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Abstract: The effect of carvacrol (CAR) on oxidative stress, inflammation, and liver dysfunction induced by lipopolysaccharide (LPS) was explored. The rats (n=40) were daily injected (2 weeks) by saline as control, LPS (1 mg/kg, i.p.), and 25, 50 or 100 mg/kg CAR (i.p.) before LPS. LPS increased aspartate transaminase (AST: 162±13 U/L), alanine aminotransferase (ALT: 74.6±2.15 U/L), alkaline phosphatase (ALK-P: 811±51 U/L), interlukine-1β (IL-1β: 1254±51 pg/g tissue), malondialdehyde (MDA: 32±1.09 nM/g tissue), and nitric oxide (NO: 224±13.5 nM/g tissue) (P

The effect of periodic exposure to formaldehyde in the Anatomy laboratory on some liver function indices in fifteen male wistar rats divided into three groups of A,B and C with 5 animals in each group were investigated. Group A served as control with nil exposure while groups B and C were the test groups with 5 months exposure on non-dissection days and dissection days respectively. Formaldehyde air level was measured both at experimental and control sites. Some liver function indices measured include Alanine aminotransferase (ALT), Aspartate aminotransferase (AST) and alkaline phosphatase (ALP). Statistical analysis was done using Graph Pad Prism version 5.0. Results were presented as Mean ± SEM. Analysis of Variance was used to compare the means of test and control values while post hoc test was done using Student Newman Keul’s test and a P-value of less than 0.05 was considered as statistically significant. Results revealed significant increase in formaldehyde air level in the dissection hall. There was observable increase in ALT, AST and ALP but they were not significant. It was therefore concluded that periodic exposure to formaldehyde may not have any harmful effect on liver function in wistar rats.

The Child-Pugh score is widely used to assess liver function and estimate drug clearance in patients with liver cirrhosis. Recently, the albumin-bilirubin (ALBI) score, which objectively assesses liver function based only on albumin and total bilirubin levels, was developed as a new method. The purpose of this study was to analyze the relationship between the liver function assessment method and the plasma concentration of voriconazole (VRCZ), an antifungal drug for patients with liver cirrhosis. This single-center retrospective study enrolled 159 patients who received VRCZ between 2012 and 2020. In patients administered VRCZ orally, the median concentration to dose (C : D) ratio increased with the progression of Child-Pugh and ALBI grades. Positive correlations between the ALBI score and VRCZ C : D ratio were observed in patients with cirrhosis (r = 0.52 (95% confidence interval, 0.069-0.79); p < 0.05). In addition, a highly negative correlation was observed between the ALBI score and VRCZ daily maintenance dose (r=-0.79 (95% confidence interval, -0.92 to -0.50); p < 0.0001). In contrast, for patients administered VRCZ intravenously, no increase in C : D ratio was observed for both Child-Pugh and ALBI scores compared to the non-liver cirrhosis group. This may be because the injection is often used in severely ill patients, and factors other than impaired liver function may affect the plasma concentrations of VRCZ. In conclusion, the ALBI score was shown to be useful in predicting VRCZ clearance as well as the Child-Pugh score, and the initial dose of VRCZ might be determined according to the ALBI score.

Aims Royal jelly, a creamy substance secreted by honeybees, has been reported to have beneficial effects against dyslipidemia and metabolic syndrome. However, the effects of royal jelly on atherogenesis remain unknown. Hence, we prospectively evaluated whether royal jelly augments vascular endothelial function, which can reflect early atherogenesis, in healthy volunteers. Methods This was a single-center, double-blind, 1:1 randomized placebo-controlled study conducted from October 2018 to December 2019. A total of 100 healthy volunteers were randomly assigned to receive either royal jelly 690 mg or placebo daily for 4 weeks. The primary endpoint was augmentation in vascular endothelial function as assessed using the change in the reactive hyperemia peripheral arterial tonometry index (RH-PAT) index, and the secondary endpoints were the changes in liver function and lipid profiles between baseline and 4 weeks after enrollment. Results The mean age of the participants was 35.0±9.3 years in the placebo group and 36.1±9.1 years in the royal jelly groups; 45% and 50% of the placebo and the royal jelly groups, respectively, were male. The percentage relative change in the RH-PAT index was significantly higher in the royal jelly group than in the placebo group (21.4%±53.1% vs. 0.05%±40.9%, P=0.037). The percentage relative changes in alanine aminotransferase and γ-glutamyl transpeptidase were significantly lower in the royal jelly group than in the placebo group (alanine aminotransferase: -6.06%±22.2% vs. 11.6%±46.5%, P=0.02; γ-glutamyl transpeptidase: -3.45%±17.8% vs. 4.62%±19.4%, P=0.045). Lipid profiles were not significantly different between the two groups. Conclusions Royal jelly might have antiatherogenic property by improving vascular endothelial function. It also augmented liver functions in healthy volunteers.

Spontaneous hematoma of the iliopsoas muscle is rare but may cause limitation of hip flexion and functional inability of the affected limb, mimicking avascular necrosis of the femoral head in patients with alcoholic liver cirrhosis. We report a rare case of spontaneous iliopsoas hematoma that caused a positive Patrick's sign and mimicked avascular necrosis in a patient with alcoholic liver cirrhosis. A 35-year-old female presented with left inguinal pain and limitation of motion. She had a history of alcoholic liver cirrhosis. On physical examination, Patrick's sign was positive, suggestive of hip joint pathology. The Child-Pugh score was 9 and an acute decline in hemoglobin level was noted. Computed tomography scan of the abdomen indicated a 20-cm-sized hematoma along the left iliopsoas muscle. Because the patient's liver function was poor and there was no evidence of active bleeding from the iliopsoas muscle, a conservative treatment option was taken. On follow-up computed tomography one month later, the size of the hematoma decreased to 3.3 cm. Although avascular necrosis occurs frequently in patients with chronic alcohol intake, clinicians should be aware of iliopsoas muscle hematoma mimicking avascular necrosis as a clinically important bleeding complication of alcoholic liver cirrhosis patients to avoid delays in diagnosis and treatment.

Objectives Renal failure and hepatic cirrhosis are mutually aggravating factors. However, no specific therapeutic strategies for hepatic encephalopathy (HE) and end-stage kidney disease have been established. The coexistence, with an extremely poor prognosis, makes randomized controlled trials unfeasible. We evaluated whether an infusion of branched-chain amino acids was associated with mortality in patients hospitalized for HE and end-stage kidney disease. Design and Methods Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified patients with HE and end-stage kidney disease who received hemodialysis within 2 days of admission from July 2011 to March 2017. We divided the patients into those who received branched-chain amino acid infusion within 2 days of admission and those who did not. We conducted analyses using overlap weights based on propensity scores to compare in-hospital mortality between the groups. Sub-group analysis was conducted by stratifying patients by Child-Pugh class. Results We identified 553 eligible patients, including 503 patients who received branched-chain amino acid infusion and 50 who did not. The patients who received branched-chain amino acid infusion had lower mortality than those who did not (10.2% vs. 20.1%, relative risk 0.51, 95% confidence interval 0.27-0.95). Sub-group analysis showed that branched-chain amino acid infusion was associated with decreased in-hospital mortality in patients with Child-Pugh class C (16.2% vs. 39.0%, relative risk 0.41, 95% confidence interval 0.23-0.76). Conclusions Branched-chain amino acid infusion may improve the prognosis of HE in patients with end-stage kidney disease, particularly those with lower liver function. Further research is necessary to provide a suitable treatment for HE in patients with end-stage kidney disease.

Application of phytobiotic and probiotic in poultry production can positive effect on performance and produce healthy protein source for human. In this study, the effects of one commercial probiotic and phytobiotic was evaluated on chicken performance. Totally, 300 chicks were divided into 4 groups that fed basal diet, diet containing probiotic (Protexin), phytobiotic (AE), and probiotic (Protexin) plus phytobiotic (AE) in all over the growing period. The growth indices were measured weekly and analyzed in 21 and 42 days of age. At the 42 days of age, blood samples were collected from all chickens. The concentration of liver enzymes, lipid profiles and antioxidant status were measured in blood samples. Results showed that the weight gain was significantly higher and FCR significantly lower in chickens received probiotic, or probiotic plus phytobiotic in comparison with chickens received phytobiotic and control chickens (p

Background: Treatment of diabetes mellitus (DM) using plant based drugs is advancing and getting much attention in recent years. Cassia auriculata L. is widely used in Indian folk medicine for the treatment of DM. Site-specific targeted plant drug delivery by metallic nanoparticles carriers is a new emerging procedure under research due to its enhanced bioavailability and reduced toxicity. This study was therefore aimed at biosynthesizing a new silver nanoparticle of Cassia auriculata L. flower extract and study its anti-diabetic efficiency in rats. Methods: The silver nanoparticles were biosynthesized using AgNO3 solution and characterized by spectroscopy, SEM and EDAX analyses. The acute toxicity of this nano-preparation (up to 2000 mg/kg b. wt) was analyzed in rats and the anti-diabetic efficiency (for 50 mg/kg.b.wt and 200 mg/kg.b.wt) was studied in Streptozotocin induced diabetic rats. The diabetic parameters such as; blood glucose, serum protein, liver glycogen, serum lipid profile, serum levels of creatinine, urea, ALT, AST and ALP were analyzed. The histology of the liver, kidney and pancreas was evaluated after staining with Haematoxylin and Eosin. Results: The increased blood glucose in Streptozotocin induced diabetic rats was found to be significantly reduced (p Conclusion: The results of this study, proving an efficient anti-diabetic activity of the biosynthesized silver nanoparticles of Cassia auriculata L. flower extract, implies that this nano-preparation may be exploited as an alternative biopharmaceutical agent for treating DM.

