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Two experiments using rainbow trout (Oncorhynchus mykiss) were conducted to examine the combined effects of energy intake as manipulated by ration and pulp and paper mill effluent exposure over either one, or two consecutive reproductive cycles. This study demonstrated that the level of energy intake affected the full range of measured parameters from energy allocation to somatic growth and the gonadal development, steroid production and hematology. Increasing ration level expectedly increased growth, condition, liver and gonad size. Female trout in the higher ration treatments produced more follicles and had larger eggs, investing the same relative proportion of total energy into ovarian development. Sex steroid levels and hematological parameters were also positively influenced by increasing ration level in males and females. By far, the most dramatic impact of reduced ration on reproduction was to substantially reduce the frequency of sexually maturing fish. The effects of effluent exposure were not as marked as those linked to ration level and typically did not manifest unless fish were exposed through two consecutive reproductive cycles. The physiological effects of pulp and paper effluent exposure observed in these experiments were not consistent between the two experiments conducted herein, nor were they consistent with previously observed impacts in similar experiments with this effluent. Effluent exposure over one reproductive cycle did not impact physiological parameters in trout. However, when effluent exposure was maintained over two reproductive cycles, a new pattern of effluent response emerged including increased condition factor in both sexes, a decrease in the potential ability of the blood of females to transport oxygen, and increased sex steroids and reproductive investment in males. Effluent was also observed to cause reduced growth in male trout over two years. The effects of ration on gonad and liver size were far more obvious and consistent when a longer exposure was employed, thus, it appears to take more than one full year for energy intake changes to be reflected in those particular physiological endpoints.

Many studies link pulp and paper mill effluent (PPME) exposure to adverse effects in fish populations present in the mill receiving environments. These impacts are often characteristic of endocrine disruption and may include impaired reproduction, development and survival. While these physiological endpoints are well-characterized, the molecular mechanisms causing them are not yet understood. To investigate changes in gene transcription induced by exposure to a PPME at several stages of treatment, male and female fathead minnows (FHMs) were exposed for 6 days to 25% (v/v) secondary (biologically) treated kraft effluent (TK) or 100% (v/v) combined mill outfall (CMO) from a mill producing both kraft pulp and newsprint. The gene expression changes in the livers of these fish were analyzed using a 22 K oligonucleotide microarray. Exposure to TK or CMO resulted in significant changes in the expression levels of 105 and 238 targets in male FHMs and 296 and 133 targets in females, respectively. Targets were then functionally analyzed using gene ontology tools to identify the biological processes in fish hepatocytes that were affected by exposure to PPME after its secondary treatment. Proteolysis was affected in female FHMs exposed to both TK and CMO. In male FHMs, no processes were affected by TK exposure, while sterol, isoprenoid, steroid and cholesterol biosynthesis and electron transport were up-regulated by CMO exposure. The results presented in this study indicate that short-term exposure to PPMEs affects the expression of reproduction-related genes in the livers of both male and female FHMs, and that secondary treatment of PPMEs may not neutralize all of their metabolic effects in fish. Gene ontology analysis of microarray data may enable identification of biological processes altered by toxicant exposure and thus provide an additional tool for monitoring the impact of PPMEs on fish populations.

Background:Clinical presentations of Wilson's disease (WD) in childhood ranges from asymptomatic liver disease to cirrhosis or acute liver failure, whereas neurological and psychiatric symptoms are rare. The basic diagnostic approach includes serum ceruloplasmin and 24-hour urinary copper excretion. Final diagnosis of WD can be established using a diagnostic scoring system based on symptoms, biochemical tests assessing copper metabolism, and molecular analysis of mutations in the ATP7B gene. Pharmacological treatment is life-long and aims at removal of copper excess by chelating agents as D-penicillamine, trientine, or inhibition of intestinal copper absorption with zinc salts. Acute liver failure often requires liver transplantation. This publication aims to provide recommendations for diagnosis, treatment, and follow-up of WD in children.Methods:Questions addressing the diagnosis, treatment, and follow-up of WD in children were formulated by a core group of ESPGHAN members. A systematic literature search on WD using MEDLINE, EMBASE, Cochrane Database from 1990 to 2016 was performed focusing on prospective and retrospective studies in children. Quality of evidence was assessed according to the GRADE system. Expert opinion supported recommendations where the evidence was regarded as weak. The ESPGHAN core group and ESPGHAN Hepatology Committee members voted on each recommendation, using the nominal voting technique.

Patients with hepatocellular carcinoma should be managed with a multidisciplinary approach framed in a network where all the diagnostic techniques and therapeutic resources are available in order to provide the optimal level of care.Given this assumption, the Coordinating Committee of the Italian Association for the Study of the Liver nominated a panel of experts to elaborate practical recommendations for the multidisciplinary management of hepatocellular carcinoma aiming to provide: (1) homogeneous and efficacious diagnostic and staging work-up, and (2) the best treatment choice tailored to patient status and tumour stage at diagnosis.The 2010 updated American Association for the Study of Liver Disease Guidelines for hepatocellular carcinoma were selected as the reference document. For each management issue, the American Association for the Study of Liver Disease recommendations were briefly summarised and discussed, according to both the scientific evidence published after their release and the clinical expertise of the Italian centres taking care of these patients. The Italian Association for the Study of the Liver expert panel recommendations are finally reported.

