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Summary: Background: Infancy is a critical period for obesity prevention. Emerging evidence links household chaos to poor health outcomes, yet its impact on obesity in infancy is unknown. Objectives: We examined associations between household chaos when infants were 6 and 12 months and weight‐for‐length (WFL) z‐score at 12 months, exploring potential mediation by infant sleep and screen time. Methods: We examined 401 predominately Black women and infants in the southeastern United States. We conducted multivariable linear regressions examining household chaos and infant WFL z‐score, assessing breastfeeding, sleep, screen time as potential mediators. Results: Among infants, 69.7% were Black and 49.0% were female. Mean breasting duration was 3.7 months. Over half (50.4%) of families had annual household incomes <$20 000. After adjustment for potential confounders, household chaos was associated with infant WFL z‐score (0.02; 95% CI 0.001, 0.04; p = 0.04) at 12 months. We did not observe associations between chaos and infant breastfeeding, sleep or screen time. Conclusions: Higher household chaos was associated with greater infant weight at 12 months, but there was no evidence of mediation by breastfeeding, sleep or screen time. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented which is concerned with the cases of two patients with AIDS-related Stomatococcus mucilaginosus.

Background The timing of energy intake is a modifiable behaviour that may influence energy regulation and the risk of obesity. We examined the associations of energy intake in the morning, midday and evening with body mass index (BMI) ( n = 239). Methods Cross-sectional analyses were performed using data from the University of California, Los Angeles Energetics Study. Energy intake was assessed using three 24-h dietary recalls and stratified by time-of-day: morning (00.00 h to 11.00 h), midday (11.00 h to 17.00 h) and evening (17.00 h to 00.00 h). Sensitivity analysis was conducted among 'true-reporters', whose self-reported energy intake was ±25% of total energy expenditure measured by doubly-labelled water ( n = 99). Logistic regression models were performed adjusting for age, sex, race, education, total daily energy intake and physical activity. Results Energy intake in the morning was not associated with BMI. Participants who consumed ≥33% (versus <33%) of their daily energy intake at 12.00 h were (nonsignificantly) less likely to be overweight/obese [odds ratio ( OR) = 0.68; 95% confidence interval ( CI) = 0.37-1.24] and this association was stronger and statistically significant among true-reporters ( OR = 0.34; 95% CI = 0.12-0.95). Those who consumed ≥33% of daily energy intake in the evening were two-fold more likely overweight/obese ( OR = 2.00; 95% CI = 1.03-3.89), although this association was not significant among true-reporters ( OR = 2.10; 95% CI = 0.60-7.29). Conclusions These data indicate that eating more of the day's total energy intake at midday is associated with a lower risk of being overweight/obese, whereas consuming more in the evening is associated with a higher risk. Randomised trials are needed to test whether shifting energy intake earlier in the day could have a regulatory effect with respect to reducing intake in the evening, thereby promoting weight loss and maintenance. [ABSTRACT FROM AUTHOR]

However, due to the insidious nature of the tumor margin nearly 25-35% of patients with iCCA have R1 resections in comparison to only 10% of patients with other liver tumors. The iCCA patients who had undergone OLT and had over 30 days of follow-up (n=7) were matched 1:3 for iCCA patients undergoing resection based on explant pathology- matching for most significant oncologic risk factors first. Resection margin was positive in 14% of patients undergoing resection vs none in the transplants. [Extracted from the article]

Summary: We report 2 observations in young girls who, after exposure to domestic rats from the same pet shop, presented with inflammatory and necrotic skin wounds in the neck and face. Since lesions did not improve with antibiotic therapy, surgical excision of necrosis healed the wounds, with a 2nd intervention necessary in 1 patient. All bacteriological investigations appeared to be negative; finally, electron microscopy of excised subepidermal tissue and PCR characterization provided the diagnosis of cowpox virus (CPXV) infection. CPXV is part of the Orthopox virus genus, like variola virus, and is generally transmitted to humans by infected cats or rodents. CPXV infection should be kept in mind when macular, vesicular, or necrotic cutaneous wounds do not improve with antibiotics. [ABSTRACT FROM AUTHOR]

No differences were noted in Recurrence free Survival (Median- 338 vs 353 vs 302days, p=0.97) or Overall Survival (Median- 589 vs 719 vs 497 days; p=0.83) among patients with no vascular reconstructions, any vascular reconstruction, and caval or multi-vessel reconstructions. B Conclusion: b These data show that patients with intrahepatic cholangiocarcinoma undergoing vascular reconstructions require more extensive hepatic resections and have a higher risk of obtaining a positive margin. [Extracted from the article]