A 77-year-old woman presented with a 2-week history of malaise, prostration, anorexia, abdominal pain, vomiting and diarrhoea. She had been taking systemic corticosteroids for the past year. During hospitalisation, renal insufficiency, ionic changes and liver function abnormalities were detected and corrected. However, the patient developed total dysphagia. UGE revealed multiple shallow ulcers below the cricopharyngeal level and in the distal oesophagus, with normal-appearing intervening mucosa. Histological examination allowed the diagnosis of herpes simplex virus esophagitis. Treatment with intravenous acyclovir was instituted for 14 days. In the elderly, herpetic esophagitis may present with non-specific complains, such as prostration or anorexia. In the reported case, dysphagia was only detected as a late symptom, addressing the importance of maintaining a high degree of suspicion for the diagnosis of herpes simplex virus esophagitis.

A 23-year-old primigravida presented to the emergency department with reports of headache. On examination, her blood pressure was found to be 190/140 mm Hg. Her laboratory results were notable for proteinuria, deranged liver function and low platelets. She was diagnosed with HELLP syndrome and was delivered via caesarean section. She noticed diminution of vision 2 days after delivery. Fundus examination revealed bilateral serous retinal detachment involving the maculae. She was managed conservatively and had complete recovery of her vision by 3 weeks postpartum.

Since the end of 2019, a new disease outbreak has been spreading worldwide, after starting from Wuhan, China. The viral pathogen responsible for the disease was named as SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2), and for the illness the acronym COVID-19 was coined (COronaVIrus Disease 2019). Viral pathogenesis, epidemiology, and clinics are still somewhat obscure, when occurring during childhood the most. This systematic review aims at evaluating the features of liver involvement and damage in course of COVID-19. An insight into what is known as to COVID-19 and hepatic damage in adulthood as well as paediatric age was given. All the most relevant papers up to 15/10/2020 were identified and discussed. Establishing whether liver damage is due to a direct viral action or host immune system inflammatory reaction or consequence of the administered drugs or secondary to another organ failure (for example the heart) is difficult. What is sure is the fact that liver function should be checked at the time of admission to hospital and during hospitalization. If hepatic markers are altered, a specific therapy to protect liver is needed.

Autoimmune hepatitis (AIH) is a chronic and progressive inflammatory process of the liver, with standard treatments including prednisone, azathioprine, and ultimately liver transplant. While there are many integrative and ayurvedic treatment options that have been shown to be helpful for other liver diseases, there are no studies that have been performed to evaluate these therapies particularly in AIH with cirrhosis. We detail the case of a 55-year-old female with cirrhosis in the setting of AIH placed on a liver transplant list after being treated with conventional therapies. She was started on various nutritional supplements and ayurvedic treatments which resulted in a significant decrease in her Model for End-Stage Liver Disease score, which was sustained at 7 months. This is the first case report to our knowledge detailing an integrative approach to cirrhosis in the setting of AIH showing such an improvement in liver function.

Any oncological treatment must aim at maximizing patient survival with the best quality of life and not merely at eliminating the tumor. Since the liver has a vital function, any radical treatment severely compromising liver function will result in a shortening of life expectancy, rather than a prolongation. Furthermore, even non-severe liver damage may imply the risk of impeding the opportunity to receive further effective therapies. This is particularly important in the case of hepatocellular carcinoma (HCC), since this tumor is associated with underlying cirrhosis in the majority of patients, and cirrhosis itself is not only a potentially lethal disease and independent prognostic factor in HCC, but it also makes liver function fragile. Accordingly, some information about liver dysfunction is included in most staging systems for HCC, in an attempt to suggest treatments that the functional liver reserve can adequately tolerate. Unfortunately, the prediction of functional liver damage in the case of antitumor treatments is very challenging and still suboptimal in any given specific patient. Moreover, while the assessment of the functional reserve has been sufficiently elucidated in the surgical setting to avoid postoperative liver failure, it has instead been less clarified for non-surgical therapies, despite the fact that this aspect appears to have become of particular relevance today, when several lines of effective non-surgical treatments, including systemic therapies, have become available. The present article will a) critically review the implications of the assessment of liver functional reserve in patients with HCC, b) illustrate the different available tools to assess the liver functional reserve and c) discuss the role of functional assessment in the setting of each type of non-surgical therapy for HCC.

Background and purpose: Asparagus contains different bioactive and volatile components including pyrazines, sulphur-containing compounds, and polyphenols. Asparagus juice is a new low-calorie LAB-containing natural juice product, the usage of which is expanding. Pyrazines and sulphur-containing compounds are degraded by bacteria on one hand, but on the other hand, dietary polyphenols prevent human colorectal diseases as modulators of the composition and/or activity of gut microbiota. However, the utility of these asparagus compounds for reversal of age-associated microbial dysbiosis and the immunometabolic disorders that dysbiosis incites body inflammatory reactions was not much explored so far. Hence, using middle-aged mice, we conducted the current study to verify the effect of freshly squeezed domestic white asparagus juice on the biomarkers reflecting immuno-metabolic pathways linking age-related dysbiosis and metabolic events. Materials and Methods: Thirty-two conventional Harlan Laboratories C57BL/6 mice aged between 11-12 months were randomly divided into two groups (n=16). Mice in control group 1 received sterile tap water. Animals in group 2 had 60 days ad libitum free-choice access to sterile tap water supplemented with 5% (v/v) freshly squeezed domestic white asparagus juice. Clinical signs of general health, hydration, and inflammation were monitored daily. Caecal content samples were analysed by qPCR for microbial composition. Histology of relevant organs was carried out on day 60 after sacrificing the mice. Universal markers of metabolic- and liver function were determined in serum samples. Caecal SCFAs contents were measured using HPLC. Results: Overall, no significant differences in general health or clinical signs of inflammation between the two groups were observed. The liver to body weight ratio in asparagus juice-drank mice was lowered. The qPCR quantification showed that asparagus juice significantly decreased the caecal Clostridium coccoides group while causing an enhancement in Clostridium leptum, Firmicutes, and bifidobacterial groups as well as total caecal bacterial count. Asparagus juice significantly elevated the caecal contents of SCFAs. Enhanced SCFAs (acetate, butyrate, and propionate) in mice receiving asparagus juice, however, did coincide with altered lipid levels in plasma or changes in the abundance of relevant bacteria for acetate-, butyrate-, and propionate production. Discussion: To the best of our knowledge, this is the first study aiming at evaluating the effect of freshly squeezed German domestic white asparagus juice on universal markers of metabolic- and liver function in middle-aged mice and the role of gut microbiota in this regard. The effectiveness of asparagus juice to improve metabolism in middle-aged mice was associated with alterations in intestinal microbiota but maybe also due to uptake of higher amounts of SCFAs. Conclusion: Hence, the key signal pathways corresponding to improved immune-metabolic homeostasis will be an important research scheme in the future.

Objective Mapping the long-term prognosis of Budd-Chiari syndrome (BCS) is difficult, as the prognosis is associated with changes in the liver function. The present study evaluated the time course changes in the liver function in a treatment group with percutaneous old balloon angioplasty (POBA) and a non-treatment group using the albumin-bilirubin score (ALBI) and Child-Pugh score during long-term follow-up. Methods In this retrospective study, 13 consecutive patients diagnosed with BCS at our hospital between 2007 and 2020 were categorized into a treatment group (n=8), which received POBA, and a non-treatment group (n=5). Differences in the liver function in the ALBI and Child-Pugh scores between the initial visit and one- and three-year follow-up were calculated and statistically evaluated. We investigated the changes in the liver function during the long-term follow-up, including events such as re-stenosis and re-treatment. Results While the Child-Pugh scores in the treatment group did not differ significantly between the initial visit and 1- or 3-year follow-up, the ALBI scores in this group improved significantly between the initial visit and the 1- or 3-year follow-up visit (p=0.0078 and 0.0156, respectively). The liver function according to the ALBI score in the treatment group showed gradual improvement from the initial value but gradual worsening in the non-treatment group. The ALBI scores also revealed that the liver function varies according to re-stenosis and re-POBA in BCS patients. Conclusion Unlike the Child-Pugh score, the ALBI score was able to capture changes in the liver function of BCS patients during the long-term course of BCS.

Background/objective Complete resection is the most effective treatment of hilar cholangiocarcinoma (HC) but may result in high morbidity and mortality. Most HC patients have jaundice, and preoperative biliary drainage may reduce their risk of obstructive jaundice. ERCP and PTBD have been advocated for this purpose. This retrospective study investigated the influence of ERCP versus PTBD versus their combination on the short-term outcomes of curative HC resection. Methods Patients having curative HC resection with preoperative biliary drainage in a span of 26 years were reviewed and divided into groups according to drainage modality. Drainage-related and surgical complications and hospital mortality were compared between groups. Intention-to-treat analysis using a separate set of initial drainage data was performed. Results Eighty-six patients were divided into: Group A, ERCP only, n = 32 (32/86 = 37.2%); Group B, PTBD only, n = 10 (10/86 = 11.6%); Group C, ERCP + PTBD, n = 44 (44/86 = 51.2%). International normalized ratio was significantly higher in Group B (p = 0.008). The three groups were comparable in operative details, hospital stay, and mortality. Fifty-two patients had postoperative complications. Significantly more patients in Groups A and C had subphrenic abscess (A: 25%, B: 0%, C: 9.1%; p = 0.035) and subsequent radiological drainage. Group A had insignificantly more patients with wound infection (31.3% vs 10% vs 22.7%, p = 0.334), chest infection (28.1% vs 20% vs 11.4%, p = 0.178), and urinary tract infection (6.3% vs 0% vs 0%, p = 0.133). The three groups had similar rates of major complications (p = 0.501). They also had comparable survival outcomes (overall, p = 0.370; disease-free, p = 0.569). Fifteen and 71 patients received PTBD and ERCP respectively as first drainage mode. These two groups were comparable in liver function, preoperative comorbidity, intraoperative details, and postoperative outcomes. Conclusion In the preoperative management of HC, the use of ERCP, PTBD or their combination is acceptable and can optimize patients' condition for curative HC resection.