Long-term studies on the reproductive fitness of fish under controlled exposure conditions are necessary to address some of the controversy surrounding the field-based studies of pulp and paper effluent effects. This study undertook effluent exposures of 2+ age rainbow trout that were approximately halfway through gonadal growth. Trout were exposed to a mixed thermomechanical/bleached kraft effluent in 12,000-L flow-through exposure tanks at an environmental research facility located at a pulp and paper mill in Kawerau, New Zealand. Trout were exposed to either upstream river water or 10% effluent in upstream river water and were maintained at a ration of 0.7% of body wet weight during the experiment. Results of the 2-month study indicated that trout survival was not significantly different between effluent-exposed tanks and reference tanks. There was extensive growth during the exposure but no differences were found due to effluent exposure. Gonadal development was not significantly different between treatments. Steroid hormone concentrations in males and females were not affected by effluent exposure. The effluent showed no potential to be estrogenic as indicated by a lack of vitellogenin induction in male trout. Other physiological indicators of energy storage and utilization also showed no significant differences. Modest induction of hepatic 7-ethoxyresorufin-O-deethylase (2.5-fold) was the only detectable biological effect of the exposure. Biliary concentration of effluent-related compounds were typical of pulp mill effluent exposure and further suggested that the source of phytosterols was in fact dietary and not effluent-derived.

EROD (ethoxyresorufin-O-deethylase) activity was determined in winter flounder, a sediment-inhabiting and non-migratory fish species, living near a pulp and paper mill in Newfoundland in relation to temperature, gender, sexual maturity, and lesions in the liver. Samples of liver were taken from fish captured by SCUBA divers at 0 degrees C, 5 degrees C and 16 degrees C. Enzymic activity was detected in fish living only above 0 degrees C. Adult males and juvenile fish had higher levels of EROD activity than prespawning females at 5 degrees C. Macrophage aggregates only or occurring simultaneously with bile ductule hyperplasia and clear cell foci in the liver, did not impair EROD activity but necrosis had a negative effect. Results from this study indicate the importance of water temperature, gender, sexual maturity and liver pathology in assessing EROD activity of fish in biomonitoring programs.

[cat] En el primer estudi confirmem que el tractament amb enoxaparina es capaç de disminuir la pressió portal en rates amb cirrosi establerta i hipertensió portal. A més, la millora en la pressió portal es va produir sense efectes en el flux sanguini portal, suggerint una disminució en la resistència vascular intrahepàtica. La falta d’efectes de l’administració aguda d’enoxaparina en la pressió portal, en els paràmetres hemodinàmics sistèmics, i en el contingut de superòxid o GMPc, suggereix que l’enoxaparina no té un efecte directe sobre el component dinàmic de la resistència vascular intrahepàtica. Per acabar de confirmar aquests resultats, es va examinar la resposta dependent d’endoteli al vasodilatador acetilcolina i no es van observar diferències entre les rates tractades amb enoxaparina i les rates tractades amb vehicle en cap dels dos models de cirrosi.. A més a més, tot i que en els tractaments de més llarga durada amb enoxaparina es van observar sobretot millores en les alteracions arquitecturals, es van observar també canvis en el to vascular. Es van disminuir els nivells d’estrès oxidatiu, de proteïnes nitrotirosinades i es va augmentar en el contingut de GMPc. A més a més, es va observar una disminució de la ratio p-Moesina/Moesina en les rates tractades amb enoxaparina, suggerint que el tractament amb enoxaparina pot modular el to vascular mitjançant la relaxació de les CHE, almenys a llarg termini. Tot i això, s’ha de tenir en compte que aquest canvis en el to vascular poden ser deguts a la millora de l’alteració estructural observada. És cert que el tractament amb enoxaparina ja es va descriure com a un bon tractament per a millorar la fibrosi hepàtica en models de dany hepàtic lleu. El nostre estudi amplia aquestes observacions a models amb cirrosi establerta. El tractament amb enoxaparina va ser iniciat en el moment on es va aturar l’administració del tòxic (tant CCl4 com TAA) com a model de regressió de malaltia avançada, o es va administrar alhora amb el tòxic, com a model de prevenció de la progressió de la cirrosi, en el model de TAA. Això ens va permetre analitzar els efectes del tractament amb enoxaparina en dos escenaris diferents. En el model de regressió amb CCl4, les rates que van rebre durant 3 setmanes el tractament van tenir més temps de regressió espontània de la fibrosi que les rates que van rebre només una setmana de tractament. Tot