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Respiratory manifestations of chronic liver disease have a profound impact on patient clinical outcomes. Certain conditions within paediatric liver disease have an associated respiratory pathology. This overlap between liver and respiratory manifestations can result in complex challenges when managing patients and requires clinicians to be able to recognise when referral to specialists is required. While liver transplantation is at the centre of treatment, it opens up further potential for respiratory complications. It is established that these complications place patients at risk of longer stays in hospital and reduced survival. Additionally, late post-transplant complications can occur, including post-transplant lymphoproliferative disease and immunosuppression-induced interstitial lung disease. Although rare, it is important for clinicians to recognise these conditions to allow for prompt management. Finally, as liver disease progresses in children, respiratory complications can occur. Hepatopulmonary syndrome can occur in the context of portal hypertension, resulting in increased mortality and poorer quality of life for patients. Another consequence is portopulmonary hypertension, which can be associated with poor survival. Failure to recognise these complications in children may result in poorer outcomes and therefore it is vital that clinicians can establish when referral to a paediatric respiratory medicine specialist is required.

Background & Aims: Von Willebrand factor antigen (vWFAg), a protein measured to test the level of vWF released from the vascular endothelium has gained much attention as a marker for portal hypertension (PHT) severity. The objectives of this study were to investigate the use of vWFAg as a biomarker along with liver and spleen stiffness measurements by transient elastography as potential predictors of clinically significant varices (CSV), variceal bleeding (VB) and decompensation in children with PHT. Methods: This observational prospective cohort study included 117 children (median age 10 [IQR 6-14] years) who underwent oesophagogastroduodenoscopy between January’2012 to November’2021 and a validation group of 33 children who underwent the same procedure between December’2021 to March’2023. Measurements of vWFAg and glycoprotein Ib binding activity of VWF (GPIbR) were available in 97 patients in the study group and in all patients in the validation group.Results: vWFAg and GPIbR were significantly higher in children with CSV (223 IU/dl and 166 IU/dl; p = 0.015 and p = 0.04, respectively) and VB (218 IU/dl and 174 IU/dl; p = 0.077 and p = 0.03, respectively) than in those without CSV or VB, respectively. Ninety-six patients had liver and spleen stiffness measurements. Spleen stiffness was significantly higher in patients with CSV compared to those without CSV (p = 0.003). In a chronic liver disease subgroup, a predictive scoring tool based on vWFAg, GPIbR, platelet count, and spleen/liver stiffness measurements could predict CSV with an AUROC of 0.76 (p = 0.04). Conclusions: This study suggests the predictive value of vWF for CSV and VB increases when combined with spleen stiffness, with AUROCs of 0.88 and 0.82, respectively. Hence, a combination of biomarkers could assist clinicians in diagnosing CSV, preventing unnecessary invasive procedures. Impacts and implications: Surveillance endoscopies in children with portal hypertension (PHT) have their own risks and non-invasive markers, such as von Willebrand factor antigen, glycoprotein Ib binding activity of VWF (GPIbR), and transient elastography could be used to predict clinically significant varices, variceal bleeding and disease compensation in children with PHT. Such non-invasive markers for PHT and varices are lacking in the paediatric population. The results show that von Willebrand factor and GPIbR along with transient elastography can be used to formulate a scoring system which can be used as a clinical tool by paediatric hepatologists to monitor the progression of PHT and risk of bleeding, and hence to stratify the performance of invasive endoscopic procedures under general anaesthesia. However, there is a need to validate the scoring system in children with portal vein thrombosis and for hepatic decompensation in a multi-centre registry in the future.

Abstract Carbon capture and catalytic conversion to methane is promising for carbon–neutral energy production. Precious metals catalysts are highly efficient; yet they have several significant drawbacks including high cost, scarcity, environmental impact from the mining and intense processing requirements. Previous experimental studies and the current analytical work show that refractory grade chromitites (chromium rich rocks with Al2O3 > 20% and Cr2O3 + Al2O3 > 60%) with certain noble metal concentrations (i.e., Ir: 17–45 ppb, Ru: 73–178 ppb) catalyse Sabatier reactions and produce abiotic methane; a process which has not been investigated at the industrial scale. Thus, a natural source (chromitites) hosting noble metals might be used instead of concentrating noble metals for catalysis. Stochastic machine-learning algorithms show that among the various phases, the noble metal alloys are natural methanation catalysts. Such alloys form when pre-existing platinum group minerals (PGM) are chemically destructed. Chemical destruction of existing PGM results to mass loss forming locally a nano-porous surface. The chromium-rich spinel phases, hosting the PGM inclusions, are subsequently a second-tier support. The current work is the first multi-disciplinary research showing that noble metal alloys within chromium-rich rocks are double-supported, Sabatier catalysts. Thus, such sources could be a promising material in the search of low-cost, sustainable materials for green energy production.