BACKGROUND: Critically ill patients commonly suffer from infections that require antimicrobial therapy. In previous studies, liver dysfunction was shown to have an essential impact on the dose selection in these patients. This pilot study aims to assess the influence of liver dysfunction, measured by the novel LiMAx test, on clinical outcomes in critically ill patients treated with linezolid. METHODS: Twenty-nine critically ill patients were included and treated with linezolid. Indications for linezolid therapy were secondary or tertiary peritonitis (46.7%), bloodstream infection (6.7%) and 46.7% were other infections with gram-positive bacteria. Linezolid Cmin, maximal liver function capacity (LiMAx test) and plasma samples were collected while linezolid therapy was in a steady-state condition. Furthermore, potential factors for the clinical outcome were investigated using logistic regression analysis. Clinical cure was defined as the resolution or significant improvement of clinical symptoms without using additional antibiotic therapy or intervention. RESULTS: Cured patients presented lower median linezolid Cmin yet a significantly higher mean LiMAx-value compared to the clinical failure group (1.9 mg/L vs. 5.1 mg/L) (349 μg/kg/h vs. 131 μg/kg/h). In the logistic regression model, LiMAx < 178 μg/kg/h was the only independent predictor of clinical failure with a sensitivity of 77% and specificity of 93%. CONCLUSIONS: The LiMAx test predicts clinical failure more precisely than linezolid trough levels in critically ill surgical patients. Therefore liver failure may have a stronger impact on the outcome of critically ill surgical patients than low linezolid Cmin. While linezolid Cmin failed to predict patient’s outcome, LiMAx results were the only independent predictor of clinical failure.

BACKGROUND/OBJECTIVES: Cirrhosis of liver is associated with loss of liver function, portal hypertension, and pancreatic β-cell dysfunction leading to hepatogenous diabetes (HD). Often HD is an underestimated and understudied problem, particularly in the Indian subcontinent, where the prevalence of both Chronic liver disease (CLD) and diabetes is high. Hence this study was planned to highlight the prevalence of HD and its association with the severity of cirrhosis. METHODS: A total of 121 cirrhotic patients without a history of diabetes were included in this prospective cross-sectional study. Seventy five g oral glucose tolerance test (OGTT) was done in all patients. Fasting serum insulin levels were done to calculate insulin resistance (IR) using homeostatic model assessment-insulin resistance (HOMA-IR). Upper gastrointestinal endoscopy was done to detect varices. Patients were divided into HD group and non-HD group for comparison of results. RESULTS: HD was seen in 52 (42.98%) patients; among them, 63.4% did not show evidence of HD by fasting plasma glucose (FPG) levels. Impaired glucose tolerance (IGT) was seen in 58 (47.93%) patients. Compared with the non-HD group, the HD group had significantly higher model for end-stage liver disease (MELD) score (P = 0.038), HOMA-IR (P 15), CTP score (>10), higher bilirubin levels, large varices, bleeding varices, and HCC. FPG levels and glycated hemoglobin (HbA1c) cannot be relied upon, and OGTT aids in the unmasking of HD in these patients.

To extend previous molecular analyses of rejection in liver transplant biopsies in the INTERLIVER study (ClinicalTrials.gov #NCT03193151), the present study aimed to define the gene expression selective for parenchymal injury, fibrosis, and steatohepatitis. We analyzed genome-wide microarray measurements from 337 liver transplant biopsies from 13 centers. We examined expression of genes previously annotated as increased in injury and fibrosis using principal component analysis (PCA). PC1 reflected parenchymal injury and related inflammation in the early posttransplant period, slowly regressing over many months. PC2 separated early injury from late fibrosis. Positive PC3 identified a distinct mildly inflamed state correlating with histologic steatohepatitis. Injury PCs correlated with liver function and histologic abnormalities. A classifier trained on histologic steatohepatitis predicted histologic steatohepatitis with cross-validated AUC = 0.83, and was associated with pathways reflecting metabolic abnormalities distinct from fibrosis. PC2 predicted histologic fibrosis (AUC = 0.80), as did a molecular fibrosis classifier (AUC = 0.74). The fibrosis classifier correlated with matrix remodeling pathways with minimal overlap with those selective for steatohepatitis, although some biopsies had both. Genome-wide assessment of liver transplant biopsies can not only detect molecular changes induced by rejection but also those correlating with parenchymal injury, steatohepatitis, and fibrosis, offering potential insights into disease mechanisms for primary diseases.

ABO-incompatible living donor liver transplantation (ABOi-LDLT) is on the rise as a viable option in countries with limited access to deceased donor grafts. While reported outcomes of ABOi-LT in children are similar to ABO- Compatible liver transplant (ABOc-LT), most children beyond 1–2 years of age will need desensitization to overcome the immunological barrier of incompatible blood groups. The current standard protocol for desensitization is Rituximab that targets B lymphocytes and is given 2–3 weeks prior to LT. However, this timeline may not be feasible in children requiring emergency LT for acute liver failure (ALF) or acute-on-chronic liver failure (ACLF). In this emergency situation of ABOi-LT, a safe multipronged approach may be an acceptable alternative solution. We report a child with acute Wilson’s disease with rapidly deteriorating liver function who underwent a successful ABOi-LDLT using a rapid desensitization protocol.

Objective To investigate the association of the maternal serum albumin (MAlb) level with fetal growth and fetal growth restriction (FGR) risk in term-born singletons. Design Prospective cohort study. Setting Four hospital maternity units of the Tongji Maternal and Child Health Cohort study initiated from September 2013 to April 2016 at Wuhan City, in central China. Patient(s) A total of 3,065 mother–offspring pairs. Intervention(s) None. Main Outcome Measure(s) Fetal growth was evaluated by birth weight (BW) and birth length. Fetal growth restriction was defined as BW below the 10th percentile. Result(s) All MAlb levels were within the upper limit of normal. After adjustment for liver function parameters, inflammatory indicators, and others, a reverse U-shaped relationship between MAlb and fetal growth was observed. Specifically, BW increased significantly with an increasing MAlb level when the MAlb level was 36.1 g/L (per g/L: β = −15.1; 95% CI, −21.2, −8.9). There was a similar association between MAlb and birth length. Furthermore, the adjusted odd ratios of FGR across increasing tertiles of the MAlb levels were 1.0 (reference), 1.1 (0.7, 1.8), and 1.7 (1.0, 2.6). Conclusion(s) There was a reverse U-shaped association between MAlb and fetal growth. A higher MAlb level was associated with an increased risk of FGR. Clinical Trial Registration Number NCT03099837.

The study aimed to evaluate the effective role of Bacillus clausii on immunity and hepato-protection in broiler chickens. Total one hundred and twenty (1 2 0) day-old broiler chicks were alienated into four groups as group-A (Control), group-B {0.01 ml/ L (4 × 106 Spore)}, group-C {0.02 ml/ L (8 × 106 Spore)} and group-D {0.03 ml/ L (12 × 106 Spore)}. Each group was consisting of 3 replicate per group (10 birds/replicate). Immunization of birds was performed according to standard vaccination schedule of broiler chicks during the trial period of 35 days. The Serum biochemical parameters analyzed were liver function tests like Alanine aminotransferase (ALT), Aspartate aminotransferase (AST), the total proteins and alkaline phosphates (ALP). Similarly the Humoral antibody titers of Newcastle Disease (ND) Immunoglobulin-M (IgM), Immunoglobulin-G (IgG) and Immunoglobulin-A (IgA) were also determined. The results showed that Bacillus clausii supplementation @ 0.03 ml/L significantly maintained the liver biomarkers (AST, ALT and ALP) at normal level as compared to control and other treated groups. Immuno-globulins (G, M and A) level was significantly elevated with highest supplementation (0.03 ml/L). No significant (p > 0.05) changes were observed for antigen specific antibody titer against ND. In conclusion, supplementation of Bacillus clausii @ 0.03 ml/L as probiotic in drinking water significantly improved the liver function and humoralimmunity of broiler chicks.

Background Both microwave ablation and robot-assisted hepatectomy are representative minimally invasive treatments for early hepatocellular carcinoma. Our study compares the practicability and medium-term therapeutic efficacy between them. Methods Patients with early HCC treated by MWA or RH from 2013 to 2019 were included. Propensity score matching (PSM) and inverse probability of treatment weight (IPTW) were used to minimize baseline imbalance. Operation trauma, postoperative recovery, complications, cost and oncological efficacy were compared. Results 401 patients with a median follow-up of 28 months were included (MWA n = 240; RH n = 161). After PSM, 3-year recurrence-free survival (RFS), overall survival (OS) and cancer-specific survival (CSS) of MWA group and RH group were 52.2% vs 65.8%, 91.5% vs 91.3% and 91.5% vs 91.3%, respectively. OS and CSS were comparable (p = 0.44 and 0.96), while RFS of MWA was slightly lower but not significant (p = 0.097). The above results after IPTW followed the same trend. After PSM, MWA showed advantages in operation time and blood loss, while RH performed better in postoperative liver function. There was no significant difference in incidence of severe complications between two groups. Conclusions For early HCC parents, both treatments can achieve good, safe and comparable medium-term therapeutic effects. MWA is more minimally invasive, while RH has better accuracy and causes less damage to liver parenchyma.