i això, tant les d’una setmana de tractament com les de 3 setmanes de tractament van tenir una disminució del 25% del contingut de col·lagen analitzat per tinció de Sirius Red. Això també es va observar en el model de cirrosi de TAA tant en regressió com en prevenció. Tot els resultats van cap a la mateixa direcció i suggereixen el paper de l’enoxaparina en disminució de la fibrosi hepàtica. A més, es va observar una disminució dels nivells d’activació de les CHE en les rates tractades amb enoxaparina, tant a nivell de teixit com en cèl·lula aïllada de rata tractada. A part de l’efecte de l’enoxaparina en la fibrosi hepàtica, es va observar la influència de del tractament en la prevenció d’esdeveniments trombòtics en la microcirculació hepàtica. De fet, s’ha suggerit que aquests podrien jugar un paper important en la progressió de la fibrosi hepàtica. Per explorar aquest efecte hem avaluat el contingut de fibrina en el parènquima hepàtic com a marcador de la formació de microtrombes. Els fetges de rates tractades amb enoxaparina van tenir una menor deposició de fibrina. Aquest fet ja es va observar en les rates tractades durant una setmana, però l’efecte va ser més gran i significatiu en les rates tractades durant 3 setmanes. Aquestes troballes confirmen la connexió que hi ha entre trombosi i fibrosi hepàtica i consolida el concepte de l’ús dels anticoagulants per a la prevenció/dissolució dels microtrombes per a millorar la fibrosi hepàtica. Per contra, no es van observar canvis a nivell d’inflamació. Per tant, encara que no podem descartar completament el potencial efecte del tractament amb enoxaparina en la reducció de la inflamació, no sembla que aquests sigui el principal mecanisme responsable de la millora les alteracions arquitecturals en la cirrosi hepàtica. És important remarcar que els efectes beneficiosos del tractament amb enoxaparina en la reducció de la pressió portal, resistència vascular intrahepàtica i fibrosi hepàtica no es van associar a efectes deleteris en els animals. No es van observar diferencies en els enzims hepàtics, ni es va observar sagnats durant el tractament o durant l’estudi hemodinàmic. En el segon estudi es va avaluar l’efecte de l’anticoagulant oral, Rivaroxaban, en la cirrosi hepàtica. Com ja es va veure en el primer estudi, la teràpia anticoagulant pot ser una bona estratègia terapèutica per al tractament de la hipertensió portal en la cirrosi. Tot i això, les heparines de baix pes molecular són dependents dels nivells sanguinis d’antitrombina, que de fet poden estar disminuïts en els pacients cirròtics. Es per això que vam estudiar els efectes de Rivaroxaban, que és un inhibidor directe del factor Xa (tant el Factor Xa lliure com el que es troba unit al complex de protrombinasa) i és independent dels nivells d’antitrombina. A més a més, Rivaroxaban té l’avantatge de ser biodisponible via oral i té una acció ràpida. Tot això, fa de rivaroxaban un anticoagulant més previsible i potencialment més eficient comparat amb altres heparines. En aquest estudi hem confirmat els efectes beneficiosos de l’ús d’anticoagulants per a millora la hipertensió portal en la cirrosi. Hem demostrat que l’administració oral de rivaroxaban disminueix els nivells d’estrès oxidatiu, millora la biodisponibilitat de NO, desactiva les CHE i millora la hipertensió portal en dos models de cirrosi en rata. La disminució de la pressió portal observada en les rates tractades amb rivaroxaban no es va associar a canvis en el flux sanguini portal en cap dels dos models, suggerint que el principal efecte ve de la disminució en la resistència vascular intrahepàtica. De fet, es va observar una disminució de la resistència vascular intrahepàtica en fetges de rates tractades amb rivaroxaban quan es va avaluar en un sistema de perfusió ex vivo amb el flux controlat. L’estudi dels mecanismes de la millora en la funció microcirculatòria hepàtica van mostrar que rivaroxaban disminuïa els nivells d’estrès oxidatiu, probablement pel menor reclutament de cèl·lules inflamatòries. També augmentava els nivells de GMPc, millorava la resposta a dosis creixents d’acetilcolina i disminuïa l’expressió del marcador d’activació de CES, el factor von Willebrand. Tot això indicava que el tractament amb rivaroxaban té un efecte important en la millora de la disfunció endotelial en el fetge cirròtic. D’altra banda també es va estudiar l’efecte de rivaroxaban sobre les CHE. Es va observar que el tractament amb rivaroxaban disminuïa els marcadors d’activació i proliferació de les CHE que correlacionen amb la seva capacitat de síntesi de matriu extracel·lular. Aquest efecte no es va associar a canvis importants en el contingut de fibra en el fetge. Degut als canvis observats en els nivells d’activació de les CHE, es temptador especular que un tractament més llarg amb rivaroxaban s’associaria a una disminució en els nivells de fibrosi hepàtica. Això està recolzat pels efectes beneficiosos observats a