Background & Aims: PEDFIC 2, an ongoing, open-label, 72-week study, evaluates odevixibat, an ileal bile acid transporter inhibitor, in patients with progressive familial intrahepatic cholestasis. Methods: PEDFIC 2 enrolled and dosed 69 patients across two cohorts; all received odevixibat 120 μg/kg per day. Cohort 1 comprised children from PEDFIC 1, and cohort 2 comprised new patients (any age). We report data through 15 July 2020, with Week 24 of PEDFIC 2 the main time point analysed. This represents up to 48 weeks of cumulative exposure for patients treated with odevixibat from the 24-week PEDFIC 1 study (cohort 1A) and up to 24 weeks of treatment for those who initiated odevixibat in PEDFIC 2 (patients who received placebo in PEDFIC 1 [cohort 1B] or cohort 2 patients). Primary endpoints for this prespecified interim analysis were change from baseline to Weeks 22–24 in serum bile acids (sBAs) and proportion of positive pruritus assessments (≥1-point drop from PEDFIC 2 baseline in pruritus on a 0–4 scale or score ≤1) over the 24-week period. Safety monitoring included evaluating treatment-emergent adverse events (TEAEs). Results: In cohort 1A, mean change from PEDFIC 1 baseline to Weeks 22–24 of PEDFIC 2 in sBAs was -201 μmol/L (p

The rare-earth elements (REEs) are strategic metals which are indispensable to the development of modern defence systems, electronic applications, and green technologies. The growing economic and strategic importance of these sectors, coupled with uncertainty in the global supply, has led to the development of many new deposits around the world. Many of these deposits, such as the Nechalacho deposit, are complex and contain multiple rare-earth element-bearing minerals (REMs) for which there is limited processing knowledge. This study explores a physical-separations-based flowsheet to beneficiate the Nechalacho deposit, which employs a spiral concentrator to preconcentrate the ore at a relatively coarse particle size (d80 = 120 μm), before further size reduction (d100 = 53 μm) and separation using a Mozley laboratory shaking table and two stages (low- and high-intensity) of magnetic separation. QEMSCAN was used to understand the effectiveness of each stage of separation and provide recommendations to improve the process. Although optimisation would be required, the results demonstrate that the physical-separations-based flowsheet could be an effective method of beneficiation.

Background & Aims: Bile salt export pump (BSEP) deficiency frequently necessitates liver transplantation in childhood. In contrast to two predicted protein truncating mutations (PPTMs), homozygous p.D482G or p.E297G mutations are associated with relatively mild phenotypes, responsive to surgical interruption of the enterohepatic circulation (siEHC). The phenotype of patients with a compound heterozygous genotype of one p.D482G or p.E297G mutation and one PPTM has remained unclear. We aimed to assess their genotype-phenotype relationship. Methods: From the NAPPED database, we selected patients with homozygous p.D482G or p.E297G mutations (BSEP1/1; n = 31), with one p.D482G or p.E297G, and one PPTM (BSEP1/3; n = 30), and with two PPTMs (BSEP3/3; n = 77). We compared clinical presentation, native liver survival (NLS), and the effect of siEHC on NLS. Results: The groups had a similar median age at presentation (0.7-1.3 years). Overall NLS at age 10 years was 21% in BSEP1/3 vs. 75% in BSEP1/1 and 23% in BSEP3/3 (p

Mutations in the transaldolase 1 (TALDO1) gene have been described in a limited number of cases. Several organs can be affected and clinical manifestations are variable, but often include liver dysfunction and/or hepatosplenomegaly. We report 4 patients presenting with liver disease: 2 with early‐onset hepatocellular carcinoma (HCC). Patients with cholestasis and mutations in TALDO1 were identified by next‐generation sequencing. Clinical, laboratory, and histological data were collected. Four (1 male) patients were identified with variants predicted to be damaging in TALDO1. Three patients were homozygous (two protein truncating/one missense mutations), 1 one was compound heterozygous (two missense mutations). Median age at presentation was 4 months (range, 2‐210 days) with jaundice (3), hepatosplenomegaly (3), and pancytopaenia (1). The diagnosis was corroborated by detection of minimal transaldolase enzyme activity in skin fibroblasts in two cases and raised urine polyols in the third. Three patients underwent liver transplantation (LT), 2 of whom had confirmed HCC on explanted liver. One patient suddenly died shortly after LT. The nontransplanted case has a chronic liver disease with multiple dysplastic liver nodules, but normal liver biochemistry and alpha‐fetoprotein. Median follow‐up was 4 years (range, 1‐21). Conclusion: Transaldolase deficiency can include early‐onset normal gamma‐glutamyltransferase liver disease with multisystem involvement and variable progression. Patients with this disease are at risk of early‐onset HCC and may require early LT.