The objective of the study — to assess the correlation between resistin and indexes of the functional state of the liver in patients with non-alcoholic fatty liver disease (NAFLD), type 2 diabetes mellitus (DM) and with their combination. Materials and methods. 110 patients were examined, among them 20 patients with NAFLD, 20 patients with DM type 2 and 70 patients with comorbidity (NAFLD + DM type 2), they were divided into 2 subgroups — 20 patients with normal body weight and 50 obese patients. The control group consisted of 20 apparently healthy individuals. Comprehensive clinical, laboratory (with determination of indicators of protein, pigment, enzyme and carbohydrate metabolism, resistin level), instrumental (ultrasound of the liver and liver biopsy (8 patients)) examinations were carried out. Results. Significant increase in plasma resistin levels in patients with comorbidity was revealed. Significant correlations between resistin levels and indicators of the functional state of the liver in these patients were established. Conclusion. In patients with NAFLD, DM type 2 and their combination, especially with concomitant obesity, there is an imbalance of fatty tissue products, a sign of which is the increase of resistin level. The relationship between resistin and indicators of the functional state of the liver mainly in the subgroup with comorbid disorders and obesity give reason to believe that hormone and metabolic disorders that affect liver function activate and worsen in obesity.

Steatohepatitis and diarrhea are well-known complications in children undergoing liver transplantation (LT) for progressive familial intrahepatic cholestasis (PFIC) type 1. Despite medical management with bile acid binders, the condition is progressive and can be associated with allograft loss. We report the case of a seven-year-old boy who underwent LT at the age of 2 years for PFIC type 1. Over the next five years, he developed refractory diarrhea, emaciation, worsening liver function, and steatohepatitis. Aiming to interrupt the enterohepatic circulation, at the age of 7 years, he underwent a total internal biliary diversion. The patient's postprocedure period was uneventful. His diarrhea settled and the transaminases normalized his follow-up liver biopsy after a year showed a complete resolution of steatohepatitis. At 18 months' follow-up, he has gained weight and remains asymptomatic. In this report, we show post-LT complications especially allograft injury related to the pathology of PFIC-1 can be safely and effectively managed by performing a total internal biliary diversion.

Antioxidant defence mechanisms, such as the nuclear factor-erythroid 2-related-factor-2 (NRF2) axis, are integral to oxidative stress responses and ischemic injury. Hepatic antioxidant capacity is contingent on parenchymal quality, and there is a need to develop new insights into key molecular mechanisms in marginal liver allografts that might provide therapeutic targets. This study examines the clinical relevance of NRF2 in donor livers and its response to normothermic machine perfusion (NMP). Discarded donor livers (n = 40) were stratified into a high NRF2 and low NRF2 group by quantifying NRF2 expression. High NRF2 livers had significantly lower transaminase levels, hepatic vascular inflammation and peri-portal CD3+ T cell infiltration. Human liver allografts (n = 8) were then exposed to 6-h of NMP and high NRF2 livers had significantly reduced liver enzyme alterations and improved lactate clearance. To investigate these findings further, we used a rat fatty-liver model, treating livers with an NRF2 agonist during NMP. Treated livers had increased NRF2 expression and reduced transaminase derangements following NMP compared to vehicle control. These results support the association of elevated NRF2 expression with improved liver function. Targeting this axis could have a rationale in future studies and NRF2 agonists may represent a supplemental treatment strategy for rescuing marginal donor livers.

Summary Background Given the novelty of gene replacement therapy with onasemnogene abeparvovec in spinal muscular atrophy, efficacy and safety data are limited, especially for children older than 24 months, those weighing more than 8·5 kg, and those who have received nusinersen. We aimed to provide real-world data on motor function and safety after gene replacement therapy in different patient subgroups. Methods We did a protocol-based, multicentre prospective observational study between Sept 21, 2019, and April 20, 2021, in 18 paediatric neuromuscular centres in Germany and Austria. All children with spinal muscular atrophy types 1 and 2 receiving onasemnogene abeparvovec were included in our cohort, and there were no specific exclusion criteria. Motor function was assessed at the time of gene replacement therapy and 6 months afterwards, using the Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP INTEND) and Hammersmith Functional Motor Scale-Expanded (HFMSE) scores. Additionally, in children pretreated with nusinersen, motor function was assessed before and after treatment switch. Off-target adverse events were analysed with a focus on liver function, thrombocytopaenia, and potential cardiotoxicity. Findings 76 children (58 pretreated with nusinersen and 18 who were nusinersen naive) with spinal muscular atrophy were treated with onasemnogene abeparvovec at a mean age of 16·8 months (range 0·8–59·0, IQR 9–23) and a mean weight of 9·1 kg (range 4·0–15·0, IQR 7·4–10·6). In 60 patients with available data, 49 had a significant improvement on the CHOP-INTEND score (≥4 points) and HFMSE score (≥3 points). Mean CHOP INTEND scores increased significantly in the 6 months after therapy in children younger than 8 months (n=16; mean change 13·8 [SD 8·5]; p Interpretation This study provides class IV evidence that children with spinal muscular atrophy aged 24 months or younger and patients pretreated with nusinersen significantly benefit from gene replacement therapy, but adverse events can be severe and need to be closely monitored. Funding None. Translation For the German translation of the abstract see Supplementary Materials section.

Background Hepatitis E virus (HEV) is a major causative agent of acute hepatitis worldwide, prompting continuous HEV vaccine efforts. Vaccine development is hampered by the lack of convenient animal models susceptible to infection with different HEV genotypes. We produced recombinant open reading frame 2 protein (pORF2; p551) of HEV genotype (GT) 3 and assessed its immunogenicity and protectivity against HEV challenge in common marmosets (Callithrix jacchus, CM). Methods p551 with consensus sequence corresponding to amino acid residues 110–660 of HEV GT3 pORF2 was expressed in E. coli and purified by affinity chromatography. CMs were immunized intramuscularly with 20 μg of p551 VLPs with alum adjuvant (n = 4) or adjuvant alone (n = 2) at weeks 0, 3, 7 and 19. At week 27, p551-immunized and control animals were challenged with HEV GT1 or GT3 and thereafter longitudinally screened for markers of liver function, anti-HEV IgG and HEV RNA in feces and sera. Results Purified p551 formed VLPs with particle size of 27.71 ± 2.42 nm. Two immunizations with p551 induced anti-HEV IgG mean titer of 1:1810. Immunized CMs challenged with homologous and heterologous HEV genotype did not develop HEV infection during the follow-up. Control CMs infected with both HEV GT1 and GT3 demonstrated signs of HEV infection with virus shedding and elevation of the levels of liver enzymes. High levels of anti-HEV IgG persisted in vaccinated CMs and control CMs that resolved HEV infection, for up to two years post challenge. Conclusions CMs are shown to be a convenient laboratory animal model susceptible to infection with HEV GT1 and GT3. Immunization with HEV GT3 ORF2/p551 triggers potent anti-HEV antibody response protecting CMs from homologous and heterologous HEV challenge. This advances p551 in VLPs as a prototype vaccine against HEV.

Objectives Hepatocellular carcinoma is the fourth leading cause of cancer deaths in the world. Conventional methods of cancer therapy are either invasive or have undesirable side effects. Therefore, exploring new therapeutic strategies to control the progression of hepatocellular carcinoma, such as cell-based therapies, is a key issue for prolonging patient survival. In this study, we aimed to evaluate tumor suppressive effects of mesenchymal stem cells on the in vivo progression of hepatocellular carcinoma in murine model. Materials and methods Hepatocellular carcinoma was induced in 40 rats with diethylnitrosamine. Rats were divided into 4 groups: 1 group injected with diethylnitrosamine only, 1 group injected with diethylnitrosamine and 1 dose of rat bone marrowderived mesenchymal stem cells, 1 group injected with diethylnitrosamine and 2 doses of rat bone marrowderived mesenchymal stem cells, and 1 group was injected with diethylnitrosamine and 3 doses of rat bone marrow-derived mesenchymal stem cells. Rats were killed after 1 month of dose 3. Liver specimens were histopathologically examined, and serum samples were examined for liver function and cytokines. Results Histopathological examination revealed that mesenchymal stem cell transplant induced liver regeneration. It also improved liver function as revealed by decreased levels of alanine and aspartate aminotransferase. Mesenchymal stem cells also repaired the immunopathology of the liver environment, as it decreased levels of interleukin 2 and 10, tumor necrosis factor α, and interferon γ. Conclusions Mesenchymal stem cell infusion significantly enhanced hepatic structure and function of livers in a rat hepatocellular carcinoma model.

Purpose This guideline provides evidence-based recommendations for the indications and technique-dose of external beam radiation therapy (EBRT) in hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (IHC). Methods The American Society for Radiation Oncology convened a task force to address 5 key questions focused on the indications, techniques, and outcomes of EBRT in HCC and IHC. It is intended to cover the definitive, consolidative, salvage, preoperative (including bridge to transplant), and adjuvant settings as well as palliative EBRT for symptomatic primary lesions. Recommendations were based on a systematic literature review and created using a predefined consensus-building methodology and system for grading evidence quality and recommendation strength. Results Strong recommendations are made for using EBRT as a potential first-line treatment in patients with liver-confined HCC who are not candidates for curative therapy, consolidative therapy after incomplete response to liver-directed therapies, and as a salvage option for local recurrences. The guideline conditionally recommends EBRT for patients with liver-confined multifocal or unresectable HCC, or those with macrovascular invasion, sequenced with systemic or catheter-based therapies. Palliative EBRT is conditionally recommended for symptomatic primary HCC and/or macrovascular tumor thrombi. EBRT is conditionally recommended as a bridge to transplant or prior to surgery in carefully selected patients. For patients with unresectable IHC, consolidative EBRT with or without chemotherapy should be considered, typically after systemic therapy. Adjuvant EBRT is conditionally recommended for resected IHC with high-risk features. Selection of dose-fractionation regimen and technique should be based on disease extent, disease location, underlying liver function, and available technologies. Conclusions The task force has proposed recommendations to inform best clinical practices on the use of EBRT for HCC and IHC with strong emphasis on multidisciplinary care. Future studies should focus on further defining the role of EBRT in the context of liver-directed and systemic therapies and refining optimal regimens and techniques.

