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Giansante L, McDonagh E, Basso J, Haris A, Kc S, Withey SJ, Shur J, Fotiadis N, Goldberg SN, Johnston EW. Bolus-Tracked Biphasic Contrast-Enhanced CT Imaging Following Microwave Liver Ablation Improves Ablation Zone Conspicuity and Semi-automatic Segmentation Quality. Cardiovasc Intervent Radiol 2025; 48:643-652. [PMID: 39789263 PMCID: PMC12053197 DOI: 10.1007/s00270-024-03948-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2024] [Accepted: 12/16/2024] [Indexed: 01/12/2025]
Abstract
PURPOSE Contrast-enhanced CT (CECT) may be performed immediately following microwave liver ablation for assessment of ablative margins. However, practices and protocols vary among institutions. Here, we compare a standardized bolus-tracked biphasic CECT protocol and compare this with a single venous phase fixed delay protocol for ablation zone (AZ) assessment. METHODS An institutional review board approved study performed at a specialist cancer centre. A prospective cohort of patients undergoing bolus-tracked biphasic imaging was compared with a retrospective cohort of patients who underwent fixed delay venous phase imaging. AZ conspicuity and segmentation quality were semi-quantitatively scored using Five-point Likert scales. Time between ablation and image acquisition was recorded for each AZ and was correlated to AZ conspicuity and segmentation quality. RESULTS Forty patients, median age 59 years (IQR 48-66 years), 24 men, underwent microwave ablation of 68 liver tumours. AZ conspicuity was higher in the bolus-tracked (n = 33) vs. fixed delay (n = 35) cohorts, 4.5 vs. 2.5, P < 0.0001. Commensurate segmentation quality was also higher, 5.0 vs. 3.0 respectively, P < 0.0001. Ordinal regression showed that image quality scores declined by 3-4% for each minute that passes after ablation, particularly for arterial phase images, where regression coefficients were - 0.04, P = 0.007, and -0.03, P = 0.012 for conspicuity and segmentation quality, respectively. CONCLUSION Bolus-tracked biphasic contrast-enhanced CT protocols improve both conspicuity and semi-automatic segmentation quality of microwave liver ablation zones, particularly if imaged soon after ablation. EVIDENCE-BASED MEDICINE Level 2b; exploratory prospective cohort study.
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Affiliation(s)
- Louise Giansante
- Joint Dept. of Physics, The Royal Marsden, 203 Fulham Road, London, SW36JJ, UK
| | - Ed McDonagh
- Joint Dept. of Physics, The Royal Marsden, 203 Fulham Road, London, SW36JJ, UK
- Department of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - Jodie Basso
- Interventional Radiology, The Royal Marsden, 203 Fulham Road, London, SW36JJ, UK
| | - Arafat Haris
- Interventional Radiology, The Royal Marsden, 203 Fulham Road, London, SW36JJ, UK
| | - Sajjan Kc
- Interventional Radiology, The Royal Marsden, 203 Fulham Road, London, SW36JJ, UK
| | - Samuel J Withey
- Diagnostic Radiology, The Royal Marsden, 203 Fulham Road, London, SW36JJ, UK
| | - Joshua Shur
- Diagnostic Radiology, The Royal Marsden, 203 Fulham Road, London, SW36JJ, UK
| | - Nicos Fotiadis
- Interventional Radiology, The Royal Marsden, 203 Fulham Road, London, SW36JJ, UK
- Department of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
| | - S Nahum Goldberg
- Hadassah Hebrew University Medical Center, Ein Karem, Jerusalem, Israel
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02215, USA
| | - Edward W Johnston
- Interventional Radiology, The Royal Marsden, 203 Fulham Road, London, SW36JJ, UK.
- Department of Radiotherapy and Imaging, Institute of Cancer Research, London, UK.
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Singh K, Jacobs BA. A Network Based Model for Predicting Spatial Progression of Metastasis. Bull Math Biol 2025; 87:65. [PMID: 40202589 PMCID: PMC11982130 DOI: 10.1007/s11538-025-01441-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Accepted: 03/10/2025] [Indexed: 04/10/2025]
Abstract
Metastatic cancer is reported to have a mortality rate of 90%. Understanding the underlying principles of metastasis and quantifying them through mathematical modelling provides insights into potential treatment regimes. This work presents a partial differential equation based mathematical model embedded on a network, representing the organs and the blood vessels between them, with the aim of predicting likely secondary metastatic sites. Through this framework the relationship between metastasis and blood flow and between metastasis and the diffusive behaviour of cancer is explored. An analysis of the model predictions showed a good correlation with clinical data for some cancer types, particularly for cancers originating in the gut and liver. The model also predicts an inverse relationship between blood velocity and the concentration of cancer cells in secondary organs. Finally, for anisotropic diffusive behaviour, where the cancer experiences greater diffusivity in one direction, metastatic efficiency decreased. This is aligned with the clinical observation that gliomas of the brain, which typically show anisotropic diffusive behaviour, exhibit fewer metastases. The investigation yields some valuable results for clinical practitioners and researchers-as it clarifies some aspects of cancer that have hitherto been difficult to study, such as the impact of differing diffusive behaviours and blood flow rates on the global spread of cancer. The model provides a good framework for studying cancer progression using cancer-specific information when simulating metastasis.
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Affiliation(s)
- Khimeer Singh
- School of Computational and Applied Mathematics, University of the Witwatersrand, 1 Jan Smuts Avenue, Johannesburg, 2017, Gauteng, South Africa.
| | - Byron A Jacobs
- Department of Mathematics and Applied Mathematics, University of Johannesburg, Auckland Park, PO Box 524, Johannesburg, 2006, Gauteng, South Africa
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Kim SK, Lee TY. Splenic Duplication, a Rare Cause of Gastric Varices: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2025; 86:298-303. [PMID: 40201614 PMCID: PMC11973118 DOI: 10.3348/jksr.2024.0077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/26/2024] [Accepted: 08/28/2024] [Indexed: 04/10/2025]
Abstract
Splenic duplication, also known as polysplenia syndrome, is a condition occasionally observed in which the spleen is divided into segments of similar size. However, gastric fundic varices arising from a duplicated spleen are exceedingly rare, and this medical anomaly has been infrequently reported in the literature. This case report presents a 40-year-old male with a rare instance of gastric fundic varices secondary to splenic duplication. Comprehensive imaging studies, including endoscopy, CT, Doppler US, and radioisotope splenic scans, were performed to confirm the diagnosis. This case contributes to valuable information in the medical literature, shedding light on a seldom-discussed condition.
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Zarei S, Ghalichi F, Ahmadlouydarab M. Computational exploration of injection strategies for improving medicine distribution in the liver. Comput Biol Med 2025; 185:109585. [PMID: 39729858 DOI: 10.1016/j.compbiomed.2024.109585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2024] [Revised: 11/24/2024] [Accepted: 12/13/2024] [Indexed: 12/29/2024]
Abstract
BACKGROUND AND OBJECTIVES The liver, a vital metabolic organ, is always susceptible to various diseases that ultimately lead to fibrosis, cirrhosis, acute liver failure, chronic liver failure, and even cancer. Optimal and specific medicine delivery in various diseases, hepatectomy, shunt placement, and other surgical interventions to reduce liver damage, transplantation, optimal preservation, and revival of the donated organ all rely on a complete understanding of perfusion and mass transfer in the liver. This study aims to simulate the computational fluid dynamics of perfusion and the temporal-spatial distribution of a medicine in a healthy liver to evaluate the hemodynamic characteristics of flow and medicine transport with the purpose of more effective liver treatment. METHODS Patient-specific geometries of parenchyma and hepatic artery, portal vein, and hepatic vein vessels of a healthy liver were segmented and reconstructed from the abdominal computed tomography scan images. Mesh was generated for the comprehensive combined model using unstructured tetrahedral elements. Transient pressure values were applied as boundary conditions at the portal vein and hepatic artery inlets, and pressure outlet boundary condition was assumed at the hepatic vein outlet. Medicine injection was done through the portal vein. The liver parenchyma was assumed to be a porous medium. Finally, computational fluid dynamics (CFD) simulation was performed to investigate blood perfusion, medicine distribution, and saturation time. RESULTS The velocity parameter values calculated for the hepatic artery, portal vein, and hepatic vein vessels were consistent with the physiological ranges. The mass flow rate was higher in the portal vein than in the hepatic artery, which was consistent with high perfusion through the portal vein. The portal pressure gradient was 8.53 mmHg. From a pharmacokinetic viewpoint, medicine distribution in porous tissue was a heterogeneous process. Medicine distribution was higher at end-diastolic pressure than at peak-systolic pressure which showed the influence of hepatic artery flow. The tissue was saturated faster at first 40 s and with decreasing porosity, saturation time decreased, and distribution improved. CONCLUSION The right lobe included a higher number of vascular terminals due to its larger volume, and the flow rate was higher in this lobe compared to the left lobe. This showed the significant effect of the right lobe on the overall function of the body. Recirculation flow zones along hepatic artery and portal vein branches emphasized the sensitivity of downstream vessels. Rotational flow and potential vortex formation at the hepatic vein outlet may indicate a risk of plaque and clot formation in this region. The heterogeneous distribution of medicine indicated the importance of injection time in treating liver diseases. The percentage of tissue porosity affected the saturation time, so adjusting the medicine dose and injection time could be challenging in treatments.