Abstract Prophylactic endoscopy is routine in adults with portal hypertension (PHTN), but there is limited data in pediatrics. We sought to describe our experience with prophylactic endoscopy in pediatric PHTN. This is a retrospective study of 87 children who began surveillance endoscopy prior to gastrointestinal bleeding (primary prophylaxis) and 52 who began after an episode of bleeding (secondary prophylaxis) from 01/01/1994 to 07/01/2019. Patients who underwent primary prophylaxis had a lower mean number of endoscopies (3.897 vs 6.269, p = 0.001). The primary prophylaxis group was less likely to require a portosystemic shunt (6% vs 15%, p

Abstract Aim Coats plus syndrome (CP) is a rare autosomal recessive disorder, characterised by retinal telangiectasia exudates (Coats disease), leukodystrophy, distinctive intracranial calcification and cysts, as well as extra‐neurological features including abnormal vasculature of the gastrointestinal tract, portal hypertension and osteopenia with a tendency to fractures. CP most frequently occurs due to loss‐of‐function mutations in CTC1. The encoded protein CTC1 constitutes part of the CST (CTC1‐STN1‐TEN1) complex, and three patients have been described with CP due to biallelic mutations in STN1. Together with the identification of homozygosity for a specific loss‐of‐function mutation in POT1 in a sibling pair, these observations highlight a defect in the maintenance of telomere integrity as the cause of CP, although the precise mechanism leading to the micro‐vasculopathy seen at a pathological level remains unclear. Here, we present the investigation of a fourth child who presented to us with retinal exudates, intracranial calcifications and developmental delay, in keeping with a diagnosis of CP, and later went on to develop pancytopenia and gastrointestinal bleeding. Genome sequencing revealed compound heterozygous variants in STN1 as the likely genetic cause of CP in this present case. Methods We assessed the phenotype to be CP and undertook targeted sequencing. Results Whilst sequencing of CTC1 and POT1 was normal, we identified novel compound heterozygous variants in STN1 (previous gene symbol OBFC1): one loss‐of‐function––c.894dup (p.(Asp299Argfs*58)); and one missense––c.707T>C (p.(Leu236Pro)). Conclusion Given the clinical phenotype and identified variants we suggest that this is only the fourth patient reported to date with CP due to mutations in STN1.

In coming years, global lithium production is expected to increase as the result of widespread electric vehicle adoption. To meet the expected increase in demand, lithium must be sourced from both brine and hard-rock deposits. Heavy liquid separation (HLS) and dense media separation (DMS) tests were conducted on the pegmatites from Hidden Lake, NWT, Canada to demonstrate the potential role of this technology in the concentration of spodumene (LiAlSi2O6) from hard-rock sources. A continuously operated DMS circuit test, conducted on +840 µm material, produced a concentrate grading 6.11% Li2O with ~50% lithium recovery. The circuit rejected 50% of the original mass to tailings, with only 8% lithium losses. Sensitivity analysis showed that minor changes (+/−0.05) in the DMS-specific gravity cut point resulted in significant changes to the mass rejected and to the concentrate grade produced; this may limit the feasibility and operability of the downstream grinding and flotation circuits. The results demonstrate the potential for DMS in the concentration of spodumene from the Hidden Lake pegmatites, and by extension, the potential for DMS in the concentration of spodumene from other hard-rock occurrences.