Following curative liver resection (LR), resectable tumor recurrence in patients with preserved liver function leads to deciding between a repeat LR and a salvage liver transplantation (LT), if a donor's liver is available. This retrospective study compared survival outcomes and recurrence pattern following salvage living donor LT (LDLT) and repeat LR in patients with recurrent hepatocellular carcinoma (HCC). We reviewed the medical records of patients who underwent repeat LR (n = 163) or LDLT (n = 84) for recurrent HCC following curative resections, between January 2005 and December 2017 at a single institution. A 1:1 propensity score matching led to 42 patients per group. Disease-specific and recurrence-free survival were significantly better in the salvage LDLT group than in the repeat LR group (p = .042; HR = 2.40; 95% CI, 0.69-6.00 and p < .001; HR = 4.23; 95% CI, 2.05-8.71, respectively). Despite significant differences in recurrence patterns between the two groups (p = .019), the patient death rates, after recurrence, were similar for both groups (p = .760). This study indicates that salvage LDLT is superior to repeat LR for treating patients with transplantable, intrahepatic HCC recurrence, even in patients with Child-Pugh class A liver cirrhosis.

Background Potential indications for surgery frequently arise in patients awaiting liver transplantation. There is a risk of hepatic decompensation and death triggered by surgical trauma, but this has not been studied in detail in this unique population. We aimed to quantify the impact of surgical interventions in patients awaiting liver transplantation on hepatic function and identify risk factors for decompensation. Methods All surgeries between 2000 and 2018 in patients awaiting liver transplantation in a highvolume German liver transplant center were analyzed retrospectively. Change in liver function measured as indicated by MELD score was assessed and complication rates recorded. The primary endpoint was a composite of an increase in MELD score by > 5 points or death. A logistic regression model was used for multivariate analysis to identify risk factors. Results In total, 177 surgical procedures in 148 patients were analyzed. The primary endpoint was reached in 42 cases (23.7%). The overall in-hospital complication rate (including death) was 44.1%. Multivariate analysis identified elevated leukocyte count, perioperative blood transfusion, preoperative presence of ascites, and preoperative circulatory support as independent risk factors for a decline in liver function or death. Conclusion Surgery in patients awaiting liver transplantation carries a relevant risk of hepatic decompensation and death that needs to be considered when deciding whether to perform elective surgery prior to or defer until after liver transplantation.

Background: The aim of this study is to evaluate the outcomes and prognostic factors in patients with hepatocellular carcinoma (HCC) and Child–Turcotte–Pugh (CTP) class B liver function after stereotactic ablative radiotherapy (SABR). Materials and Methods: This retrospective study evaluated patients with HCC and impaired liver function who underwent SABR between December 2007 and August 2016. All patients had CTP class B liver function before treatment. Local control (LC) rate, overall survival (OS) rate, prognostic factors, and radiation-related toxicity were evaluated. Results: This study included 34 patients. The majority had a CTP score of B7 (52.9%) and advanced HCC (91.2%). The median survival time was 4.8 months, and the 1-year OS rate was 21.4%. Only the tumor number (multiple vs. single) was identified as an independent predictor of survival. The 1-year LC rate was 95.8%. Eight patients (23.5%) developed the radiation-induced liver disease, and 15 (44.1%) had a CTP score decline of ≥2 within 3 months. Other toxicities were generally tolerable. Conclusion: SABR may be considered as an alternative option for patients with HCC and CTP class B liver function, particularly for those with a single lesion.

OBJECTIVE To study the association of hyperuricaemia with clinical and pathological characteristics of patients with IgA nephropathy, and to clarify adverse effects of hyperuricaemia on the onset and progression of IgA nephropathy. METHODS A total of 244 patients with IgA nephropathy enrolled in Jiangjin Center Hospital were divided into a group with normal serum uric acid level and a group with elevated level. Age, gender, course of disease, blood pressure, liver function, renal function, blood lipid levels, blood glucose level, 24-hour urine protein level and pathological grades were recorded. The correlations of serum uric acid level with clinical indices and pathological grades were analyzed. RESULTS The incidence rate of IgA nephropathy complicated with hyperuricaemia was 25.4%. The two groups had significantly different course of disease, body mass index (BMI), and levels of urea nitrogen, creatinine, triglyceride and urine protein (p

Osteoarthritis is the most common form of arthritis, involving inflammation and major structural changes of the joint, causing pain and functional disability. Pain and stiffness, particularly after exercise, are the major symptoms, resulting in considerable impact on ability to perform activities of daily living. There is discordance between symptoms and radiographic changes, with some sufferers not experiencing symptoms, but showing osteoarthritic changes on X-ray. The present study was performed to examine the effect of ginger and turmeric consumption on liver function (ALT, AST), phosphorus, total calcium , ionized calcium, x-ray and histopathologyon osteoporosis rats induced by prednisone acetate at a dose of 4 mg / kg bw three time a week for three weeks. On the other hand, the chemical constituent’s moisture, protein, fat, crude fibre, total digestible nutrients, ash, carbohydrate, phosphorous, calcium was determined for the tested ginger and turmeric. In addition to, volatile compounds and analysis of phytochemicals was determined for the tested ginger and turmeric. This work was carried out on 48 non-pregnant female albino rats (age 6 to 8 weeks and about 160 to 210g body weight) classified into two main groups. The first main group (6) fed on basal diet and the second main group (42 rats)injected with prednisone acetate at a dose of 4 mg / kg bw three time a week for three weeks to cause osteoporosis and divided into seven subgroups such as each group consists of (6rats). Then fed on basal diet containing 10% -15% ginger, 10% -15% turmericand10% -15% ginger and turmeric. Results revealed that all osteoporosis groups administrated with different levels of ginger and turmeric (10-15%) had significant decrease liver function (ALT, AST), phosphorus, total calcium, ionized calcium comparing with the positive control group. On the other hand, x-ray and histopathologyof the positive control group after two months revealed bone loss of different part such as fibula, tibia and femur in addition to bone demineralization and femoral fracture and fibula bone trabexculae showed dystrophy and resorption and osteoporosis. These findings revealed that ginger andturmeric treatment attenuated and treated degrees to osteoporosis in compare to positive control group.

Background Drug reaction with eosinophilia and systemic symptoms (DRESS) is an intractable drug hypersensitivity disease with high mortality. The current standard treatment requires high-dose and long-term systemic corticosteroids, which may lead to adverse effects and intolerability of patients. Objective To evaluate the efficacy and safety of cyclosporine in patients with corticosteroid-dependent DRESS or intolerance to systemic corticosteroids. Methods A retrospective review of 8 patients with corticosteroid-dependent DRESS who were treated with cyclosporine as an alternative treatment owing to suboptimal response to regular doses of systemic corticosteroids for at least 3 weeks, flare-ups when tapering corticosteroids, or experiencing intolerable adverse effects of corticosteroids. Results In all 8 patients (4 women and 4 men; age range, 15-75 years), either intractable skin eruptions, persistent eosinophilia, or elevated liver function was noted after at least 3 weeks of treatment with systemic corticosteroids. The patients had marked cutaneous improvement and normalization of liver function and eosinophil count after adding cyclosporine, and the systemic corticosteroid treatment was smoothly tapered down. The mean dosage of cyclosporine was 1.68 ± 0.73 mg/kg/d, and the mean duration of cyclosporine treatment was 76.13 ± 35.64 days. Their serum eosinophil counts, serum alanine aminotransferase levels, and serum thymus and activation-regulated chemokine levels were all elevated at baseline and then significantly decreased during the recovery stage after cyclosporine therapy (P Conclusion Cyclosporine is an effective and safe therapeutic alternative as a steroid-sparing agent for corticosteroid-dependent DRESS. Further prospective randomized controlled studies are required to confirm these preliminary results.