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Affiliation(s)
- Sevda Zarei
- Department of Biomedical Engineering, Division of Biomechanics, Sahand University of Technology, Tabriz, Iran
| | - Farzan Ghalichi
- Department of Biomedical Engineering, Division of Biomechanics, Sahand University of Technology, Tabriz, Iran
| | - Majid Ahmadlouydarab
- Faculty of Chemical & Petroleum Engineering, University of Tabriz, Tabriz, Iran.
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Hyodo R, Takehara Y, Ishizu Y, Nishida K, Mizuno T, Ichikawa K, Horiguchi R, Kurata N, Ogura Y, Yokoyama S, Naganawa S, Jin N, Ichiba Y. Evaluation of 4D Flow MRI-Derived Relative Residence Time as a Marker for Cirrhosis Associated Portal Vein Thrombosis. J Magn Reson Imaging 2024; 60:2592-2601. [PMID: 38490816 DOI: 10.1002/jmri.29357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/04/2024] [Accepted: 03/06/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Portal vein thrombosis (PVT) is thought to arise from stagnant blood flow, yet conclusive evidence is lacking. Relative residence time (RRT) assessed using 4D Flow MRI may offer insight into portal flow stagnation. PURPOSE To explore the relationship between RRT values and the presence of PVT in cirrhotic participants. STUDY TYPE Prospective. POPULATION Forty-eight participants with liver cirrhosis (27 males, median age 67 years [IQR: 57-73]) and 20 healthy control participants (12 males, median age 45 years [IQR: 40-54]). FIELD STRENGTH/SEQUENCE 3 T/4D Flow MRI. ASSESSMENT Laboratory (liver and kidney function test results and platelet count) and clinical data (presence of tumors and other imaging findings), and portal hemodynamics derived from 4D Flow MRI (spatiotemporally averaged RRT [RRT-mean], flow velocity, and flow rate) were analyzed. STATISTICAL TESTS We used multivariable logistic regression, adjusted by selected covariates through the Lasso method, to explore whether RRT-mean is an independent risk factor for PVT. The area under the ROC curve (AUC) was also calculated to assess the model's discriminative ability. P < 0.05 indicated statistical significance. RESULTS The liver cirrhosis group consisted of 16 participants with PVT and 32 without PVT. Higher RRT-mean values (odds ratio [OR] 11.4 [95% CI: 2.19, 118]) and lower platelet count (OR 0.98 per 1000 μL [95% CI: 0.96, 0.99]) were independent risk factors for PVT. The incorporation of RRT-mean (AUC, 0.77) alongside platelet count (AUC, 0.75) resulted in an AUC of 0.84. When including healthy control participants, RRT-mean had an adjusted OR of 12.4 and the AUC of the combined model (RRT-mean and platelet count) was 0.90. DATA CONCLUSION Prolonged RRT values and low platelet count were significantly associated with the presence of PVT in cirrhotic participants. RRT values derived from 4D Flow MRI may have potential clinical relevance in the management of PVT. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Ryota Hyodo
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yasuo Takehara
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Fundamental Development for Advanced Low Invasive Diagnostic Imaging, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoji Ishizu
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kazuki Nishida
- Center for Advanced Medicine and Clinical Research Department of Advanced Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Takashi Mizuno
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Kazushige Ichikawa
- Department of Radiological Technology, Nagoya University Hospital, Nagoya, Japan
| | - Ryota Horiguchi
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobuhiko Kurata
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Yasuhiro Ogura
- Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan
| | - Shinya Yokoyama
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ning Jin
- Siemens Medical Solutions USA Inc., Malvern, Pennsylvania, USA
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Toulitsis E, Tsekouras AA, Macheras P. FDA and EMA Oversight of Disruptive Science on Application of Finite Absorption Time (F.A.T.) Concept in Oral Drug Absorption: Time for Scientific and Regulatory Changes. Pharmaceutics 2024; 16:1435. [PMID: 39598557 PMCID: PMC11597828 DOI: 10.3390/pharmaceutics16111435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Revised: 11/01/2024] [Accepted: 11/06/2024] [Indexed: 11/29/2024] Open
Abstract
Background: It has been demonstrated that the concept of infinite absorption time, associated with the absorption rate constant, which drives a drug's gastrointestinal absorption rate, is not physiologically sound. The recent analysis of oral drug absorption data based on the finite absorption time (F.A.T.) concept and the relevant physiologically based finite-time pharmacokinetic (PBFTPK) models developed provided a better physiologically sound description of oral drug absorption. Methods: In this study, we re-analyzed, using PBFTPK models, seven data sets of ketoprofen, amplodipine, theophylline (three formulations), and two formulations (reference, test) from a levonorgestrel bioequivalence study. Equations for one-compartment-model drugs, for the estimation of fraction of dose absorbed or the bioavailable fraction exclusively from oral data, were developed. Results: In all cases, meaningful estimates for (i) the number of absorption stages, namely, one for ketoprofen and the levonorgestrel formulations, two for amlodipine, the immediate-release theophylline formulation, and the extended-release Theotrim formulation, and three for the extended-release Theodur formulation, (ii) the duration of each absorption stage and the corresponding drug input rate, and (iii) the total duration of drug absorption, which ranged from 0.75 h (ketoprofen) to 11.6 h for Theodur were derived. Estimates for the bioavailable fraction of ketoprofen and two theophylline formulations exhibiting one-compartment-model kinetics were derived. Conclusions: This study provides insights into the detailed characteristics of oral drug absorption. The use of PBFTPK models in drug absorption analysis can be leveraged as a computational framework to discontinue the perpetuation of the mathematical fallacy of classical pharmacokinetic analysis based on the absorption rate constant as well as in the physiologically based pharmacokinetic (PBPK) studies and pharmacometrics. The present study is an additional piece of evidence for the scientific and regulatory changes required to be implemented by the regulatory agencies in the not-too-distant future.
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Affiliation(s)
- Elias Toulitsis
- Faculty of Pharmacy, National and Kapodistrian University of Athens, 15784 Athens, Greece;
| | - Athanasios A. Tsekouras
- Department of Chemistry, National and Kapodistrian University of Athens, 15784 Athens, Greece;
- PharmaInformatics Unit, ATHENA Research Center, 15125 Athens, Greece
| | - Panos Macheras
- Faculty of Pharmacy, National and Kapodistrian University of Athens, 15784 Athens, Greece;
- PharmaInformatics Unit, ATHENA Research Center, 15125 Athens, Greece
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Salehi Ravesh M, Langguth P, Moritz JD, Rinne K, Harneit PL, Schulze-Nagel J, Graessner J, Uebing A, Jansen O, Both M, Hansen JH. Quantifying and visualizing abdominal hemodynamics in patients with Fontan circulation by 4D phase-contrast flow magnetic resonance imaging at 1.5 T. Int J Cardiol 2024; 413:132391. [PMID: 39059472 DOI: 10.1016/j.ijcard.2024.132391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 07/16/2024] [Accepted: 07/23/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Liver fibrosis has been recognized as a long-term morbidity associated with Fontan circulation (Fontan-associated liver disease, FALD). The pathophysiology of FALD is not completely understood and abnormal flow dynamics may be associated with this condition. Liver hemodynamics can be quantitatively evaluated with four-dimensional phase-contrast flow magnetic resonance imaging (4D PC flow MRI). The study aimed to evaluate suitability of liver 4D PC flow MRI in Fontan patients and relate flow measurements to normal values and FALD severity. PATIENTS AND METHODS Twenty-two Fontan patients were examined by 4D PC flow MRI at 1.5 Tesla to assess mesenteric, portal, splenic, and hepatic venous blood flow. Severity of FALD was graded based on routine screening, including abdominal ultrasound and laboratory tests. RESULTS Median age was 18.5 (interquartile range, IQR 15.5-20.2) years. FALD was graded as "none or mild" in 16 and as "moderate to severe" in six cases. Ten patients presented at least one feature of portal hypertension (ascites, splenomegaly, or thrombocytopenia). For the entire cohort, blood flow in the superior mesenteric, splenic, and portal vein was lower than reported in the literature. No significant differences were observed in relation to FALD severity. Features of portal hypertension were associated with a higher splenic vein blood flow (0.34 ± 0.17 vs. 0.20 ± 0.07 l/min, p = 0.046). Splenic vein blood flow was negatively correlated to platelet count (r = -0.590, p = 0.005). CONCLUSIONS 4D PC flow MRI appears suitable to assess liver hemodynamics in Fontan patients and integration into clinical follow-up might help to improve our understanding of FALD.