Abstract: Cholestasis progressing to end-stage liver disease (ESLD) is common in intestinal failure (IF) in infants. Isolated liver transplantation (OLT) is performed when eventual enteral sufficiency is expected. We reviewed our experience with OLT for ESLD in patients with residual IF. From 1998 to 2004, four IF patients underwent OLT for ESLD at our institution. Three were performed as UNOS status I for acute decompensation of chronic liver failure; one other with severe cholestasis with a living donor. The living donor recipient died within months after OLT of chronic respiratory failure despite normal liver function. One recipient remains on parenteral nutrition (PN) and continues to receive partial enteral feeds with normal liver function. Two other recipients became enterally sufficient after the OLT. Biliary complications occurred in two patients, one with late hepatic artery thrombosis. Resolution was achieved with serial balloon dilatations and the other by conversion from duct-to-duct anastomosis to a choledochoduodenostomy. The morbidity of OLT for this indication is higher than for others likely because of comorbidities like sepsis and pulmonary insufficiency. OLT is complicated further by the attempt to maximally preserve residual bowel length for the biliary reconstruction. OLT can be an emergent life-saving procedure in IF patients despite higher morbidity. Improved liver function and diminished portal pressures may shorten the time to enteral sufficiency. Management of parenteral nutrition after OLT can avoid ESLD and eliminate small bowel transplantation in selected patients. [Copyright &y& Elsevier]

Some diseases that result from inborn errors of critical metabolic or synthetic processes mainly involving the liver do not cause structural liver damage. These disorders can be treated by the addition of liver tissue (auxiliary liver transplantation) rather than liver replacement. We report correction of the metabolic error in a 13-year-old girl with Crigler-Najjar syndrome type 1 by auxiliary (left lateral segment) transplantation. The first graft failed and was replaced successfully. The second graft shows features of chronic rejection, but at 2 years postoperatively bilirubin conjugating ability has not been impaired. Another graft may become necessary in due course. [ABSTRACT FROM AUTHOR]

Abstract Glycogen storage disease (GSD) types I, III, and IV can be associated with severe liver disease. The possible development of hepatocellular carcinoma and/or hepatic failure make these GSDs potential candidates for liver transplantation. Early diagnosis and initiation of effective dietary therapy have dramatically improved the outcome of GSD type I by reducing the incidence of liver adenoma and renal insufficiency. Nine type I and 3 type III patients have received liver transplants because of poor metabolic control, multiple liver adenomas, or progressive liver failure. Metabolic abnormalities were corrected in all GSD type I and type III patients, while catch-up growth was reported only in two patients. Whether liver transplantation results in reversal and/or prevention of renal disease remains unclear. Neutropenia persisted in both GSDIb patients post liver transplantation necessitating continuous granulocyte colony stimulating factor treatment. Thirteen GSD type IV patients were liver transplanted because of progressive liver cirrhosis and failure. All but one patient have not had neuromuscular or cardiac complications during follow-up periods for as long as 13 years. Four have died within a week and 5 years after transplantation. Caution should be taken in selecting GSD type IV candidates for liver transplantation because of the variable phenotype, which may include life-limiting extrahepatic manifestations. It remains to be evaluated, whether a genotypephenotype correlation exists for GSD type IV, which may aid in the decision making. [ABSTRACT FROM AUTHOR]

Decreasing the graft size in living donor liver transplantation (LDLT) increases the risk of early allograft dysfunction. Graft-to-recipient weight ratio (GRWR) of 0.8 is considered the threshold. There is evidence that smaller volume grafts may also provide equally good outcomes, the cut-off of which remains unknown. In this retrospective multicenter study, 92 adult LDLTs with a final GRWR ≤0.6 performed at 12 international liver transplant centers over a 3-year period were included. Perioperative data including preoperative status, portal flow hemodynamics (PFH) and portal flow modulation, development of small for size syndrome (SFSS), morbidity, and mortality was collated and analyzed. Thirty-two (36.7%) patients developed SFSS and this was associated with increased 30-day, 90-day, and 1-year mortality. The preoperative model for end-stage liver disease and inpatient status were independent predictors for SFSS (P < .05). Pre-liver transplant renal dysfunction was an independent predictor of survival (hazard ratio 3.1; 95% confidence intervals 1.1, 8.9, P = .035). PFH or portal flow modulation were not predictive of SFSS or survival. We report the largest ever multicenter study of LDLT outcomes using ultralow GRWR grafts and for the first time validate the International Liver Transplantation Society-International Living donor liver transplantation study group-Liver Transplantation Society of India consensus definition and grading of SFSS. Preoperative recipient condition rather than GRWR and PFH were independent predictors of SFSS. Algorithms to predict SFSS and LT outcomes should incorporate recipient factors along with GRWR., Competing Interests: Declaration of competing interest The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation., (Copyright © 2024 American Society of Transplantation & American Society of Transplant Surgeons. Published by Elsevier Inc. All rights reserved.)