This research was conducted to evaluate synergistic effects of red cabbage leaves either powder or methanolic extract with or without chromium on obese rats by evaluation nutritional indicators, serum lipids profiles, antioxidant enzymes, and some hepatic marker. After induction of obesity in rats by feed in high fat diet for six weeks, obese rats were randomly classified into six groups (seven rats in each) that include positive control group (basal diet), cabbage powder (15% of cabbage powder in basal diet) group, chromium (basal diet and 4.5 µg/ kg body weight/d chromium) group, cabbage extract (basal diet and 20 mg/kg/ body weight /d of cabbage extract ) group, cabbage powder + chromium (15% of cabbage powder in basal diet and 4.5 µg/ kg body weight /d chromium) group and cabbage extract + chromium (basal diet and 20 mg/kg/d of cabbage extract and 4.5 µg/ kg/d chromium) group. The experiment period was 60 days after induction of obesity. The obtained results recorded that administration of cabbage powder with chromium or cabbage extract with chromium could lower body weight gain (BWG) and feed intake (FI) and elevate feed efficiency ratio (FER) compared to positive obese control group. All treated groups showed improvement in both serum and liver lipids profiles and liver function enzymes appeared prominently in cabbage powder with chromium and cabbage extract with chromium groups compared with positive control group. It is recommended to administer red cabbage leaves or its extract with chromium as a diet for patients with obesity التاثيرات التأزرية المضادة للسمنة لتناول الکرنب الأحمر والکروم على الفئران البدينة أجريت هذه الدراسة لتقييم التاثير التأزري لأوراق الکرنب الاحمر علي صورة مسحوق أو مستخلص ميثانولي مع وبدون الکروم علي الفئران المصابة بالسمنة عن طريق تقييم المؤشرات الغذائية و دهون السيرم والإنزيمات المضادة للأکسدة و بعض وظائف الکبد. وتم إصابة الفئران بالسمنة عن طريق تغذيتها علي وجبات عالية الدهون لمدة ستة أسابيع. تم تقسيم الفئران المصابة بالسمنة بشکل عشوائي إلى ست مجموعات "سبعة فئران في کل مجموعة" وهي المجموعة الضابطة الإيجابية المصابة بالسمنة والتي تناولت الوجبة الاساسية والمجموعة المعالجة بمسحوق الکرنب 15٪ من مسحوق الکرنب في الوجبة الأساسية والمجموعة المعالجة بالکروم مع الوجبة الاساسية بجرعة 4.5 ميکروجرام/کجم من وزن الجسم کروم والمجموعة المعالجة بمستخلص الکرنب مع الوجبه الاساسية بجرعة 20 ملجم / کجم من وزن الجسم مستخلص الکرنب والمجموعة المعالجة بمسحوق الکرنب مع الکروم 15٪ من مسحوق الکرنب و4.5 ميکروجرام/ کجم کروم والمجموعة المعالجة بمستخلص الکرنب مع الکروم مع الوجبه الاساسية 20 ملجم /کجم من وزن الجسم لمستخلص الکرنب و4.5 ميکروجرام/ کجم من الکروم. واستمرت الدراسة لمدة 60 يوما بعد الاصابة بالسمنة. اسفرت نتائج الدراسة علي أن تناول مسحوق الکرنب مع الکروم أومستخلص الکرنب مع الکروم اظهر نقص معنوي في الوزن المکتسب والمتناول من الطعام ونسبه کفاءه الطعام بالمقارنة بالمجموعة الضابطه الإيجابية المريضة بالسمنة. کما أظهرت جميع المجموعات المعالجة تحسن معنوي في کل من مؤشرات الدهون في السيرم والکبد وتحسن معنوي في انزيمات کفاءه الکبد ومضادات الاکسده وکانت افضل النتائج في المجموعات المتناولة لمسحوق الکرنب مع الکروم و المتناوله لمستخلص الکرنب مع الکروم بالمقارنة مع المجموعة الضابطه الإيجابية. وتوصي نتائج الدراسة بضرورة تناول الکرنب الاحمرومستخلصه مع الکروم کنظام غذائي لمرضي السمنة لما له من تاثيرات ايجابية علي نقص الوزن وتحسين وظائف الکبد وخفض دهون الدم.

Melissa officinalis L(MO) is also known as bee balm, lemon balm, honey balm, and is a perennial herb. It is a member of the Lamiaceae family Which is often referred to as (the mint family). The influence of diet containing fortified bread with(5, 7.5 , 10%)Meliss powder(MP) on rats suffering from oxidative stress has been studied. Fortified bread with (5 , 7.5 , 10%) MP were prepared and were subjected to sensory evaluation.The best level of fortified bread after sensory evaluation was 5% but the best level of fortified bread after the biological study was 10%.The chemical composition of bread was estimated at 5% due to its acceptance in sensory evaluation. Twenty five male albino rats(170-190g) were randomly distributed into 5 equal groups,of5 rats each. Group 1 was fed on the basal diet containing unfortified pan bread and kept as a negative control group. The other 4 groups (n=20 rats), were injected with a single intraperitoneal dose of 125mg/kgbw of potassium bromate (KBro3) for oxidative stress induction group 2 was fed on the basal diet, which includes unfortified pan bread as positive control rats, groups 3 , 4 and 5 were fed on diet containing fortified pan bread with (5 , 7.5 & 10%)MP respectively. The obtained results revealed that the injected groups with levels 10% of diet containing fortified bread with MP had significant decrease in serum levels of lipid profile (total cholesterol, triglycerides , LDL , VLDL), kidney,liver function and serum malondialdehyde (MDA) and significant increased in serum levels of HDL, total antioxidant capacity (TAC), glutathione (GSH), levels of glutathione peroxidase (GPX),superoxide dismutase (SOD) and catalase (CAT) enzymes.Moreover,there was a significant reduced in MDA and increase in GSH levels and the activity of antioxidant enzymes(GPX, SOD and CAT)in liver tissues as well as partially improvements in liver structures compared to positive intoxicated “control group”, but non significant increase in(BWG%) , FI and FER which nearly returned toward the negative control group.The best improvements among all the biochemical parameters and histological structures of liver which were tended toward normal results were observed in group treated with bread fortified 10%MP.In conclusion,the present findings suggested that regular intake from 10% fortified bread with MP may be useful in improving liver and kidney functions and may protect against potassium bromate (KBro3) which induced oxidative stress in rats. تعرف نبات المليسيا أيضا باسم بلسم النحل ، بلسم الليمون ، بلسم العسل ، وهو عشب معمر. وهو عضو في عائلة (النباتات المزهرة) التي غالبا ما يشار إليها باسم (عائلة النعناع)، أجريت هذه الدراسة لمعرفة تأثير النظام الغذائي المحتوي على الخبز المدعم بنسبة (5 ، 7.5 ، 10٪) من مسحوق المليسيا (MP) على الفئران التي تعاني من الإجهاد التأکسدي ، تم أستخدام مستويات مختلفة من النظام الغذائي المحتوي على الخبز المدعم بنسبة (5 ، 7.5 ، 10٪) تم استخدام مسحوق المليسيا في تحضير الخبز المختبرة التي خضعت للتقييم الحسي ، وکان أفضل مستوى للخبز المدعم بعد التقييم الحسي 5٪ ولکن أفضل مستوى للخبز المدعم بعد الاختبارات البيولوجية کان 10٪ ، وتم تقدير الترکيب الکميائى لنسبة 5٪ بسبب حصوله على احسن قبول في التقييم الحسي ، أستخدمت هذه الدراسة خمسه وعشرون جرذآ من ذکور الألبينو تم تقسيمهم بشکل عشوائى الى خمس مجموعات تحتوى کل منها على خمس فئران.المجموعة الأولى تم تغذيتها على النظام الغذائى الأساسى کمجموعة ضابطة سالبة وتم حقن باقى الفئران الأخرى 20فأر بواسطة برومات البوتاسيوم تم حقنها داخل الغشاء البريتونى بجرعة واحدة(125ملجم / کجم من وزن الجسم) لأحداث الإجهاد التأکسدي ، بعد ذلک تم تقسيم المجموعات التى تم حقنها إلى 4 مجموعات فرعية على النحو التالي ، المجموعة الفرعية 2 التي تم تغذيتها على النظام الغذائي الأساسي تحتوي على خبز غير مدعم کمجموعة کنترول موجبة ، المجموعات الفرعية 3 و 4 و 5تم التغذية على حمية تحتوي على خبز مدعم بمسحوق المليسيا بنسبة (5 ، 7.5 ، 10٪) على التوالي ، وأظهرت النتائج المتحصل عليها أن المجموعه التى تغذت بمستوى 10٪ من الخبز المدعم بمسحوق المليسيا قد أحدثت انخفاض معنوي بشکل ملحوظ في مستويات مصل الدم من الکوليسترول الکلي ، الدهون الثلاثية ، الليبوبروتينات منخفضة الکثافة LDL-c ، الليبوبروتينات متوسطة الکثافة VLDL-c ، اليوريا ، حمض البوليک ، الکرياتينين ، ووظائف الکبد(AST ،ALT،ALP) و MDA وزيادة ملحوظة في مستويات المصل من الليبوبروتينات عالية الکثافة HDL-c ، والقدرة الإجمالية لمضادات الأکسدة (TAC) ، والجلوتاثيون (GSH) ، ونشاط أنزيمات الجلوتاثيون بيروکسيديز (GPX) ، (SOD) والإنزيمات (CAT). کما أظهرت النتائج حدوث أنخفاض في MDA وزيادة في محتوى GSH ونشاط إنزيمات مضادات الأکسدة (GPX و SOD و CAT) في أنسجة الکبد بالإضافة إلى التحسينات الجزئية في أنسجة الکبد مقارنة بتلک المجموعة الضابطة الموجبة ، وعدم وجود فروق معنوية تذکر بالنسبة للطعام المأخوذ والنسبة المئوية للزيادة فى وزن الجسم ومدى الاستفادة من الغذاء المتناول والتى کانت تميل نحو نتائج المجموعة الضابطة السليمه ، وکانت أفضل النتائج لجميع المؤشرات البيوکيميائية والهستوباثولوجية لانسجة الکبد والتى کانت قريبة من النتائج الطبيعية کانت للمجموعة التى تغذت على الخبز المدعم ب 10% من مسحوق المليسيا فى النهاية تشير النتائج الحالية الى أن الأستخدام المنتظم من الخبز المدعم ب 10% من مسحوق المليسيا له تأثير مفيد فى تحسن وظائف الکبد والکلى ويعد عامل وقائى ضد الأجهاد التأکسدى المحدث ببرومات البوتاسيوم فى الفئران. الکلمات المفتاحية:أنزيمات مضادات الأکسدة , وظائف الکبد , وظائف الکلى , دهون الدم, مليسيا , الأجهاد التأکسدى , الفئران.

Background Simplifying immunosuppressive therapy after liver transplant may improve patient compliance, thereby preventing acute rejection and graft loss. This phase 4, open-label, single-center study was conducted to evaluate the efficacy and safety of twice-daily to once-daily tacrolimus conversion in stable liver transplant recipients. Methods Between May 2017 and January 2019, twice-daily tacrolimus was converted to once-daily tacrolimus in 101 stable recipients at least 12 months post-liver transplant in Asan Medical Center. The doses of both drugs was converted to 1:1, and the target trough level was 5 to 10 ng/mL. We prospectively analyzed graft function, drug compliance, and adverse reactions after switching regimen for 24 weeks. Results There was no acute rejection confirmed histologically within 24 weeks, which was the primary endpoint, and there was no chronic rejection, fatal deterioration of liver function, or death in any patient during this period. After conversion, the trough level of tacrolimus decreased, and the mean ± standard deviation differences between the trough level and baseline level were 1.46 (±2.41) ng/mL, 0.43 (±2.08) ng/mL, and 0.07 (±2.73) ng/mL at 3, 12, and 24 weeks after conversion, respectively. Despite transient fluctuations of the trough level, there was no evidence of rejection or graft dysfunction. There were 37 adverse reactions after conversion; most of them were mild, and thrombocytopenia developed in 1 patient as an adverse drug response. Drug compliance improved after conversion according to questionnaire responses. Conclusions The conversion to once-daily tacrolimus in stable liver transplant recipients is an effective and safe therapeutic strategy improving drug compliance.