The new mineral species, eliopoulosite, V7S8, was discovered in the abandoned chromium mine of Agios Stefanos of the Othrys ophiolite, located in central Greece. The investigated samples consist of massive chromitite hosted in a strongly altered mantle tectonite, and are associated with nickelphosphide, awaruite, tsikourasite, and grammatikopoulosite. Eliopoulosite is brittle and has a metallic luster. In plane-reflected polarized light, it is grayish-brown and shows no internal reflections, bireflectance, and pleochroism. It is weakly anisotropic, with colors varying from light to dark greenish. Reflectance values of mineral in air (Ro, Re’ in %) are: 34.8−35.7 at 470 nm, 38−39 at 546 nm, 40−41.3 at 589 nm, and 42.5−44.2 at 650 nm. Electron-microprobe analyses yielded a mean composition (wt.%) of: S 41.78, V 54.11, Ni 1.71, Fe 1.1, Co 0.67, and Mo 0.66, totali 100.03. On the basis of Σatoms = 15 apfu and taking into account the structural data, the empirical formula of eliopoulosite is (V6.55Ni0.19Fe0.12Co0.07Mo0.04)Σ = 6.97S8.03. The simplified formula is (V, Ni, Fe)7S8 and the ideal formula is V7S8, which corresponds to V 58.16%, S 41.84%, total 100 wt.%. The density, based on the empirical formula and unit-cell volume refined form single-crystal structure XRD data, is 4.545 g·cm−3. The mineral is trigonal, space group P3221, with a = 6.689(3) Å, c = 17.403(6) Å, V = 674.4(5) Å3, Z = 3, and exhibits a twelve-fold superstructure (2a × 2a × 3c) of the NiAs-type subcell with V-atoms octahedrally coordinated by S atoms. The distribution of vacancies is discussed in relation to other pyrrhotite-like compounds. The mineral name is for Dr. Demetrios Eliopoulos (1947−2019), a geoscientist at the Institute of Geology and Mineral Exploration (IGME) of Greece and his widow, Prof. Maria Eliopoulos (nee Economou, 1947), University of Athens, Greece, for their contributions to the knowledge of ore deposits of Greece and to the mineralogical, petrographic, and geochemical studies of ophiolites, including the Othrys complex. The mineral and its name have been approved by the Commission of New Minerals, Nomenclature, and Classification of the International Mineralogical Association (No. 2019-96).

Tsikourasite, Mo3Ni2P1+x (x < 0.25), is a new phosphide discovered in a mantle-hosted podiform chromitite collected in the abandoned mine of Agios Stefanos (Othrys ophiolite), Central Greece. It forms tiny grains (from a few μm up to about 80 μm) and occurs as isolated grains or associated with other known minerals such as nickelphosphide and awaruite, and with undetermined minerals such as Ni-allabogdanite or Ni-barringerite and a V-sulphide. Tsikourasite is brittle and has a metallic luster. In plane-polarized light, tsikourasite is white yellow and it shows no bireflectance, anisotropism or pleochroism. Internal reflections were not observed, Reflectance values of tsikourasite in air (R in %) are: 55.7 at 470 nm, 56.8 at 546 nm, 57.5 at 589 nm and 58.5 at 650 nm. Five spot analyses of tsikourasite give the average composition: P 7.97, S 0.67, V 14.13, Fe 14.37, Co 7.59, Ni 23.9, and Mo 44.16, total 99.60 wt.%, corresponding to the empirical formula (Mo1.778V1.071Fe0.082Co0.069)Σ3.000(Ni1.572Co0.428)Σ2.000(P0.981S0.079)Σ1.060, on the basis of Σ(Mo +V + Fe + Co + Ni) = 5 apfu and taking into account the structural results. The simplified formula is Mo3Ni2P1+x (x < 0.25). The density, which was calculated based on the empirical formula and single-crystal data, is 9.182 g/cm3. The mineral is cubic, space group F-43m, with a = 10.8215(5) Å and Z = 16. Although tsikourasite is similar in composition to those of monipite (MoNiP), polekhovskyite (MoNiP2), and the synthetic compound MoNiP2, all these phases are hexagonal and not cubic like tsikourasite. It exhibits the same structure as the cubic Mo3Ni2P1.18 compound [space group F-43m, a = 10.846(2) Å] synthesized at 1350 °C. The mineral and its name have been approved by the Commission of New Minerals, Nomenclature and Classification of the International Mineralogical Association (No. 2018-156). The mineral honors Professor Basilios Tsikouras of the Universiti Brunei Darussalam.

Background and Aim. Neonatal hemochromatosis (NH) is characterised by severe liver injury and extrahepatic siderosis sparing the reticuloendothelial system. Its aetiology is obscure, although it has been proposed as an alloimmune disease, resulting from immunological reaction to self-antigens (alloantigens) which the body recognizes as foreign. We studied an infant with NH and his mother whose sera contained antimitochondrial antibody (AMA), the hallmark of primary biliary cirrhosis (PBC). Material and Methods. To investigate the origin of AMA in the infant, we studied isotype distributions in serum from the mother and infant. Serum samples were obtained at diagnosis of NH, after liver transplantation (LT; age 1 month), and over the ensuing 17 months. Results. At NH diagnosis, infant and maternal serum contained AMA of the IgG isotype, predominantly of the G3 and G1 subclasses. AMA strongly reacted against the pyruvate dehydrogenase complex E2 subunit (PDC-E2), the major PBC-specific AMA autoantigen. Anti-PDC-E2 responses in both infant and mother declined over time, being present 2 months after LT (mother and child) and absent 10 months later (mother) and 17 months later (child). Conclusion. The association of maternally transferred IgG1 and IgG3 subclass AMA with the appearance of liver damage in an infant with NH may suggest a causal link between antibody and liver damage.