Background & Aims: Little is known about the potential impact of statins on the progression of noncirrhotic chronic liver diseases (CLDs) to severe liver disease., Methods: Using liver histopathology data in a nationwide Swedish cohort, we identified 3862 noncirrhotic individuals with CLD and statin exposure, defined as a statin prescription filled for 30 or more cumulative defined daily doses. Statin users were matched to 3862 (statin) nonusers with CLD through direct 1:1 matching followed by propensity score matching. Cox regression was used to estimate hazard ratios (HRs) for the primary outcome of incident severe liver disease (a composite of cirrhosis, hepatocellular carcinoma, and liver transplantation/liver-related mortality)., Results: A total of 45.3% of CLD patients had nonalcoholic fatty liver disease, 21.9% had alcohol-related liver disease, 17.7% had viral hepatitis, and 15.1% had autoimmune hepatitis. During follow-up evaluation, 234 (6.1%) statin users vs 276 (7.1%) nonusers developed severe liver disease. Statin use was associated with a decreased risk of developing severe liver disease (HR, 0.60; 95% CI, 0.48-0.74). Statistically significantly lower rates of severe liver disease were seen in alcohol-related liver disease (HR, 0.30; 95% CI, 0.19-0.49) and in nonalcoholic fatty liver disease (HR, 0.68; 95% CI, 0.45-1.00), but not in viral hepatitis (HR, 0.76; 95% CI, 0.51-1.14) or autoimmune hepatitis (HR, 0.88; 95% CI, 0.48-1.58). Statin use had a protective association in both prefibrosis and fibrosis stages at diagnosis. Statin use was associated with lower rates of progression to cirrhosis (HR, 0.62; 95% CI, 0.49-0.78), hepatocellular carcinoma (HR, 0.44; 95% CI, 0.27-0.71), and liver-related mortality (HR, 0.55; 95% CI, 0.36-0.82)., Conclusions: Among individuals with noncirrhotic CLD, incident statin use was linked to lower rates of severe liver disease, suggesting a potential disease-modifying role., (Copyright © 2024 AGA Institute. Published by Elsevier Inc. All rights reserved.)

Background: Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture., Objective: This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system., Methods: This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria., Results: This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024., Conclusions: This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec., International Registered Report Identifier (irrid): PRR1-10.2196/53150., (©Sabrina Guay-Bélanger, Emmanuelle Aubin, Marie Cimon, Patrick Archambault, Virginie Blanchette, Anik Giguere, Amédé Gogovor, Michèle Morin, Ali Ben Charif, Nouha Ben Gaied, Julie Bickerstaff, Nancy Chénard, Julie Emond, Julie Gilbert, Isabelle Violet, France Légaré. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 20.11.2023.)

Small-for-size syndrome (SFSS) is a well-recognized complication following liver transplantation (LT), with up to 20% developing this following living donor LT (LDLT). Preventing SFSS involves consideration of factors before the surgical procedure, including donor and recipient selection, and factors during the surgical procedure, including adequate outflow reconstruction, graft portal inflow modulation, and management of portosystemic shunts. International Liver Transplantation Society, International Living Donor Liver Transplantation Group, and Liver Transplant Society of India Consensus Conference was convened in January 2023 to develop recommendations for the prediction and management of SFSS in LDLT. The format of the conference was based on the Grading of Recommendations, Assessment, Development, and Evaluation system. International experts in this field were allocated to 4 working groups (diagnosis, prevention, anesthesia, and critical care considerations, and management of established SFSS). The working groups prepared evidence-based recommendations to answer-specific questions considering the currently available literature. The working group members, independent panel, and conference attendees served as jury to edit and confirm the final recommendations presented at the end of the conference by each working group separately. This report presents the final statements and evidence-based recommendations provided by working group 2 that can be implemented to prevent SFSS in LDLT patients., Competing Interests: The authors declare no funding or conflicts of interest, (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The authors declare no funding or conflicts of interest.

Background: When a partial liver graft is unable to meet the demands of the recipient, a clinical phenomenon, small-for-size syndrome (SFSS), may ensue. Clear definition, diagnosis, and management are needed to optimize transplant outcomes., Methods: A Consensus Scientific committee (106 members from 21 countries) performed an extensive literature review on specific aspects of SFSS, recommendations underwent blinded review by an independent panel, and discussion/voting on the recommendations occurred at the Consensus Conference., Results: The ideal graft-to-recipient weight ratio of ≥0.8% (or graft volume standard liver volume ratio of ≥40%) is recommended. It is also recommended to measure portal pressure or portal blood flow during living donor liver transplantation and maintain a postreperfusion portal pressure of <15 mm Hg and/or portal blood flow of <250 mL/min/100 g graft weight to optimize outcomes. The typical time point to diagnose SFSS is the postoperative day 7 to facilitate treatment and intervention. An objective 3-grade stratification of severity for protocolized management of SFSS is proposed., Conclusions: The proposed grading system based on clinical and biochemical factors will help clinicians in the early identification of patients at risk of developing SFSS and institute timely therapeutic measures. The validity of this newly created grading system should be evaluated in future prospective studies., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)