sobre les alteracions del parènquima: estudis ultraestructurals realitzats mitjançant microscopia electrònica van confirmar que les rates tractades amb rivaroxaban tenien una menor formació de membrana basal en els sinusoides hepàtics i que els hepatòcits tenen més projeccions, suggerint una millor estructura del sinusoid hepàtic. Finalment, es va confirmar una disminució del contingut de fibrina en les rates tractades amb rivaroxaban, suggerint una disminució de la microtrombosi hepàtica. Els efectes beneficiosos deguts al tractament amb rivaroxaban no es van associar a efectes deleteris en l’hemodinàmica sistèmica ni en un augment de sagnats durant el tractament. El tercer estudi aporta nova informació, fins ara no coneguda, sobre el potencial dany de l’estès oxidatiu mitocondrial en les cèl·lules hepàtiques durant la cirrosi i sobre l’ús dels antioxidants dirigits a mitocondri com a estratègia terapèutica per a la hipertensió portal i la cirrosi. Tal i com s’ha explicat anteriorment, les CHE són les principals cèl·lules implicades en la síntesi de matriu extracel·lular que contribueix en l’augment de la resistència vascular intrahepàtica en la cirrosi. Tenint en compte que l’augment de l’estrès oxidatiu en la cirrosi és un dels principals mecanismes que activen les CHE i que els mitocondris són un dels principals productors d’espècies reactives d’oxigen, aquest estudi es va centrar en avaluar els efectes de l’antioxidant dirigit a mitocondri, mitoquinona en l’estrès oxidatiu, fenotip de les CHE, la fibrosi hepàtica i la hipertensió portal en models pre-clínics de cirrosi. Els resultats del present estudi mostren que el tractament amb mitoquinona disminueix l’estrès oxidatiu hepàtic, desactiva les CHE i disminueix la fibrosi hepàtica i la hipertensió portal en les rates cirròtiques. Estudis anteriors van demostrar el rol de l’estrès oxidatiu en la fisiopatologia de la cirrosi i la hipertensió portal. En el present estudi demostrem que el tractament amb mitoquinona va aconseguir disminuir els nivells d’estrès oxidatiu, com altres teràpies utilitzades com ara el tempol o el resveratrol, però amb la diferència que la mitoquinona té l’avantatge de ser administrada oralment. A més a més, les altres teràpies antioxidants no poden dirigir-se a l’interior del mitocondri i, per tant, no poden contrarestar l’estrès oxidatiu mitocondrial que pot resultar en dany i disfunció mitocondrial i endegar una cascada de conseqüències deletèries per a la cèl·lula com ara la inflamació o la mort cel·lular. El nostre estudi demostra que part de l’estrès oxidatiu observat en els fetges cirròtics prové del mitocondris dels hepatòcits i de les CHE. A més, demostrem que la mitoquinona es capaç de disminuir l’estrès oxidatiu mitocondrial en els principals tipus cel·lulars hepàtics. Aquest augment de l’estrès oxidatiu mitocondrial en la cirrosi pot ser causat, almenys en part, per la disminució en l’expressió i l’activitat de la isoforma mitocondrial de la superòxid dismutasa, que s’ha vist disminuïda en la cirrosi. És important destacar que el tractament amb mitoquinona és capaç de disminuir l’activació de les CHE de rata tant in vitro com in vivo. A més, la desactivació de les CHE es va confirmar tant en CHE aïllades de biòpsies humanes, en la línia cel·lular humana de CHE, LX2, i en el model ex vivo per a l’estudi de mostres de fetge humanes, els talls de precisió de fetges humans (hPCLS). Aquests efectes es van evidenciar quan es va veure que la proliferació de les CHE estava disminuïda però no la seva viabilitat. Per confirmar la capacitat terapèutica de la mitoquinona, es va avaluar els seus efectes en dos models de cirrosi. Les observacions in vivo van demostrar que el tractament amb mitoquinona disminuïa la pressió portal, sense canvis en el flux sanguini portal, suggerint una disminució en la resistència vascular intrahepàtica. A més, els animals tractats amb mitoquinona van tenir una disminució del contingut de fibra hepàtica en ambdós models. Suggerint que la disminució de la fibrosi hepàtica és el principal mecanisme amb el que la mitoquinona disminueix la pressió portal, ja que no es van trobar efectes importants de la mitoquinona sobre el to vascular hepàtic almenys durant el temps de tractament estudiat, i que altres antioxidants sí que han demostrat una millora de la disfunció endotelial. A més, es sap que els nivells de les espècies reactives d’oxigen estan directament lligades a la inflamació. Per això vam analitzar l’expressió dels marcadors CD68 i CD163 com a marcadors d’inflamació. En aquest estudi vam observar una disminució del nombre de cèl·lules positives per CD68, suggerint un efecte de la mitoquinona en la reducció de la inflamació hepàtica. Aquests resultats només es van observar en el model de CCl4 i no en el de TAA, suggerint que la reducció de la inflamació pot contribuir a la millora de la fibrosi hepàtica però no és el principal mecanisme. Les diferències observades entre els dos