Abstract: The present work investigated the effects of Syzgium cumini L seeds ethanolic extract against carbon tetrachloride induced kidney toxicity in Sprague–Dawley male rats. Twenty four adult male albino rats were divided into two main groups: The first main group (6 rats) fed on basal diet as control negative group (C-ve). The second main group (18 rats) fed on basal diet for 28 days. At 27th and 28th days all rats were administrated ccl4 by gavage (1ml/kgb.w). The second main group was divided into 3 groups each group contained 6 rats as follows: Group 1: positive control, rats fed on basal diet only (C+ve). Group 2&3: fed on basal diet and received jumbolan seeds extract (250 and 500 mgkg) orally. At the end of the experiment biological data were calculated, blood samples were taken, kidney collected, weighted. Serum was separated to biochemical analysis. Tissue lipid peroxidation (LPX) and activity of antioxidant enzymes in kidney were also performed. Also histopathological examination for kidneys were performed. Results showed that CCl4 caused elevation in serum levels of creatinine, urea, uric acid, serum potassium, sodium, glucose and liver function. MDA level was also increased significantly whereas SOD, and CAT levels were decreased in the kidney tissue homogenates of CCl4 treated rats. Ethanolic extract of jumbolan seeds successfully improve the alterations of these effects in the experimental animals. Our study demonstrated that the ethanolic extract of jumbolan seeds could protect kidney tissues against CCl4-induced oxidative stress by increasing ant oxidative defense activities. الملخص العربى التأثير المضاد للأکسدة لبذور مستخلص الجامبوزا الإيثانولي ضد رابع کلوريد الکربون الذي يسبب التسمم الکلوي في فئران التجارب تبحث هذه الدراسة تأثير المستخلص الإيثانولي لبذور الجامبوزا ضد السمية الکلوية التي يسببها رابع کلوريد الکربون في ذکور فئران الألبينو. استخدم في هذه الدراسة عدد 24 فأرا بالغا تم تقسيمهم إلى مجموعتين رئيسيتين : المجموعة الرئيسية الأولى ( 6 فئران) تم تغذيتها على غذاء أساسي و استخدمت کمجموعة ضابطة سالبة. المجموعة الأساسية الثانية (18 فأرا) تم تغذيتها على غذاء أساسي لمدة 28 يوما , و في اليوم السابع و العشرون و الثامن و العشرون تم حقن کل فئران هذه المجموعة بمادة رابع کلوريد الکربون (1 مللي|کجم وزن) ويخلط مع البارافين السائل بنسبة (1: 1 ، حجم / حجم) . المجموعة الرئيسية الثانية تم تقسيمها إلى ثلاث مجموعات , کل مجموعة تحتوي على 6 فئران کالتالي:- المجموعة الأولى: مجموعة ضابطة إيجابية تم تغذيتها على غذاء أساسي. المجموعة الثانية و الثالثة : تم تغذيتهم على غذاء أساسي مع إعطاء فئران هذه المجموعات (250 و 500 ملجم مستخلص ميثانولي لبذور الجامبوزا کجم وزن) عن طريق الفم. فى نهاية التجربة تم حساب التقديرات البيولوجية واخذت عينات الدم وفصل الکلى ووزنها ثم اجراء التحاليل البيوکمائية وکذلک الانزيمات المؤکسه مثل MDA والانزيمات المضاد للأکسدة فى نسيج الکلى . کما تم إجراء الفحص التشريحي للکلى.أظهرت النتائج ان رابع کلوريد الکربون تسبب في ارتفاع ملحوظ في مستويات مصل الدم من الکرياتينين واليوريا وحمض البوليک وبوتاسيوم الدم والصوديوم والجلوکوز ووظائف الکبد. کما أحدثت ارتفاعا في مستوى MDA بشکل ملحوظ بينما انخفضت مستويات SOD و CAT في أنسجة الکلى للفئران المعالجة بـرابع کلوريد الکربون. نجح المستخلص الإيثانولي لبذور الجامبوزا في تحسن أنسجة الکلى . أظهرت الدراسة أن تقليل المستخلص الإيثانولي لبذور الجامبوزا يمکن أن يحمي أنسجة الکلى من الإجهاد التأکسدي الناجم عن CCl4 عن طريق زيادة أنشطة الدفاع ضد الأکسدة. الکلمات المفتاحية: الجامبوزا - الکلى- الکرياتينين- اليوريک اسيد –اليوريا –الکتاليز.

This is a summary of a research study (known as a clinical trial) called CROWN. The study tested two medicines called lorlatinib and crizotinib in participants with untreated non-small cell lung cancer that had spread to other parts of their body. All those who took part had changes in a gene called ALK, which is involved in cell growth. In total, 296 participants from 23 countries took part. Half the participants took lorlatinib and half took crizotinib. After participants started taking lorlatinib or crizotinib, they were checked regularly to see if their tumors had grown or spread to other parts of their body (known as tumor progression) and to monitor any side effects. After 1 year of treatment, the participants who took lorlatinib were twice as likely to be alive with no tumor growth as the participants who took crizotinib. More participants who took lorlatinib had cancer that shrank (76%) compared with the participants who took crizotinib (58%). This was also true of the participants whose cancer had spread to their brain. The most common side effects in participants who took lorlatinib were increases in the amount of cholesterol and triglycerides (a type of fat) in their blood, swelling, weight gain, nerve damage, unclear thoughts, and diarrhea. Among the participants who took crizotinib, the most common side effects were diarrhea, feeling like you want to throw up, sight problems, swelling, vomiting, changes in liver function, and feeling tired. Overall, the CROWN study showed that fewer participants with advanced ALK+ non-small cell lung cancer died or had tumor growth with lorlatinib compared with crizotinib treatment. ClinicalTrials.gov NCT number: NCT03052608 .

More than 80% of global hepatocellular carcinoma (HCC) patients are estimated to occur in sub-Saharan Africa (SSA) and Eastern Asia. The most common risk factor of HCC in SSA is chronic hepatitis B virus (HBV) infection, with the incidence highest in West Africa. HBV is highly endemic in SSA and is perpetuated by incomplete adherence to birth dose immunization, lack of longitudinal follow-up care, and impaired access to antiviral therapy. HBV may directly cause HCC through somatic genetic alterations or indirectly through altered liver function and liver cirrhosis. Other risk factors of HCC in SSA include aflatoxins and, to a lesser extent, African iron overload. HIV plus HBV co-infection increases the risk of developing HCC and is increasingly becoming more common because of improving the survival of patients with HIV infection. Compared with the rest of the world, patients with HCC in SSA have the lowest survival. This is partly due to the late presentation of HCC with advanced symptomatic disease as a result of underdeveloped surveillance practices. Moreover, access to care and resource limitations further limit outcomes for the patients who receive a diagnosis in SSA. There is a need for multipronged strategies to decrease the incidence of HCC and improve its outcomes in SSA.

Ketotic dairy cows exhibit a state of negative energy balance (NEB) characterized by elevated circulating levels of β-hydroxybutyrate (BHB) and fatty acids. Impaired hepatic insulin signaling in dairy cows occurs frequently during the transition into lactation, but its role on liver function during this period is not well known. In nonruminants, endoplasmic reticulum (ER) stress is a causal factor contributing to impaired insulin signaling in the liver. Thus, the aim of this study was to investigate the status of hepatic insulin and ER stress signaling and whether ER stress contributes to impaired insulin signaling in dairy cows with ketosis. Healthy (control cows, n = 10, BHB ≤0.6 mM) and ketotic (ketotic cows, n = 10, BHB ≥1.2 mM) cows at 3 to 10 d in milk were selected for liver biopsy and blood sampling before feeding. In vitro experiments were conducted with isolated hepatocytes from 5 healthy calves (1 d old, fasted female, 30-40 kg of body weight). Treatments included BHB (0, 0.9, 1.8, 3.6 mM), tauroursodeoxycholic acid (TUDCA, a canonical inhibitor of ER stress), and different incubation times (0.5, 1, 2, 3, 5, 7, 9, or 12 h). Ketotic cows had lower daily milk yield (median: 29.50 vs. 23.00 kg), higher plasma nonesterified fatty acid (NEFA) (median: 0.33 vs. 1.17 mM), BHB (median: 0.43 vs. 3.22 mM), aspartate aminotransferase (median: 70.58 vs. 155.70 U/L), alanine aminotransferase (median: 18.31 vs. 37.90 U/L), lower plasma glucose (median: 4.32 vs. 2.37 mg/dL), and revised quantitative insulin sensitivity check index (median: 0.39 vs. 0.37) compared with healthy cows. Increased abundance of phosphorylated insulin receptor substrate-1 (IRS1) and decreased abundance of phosphorylated protein kinase B (AKT) and glycogen synthase kinase-3β (GSK3β) in ketotic cows indicated a state of insulin resistance. In addition, abundance of phosphorylated protein kinase RNA-like ER kinase (PERK) and inositol requiring protein-1α (IRE1α), and cleavage of activating transcription factor-6 (ATF6) were greater in the liver of ketotic cows. In vitro, at the early stages of incubation, treatment with BHB upregulated abundance of phosphorylated of IRE1α, PERK, and the cleavage of ATF6, as well as several unfolded protein response genes [X-box-binding protein-1 (XBP1), 78 kDa glucose-regulated protein (GRP78), and C/EBP homologous protein (CHOP)]. Furthermore, in response to increasing doses of BHB, the phosphorylation level of PERK, IRE1α, and the cleavage of ATF6, and the abundance of XBP1, GRP78, and CHOP increased. In addition, BHB treatment increased phosphorylation of IRS1 and decreased phosphorylation of AKT and GSK3β, and upregulated abundance of gluconeogenic genes (phosphoenolpyruvate carboxykinase and glucose-6-phosphatase). Importantly, these changes were reversed by inhibiting ER stress with TUDCA treatment. Overall, the present study indicated that reversing ER stress during ketosis might help alleviate hepatic insulin resistance. Targeting ER stress may represent a potential therapeutic target for controlling the negative aspects of ketosis on liver function.

Objective: To analyze the effect and value of vitamin C in the treatment of sepsis. Methods: Forty-four patients with sepsis treated in our hospital from June 2019 to June 2021 were investigated. The above subjects were divided into conventional group and research group, each with 22 cases, using the method of drawing lots. Routine treatment was applied in the conventional group, and the patients of the research group were treated with vitamin C on the basis of the routine method. The effective rate after treatment and the score of liver and kidney function in patients with sepsis were compared between the two groups. Results: The total effective rate (95.45%) of the research group with increased vitamin C in the treatment of sepsis was much higher than that of the conventional group (72.72%), and the scores of liver function and renal function in the research group were much higher than those in the conventional group at different times (P < 0.05). Conclusion: Vitamin C has a good effect in the treatment of sepsis. It not only greatly reduces the mortality of sepsis patients, but also effectively improves the liver function and renal function of sepsis patients. It is of high application value. It is recommended to be popularized for applications.

Doxorubicin (DOX) is one of the widely used anti-tumor drugs. However, DOX-induced cardiotoxicity (DIC) and hepatotoxicity (DIH) are among the side effects that limited its therapeutic efficiency and clinical applicability. This study aimed to investigate the cardioprotective and hepatoprotective potentials of curcumin (CMN)—a bioactive polyphenolic compound—in alleviating DOX-induced cardiotoxicity (DIC) and hepatotoxicity (DIH) in male rats. A single intraperitoneal (i.p.) dose of DOX (20 mg/kg) was used to induce DIC and DIH. DOX-intoxicated rats were co-treated with CMN (100 mg/kg, oral) for 10 days before and 5 days after a single dose of DOX. We studied the anti-inflammatory and anti-oxidative activities of CMN on biochemical and immunohistochemical aspects. DOX disrupted cardiac and hepatic functions and stimulated oxidative stress and inflammation in both tissues that was confirmed biochemically and immunohistochemically. DOX enhanced inflammatory interferon-gamma (IFN-γ) and upregulated immunoexpression of nuclear factor-κB (NF-κB), inducible nitric oxide synthase (iNOS), and tumor necrosis factor-alpha (TNF-α). DOX induced structural alterations in both cardiac and hepatic tissues. CMN demonstrated cardioprotective potential through reducing cardiac troponin I (cTn1) and aspartate amino transaminase (AST). In addition, CMN significantly ameliorated liver function through decreasing alanine amino transaminase (ALT) and, gamma-glutamyl transferase (GGT), total cholesterol (TC), and triglycerides (TG). CMN demonstrated anti-inflammatory potential through decreasing IFN-γ levels and immunoexpression of iNOS, NF-κB, and TNF-α. Histopathologically, CMN restored DOX-associated cardiac and liver structural alterations. CMN showed anti-oxidative and anti-inflammatory potentials in both the cardiac and hepatic tissues. In addition, cTn1, IFN-γ, and AST could be used as blood-based biomarkers.

By inhibiting the growth of pathogenic bacteria and modulating the local intestinal immune system, probiotics may reduce bacterial translocation and systemic endotoxaemia, factors partially responsible for post-operative complications following liver resection for hepatocellular carcinoma in patients with cirrhosis. Patients with resectable hepatocellular carcinoma developed in the setting of chronic liver disease were prospectively divided into two equal-sized groups: one receiving probiotic treatment 14 days prior to surgery and the other receiving placebo. The primary endpoint was the level of circulating endotoxins after hepatectomy. Secondary endpoints were systemic inflammation (inflammatory cytokine levels), post-operative liver function and overall post-operative complication rate. From May 2013 to December 2018, 64 patients were randomized, and 54 patients were included in the analysis, 27 in each arm. No significant change in endotoxin levels was observed over time in either group (P = 0.299). No difference between the groups in terms of post-operative liver function and overall complication rates was observed. The only differences observed were significant increases in the levels of TNFalpha (P = 0.019) and interleukin 1-b (P = 0.028) in the probiotic group in the post-operative period. Contrary to the modest data reported in the literature, the administration of probiotics before minor liver resection for hepatocellular carcinoma developed in the setting of compensated chronic liver disease does not seem to have an impact on circulating endotoxin levels or post-operative complication rates. Trial registration: NCT02021253.

Aging have an impact on the pharmacokinetic and pharmacodynamic characteristics of drugs, resulting in clinically relevant safety and efficacy consequences. There appear to be a rise in gastrointestinal (GI) problems with age, and certain slight variations in the GI tract have been noted. Nevertheless, insufficient studies have been done on the impact of aging on the expression and activity of these GI transporters. Aging is associated with some reduction in first-pass metabolism that might be due to a decrease in liver mass and perfusion. Some medications with considerable first-pass metabolism, can have markedly enhanced bioavailability and, as a consequence bioavailability. Other high clearance (CL) medications have identical bioavailability in both young and old individuals. However, at the other hand, the first-pass activation of some prodrugs, may be slowed or decreased, leading to a reduction in bioavailability. Some drugs may have a low bioavailability when taken orally, benefitted from transdermal administration. There are still no specific age-related liver ailments, routine clinical tests of liver function do not vary substantially with age, the course, and outcome of some liver diseases can be affected by age. The characteristic of high or low extraction of a drug by the liver has been attributed to whether the metabolic clearance (CL) of a drug falls or remains unchanged with age. Reduction in renal function in elderly subjects, particularly glomerular filtration rate, affects the clearance of many drugs such as water-soluble antibiotics and nonsteroidal anti-inflammatory drugs. The therapeutic significance of these declines in renal excretion is governed by the drug's expected toxicity. Many drugs show their effects specially in old age patients in different manner and depend on age related factors. It must take appropriate precautions for administering of different drugs to the old age patients.

OBJECTIVE Hepatocellular carcinoma (HCC) is the sixth among the most common cancers and the fourth among cancer-related causes of death in the world. In the evaluation of liver function in HCC patients, parameters such as albumin-bilirubin, prothrombin time-international normalized ratio (PT-INR) to albumin ratio (PTAR) are used among new methods other than Child-Pugh and MELD scores. Biomarkers are widely used in clinical practice in cases such as diagnosing various diseases, evaluating treatment response and predicting prognosis. We aimed to evaluate the prognostic role of serum ferritin and INR/albumin ratio in patients with chronic liver disease who develop HCC. METHODS This retrospective study included 534 patients who were followed up with the diagnosis of HCC between 2009 and 2020. The patients with HCC etiology were evaluated in 3 groups (chronic hepatitis B group, chronic hepatitis C group, and other group). When comparing serum ferritin level and prothromin time-international normalized ratio to albumin ratio with Child Pugh score (CTP) in chronic liver patients with HCC, liver functional reserve and its role in predicting prognosis were investigated. RESULTS The serum ferritin level was 226 ± 334 in the CTP A group, 239 ± 302 in the CTP B group, and 678 ± 966 in the CTP C group, and the p value was 0.001. The PTAR CTP group was 0.35 ± 0.10, the CTP B group was 0.50 ± 0.26, the CTP C group was 1.18 ± 6.01, and the p value was 0.001. Multivariant analysis results showed that ferritin hazard ratio is 1.00, 95% CI 0.99-1.00, and p value was 0.09, and PTAR hazard ratio is 1.38, 95% CI 2.37-8.00, and p value was 0.49. The etiological distribution of HCC was determined as HBV (61.6%), HCV (19.9%), and other etiologies (18.5%). Significant values were determined for age, gender, glucose, GGT, T. cholesterol, and tumor diameter parameters according to etiological distribution. CONCLUSIONS Serum ferritin level and PTAR score increased in proportion to the severity of liver disease and were associated with poor prognosis. We think that high serum ferritin and PTAR score is a prognostic biomarker in predicting the synthesis function of the liver and mortality in critically ill patients with cirrhosis.

Sarcoidosis is a multisystem disease usually affecting the chest, hilar lymph nodes, and lungs, but can potentially involve any organ; therefore, its clinical presentation may vary. Hepatobiliary involvement is rare, and typically asymptomatic; however, it can lead to cirrhosis, and may require liver transplantation. In this report, we present a rare case of a patient affected by sarcoidosis with hepatobiliary involvement. He presented to our hospital complaining of dyspnea triggered by moderate efforts and oppressive thoracic discomfort. Chest X-ray showed multiple bilateral nodular opacities and enlargement of both hilar regions, confirmed by a subsequent total-body computed tomography scan and positron emission tomography, which also revealed cardiac, splenic, and hepatic involvement. Liver function was studied via gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging, and magnetic resonance cholangiopancreatography (MRCP) was also performed. The diagnosis of sarcoidosis was finally achieved via liver biopsy, revealing non-necrotizing granulomas in the periportal space. The patient was treated with prednisone per os, with regression of all lesions at all levels. Although other cases of biliary sarcoidosis have been described, this report provides a complete image set of Gd-EOB-DTPA-enhanced magnetic resonance and MRCP images that is lacking in the English literature, and which may be useful for diagnosis.