiliation(s)
- Zhao Xia Yang
- Department of Radiology, Zhongshan Hospital of Fudan University and Shanghai Institute of Medical Imaging, Shanghai, China.
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Abstract
The state of clinical art of the coagulopathy of cirrhosis changed considerably over the last decade. Until 2005, cirrhosis was considered as the epitome of the hemorrhagic coagulopathies and the abnormal hemostasis tests associated with the disease were corrected with infusion of fresh frozen plasma or platelets to minimize the risk of bleeding. Since that time, a great deal of work has been done and there is now a change of paradigm. The prothrombin time once considered as an isolated measure of bleeding risk was rejected, and cirrhosis shifted from a purely hemorrhagic construct to a mixed and thrombosis-prone paradigm. In this article we examine the interesting history of how these conceptual changes came about.
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50
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Andrade S, Bartels DB, Lange R, Sandford L, Gurwitz J. Safety of metamizole: a systematic review of the literature. J Clin Pharm Ther 2016. [DOI: '10.1111/jcpt.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Affiliation(s)
- S. Andrade
- Meyers Primary Care Institute and University of Massachusetts Medical School; Worcester MA USA
| | - D. B. Bartels
- Corporate Department Global Epidemiology; Boehringer Ingelheim GmbH; Ingelheim am Rhein Germany
- Institute of Epidemiology; Social Medicine and Health Systems Research; Hannover Medical School; Hannover Germany
| | - R. Lange
- Consumer Health Care Development, Medicine, and Regulatory Affairs; Boehringer Ingelheim GmbH; Ingelheim am Rhein Germany
| | - L. Sandford
- Meyers Primary Care Institute and University of Massachusetts Medical School; Worcester MA USA
| | - J. Gurwitz
- Meyers Primary Care Institute and University of Massachusetts Medical School; Worcester MA USA
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