models de cirrosi, pot ser degut a les diferències intrínseques dels dos models. De fet, s’ha descrit que el model induït per CCl4 acumula més estrès oxidatiu que el model per TAA, fent així el model per CCl4 més susceptible per a una teràpia antioxidant que no el model de TAA. Tot i això, cal destacar que tots els beneficis observats pel tractament amb mitoquinona no es van associar a efectes deleteris en els animals cirròtics en cap dels dos models., [eng] The present doctoral thesis is focused in the development of new therapeutical strategies for the treatment of portal hypertension, one of the main complications of cirrhosis. Increase in portal pressure is directly related to the increased intrahepatic vascular resistance, mainly due to increased vascular tone and increased hepatic fibrosis. Therefore, the main objective of the present doctoral thesis was to study the use of the anticoagulants enoxaparin and rivaroxaban, and the mitochondrial-directed antioxidant mitoquinone and to evaluate their effects on intrahepatic vascular resistance and portal pressure in preclinical models of cirrhosis with portal hypertension. On the one hand, the results of the present doctoral thesis concluded that the anticoagulants, both the anti-thrombin like enoxaparin and the anti-factor Xa (thrombin-independent) rivaroxaban significantly improve portal pressure of animals with cirrhosis and portal hypertension mainly due to improved vascular tone and hepatic fibrosis. On the other hand, we observed that mitochondrial oxidative stress was increased in cirrhotic livers and hepatocytes and hepatic stellate cells were the main cells producing mitochondrial oxidative stress. Furthermore, we confirmed the beneficial effects of antioxidants on cirrhosis. The results concluded that the mitochondrial-directed antioxidant mitoquinone decreased significantly portal pressure and intrahepatic vascular resistance. Moreover, an important deactivation of the main cells producing collagen was observed both in rat and in human cells. These results suggest that anticoagulant and antioxidant treatment may be a potential therapeutical strategy for the treatment of portal hypertension in cirrhotic patients., [spa] Esta tesis estudia el efecto de diferentes estrategias terapéuticas para el tratamiento de la hipertensión portal en models preclínicos de cirrosis. Se han estudiado los efectos de dos anticoagulantes (enoxaparina y rivaroxaban) y el efecto de un antioxidante dirigido a mitocondria (mitoquinona). En el primer estudio, se evaluó el efecto del anticoagulante enoxaparina en modelos preclínicos de cirrosis. Se observó que el tratamiento agudo con enoxaparina no afectó los parámetros sistémicos ni hemodinámicos evaluados. Tampoco modificó los niveles de GMPc o el contenido de estrés oxidativo hepático. El tratamiento a corto plazo (1 semana) disminuyó de manera significativa la presión portal en ratas cirróticas sin modificar el flujo. También disminuyó de manera significativa los niveles de estrés oxidativo y aumentó la biodisponibilidad de óxido nítrico (NO). Además, el tratamiento disminuyó un 26% la fibra hepática. Estos cambios se asociaron a una mejora del fenotipo de las células estrelladas hepáticas (CEH). También se observó una mejor en la microtrombosis hepática. El tratamiento a largo plazo (3 semanas) también disminuyó de manera significativa la presión portal en los dos modelos de cirrosis preclínica, sin cambios en los otros parámetros hemodinámicos. En este caso, también se observó una disminución del estrés oxidativo, pero sin mejora en la biodisponibilidad de NO. El tratamiento con enoxaparina redujo un 35% el área de fibrosis, cambios también asociados a una mejora del fenotipo de las CHE. También disminuyó el contenido de fibrina, mejorando así la microtrombosis hepática. Finalmente, también se observaron efectos beneficiosos en el modelo de prevención en ratas cirróticas por tioacetamida. La presión portal fue menor, en las ratas tratadas con enoxaparina, aunque los cambios no fueron tan marcados como en el modelo de regresión. También se redujo el área de fibrosis hepática, se mejoró el fenotipo de las CHE y hubo una menor microtrombosis hepática. En el segundo estudio, el anticoagulante oral anti factor Xa Rivaroxaban, disminuyó significativamente la presión portal en los dos modelos de cirrosis preclínica. La disminución de la presión portal no se asoció a cambios ni en el flujo sanguíneo portal ni en la presión arterial media, sugiriendo una disminución en la resistencia vascular intrahepática. Este hecho se confirmó ex vivo, donde se observó una disminución significativa de la resistencia vascular intrahepática del 35% en un sistema de perfusión con el flujo controlado. El tratamiento durante dos semanas disminuyó los niveles de estrés oxidativo, el número de células de Kupffer y aumentó la biodisponibilidad del NO. Las ratas tratadas con rivaroxaban tuvieron una mejor respuesta, aunque no significativa, al vasodilatador acetilcolina. Para confirmar el efecto beneficioso de rivaroxaban sobre el endotelio sinusoidal hepático, se evaluó el fenotipo de las células endoteliales sinusoidales y se observó una disminución en el marcador de activación, el factor von Willebrand, y una menor presencia de membrana basal. El tratamiento con rivaroxaban disminuyó el número y la activación de las CHE tanto a nivel de tejido como a nivel de célula aislada. No se observaron cambios en la apoptosis sugiriendo que el menor número de CHE vendría de una menor proliferación y no de un aumento en la muerte celular. Finalmente se observó que el tratamiento disminuía el contenido de fibrina sugiriendo una disminución de la microtrombosis hepática y se confirmó que los efectos de rivaroxaban sobre las CHE no era directos sino a través de la inhibición de la cascada de coagulación e inhibiendo la activación de los receptores PAR. En el tercer y último estudio se evaluó el efecto del tratamiento con un antioxidante dirigido a mitocondria. En un inicio se confirmó que en la cirrosis existe un aumento significativo de estrés oxidativo mitocondrial y que las principales células productores de éste estrés eran las CHE y los hepatocitos. El tratamiento con mitoquinona in vitro disminuyó significativamente el nivel de estrés oxidativo en todas las estirpes celulares hepáticas estudiadas. Además, disminuyó el nivel de activación de las CHE tanto de rata como humanas. Esto se confirmó en cortes ultrafinos de biopsias humanas y en líneas celulares. A nivel in vivo se observó que mitoquinona produjo un descenso significativo del nivel de estrés oxidativo hepático, tanto a nivel mitocondrial como total. A demás se disminuyó el contenido de proteínas nitrotirosinadas y la expresión génica de un factor inducido por el estrés oxidativo, Hif1a. Las ratas tratadas con mitoquinona tuvieron una disminución significativa de la presión portal y no se asoció a cambios ni en el flujo sanguíneo portal ni en la presión arterial media, sugiriendo una disminución en la resistencia vascular intrahepática. Mitoquinona también disminuyó el grado de fibrosis hepática y el nivel de activación de las CHE. Finalmente, se observó que el tratamiento con mitoquinona disminuyó significativamente el nivel de inflamación hepática. Para finalizar, esta tesis doctoral concluye que tanto el tratamiento con anticoagulantes, como el tratamiento con antioxidantes dirigidos a mitocondria pueden ser una potencial vía de tratamiento para la hipertensión portal en pacientes cirróticos.

The study reported in this paper tested the hypothesis that the developmental and reproductive health of mosquitofish (Gambusia affinis) exposed to pulp and paper effluent in the Dengcun River would differ from that of mosquitofish living in a reference site. We also studied whether morphological characteristics such as the anal fin and hemal spines of mosquitofish could serve as indicators for evaluating the androgenic effect and mosquitofish population security in the Dengcun River. Male and female mosquitofish were captured at three sites contaminated by pulp and paper effluent in the Dengcun River in Sihui, South China, and at a nearby uncontaminated reference site. Samples were collected from the sampling sites on the same day in August 2009. We compared the populations by total length, wet body and liver mass, gonad mass, and population composition. We also compared the populations according to number of anal fin segments, oocyte and embryo count, anal fin and hemal spine morphology among females, and by sperm count and viability among males, and observed the gonadal and liver histology of both males and females. Female mosquitofish exposed to pulp and paper effluent in the Dengcun River were generally smaller in length and mass, had a greater number of anal fin segments and more embryos, but had significantly fewer oocytes in comparison with those living at the reference site. The higher number of anal fin ray 3 segments and the increased ray 4:6 length ratio observed among fish taken from the Dengcun River sites indicated that they might be subject to the androgenic effect. Furthermore, the significantly different hemal spine morphology of the effluent-affected females also indicated the pulp and paper mills effluents in Dengcun River might contain androgenic substance(s). Male mosquitofish at the sites exposed to effluent had a higher number of anal fin segments and greater testis mass in comparison with those living at the reference site. No evidence of intersex was found in either males or females, although histopathological tests on females revealed histologic abnormalities in the liver and gonads. It can be concluded that pulp and paper effluent contamination in the Dengcun River has affected a number of developmental parameters and reproductive characteristics in mosquitofish, with possible adverse effects on reproduction in this population.

INTRODUCTION: Acute kidney injury is associated with high mortality in the perioperative period of liver transplantation. The aim of this position paper was to provide an up-to-date overview with special emphases on diagnosis, risk factors, and treatment. EVIDENCEACQUISITION: The Liver Intensive Care Group of Europe nominated a panel of recognized international experts who reviewed the available literature published from 1990 to January 2016 and produced clinical recommendations. The level of evidence and strength of recommendation were judged according to the Grading of Recommendations Assessment Development and Evaluation system. EVIDENCESYNTHESIS: Diagnosis of AKIshould be based on the KDIGOcriteria. The preoperative risk factors are more related to the patients predisposing factors and post-operative risk factors tend to be difficult to control. Therefore, focusing on intra-operative risk factors it would be important to maintain an adequate hemodynamics and to keep inferior vena cava clamping as short as possible. Biomarkers to identify AKIat an early stage are available; however, there is a lack of robust data that indicates their true beneficial effect. Intraoperative renal replacement therapy may be beneficial in some selective cases whereas its postoperative timing is still under debate. CONCLUSIONS: Perioperative liver transplant risk factors for acute kidney injury are difficult to control. Therefore, the focus should be on intra-operative hemodynamics and nephrotoxic drugs avoidance. Prospective randomized trials are needed to show the beneficial effect of early replacement therapy. In this context, the new biomarkers would be helpful in identifying kidney injury earlier OA embargo

This review summarizes our current understanding of nonalcoholic fatty liver disease (NAFLD), a multi-factorial systemic disease resulting from a complex interaction between a specific genetic background and multiple environmental/metabolic “hits”. The role of gut microbiota, lipotoxicity, inflammation and their molecular pathways is reviewed in-depth. We also discuss the epidemiology and natural history of NAFLD by pinpointing the remarkably high prevalence of NAFLD worldwide and its inherent systemic complications: hepatic (steatohepatitis, advanced fibrosis and cirrhosis), cardio-metabolic (cardiovascular disease, cardiomyopathy, arrhythmias and type 2 diabetes) and neoplastic (primary liver cancers and extra-hepatic cancers). Moreover, we critically report on the diagnostic role of non-invasive biomarkers, imaging techniques and liver biopsy, which remains the reference standard for diagnosing the disease, but cannot be proposed to all patients with suspected NAFLD. Finally, the management of NAFLD is also reviewed, by highlighting the lifestyle changes and the pharmacological options, with a focus on the innovative drugs. We conclude that the results of ongoing studies are eagerly expected to lead to introduce into the clinical arena new diagnostic and prognostic biomarkers, prevention and surveillance strategies as well as to new drugs for a tailored approach to the management of NAFLD in the individual patient.

Toxic effects of unbleached (sulfate or sulfite) and bleached (sulfate) paper mill effluents were studied in a primary culture of rainbow trout liver cells. The effluents and control water from a clean area were extracted with diethyl ether and added to the cultures dissolved in dimethyl sulfoxide. Plasma membrane integrity was studied by measuring lactate dehydrogenase (LDH) leakage. The cellular content of glutathione (GSH) was used as an indicator of oxidative stress and the formation of reactive intermediates. Dose-response studies indicated that unbleached effluents contained more potent toxic substances than bleached effluents. Both unbleached and bleached effluents contained organic diethyl ether-extractable substances which increased cytochrome P450-dependent 7-ethoxyresorufin-O-deethylase (EROD) activities. The inducing effects were seen at concentrations substantially lower than those decreasing GSH content and increasing LDH leakage. Possible EROD inducing substances in bleached effluents are chlorinated organic compounds. Inducing compounds in unbleached effluents are yet to be identified. Furthermore, at higher concentrations the effluents contained substances that inhibited the cytochrome P450 system. The results show that the trout primary hepatocyte cultures afford a convenient in vitro method for screening cytochrome P450 inducing components extracted from industrial effluents to investigate mechanisms by which wastewaters cause injury in cells.

The use of human albumin is common in hepatology since international scientific societies support its administration to treat or prevent severe complications of cirrhosis, such as the prevention of post-paracentesis circulatory dysfunction after large-volume paracentesis and renal failure induced by spontaneous bacterial peritonitis, and the treatment of hepatorenal syndrome in association with vasoconstrictors. However, these indications are often disregarded, mainly because the high cost of human albumin leads health authorities and hospital administrations to restrict its use. On the other hand, physicians often prescribe human albumin in patients with advanced cirrhosis for indications that are not supported by solid scientific evidence and/or are still under investigation in clinical trials. In order to implement appropriate prescription of human albumin and to avoid its futile use, the Italian Association for the Study of the Liver (AISF) and the Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) nominated a panel of experts, who reviewed the available clinical literature and produced practical clinical recommendations for the use of human albumin in patients with cirrhosis.

The common bully (Gobiomorphus cotidianus), a smallbodied New Zealand native fish species, was used to monitor population impacts of multiple effluents in the Tarawera River, New Zealand. In an initial survey, the absence of reproductive development at the expected spawning time for common bully was observed in a population downstream of effluent discharges. Subsequently, we examined the hypotheses that the observed changes were due to effluent exposure, migratory patterns, or genetic differences between populations. Liver detoxification enzyme activity and stable isotopes provided evidence against upstream migration of sexually mature bully. The observed presence of developed gonads in the downstream population during winter season resulted in the rejection of the hypothesis that reproductive failure was due to effluent exposure, and it was concluded that there were substantial differences in reproductive timing. Genetic analyses of two upstream, one downstream, and one population from a nearby coastal river indicated the upstream (reference) and downstream (effluent exposed) bully in the river formed genetically distinct populations. The identification of a nearby river population with similar reproductive timing and high genetic similarity to the effluent-exposed population suggests that the observed differences in the genetics of the downstream population were not caused by effluent exposure. The genetic analysis did highlight the lack of donwstream dispersion and gene flow in the river which could possibly be related to anthropogenic stress.

Introduction: Antineoplastic drug, Cyclophosphamide (CP), is a widely used drug that causes toxicity through its metabolites, phosphoramide mustard and acrolein. Squalene (SQ), an intermediate in the cholesterol metabolism has antioxidant and membrane stabilizing property. In the present study, the protective role of SQ towards the tissue defense system of the liver and kidney in the toxicity induced by CP was assessed. Material and methods: Normal Wistar albino rats were administered CP in a dose of 150 mg/kg b.wt., i.p., twice, for 2 consecutive days to induce toxicity. SQ, in a dose of 0.4 ml/day/rat p.o. was used to treat the toxicity induced by CP. Results: Significantly decreased activities of enzymic antioxidants [superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPx), glutathione-s-transferase (GST) and glutathione reductase (GR)], decreased levels of reduced glutathione and increased levels of thiobarbutric acid reactive substance (TBARS) were observed. These pathological alterations were significantly normalized during the treatment of SQ. Conclusions: CP toxicity increased the free radical levels in the tissues and affected the activities of the enzymic antioxidants. Increased levels of TBARS [a measure of lipid peroxidation (LPO)] and decreased levels of GSH (due to utilization for detoxification process) evidenced the damage to these tissues. Protection exerted by SQ could be due to free radical quenching, providing additional alkylation site to CP metabolites and by inducing enzymic antioxidant production in these tissues. In conclusions improved antioxidant defense system in the liver and kidney of the experimental rats confirms the protective role of SQ against CP induced toxicities.

By definition, Supplements are collections of papers that deal with related issues or topics, are published as a separate issue of the journal or as part of a regular issue, and are usually funded by sources other than the journal’s Publisher. In 2006 we published in Acta Cirurgica Brasileira a thematic Supplement on liver surgery involving aspects of clinical and experimental research. The papers published in the Supplement were the result of investigations carried out in the Clinical Surgery Postgraduation Program by students and professors of the Division of Digestive Surgery and Liver Transplant. As the central theme, the liver was approached in terms of various aspects contributing to a thematic investigation. In my opinion, this was important from a pedagogic viewpoint, providing the reader with the rare opportunity of evaluating and studying the clinical, surgical, biochemical, physiopathological, and pharmacological aspects of an organ as a central focal point and their relation to liver surgery as a whole and to liver transplantation in particular. This didactic and pedagogic quality of a Supplement is extremely important because, after peer review, the papers are exposed to the scientific community in a clear and ordered manner based on a pre-established criterion. It is important to emphasize that, in order to be useful for consultation and to fulfill its thematic objective, a Supplement must have the fundamental characteristic of an intimate relation between the papers published in it. Supplements can serve useful purposes: education, exchange of research information, ease of access to focused content, and improved cooperation between academic and corporate entities. An example is a recent normal issue of the Brazilian Journal of Medical and Biological Research, which emphasized the research tradition of establishing, maintaining and exploiting birth cohort studies of the Ribeirao Preto Medical School. This research line was highlighted as a central theme in this issue of this important Brazilian journal devoted to medical and biological research, which contains a series of twelve papers from the Ribeirao Preto and Sao Luis birth cohort studies from the Southeast and Northeast of Brazil, respectively. The topics covered in this group of reports vary and include predictors of perinatal health and maternal risk factors, early life determinants of cardiovascular risk factors in childhood and adolescence, use of health services, and a description of dietary characteristics of young adults, amongst other topics. There was also a guide to the background, objectives, sampling and protocols employed across these studies, which, together with similar pieces published in past issues of the same journal, will serve as a very useful starting point, particularly for potential collaborators. The present Supplement is centered on the clinical and experimental research carried out in the Departament of Surgery and Anatomy of the Ribeirao Preto Medical School, involving papers fully originating from the postgraduation program sensu stricto, developed by both the faculty members and the postgraduate students. Each paper was evaluated by one or two reviewers from the Department of Surgery or from other institutions (peer review). The comments of the reviewers were published together with the respective papers, showing transparency in the evaluation and also providing elements to the readers for a more adequate additional interpretation. The research tradition of the Department of Surgery and Anatomy, the high note attributed to it by CAPES and the high international renown of Acta Cirurgica Brasileira represent the proper foundation for this Supplement, which has been conceived with the main purpose of providing a proper dissemination of the knowledge produced in an environment devoted to the quality of scientific investigation.