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Affiliation(s)
- Mona Salehi Ravesh
- University Hospital of Schleswig-Holstein, Campus Kiel, Department of Radiology and Neuroradiology, Germany
| | - Patrick Langguth
- University Hospital of Schleswig-Holstein, Campus Kiel, Department of Radiology and Neuroradiology, Germany
| | - Joerg Detlev Moritz
- University Hospital of Schleswig-Holstein, Campus Kiel, Department of Radiology and Neuroradiology, Germany
| | - Katy Rinne
- University Hospital of Schleswig-Holstein, Campus Kiel, Department of Congenital Heart Disease and Pediatric Cardiology, Germany
| | - Paul Lennard Harneit
- University Hospital of Schleswig-Holstein, Campus Kiel, Department of Congenital Heart Disease and Pediatric Cardiology, Germany
| | - Juliane Schulze-Nagel
- University Hospital of Schleswig-Holstein, Campus Kiel, Department of Congenital Heart Disease and Pediatric Cardiology, Germany
| | | | - Anselm Uebing
- University Hospital of Schleswig-Holstein, Campus Kiel, Department of Congenital Heart Disease and Pediatric Cardiology, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany
| | - Olav Jansen
- University Hospital of Schleswig-Holstein, Campus Kiel, Department of Radiology and Neuroradiology, Germany
| | - Marcus Both
- University Hospital of Schleswig-Holstein, Campus Kiel, Department of Radiology and Neuroradiology, Germany
| | - Jan Hinnerk Hansen
- University Hospital of Schleswig-Holstein, Campus Kiel, Department of Congenital Heart Disease and Pediatric Cardiology, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Germany.
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Bruna M, Alfaro S, Muñoz F, Cisternas L, Gonzalez C, Conlledo R, Ulloa-Morrison R, Huilcaman M, Retamal J, Castro R, Rola P, Wong A, Argaiz ER, Contreras R, Hernandez G, Kattan E. Dynamic changes of hepatic vein Doppler velocities predict preload responsiveness in mechanically ventilated critically ill patients. Intensive Care Med Exp 2024; 12:46. [PMID: 38717558 PMCID: PMC11078902 DOI: 10.1186/s40635-024-00631-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 05/04/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Assessment of dynamic parameters to guide fluid administration is one of the mainstays of current resuscitation strategies. Each test has its own limitations, but passive leg raising (PLR) has emerged as one of the most versatile preload responsiveness tests. However, it requires real-time cardiac output (CO) measurement either through advanced monitoring devices, which are not routinely available, or echocardiography, which is not always feasible. Analysis of the hepatic vein Doppler waveform change, a simpler ultrasound-based assessment, during a dynamic test such as PLR could be useful in predicting preload responsiveness. The objective of this study was to assess the diagnostic accuracy of hepatic vein Doppler S and D-wave velocities during PLR as a predictor of preload responsiveness. METHODS Prospective observational study conducted in two medical-surgical ICUs in Chile. Patients in circulatory failure and connected to controlled mechanical ventilation were included from August to December 2023. A baseline ultrasound assessment of cardiac function was performed. Then, simultaneously, ultrasound measurements of hepatic vein Doppler S and D waves and cardiac output by continuous pulse contour analysis device were performed during a PLR maneuver. RESULTS Thirty-seven patients were analyzed. 63% of the patients were preload responsive defined by a 10% increase in CO after passive leg raising. A 20% increase in the maximum S wave velocity after PLR showed the best diagnostic accuracy with a sensitivity of 69.6% (49.1-84.4) and specificity of 92.8 (68.5-99.6) to detect preload responsiveness, with an area under curve of receiving operator characteristic (AUC-ROC) of 0.82 ± 0.07 (p = 0.001 vs. AUC-ROC of 0.5). D-wave velocities showed worse diagnostic accuracy. CONCLUSIONS Hepatic vein Doppler assessment emerges as a novel complementary technique with adequate predictive capacity to identify preload responsiveness in patients in mechanical ventilation and circulatory failure. This technique could become valuable in scenarios of basic hemodynamic monitoring and when echocardiography is not feasible. Future studies should confirm these results.
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Affiliation(s)
- Mario Bruna
- Unidad de Cuidados Intensivos, Hospital de Quilpué, Quilpué, Chile
- Facultad de Medicina, Escuela de Medicina, Universidad Andrés Bello, Viña del Mar, Chile
| | - Sebastian Alfaro
- Unidad de Cuidados Intensivos, Hospital de Quilpué, Quilpué, Chile
| | - Felipe Muñoz
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Liliana Cisternas
- Unidad de Cuidados Intensivos, Hospital de Quilpué, Quilpué, Chile
- Facultad de Medicina, Escuela de Medicina, Universidad Andrés Bello, Viña del Mar, Chile
| | - Cecilia Gonzalez
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Rodrigo Conlledo
- Unidad de Cuidados Intensivos, Hospital de Quilpué, Quilpué, Chile
- Facultad de Medicina, Escuela de Medicina, Universidad Andrés Bello, Viña del Mar, Chile
| | | | - Marcos Huilcaman
- Unidad de Cuidados Intensivos, Hospital Gustavo Fricke, Viña del Mar, Chile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Ricardo Castro
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Philippe Rola
- Intensive Care Unit, Hopital Santa Cabrini, CIUSSS EMTL, Montreal, Canada
| | - Adrian Wong
- Department of Critical Care, King's College Hospital, London, UK
| | - Eduardo R Argaiz
- Departamento de Nefrología y Metabolismo Mineral, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Mexico City, Mexico
| | - Roberto Contreras
- Unidad de Cuidados Intensivos, Hospital Biprovincial Quillota-Petorca, Quillota, Chile
| | - Glenn Hernandez
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile.
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Al-Turaihi Z, Simon M, Smith RJ, Horrow MM. US of the Portal Vein. Radiographics 2024; 44:e230118. [PMID: 38573815 DOI: 10.1148/rg.230118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Affiliation(s)
- Zahraa Al-Turaihi
- From the Department of Radiology, Jefferson Einstein Hospital, 5501 Old York Rd, Philadelphia, PA 19141
| | - Matthew Simon
- From the Department of Radiology, Jefferson Einstein Hospital, 5501 Old York Rd, Philadelphia, PA 19141
| | - Ryan J Smith
- From the Department of Radiology, Jefferson Einstein Hospital, 5501 Old York Rd, Philadelphia, PA 19141
| | - Mindy M Horrow
- From the Department of Radiology, Jefferson Einstein Hospital, 5501 Old York Rd, Philadelphia, PA 19141
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Ndhlovu E, Zhang BX, Chen XP, Zhu P. Thermal ablation for hepatic tumors in high-risk locations. Clin Res Hepatol Gastroenterol 2024; 48:102300. [PMID: 38367803 DOI: 10.1016/j.clinre.2024.102300] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 01/21/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
Thermal ablative techniques such as radiofrequency and microwave ablation are minimally invasive and cost-effective approaches that are currently being adopted as alternatives to surgical resection for primary and metastatic liver malignancies. However, they are considered to be relatively contraindicated for tumors in high-risk locations due to technical difficulties and a perceived increased risk of perioperative complications. Several techniques, including artificial ascites, non-touch multibipolar ablation, and laparoscopically assisted ablation, can be used to improve the outcomes of ablation for high-risk tumors. This review aims to provide a comprehensive summary of the techniques currently used to improve thermal ablation outcomes for high-risk liver tumors.
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Affiliation(s)
- Elijah Ndhlovu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Bi-Xiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Qiaokou District, Wuhan 430030, China.
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Muñoz F, Born P, Bruna M, Ulloa R, González C, Philp V, Mondaca R, Blanco JP, Valenzuela ED, Retamal J, Miralles F, Wendel-Garcia PD, Ospina-Tascón GA, Castro R, Rola P, Bakker J, Hernández G, Kattan E. Coexistence of a fluid responsive state and venous congestion signals in critically ill patients: a multicenter observational proof-of-concept study. Crit Care 2024; 28:52. [PMID: 38374167 PMCID: PMC10877871 DOI: 10.1186/s13054-024-04834-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/10/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Current recommendations support guiding fluid resuscitation through the assessment of fluid responsiveness. Recently, the concept of fluid tolerance and the prevention of venous congestion (VC) have emerged as relevant aspects to be considered to avoid potentially deleterious side effects of fluid resuscitation. However, there is paucity of data on the relationship of fluid responsiveness and VC. This study aims to compare the prevalence of venous congestion in fluid responsive and fluid unresponsive critically ill patients after intensive care (ICU) admission. METHODS Multicenter, prospective cross-sectional observational study conducted in three medical-surgical ICUs in Chile. Consecutive mechanically ventilated patients that required vasopressors and admitted < 24 h to ICU were included between November 2022 and June 2023. Patients were assessed simultaneously for fluid responsiveness and VC at a single timepoint. Fluid responsiveness status, VC signals such as central venous pressure, estimation of left ventricular filling pressures, lung, and abdominal ultrasound congestion indexes and relevant clinical data were collected. RESULTS Ninety patients were included. Median age was 63 [45-71] years old, and median SOFA score was 9 [7-11]. Thirty-eight percent of the patients were fluid responsive (FR+), while 62% were fluid unresponsive (FR-). The most prevalent diagnosis was sepsis (41%) followed by respiratory failure (22%). The prevalence of at least one VC signal was not significantly different between FR+ and FR- groups (53% vs. 57%, p = 0.69), as well as the proportion of patients with 2 or 3 VC signals (15% vs. 21%, p = 0.4). We found no association between fluid balance, CRT status, or diagnostic group and the presence of VC signals. CONCLUSIONS Venous congestion signals were prevalent in both fluid responsive and unresponsive critically ill patients. The presence of venous congestion was not associated with fluid balance or diagnostic group. Further studies should assess the clinical relevance of these results and their potential impact on resuscitation and monitoring practices.
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Affiliation(s)
- Felipe Muñoz
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Pablo Born
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Mario Bruna
- Unidad de Cuidados Intensivos, Hospital de Quilpué, Quilpué, Chile
| | - Rodrigo Ulloa
- Unidad de Cuidados Intensivos, Hospital Las Higueras, Talcahuano, Chile
| | - Cecilia González
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Valerie Philp
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Roberto Mondaca
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Juan Pablo Blanco
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Emilio Daniel Valenzuela
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Jaime Retamal
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | | | - Pedro D Wendel-Garcia
- Institute of Intensive Care Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gustavo A Ospina-Tascón
- Department of Intensive Care Medicine, Fundación Valle del Lili, Cali, Colombia
- Translational Research Laboratory in Critical Care Medicine (TransLab-CCM), Universidad Icesi, Cali, Colombia
| | - Ricardo Castro
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Philippe Rola
- Intensive Care Unit, Hopital Santa Cabrini, CIUSSS EMTL, Montreal, Canada
| | - Jan Bakker
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
- Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, USA
| | - Glenn Hernández
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile
| | - Eduardo Kattan
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, Santiago, Chile.
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12
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Lee J, Choi S, Cho SH, Yang H, Sung PS, Bae SH. The Portal Venous Pulsatility Index and Main Portal Vein Diameter as Surrogate Markers for Liver Fibrosis in Nonalcoholic Fatty Liver Disease and Metabolic-Dysfunction-Associated Steatotic Liver Disease. Diagnostics (Basel) 2024; 14:393. [PMID: 38396432 PMCID: PMC10888470 DOI: 10.3390/diagnostics14040393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024] Open
Abstract
(1) Background: Despite numerous noninvasive methods for assessing liver fibrosis, effective ultrasound parameters remain limited. We aimed to identify easily measurable ultrasound parameters capable of predicting liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and metabolic-dysfunction-associated steatotic liver disease (MASLD); (2) Methods: The data of 994 patients diagnosed with NAFLD via ultrasound at the Armed Forces Goyang Hospital were retrospectively collected from June 2022 to July 2023. A liver stiffness measurement (LSM) ≥ 8.2 kPa was classified as significant fibrosis. Liver steatosis with cardiometabolic risk factors was defined as MASLD. Two ultrasound variables, the portal venous pulsatility index (VPI) and main portal vein diameter (MPVD), were measured; (3) Results: Of 994 patients, 68 had significant fibrosis. Significant differences in VPI (0.27 vs. 0.34, p < 0.001) and MPVD (10.16 mm vs. 8.98 mm, p < 0.001) were observed between the fibrotic and non-fibrotic groups. A logistic analysis adjusted for age and body mass index (BMI) revealed that only VPI (OR of 0.955, p = 0.022, VPI on a 0.01 scale) and MPVD (OR of 1.501, p < 0.001) were significantly associated with significant liver fibrosis. In the MASLD cohort (n = 939), VPI and MPVD were associated with significant fibrosis. To achieve better accuracy in predicting liver fibrosis, we established a nomogram that incorporated MPVD and VPI. The established nomogram was validated in the test cohort, yielding an area under the receiver operating characteristic curve of 0.821 for detecting significant liver fibrosis; (4) Conclusions: VPI and MPVD, as possible surrogate markers, are useful in predicting significant fibrosis in patients with NAFLD and MASLD.
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Affiliation(s)
- Jaejun Lee
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.L.); (H.Y.); (P.-S.S.)
- Department of Internal Medicine, Armed Forces Goyang Hospital, Goyang 10267, Republic of Korea;
| | - Seungmyeon Choi
- Department of Radiology, Armed Forces Goyang Hospital, Goyang 10267, Republic of Korea;
| | - Seong-Hyun Cho
- Department of Internal Medicine, Armed Forces Goyang Hospital, Goyang 10267, Republic of Korea;
| | - Hyun Yang
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.L.); (H.Y.); (P.-S.S.)
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul 03383, Republic of Korea
| | - Pil-Soo Sung
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.L.); (H.Y.); (P.-S.S.)
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Si-Hyun Bae
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea; (J.L.); (H.Y.); (P.-S.S.)
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, College of Medicine, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul 03383, Republic of Korea
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Forado-Benatar I, Caravaca-Pérez P, Rodriguez-Espinosa D, Guzman-Bofarull J, Cuadrado-Payán E, Moayedi Y, Broseta JJ, Farrero M. Tricuspid regurgitation, right ventricular function, and renal congestion: a cardiorenal triangle. Front Cardiovasc Med 2023; 10:1255503. [PMID: 37859684 PMCID: PMC10583553 DOI: 10.3389/fcvm.2023.1255503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
There is a growing interest in the evaluation of tricuspid regurgitation due to its increasing prevalence and detrimental impact on clinical outcomes. Historically, it has been coined the "forgotten" defect in the field of valvular heart disease due to the lack of effective treatments to improve prognosis. However, the development of percutaneous treatment techniques has led to a new era in its management, with promising results and diminished complication risk. In spite of these advances, a comprehensive exploration of the pathophysiological mechanisms is essential to establish clear indications and optimal timing for medical and percutaneous intervention. This review will address the most important aspects related to the diagnosis, pathophysiology and treatment of tricuspid regurgitation from a cardiorenal perspective, with a special emphasis on the interaction between right ventricular dysfunction and the development of hepatorenal congestion.
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Affiliation(s)
| | | | - Diana Rodriguez-Espinosa
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | | | - Elena Cuadrado-Payán
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Yasbanoo Moayedi
- Ted Rogers Centre for Heart Research, Peter Munk Cardiac Centre, University Health Network, Toronto, ON, Canada
| | - José Jesús Broseta
- Department of Nephrology and Renal Transplantation, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Marta Farrero
- Department of Cardiology, Hospital Clínic of Barcelona, Barcelona, Spain
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14
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Hansebout C, Desai TV, Dhir A. Utility of transesophageal echocardiography during orthotopic liver transplantation: A narrative review. Ann Card Anaesth 2023; 26:367-379. [PMID: 37861569 PMCID: PMC10691562 DOI: 10.4103/aca.aca_186_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 02/10/2023] [Accepted: 02/21/2023] [Indexed: 10/21/2023] Open
Abstract
Orthotopic liver transplantation (OLT) is the standard of care for patients suffering from end stage liver disease (ESLD). This is a high-risk procedure with the potential for hemorrhage, large shifts in preload and afterload, and release of vasoactive mediators that can have profound effects on hemodynamic equilibrium. In addition, patients with ESLD can have preexisting coronary artery disease, cirrhotic cardiomyopathy, porto-pulomary hypertension and imbalanced coagulation. As cardiovascular involvement is invariable and patient are at an appreciable risk of intraoperative cardiac arrest, Trans esophageal echocardiography (TEE) is increasingly becoming a routinely utilized monitor during OLT in patients without contraindications to its use. A comprehensive TEE assessment performed by trained operators provides a wealth of information on baseline cardiac function, while a focused study specific for the ESLD patients can help in prompt diagnosis and treatment of critical events. Future studies utilizing TEE will eventually optimize examination safety, quality, permit patient risk stratification, provide intraoperative guidance, and allow for evaluation of graft vasculature.
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Affiliation(s)
- Christopher Hansebout
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Tejal V. Desai
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
| | - Achal Dhir
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre, University of Western Ontario, London, Ontario, Canada
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Liu XY, Lu JF, Wang LD, Wang ZY. Diagnostic value of shear wave velocity measured by virtual touch tissue imaging quantification combined with hepatic blood flow index measured by single-photon emission computed tomography first-pass method for hepatitis B fibrosis. Shijie Huaren Xiaohua Zazhi 2023; 31:492-500. [DOI: 10.11569/wcjd.v31.i12.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 02/17/2023] [Accepted: 06/16/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND The degree of liver fibrosis in patients with chronic liver disease can be evaluated by combining single-photon emission computed tomography (SPECT) first-pass method to measure hepatic blood flow index with virtual touch tissue imaging quantification (VTIQ) to detect shear wave velocity (SWV).
AIM To evaluate the clinical value of VTIQ combined with SPECT first-pass method for the diagnosis of liver fibrosis in patients with chronic hepatitis B (CHB).
METHODS Forty-two CHB patients with liver fibrosis at our hospital from August 2020 to August 2021 were selected as a study group, and another 42 patients with CHB without hepatic fibrosis were selected as a control group. VTIQ was performed to obtain the shear wave transverse velocity (SWV), and SPECT examination was performed to obtain liver blood flow index. General data, routine blood indexes [white blood cell count (WBC), absolute monocyte count (AMC), and neutrophil count (NEUT)], blood coagulation function [prothombin time (PT) and prothrombin activity (PTA)], liver function indexes [total bilirubin (TBIL), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and albumin (ALB)] and SWV, and liver blood flow index were compared between the two groups. The degree of liver fibrosis in the study group was determined through liver tissue pathology, and SWV and liver blood flow index were compared among patients with different liver fibrosis degrees. Spearman correlation coefficient was used to assess the correlation of SWV and liver blood flow index with CHB liver fibrosis degree. The value of SWV and liver blood flow index in diagnosing CHB liver fibrosis was assessed by receiver operating characteristic (ROC) curve analysis.
RESULTS The SWV and liver blood flow index of the study group were significantly higher than those of the control group (P < 0.05). The SWV and hepatic blood flow index were significantly higher in patients with liver fibrosis grade S3-S4 in the study group than in those with grade S1-S2, and and in those with grade S2 than in those with grade S1 (P < 0.05). SWV and liver blood flow index were positively correlated with CHB liver fibrosis degree (P < 0.05). The area under the curve (AUC) values of SWV and liver blood flow index, alone or in combination, for the diagnosis of CHB liver fibrosis were all > 0.7, and the AUC of the combination was the largest (0.930).
CONCLUSION SWV measured by VTIQ combined with liver blood flow index measured by SPECT has appreciated value in the diagnosis of CHB liver fibrosis and in the assessment of the degree of liver fibrosis.
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Affiliation(s)
- Xiang-Yan Liu
- Department of Hepatological Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Jian-Fang Lu
- Department of Hepatological Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Li-Dong Wang
- Department of Hepatological Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Zhuo-Yi Wang
- Department of Hepatological Surgery, Shulan (Hangzhou) Hospital, Hangzhou 310000, Zhejiang Province, China
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16
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Huang A, Roberts GS, Roldán-Alzate A, Wieben O, Reeder SB, Oechtering TH. Reference values for 4D flow magnetic resonance imaging of the portal venous system. Abdom Radiol (NY) 2023; 48:2049-2059. [PMID: 37016247 PMCID: PMC10518803 DOI: 10.1007/s00261-023-03892-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/17/2023] [Accepted: 03/19/2023] [Indexed: 04/06/2023]
Abstract
PURPOSE The purpose of this work was to establish normal reference values for 4D flow MRI-derived flow, velocity, and vessel diameters, and to define characteristic flow patterns in the portal venous system of healthy adult subjects. METHODS For this retrospective study, we screened all available 4D flow MRI exams of the upper abdomen in healthy adults acquired at our institution between 2012 and 2022 at either 1.5 T or 3.0 T MRI after ≥ 5 h fasting. Flow, velocity, and effective diameter were quantified in the 8 planes in the portal venous system (splenic vein, superior mesenteric vein, main, right, and left portal veins). Vessel delineation was manually adjusted over time. Reference ranges for were defined as the mean ± 2 standard deviations. Three readers noted helical and vortical flow on time-resolved pathline visualizations. Conservation of mass flow analysis was performed for quality assurance. RESULTS We included 44 healthy subjects (26 female, 18-74 years) in the analysis. We report reference values for mean and peak flow, mean velocity, and vessel diameter in the healthy portal vein using 4D flow MRI. Normal flow patterns in the portal vein included faint helical (66%) or linear flow (34%). Conservation of mass analysis demonstrated a relative error of 1.1 ± 4.6% standard deviation (SD) at the splenomesenteric confluence and - 1.4 ± 4.1% SD at the portal bifurcation. CONCLUSION We have reported normal hemodynamic values that are necessary baseline data for emerging clinical applications of 4D flow MRI in the portal venous system. Results are consistent with previously published values from smaller cohorts.
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Affiliation(s)
- Andrew Huang
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Grant S Roberts
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Alejandro Roldán-Alzate
- Department of Mechanical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin, Madison, WI, USA
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA
- Department of Medicine, University of Wisconsin, Madison, WI, USA
- Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
| | - Thekla H Oechtering
- Department of Radiology, University of Wisconsin, Madison, WI, USA.
- Department of Radiology and Nuclear Medicine, Universität zu Lübeck, Lübeck, Germany.
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17
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Klambauer K, Cecatka S, Clevert DA. [Ultrasound diagnostics of the liver : Principles and important pathologies]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:387-402. [PMID: 37071126 DOI: 10.1007/s00117-023-01138-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 04/19/2023]
Abstract
Diffuse changes in the liver parenchyma, focal lesions and blood flow in hepatic vessels can be assessed using ultrasound. Screening by ultrasound can be used to detect hepatocellular carcinomas as possible malignant sequelae of liver cirrhosis. As metastases are far more frequent than primary malignant liver tumors, secondary malignant neoplasms should be taken into consideration as a differential diagnosis in the presence of focal liver lesions. This particularly concerns patients with a known metastatic disease. Benign focal liver lesions are often incidentally discovered in women of childbearing age. Cysts, hemangiomas and focal nodular hyperplasia mostly show typical morphological features in ultrasound and do not require further follow-up; however, with hepatic adenomas, regular follow-up is recommended due to the risk of bleeding and/or malignant transformation.
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Affiliation(s)
- Konstantin Klambauer
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, München, Deutschland.
| | - Sasa Cecatka
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, München, Deutschland
| | - Dirk-André Clevert
- Klinik und Poliklinik für Radiologie, Klinikum der Universität München, LMU München, München, Deutschland
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18
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Kishore SB, Lewindon P, Noble C, Balouch F. Enoxaparin is safe and effective for restoring and preserving forward portal venous flow in children with end-stage liver disease. J Hepatol 2023; 78:e57-e59. [PMID: 36370953 DOI: 10.1016/j.jhep.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/10/2022]
Affiliation(s)
- Shreya B Kishore
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia.
| | - Peter Lewindon
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Charlton Noble
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Fariha Balouch
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
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Wu D, Tsekouras AA, Macheras P, Kesisoglou F. Physiologically based Pharmacokinetic Models under the Prism of the Finite Absorption Time Concept. Pharm Res 2023; 40:419-429. [PMID: 36050545 DOI: 10.1007/s11095-022-03357-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/02/2022] [Indexed: 01/19/2023]
Abstract
To date, mechanistic modeling of oral drug absorption has been achieved via the use of physiologically based pharmacokinetic (PBPK) modeling, and more specifically, physiologically based biopharmaceutics model (PBBM). The concept of finite absorption time (FAT) has been developed recently and the application of the relevant physiologically based finite time pharmacokinetic (PBFTPK) models to experimental data provides explicit evidence that drug absorption terminates at a specific time point. In this manuscript, we explored how PBBM and PBFTPK models compare when applied to the same dataset. A set of six compounds with clinical data from immediate-release formulation were selected. Both models resulted in absorption time estimates within the small intestinal transit time, with PBFTPK models generally providing shorter time estimates. A clear relationship between the absorption rate and the product of permeability and luminal concentration was observed, in concurrence with the fundamental assumptions of PBFTPK models. We propose that future research on the synergy between the two modeling approaches can lead to both improvements in the initial parameterization of PBPK/PBBM models but to also expand mechanistic oral absorption concepts to more traditional pharmacometrics applications.
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Affiliation(s)
- Di Wu
- Pharmaceutical Sciences and Clinical Supply, Merck & Co., Inc., Rahway, NJ, 07065, USA
| | - Athanasios A Tsekouras
- Department of Chemistry, Laboratory of Physical Chemistry, National and Kapodistrian University of Athens, Athens, Greece.,PharmaInformatics Unit, ATHENA Research Center, Athens, Greece
| | - Panos Macheras
- PharmaInformatics Unit, ATHENA Research Center, Athens, Greece.,Faculty of Pharmacy, Laboratory of Biopharmaceutics Pharmacokinetics, National and Kapodistrian University of Athens, Athens, Greece
| | - Filippos Kesisoglou
- Pharmaceutical Sciences and Clinical Supply, Merck & Co., Inc., Rahway, NJ, 07065, USA.
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Radiologic Evaluation of Portosystemic Shunts in Humans and Small Animals: Review of the Literature with Clinical Case Reports. Diagnostics (Basel) 2023; 13:diagnostics13030482. [PMID: 36766586 PMCID: PMC9914644 DOI: 10.3390/diagnostics13030482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/05/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
The portal venous system is a network of vessels that carry blood from the capillary beds of the major abdominal organs to the liver. During embryology, the portal venous system can develop aberrantly, leading to vascular connections between the portal and systemic venous circulation known as portosystemic shunts. The purpose of this comparative review with a few short representative case reports was to present the similarities and differences in portosystemic shunts in humans and small animals and their radiologic evaluation. Aberrant vascular connections between the portal and systemic venous circulation enable portal blood to bypass metabolism and detoxification in the liver, leading to significant clinical implications. Portosystemic shunts are very rare in humans, but these connections are much more common in small animals, affecting up to 0.6% of small animals. Portosystemic shunts can be congenital or acquired and are divided into intrahepatic and extrahepatic types. Because of its ability to accurately assess abdominal structures, large vessels, and their flow dynamics without anesthesia, ultrasonography has become the first imaging modality employed for the diagnostic evaluation of portosystemic shunts in both humans and small animals. This is usually followed by contrast-enhanced computed tomographic angiography in order to better define the exact shunt anatomy and to plan treatment. It is important to understand the embryology, anatomy, pathology, and pathophysiology of portosystemic shunts in order to understand the findings of radiologic imaging and to initiate appropriate treatment.
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21
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Liu Y, Sebastian S, Huang J, Corbascio T, Engellau J, Lidgren L, Tägil M, Raina DB. Longitudinal in vivo biodistribution of nano and micro sized hydroxyapatite particles implanted in a bone defect. Front Bioeng Biotechnol 2022; 10:1076320. [PMID: 36601389 PMCID: PMC9806272 DOI: 10.3389/fbioe.2022.1076320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Hydroxyapatite (HA) has been widely used as a bone substitute and more recently as a carrier for local delivery of bone targeted drugs. Majority of the approved HA based biomaterials and drug carriers comprise of micrometer sized particulate HA (mHA) or granules and can therefore only be used for extracellular drug release. This shortcoming could be overcome with the use of cell penetrating HA nanoparticles (nHA) but a major concern with the clinical use of nHA is the lack of data on its in vivo biodistribution after implantation. In this study, we aimed to study the in vivo biodistribution of locally implanted nHA in a clinically relevant tibial void in rats and compare it with mHA or a combination of mHA and nHA. To enable in vivo tracking, HA particles were first labelled with 14C-zoledronic acid (14C-ZA), known to have a high binding affinity to HA. The labelled particles were then implanted in the animals and the radioactivity in the proximal tibia and vital organs was detected at various time points (Day 1, 7 and 28) post-implantation using scintillation counting. The local distribution of the particles in the bone was studied with micro-CT. We found that majority (>99.9%) of the implanted HA particles, irrespective of the size, stayed locally at the implantation site even after 28 days and the findings were confirmed using micro-CT. Less than 0.1% radioactivity was observed in the kidney and the spleen at later time points of day 7 and 28. No pathological changes in any of the vital organs could be observed histologically. This is the first longitudinal in vivo HA biodistribution study showing that the local implantation of nHA particles in bone is safe and that nHA could potentially be used for localized drug delivery.
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Affiliation(s)
- Yang Liu
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden,*Correspondence: Yang Liu, ; Deepak Bushan Raina,
| | - Sujeesh Sebastian
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Jintian Huang
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Tova Corbascio
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Jacob Engellau
- Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - Lars Lidgren
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Magnus Tägil
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden
| | - Deepak Bushan Raina
- Department of Clinical Sciences Lund, Orthopedics, The Faculty of Medicine, Lund University, Lund, Sweden,*Correspondence: Yang Liu, ; Deepak Bushan Raina,
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22
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Macheras P, Tsekouras AA. Columbus' egg: Oral drugs are absorbed in finite time. Eur J Pharm Sci 2022; 176:106265. [PMID: 35863551 DOI: 10.1016/j.ejps.2022.106265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/14/2022] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
The infinite time of oral drug absorption was conceived from the first day of the birth of pharmacokinetics when H. Dost introduced the term pharmacokinetics in his book published in 1953. He adopted the function developed by H. Bateman back in 1908 for the decay of the nuclei isotopes to describe oral drug absorption as a first-order process. We unveiled this false hypothesis relying on common wisdom i.e. drugs are absorbed in finite time. This false assumption had dramatic effects on the evolution of oral pharmacokinetics but most importantly on the bioavailability and bioequivalence concepts and metrics. This work focuses on the finite absorption time (FAT) concept, the relevant Physiologically Based Finite Time (PBFTPK) models developed and their applications in oral pharmacokinetics, bioavailability and bioequivalence. The crux of the matter is that drug absorption from the gastrointestinal tract takes place under sink conditions because of the high blood flow rate in the vena cava. The termination of oral, pulmonary and intranasal drug absorption at a specific time point, calls for regulatory changes in bioavailability and bioequivalence studies in terms of the study design and metrics used for the bioequivalence assessment.
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Affiliation(s)
- P Macheras
- PharmaInformatics Unit, Research Center ATHENA, Athens, Greece; Faculty of Pharmacy, Laboratory of Biopharmaceutics Pharmacokinetics, National and Kapodistrian University of Athens, Athens, Greece.
| | - A A Tsekouras
- PharmaInformatics Unit, Research Center ATHENA, Athens, Greece; Department of Chemistry, Laboratory of Physical Chemistry, National and Kapodistrian University of Athens, Athens, Greece
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23
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Meek G, Ozen S, Ozen M. I saw the sign: the “corkscrew sign” of the hepatic arteries. Clin Imaging 2022; 89:16-17. [DOI: 10.1016/j.clinimag.2022.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 04/22/2022] [Accepted: 05/23/2022] [Indexed: 11/03/2022]
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24
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Chryssafidis P, Tsekouras AA, Macheras P. Re-writing Oral Pharmacokinetics Using Physiologically Based Finite Time Pharmacokinetic (PBFTPK) Models. Pharm Res 2022; 39:691-701. [PMID: 35378697 DOI: 10.1007/s11095-022-03230-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 03/09/2022] [Indexed: 12/22/2022]
Abstract
PURPOSE To develop physiologically based finite time pharmacokinetic (PBFTPK) models for the analysis of oral pharmacokinetic data. METHODS The models are based on the passive drug diffusion mechanism under the sink conditions principle. Up to three drug successive input functions of constant rate operating for a total time τ are considered. Differential equations were written for all these models assuming linear one- or two-compartment-model disposition. The differential equations were solved and functions describing the concentration of drug as a function of time for the central and the peripheral compartment were derived. The equations were used to generate simulated data and they were also fitted to a variety of experimental literature oral pharmacokinetic data. RESULTS The simulated curves resemble real life data. The end of the absorption processes τ is either equal to tmax or longer than tmax at the descending portion of the concentration time curve. Literature oral pharmacokinetic data of paracetamol, ibuprofen, almotriptan, cyclosporine (a total of four sets of data), and niraparib were analyzed using the PBFTPK models. Estimates for τ corresponding to a single or two or three different in magnitude input rates were derived along with the other model parameters for all data analyzed. CONCLUSIONS The PBFTPK models are a powerful tool for the analysis of oral pharmacokinetic data since they rely on the physiologically sound concept of finite absorption time.
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Affiliation(s)
- Pavlos Chryssafidis
- PharmaInformatics Unit, Research Center ATHENA, Athens, Greece.,Faculty of Pharmacy, Laboratory of Biopharmaceutics Pharmacokinetics, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios A Tsekouras
- PharmaInformatics Unit, Research Center ATHENA, Athens, Greece. .,Department of Chemistry, Laboratory of Physical Chemistry, National and Kapodistrian University of Athens, Athens, Greece.
| | - Panos Macheras
- PharmaInformatics Unit, Research Center ATHENA, Athens, Greece. .,Faculty of Pharmacy, Laboratory of Biopharmaceutics Pharmacokinetics, National and Kapodistrian University of Athens, Athens, Greece.
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25
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Vardar BU, Dupuis CS, Goldstein AJ, Vardar Z, Kim YH. Ultrasonographic evaluation of patients with abnormal liver function tests in the emergency department. Ultrasonography 2022; 41:243-262. [PMID: 35026887 PMCID: PMC8942730 DOI: 10.14366/usg.21152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/18/2021] [Indexed: 12/24/2022] Open
Abstract
Ultrasonography is often the initial modality used to evaluate patients found to have abnormal liver function tests (LFTs) in the emergency department. While an assessment for biliary ductal dilatation and obstruction remains one of the main questions to answer, radiologists should also be aware of the ultrasonographic appearance of other conditions that can cause abnormal LFTs. This may be crucial for the management and disposition of patients in the emergency department. This article reviews the ultrasonographic features of diseases that may cause abnormal LFTs.
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Affiliation(s)
| | - Carolyn S Dupuis
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Alan J Goldstein
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Zeynep Vardar
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
| | - Young H Kim
- Department of Radiology, University of Massachusetts Medical School, Worcester, MA, USA
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26
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Lau YH, See KC. Point-of-care ultrasound for critically-ill patients: A mini-review of key diagnostic features and protocols. World J Crit Care Med 2022; 11:70-84. [PMID: 35433316 PMCID: PMC8968483 DOI: 10.5492/wjccm.v11.i2.70] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/08/2021] [Accepted: 02/10/2022] [Indexed: 02/06/2023] Open
Abstract
Point-of-care ultrasonography (POCUS) for managing critically ill patients is increasingly performed by intensivists or emergency physicians. Results of needs surveys among intensivists reveal emphasis on basic cardiac, lung and abdominal ultrasound, which are the commonest POCUS modalities in the intensive care unit. We therefore aim to describe the key diagnostic features of basic cardiac, lung and abdominal ultrasound as practised by intensivists or emergency physicians in terms of accuracy (sensitivity, specificity), clinical utility and limitations. We also aim to explore POCUS protocols that integrate basic cardiac, lung and abdominal ultrasound, and highlight areas for future research.
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Affiliation(s)
- Yie Hui Lau
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Kay Choong See
- Division of Respiratory & Critical Care Medicine, National University Hospital, Singapore 119074, Singapore
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27
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Portal hypertension in familial Mediterranean fever patients. Med Clin (Barc) 2022; 159:405-410. [DOI: 10.1016/j.medcli.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/17/2021] [Accepted: 12/27/2021] [Indexed: 11/17/2022]
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28
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Benson CB, Frates MC. Color Duplex Scanning of the Hepatoportal Circulation. NONINVASIVE VASCULAR DIAGNOSIS 2022:933-960. [DOI: 10.1007/978-3-030-60626-8_48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2025]
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29
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Wiskar K, Chan B, Arishenkoff S. A 78-Year-Old Male With Acute on Chronic Kidney Injury. Chest 2022; 161:e55-e58. [DOI: 10.1016/j.chest.2021.04.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/08/2021] [Accepted: 04/06/2021] [Indexed: 11/26/2022] Open
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30
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Abstract
Volume status assessment is a critical but challenging clinical skill and is especially important for the management of patients in the emergency department, intensive care unit, and dialysis unit where accurate intravascular assessment is necessary to guide appropriate fluid management. Assessment of volume status is subjective and can vary from provider to provider, posing clinical dilemmas. Traditional non-invasive methods of volume assessment include assessment of skin turgor, axillary sweat, peripheral edema, pulmonary crackles, orthostatic vital signs, and jugular venous distension. Invasive assessments of volume status include direct measurement of central venous pressure and pulmonary artery pressures. Each of these has their own limitations, challenges, and pitfalls and were often validated based on small cohorts with questionable comparators. In the past 30 years, the increased availability, progressive miniaturization, and falling price of ultrasound devices has made point of care ultrasound (POCUS) widely available. Emerging evidence base and increased uptake across multiple subspecialities has facilitated the adoption of this technology. POCUS is now widely available, relatively inexpensive, free of ionizing radiation, and can help providers make medical decisions with more precision. POCUS is not intended to replace the physical exam, but rather to complement clinical assessment, guiding providers to give thorough and accurate clinical care to their patients. We should be mindful of the nascent literature supporting the use of POCUS and other limitations as uptake increases among providers and be wary not to use POCUS to substitute clinical judgement, but integrate ultrasonographic findings carefully with history and clinical examination.
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Affiliation(s)
- David Kearney
- Renal-Electrolyte Hypertension Division, University of Pennsylvania Philadelphia, PA
| | - Nathaniel Reisinger
- Renal-Electrolyte Hypertension Division, University of Pennsylvania Philadelphia, PA
| | - Sadichhya Lohani
- Renal-Electrolyte Hypertension Division, University of Pennsylvania Philadelphia, PA
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31
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Hanafy AS, Tharwat EE. Differentiation of malignant from non-malignant portal vein thrombosis in liver cirrhosis: the challenging dilemma. EGYPTIAN LIVER JOURNAL 2021. [DOI: 10.1186/s43066-021-00158-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
PVT is an ultrasonographic finding in up to 8% of patients with liver cirrhosis. Once hepatocellular carcinoma has occurred as the final station in liver cirrhosis, the risk of PVT rises to 40%. Benign and malignant PVT can occur in patients with liver cirrhosis, and it is important to differentiate the nature of PVT as it has a great impact on patient’s management and outcome.
Diagnosis
Confirming portal vein thrombosis and extension by abdominal ultrasound, contrast-enhanced USG, CT, or MRI. Malignant criteria of PVT are pulsatile pattern in Doppler and heterogeneous contrast enhancement, which are especially seen at the arterial phase, neovascularity within PVT, portal vein thrombus with a diameter of > 23 mm while in benign thrombus, PV diameter does not exceed 20 mm. Visible hypervascular tumor is in close proximity to PVT.
Conclusion
It is not uncommon to find portal vein thrombosis in patients with liver cirrhosis, despite the fact that malignant variant is the most frequent, but efforts should be gathered to exclude benign PVT which may change the management of the patients dramatically.
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32
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Moon HH. Refractory Ascites with Intrahepatic Portal Thrombosis after Living Donor Liver Transplantation Successfully Treated by Splenic Artery Embolization and Apixaban (Case Report). KOSIN MEDICAL JOURNAL 2021. [DOI: 10.7180/kmj.2021.36.2.187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Refractory ascites is a rare complication after liver transplantation, and its incidence ranges from 5% to 7%. A 56-yearold man diagnosed with HBV-LC with massive ascites underwent living donor liver transplantation. After transplantation, more than 1000 ml/day of ascites was steadily drained until two weeks after LT. CT showed intrahepatic Rt. portal vein thrombosis and many remnant collaterals with splenomegaly. We decided to embolize the proximal splenic artery and use apixaban to reduce portal flow and resolve the intrahepatic portal thrombosis. One day after splenic artery embolization, the patient's ascites dramatically decreased. Three days later, he was discharged from the hospital. Three months later, a follow-up liver CT showed resolution of thrombosis and no ascites. Splenic artery embolization was an effective and safe procedure for portal flow modulation in portal hyertension. Apixaban was effective for partial portal vein thrombosis in a liver transplant recipient.
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33
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Millington SJ, Wiskar K, Hobbs H, Koenig S. How I Do It: Risks and Benefits of Fluid Administration as Assessed by Ultrasound. Chest 2021; 160:2196-2208. [PMID: 34245742 DOI: 10.1016/j.chest.2021.06.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 12/20/2022] Open
Abstract
For patients in shock, decisions regarding administering or withholding IV fluids are both difficult and important. Although a strategy of relatively liberal fluid administration has traditionally been popular, recent trial results suggest that moving to a more fluid-restrictive approach may be prudent. The goal of this article was to outline how whole-body point-of-care ultrasound can help clarify both the possible benefits and the potential risks of fluid administration, aiding in the risk/benefit calculations that should always accompany fluid-related decisions.
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Affiliation(s)
| | - Katie Wiskar
- University of British Columbia, Vancouver, BC, Canada
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34
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Lin Z, Chen R, Gao B, Qin S, Wu B, Liu J, Cai XC. A highly parallel simulation of patient-specific hepatic flows. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3451. [PMID: 33609008 DOI: 10.1002/cnm.3451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 01/29/2021] [Accepted: 02/13/2021] [Indexed: 06/12/2023]
Abstract
Computational hemodynamics is being developed as an alternative approach for assisting clinical diagnosis and treatment planning for liver diseases. The technology is non-invasive, but the computational time could be high when the full geometry of the blood vessels is taken into account. Existing approaches use either one-dimensional model of the artery or simplified three-dimensional tubular geometry in order to reduce the computational time, but the accuracy is sometime compromised, for example, when simulating blood flows in arteries with plaque. In this work, we study a highly parallel method for the transient incompressible Navier-Stokes equations for the simulation of the blood flows in the full three-dimensional patient-specific hepatic artery, portal vein and hepatic vein. As applications, we also simulate the flow in a patient with hepatectomy and calculate the S (PPG). One of the advantages of simulating blood flows in all hepatic vessels is that it provides a direct estimate of the PPG, which is a gold standard value to assess the portal hypertension. Moreover, the robustness and scalability of the algorithm are also investigated. A 83% parallel efficiency is achieved for solving a problem with 7 million elements on a supercomputer with more than 1000 processor cores.
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Affiliation(s)
- Zeng Lin
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen Key Laboratory for Exascale Engineering and Scientific Computing, Shenzhen, China
| | - Rongliang Chen
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen Key Laboratory for Exascale Engineering and Scientific Computing, Shenzhen, China
| | - Beibei Gao
- Department of Cardiology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shanlin Qin
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Bokai Wu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Jia Liu
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen Key Laboratory for Exascale Engineering and Scientific Computing, Shenzhen, China
| | - Xiao-Chuan Cai
- Department of Mathematics, University of Macau, Macau, China
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35
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Wahab SA, Abraham B, Bailey A, Choe KA. Imaging findings of en bloc simultaneous liver-kidney transplantation. Abdom Radiol (NY) 2021; 46:1876-1890. [PMID: 33083870 DOI: 10.1007/s00261-020-02824-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/01/2020] [Accepted: 10/10/2020] [Indexed: 10/23/2022]
Abstract
Simultaneous liver-kidney transplantations (SLKTs) are increasing in incidence, and the en bloc surgical approach is associated with a unique spectrum of vascular complications. En bloc SLKTs have a common arterial supply from the celiac axis and post-operative assessment with Doppler ultrasound can help to localize vascular lesions as either proximal in the shared arterial supply or distal in the organ-specific arteries. Venous complications predominantly include thrombosis or stenosis of the portal vein, hepatic veins, renal vein, or IVC, but have a much lower incidence. Radiologists familiar with the post-operative anatomy and complications can provide meaningful and accurate assessment to help direct clinical care. The purpose of this article is to provide a targeted review of SLKT, review the post-surgical anatomy associated with en bloc SLKT, and review the imaging evaluation of vascular complications associated with SLKT.
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36
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Early Effects of Laparoscopic Sleeve Gastrectomy and Laparoscopic One-Anastomosis Gastric Bypass on Portal Venous Flow: a Prospective Cohort Study. Obes Surg 2021; 31:2410-2418. [PMID: 33660156 DOI: 10.1007/s11695-021-05267-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Portal vein thrombosis (PVT) is an infrequent, yet potentially lethal, complication of bariatric surgery. The aim of this prospective, non-randomized, cohort study is to compare between laparoscopic sleeve gastrectomy (LSG) and laparoscopic one-anastomosis gastric bypass (LOAGB) in terms of their early postoperative effects on portal venous flow and patency. METHODS Forty-nine morbidly obese patients were allocated to one of 2 groups (A or B). Group A patients underwent LSG, whereas group B patients underwent LOAGB. Portal venous Doppler ultrasound scanning was performed preoperatively and 2 weeks postoperatively in all cases, in order to assess the portal venous flow (PVF) in terms of flow direction and peak systolic velocity (PSV); as well as to assess the portal venous patency and exclude PVT. The mean change in PSV (ΔPSV) and the mean percentage change in PSV (%ΔPSV) were determined in both groups. RESULTS In all cases (group A (n = 26); group B (n = 23)), the direction of PVF was "hepatopetal" both preoperatively and 2 weeks postoperatively. The mean ΔPSV and the mean %ΔPSV were higher in LSG patients "group A" (- 0.84 cm/s and 3.25% respectively) compared with LOAGB patients "group B"(- 0.06 cm/s and 0.27% respectively); P = 0.038 and 0.039 respectively. The mean change in PSV was in the negative direction in both groups, i.e., "deceleration." No cases of PVT were reported in the study. CONCLUSIONS Laparoscopic sleeve gastrectomy is associated with greater reduction in portal venous peak systolic flow velocity in the early postoperative period, compared with laparoscopic one-anastomosis gastric bypass.
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37
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Lin Y, Liu Y, Jiang B, Li W, Li H, Wang H. Application of Hepatic Transit Time and Shear Wave Velocity in Assessing Portal Pressure in Patients with Cirrhotic Portal Hypertension. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:272-278. [PMID: 33153804 DOI: 10.1016/j.ultrasmedbio.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/30/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
The aim of the study described here was to explore the value of hepatic transit time (HTT) and shear wave velocity (SWV) in diagnosing cirrhotic portal hypertension. Fifty-seven patients had undergone esophagogastric varicose vein embolization (group OBS) and 50 healthy controls (group CON) were retrospectively compared with respect to HTT (arterial-hepatic vein [HA-HVTT], portal vein-hepatic vein [PV-HVTT], liver parenchyma-hepatic vein [PA-HVTT]) and SWV to analyze their efficacy in diagnosing cirrhotic portal hypertension. The correlations between SWV/HTT and free portal pressure (FPP) in group OBS were also analyzed. Compared with group CON, group OBS had a shorter HTT and faster SWV. The area under the curve (AUC) of PV-HVTT (0.93) was higher than those of HA-HVTT (0.75) and PA-HVTT (0.64), the AUCs of PV-HVTT (0.93, threshold 7.9 s) and SWV (0.91, threshold 2.0 cm/s) did not statistically differ (z = 0.35, p = 0.73). HTT and FPP in group OBS had a negative correlation. In conclusion, HTT and SWV can be used to diagnose cirrhotic portal hypertension without difference in diagnostic efficacy, and HTT is more meaningful for assessing the changes in portal pressure.
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Affiliation(s)
- Yuanqiang Lin
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Yan Liu
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Bo Jiang
- Department of General Surgery, Nanhu District, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Wenhui Li
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Hequn Li
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China
| | - Hui Wang
- Department of Ultrasound, China-Japan Union Hospital, Jilin University, Changchun, Jilin, China.
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Profiling circulating microRNAs in patients with cirrhosis and acute-on-chronic liver failure. JHEP Rep 2021; 3:100233. [PMID: 33665588 PMCID: PMC7902550 DOI: 10.1016/j.jhepr.2021.100233] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/02/2020] [Accepted: 12/25/2020] [Indexed: 12/13/2022] Open
Abstract
Background & Aims MicroRNAs (miRNAs) circulate in several body fluids and can be useful biomarkers. The aim of this study was to identify blood-circulating miRNAs associated with cirrhosis progression and acute-on-chronic liver failure (ACLF). