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An important paper describing the Standards of the Polish Ultrasound Society regarding the assessment of portal and hepatic vasculature was published in the Journal of Ultrasonography. Due to the multiplicity of morphological and hemodynamic data required, the time needed to obtain these data and the legal responsibility of doctors for the results, there seems to be a need to determine a clear range of the assessed parameters depending on the reference level of a given healthcare facility. Therefore, the aim of the paper was to present the EFSUMB recommendations on the range of the evaluated ultrasonographic parameters in portal hypertension depending on the reference level. European healthcare institutions are characterized by a clear three-level reference network. Due to the lack of a similar division in Poland, we propose our own classification of the competence of medical entities. The first reference level: ultrasound assessments in a primary health care setting (performed by GPs, emergency physicians, non-specialist private practice physicians, non-specialist practice physicians); at least one mid-class ultrasound scanner with pulsed and color Doppler options, equipped with convex 3-5 MHz and linear 7-12 MHz transducers should be available at physician's disposal. The second reference level: ultrasound assessments in the hospital setting and specialist outpatient clinics, performed by specialist private practice physicians, radiologists, gastroenterologists and hepatologists; top class (premium) digital ultrasound scanner should be available at physician's disposal. Third reference level: ultrasound assessments performed in gastroenterology, hepatology and liver surgery departments as well as their specialist outpatient clinics; physicians should use top class digital ultrasound equipment. At every reference level, physicians performing abdominal ultrasound should have the appropriate certification to perform such an assessment or specialize in gastrointestinal diagnosis. [ABSTRACT FROM AUTHOR]

The present study was aimed at preparing stable dry adsorbed nanoparticles (DANs) of olanzapine (OLZ) loaded solid lipid nanoparticles (SLNs) for sustained release. OLZ SLNs were prepared by hot melt emulsification and ultrasonication using Precirol ATO 5 (PRE) as a solid lipid, combination of Kolliphor ELP (KELP) and Tween 80 (T80) as surfactants, after optimising formulation and process variables. The SLN system was subjected to evaluation of particle size, zeta potential, entrapment efficiency (EE), in-vitro drug release and ex-vivo intestinal permeability studies using the chicken intestinal segments (jejunum). Further, these SLNs were converted into stable DANs by adsorbing onto a Neusilin US2 (NUS2) and Avicel CL 611 (ACL) carriers using the granulation-evaporative drying method. The DANs were characterised for redispersion properties, in-vitro drug release, thermal behaviour, crystallinity, and morphology. The SLN and DAN had a particle size of 238.0 nm [0.274 polydispersity index (PdI)] and 302.4 [0.494 PdI] respectively. The zeta potentials of SLN and DAN were found to be −29.3 mV and −26.3 mV, respectively. The SLN had 67% EE, and showed a sustained drug release in various media. The highest permeability of SLNs was observed in ex-vivo permeation model compared to the OLZ suspension, indicating that SLNs have the potential to bypass hepatic metabolism. The adsorption of SLNs onto carriers was confirmed by surface morphology. The DAN had good flow properties and sustained drug release similar to that of SLNs. The X-ray diffraction (XRD) patterns and endothermic peaks confirmed the complete encapsulation of actives in lipid matrices. The encapsulating of OLZ in SLNs and converting it into DAN showed a sustained release and adsorption technique that can be used for improving the stability of NLC dispersion. The DANs can be offered in dosage forms such as filling into sachets, capsules and compressed into tablets. [ABSTRACT FROM AUTHOR]

The genus Crataegus (hawthorn), a member of the Rosaceae family, encompasses several species with broad geographical distribution across the Northern Hemisphere, including Asia, Europe, and the Americas. Hawthorn is recognized as an edible medicinal plant with applications related to strengthening the digestive system, promoting blood circulation, and resolving blood stasis. This study critically summarized the traditional uses, phytochemistry, and pharmacological properties to provide a theoretical basis for further studies on hawthorn and its applications in medicine and food. The available information on hawthorn was gathered from scientific databases (including Google Scholar, Web of Science, PubMed, ScienceDirect, Baidu Scholar, CNKI, online ethnobotanical databases, and ethnobotanical monographs, and considered data from 1952 to 2023). Information about traditional uses, phytochemistry, pharmacology, and safety concerns of the collected data is comprehensively summarized in this paper. The literature review revealed that hawthorn includes more than 1000 species primarily distributed in the northern temperate zone. Traditional uses of hawthorn have lasted for millennia in Asia, Europe, and the Americas. Within the past decade, 337 chemical compounds, including flavonoids, lignans, fatty acids and organic acids, monoterpenoids and sesquiterpenoids, terpenoids and steroids, have been identified from hawthorn. Modern pharmacological studies have confirmed numerous bioactivities, such as cardiovascular system influence, antitumor activity, hepatoprotective activity, antimicrobial properties, immunomodulatory functions, and anti-inflammatory activities. Additionally, evaluations have indicated that hawthorn lacks toxicity. Based on its traditional uses, chemical composition, and pharmacological studies, hawthorn has significant potential as a medicinal and edible plant with a diverse range of pharmacological activities. Traditional uses of the hawthorn include the treatment of indigestion, dysmenorrhea, and osteoporosis. However, modern pharmacological research primarily focuses on its cardiovascular and cerebrovascular system effects, antitumor effects, and liver protection properties. Currently, there is a lack of correlative research involving its traditional uses and pharmacological activities. Moreover, phytochemical and pharmacological research has yet to focus on many types of hawthorn with traditional applications. Therefore, it is imperative to research the genus Crataegus extensively. [Display omitted] • Traditional uses, phytochemistry, pharmacology, and safety concerns of hawthorn. • The medicinal uses and edible value of hawthorn. • The application and medicinal value of hawthorn in ethnopharmacology. • The challenges and opportunities of hawthorn were envisioned. [ABSTRACT FROM AUTHOR]

Background: Liver transplantation is a standard of care and a life-saving procedure for end-stage liver diseases and certain malignancies. The evidence on predictors and risk factors for poor outcomes is lacking. Therefore, we aimed to identify potential risk factors for mortality and to report on overall 90-day mortality after orthotopic liver transplantation (OLT), especially focusing on the role of fungal infections. Methods: We retrospectively reviewed medical charts of all patients undergoing OLT at a tertiary university center in Europe. Results: From 299 patients, 214 adult patients who received a first-time OLT were included. The OLT indication was mainly due to tumors (42%, 89/214) and cirrhosis (32%, 68/214), including acute liver failure in 4.7% (10/214) of patients. In total, 8% (17/214) of patients died within the first three months, with a median time to death of 15 (1–80) days. Despite a targeted antimycotic prophylaxis using echinocandins, invasive fungal infections occurred in 12% (26/214) of the patients. In the multivariate analysis, patients with invasive fungal infections had an almost five times higher chance of death (HR 4.6, 95% CI 1.1–18.8; p = 0.032). Conclusions: Short-term mortality after OLT is mainly determined by infectious and procedural complications. Fungal breakthrough infections are becoming a growing concern. Procedural, host, and fungal factors can contribute to a failure of prophylaxis. Finally, invasive fungal infections may be a potentially modifiable risk factor, but the ideal perioperative antimycotic prophylaxis has yet to be determined. [ABSTRACT FROM AUTHOR]

Since Francis Fontan first introduced the eponymous technique, the Fontan procedure, this type of surgical palliation has allowed thousands of children affected by specific heart malformations to reach adulthood. Nevertheless, abdominal, thoracic, lymphatic and neurologic complications are the price that is paid by these patients. Our review focuses on Fontan-associated liver disease; the purpose is to summarize the current understanding of its physiopathology, the aim of follow-up and the specific radiologic follow-up performed in Europe. Finally, we as members of the Abdominal Task Force of the European Society of Paediatric Radiology propose a consensus-based imaging follow-up algorithm. [ABSTRACT FROM AUTHOR]

Summary: Background: Non‐alcoholic fatty liver disease (NAFLD), prediabetes and type 2 diabetes mellitus are known to be closely linked with obesity as early as during childhood. Objectives: The study aimed to determine the prevalence of prediabetes and T2DM in children with obesity with or without increased transaminases. Methods: Data from the observational multicentre (n = 51), cross‐sectional Adipositas Patienten Verlaufsbeobachtung registry were analyzed. Mild increase (mild group) was defined by alanine transaminase (ALT) >24 to ≤50 U/L and moderate to severe increase (advanced group) by ALT > 50 U/L. Prediabetes and T2DM were defined according to recent IDF/ISPAD guidelines. Results: The prevalence of prediabetes and T2DM was 11.9% (95% CI: 11.0–12.8) and 1.4% (95% CI: 1.1–1.7) among all participants (n = 4932; male = 2481; mean age 12.9 ± 2.7 years; BMI‐SDS 2.1 ± 0.5; Tanner stage 3.2 ± 1.5). The prevalence of impaired glucose metabolism (prediabetes and T2DM) was 13.8% (95% CI: 12.1–15.4) in the mild, 21.9% (95% CI: 18.8–25.1) in the advanced group, 10.7% (95% CI: 9.4–11.9) in the control group. Mild and advanced groups had greater odds ratios for prediabetes [1.42; 95% CI: 1.17–1.72, 2.26‐fold; (1.78–2.86), respectively], the advanced group also for T2DM [2.39 (1.36–4.21)] compared to controls. While an increase in transaminases predominantly affected boys, girls within the advanced group had a higher T2DM prevalence than males (5.4 vs. male 2.1%). Conclusions: Children with obesity and increased liver transaminases as surrogates of NAFLD should be screened for T2DM. [ABSTRACT FROM AUTHOR]

Aim: Our aim is to demonstrate that a healthy diet might reduce the relation between adiposity and inflammation, whereas an unhealthy diet may increase the effect of adiposity on inflammatory biomarkers. Methods: In 618 adolescents (13–17 years) of the European HELENA study, data were available on body composition, a set of inflammation markers, and food intake determined by a self-administered computerized 24-h recall. A 9-point Mediterranean diet score and an antioxidant-rich diet score were used as dietary parameters and tested as moderator. Total body fat was represented by the sum of six skinfold thicknesses and central adiposity by waist circumference. A set of inflammation-related biomarkers was used as outcome: a pro/anti-inflammatory interleukins ratio, TGFβ-1, C-reactive protein, TNF-α, 3 cell adhesion molecules, and 3 types of immune cells; gamma-glutamyltransferase (GGT) and homocysteine were used as cardiovascular disease risk biomarkers, and alanine transaminase (ALT) as liver dysfunction biomarker. Multiple linear regression analyses tested moderation by diet in the adiposity-inflammation association and were adjusted for age, sex, country, puberty, socioeconomic status. Results: Both the Mediterranean and antioxidant-rich diet, and overall and central adiposity, were important in the moderation. Diet was a significant protective moderator in the effect of adiposity on the pro/anti-inflammatory interleukins ratio, TGFβ-1, GGT, and ALT. Conclusion: In conclusion, in some cases, a diet rich in antioxidants and essential nutrients may attenuate the concentration of inflammatory biomarkers caused by adiposity, whereas a poor diet appears to contribute to the onset of early oxidative stress signs. [ABSTRACT FROM AUTHOR]

Congenital diaphragmatic hernia is a rare disease associated with high mortality and morbidity. Antenatal ultrasound screening identifies more than 70% of cases, providing the opportunity for in utero referral to a tertiary care center for expert assessment and perinatal management. Additional genetic and morphologic assessment may be used to rule out associated anomalies. In isolated cases, the outcome may be predicted prenatally by medical imaging. The combination of lung size and liver herniation is a widely accepted method to stratify fetuses into groups with an increasing degree of pulmonary hypoplasia and corresponding mortality rates. Ultrasound measurement of the observed to expected lung-to-head ratio (o/e LHR) is most widely used. The o/e LHR is an independent predictor of survival and short-term morbidity. Finally, evaluation of stomach position has recently been introduced as an indirect method to estimate severity of the disease in left-sided defects, as it has been shown to correlate with the proportion of intrathoracic liver. Herein, we propose a protocol for the standardized ultrasound assessment of fetuses with isolated CDH and individualized prediction of neonatal outcome. [ABSTRACT FROM AUTHOR]

Objectives This study aimed to explore the associations of liver biomarkers with cardiometabolic risk factors and their clustering, and to provide reference values (percentiles) and cut-off points for liver biomarkers associated with high cardiometabolic risk in European adolescents. Methods Alanine aminotransferase ( ALT), gamma-glutamyltransferase ( GGT), aspartate aminotransferase to ALT ratio ( AST/ ALT), waist circumference, blood pressure, triglycerides, high-density lipoprotein cholesterol and insulin were measured in 1084 adolescents. We computed a continuous cardiometabolic risk score and defined the high cardiometabolic risk. Results Higher ALT and GGT and lower AST/ ALT were associated with adiposity and with the number of adverse cardiometabolic risk factors ( Ps < 0.05). Higher GGT and lower AST/ ALT were associated with higher cardiometabolic risk score ( Ps < 0.001) in males and females, and ALT only in males ( Ps < 0.001). Gender- and age-specific percentiles for liver biomarkers were provided. Receiver operating characteristic analyses showed a significant discriminatory accuracy of AST/ ALT in identifying the low/high cardiometabolic risk ( Ps < 0.01) and thresholds were provided. Conclusions Higher GGT and lower AST/ ALT are associated with higher cardiometabolic risk factors and their clustering in male and female European adolescents, whereas the associations of ALT were gender dependent. Our results suggest the usefulness of AST/ ALT as a screening test in the assessment of adolescents with high cardiometabolic risk and provide gender- and age-specific thresholds that might be of clinical interest. [ABSTRACT FROM AUTHOR]

The differential diagnosis of hepatic cystic echinococcosis (CE) may be challenging. When imaging is insufficient, serology can be applied, but no consensus diagnostic algorithm exists. We evaluated the performances of nine serological tests commercialized in Europe for the diagnosis of "echinococcosis". We performed a diagnostic accuracy study using a panel of sera from patients with hepatic CE (n = 45 "liquid" content stages, n = 25 "solid" content stages) and non-CE focal liver lesions (n = 54 with "liquid" content, n = 11 with "solid" content). The diagnosis and staging of CE were based on ultrasound (gold standard). Nine commercial seroassays (5 ELISA, 2 WB, 1 Chemiluminescence Immunoassay [CLIA] and 1 Immunochromatographic test [ICT]) were the index tests. Sensitivity (Se) ranged from 43 to 94% and from 31 to 87%, and specificity (Sp) from 68 to 100% and from 94 to 100%, when borderline results were considered positive or negative, respectively. Three seroassays (2 ELISA, 1 WB) were excluded from further analyses due to poor performances. When tests were combined, Sp was 98–100%. The best results were obtained using the WB-LDBIO alone (Se 83%) or as a third test after two non-WB tests (Se 67–86%). A validated WB or two non-WB tests, read with stringent criteria (borderline = negative and considered positive only if concordant positive), possibly confirmed by the WB, appear sensible approaches. [ABSTRACT FROM AUTHOR]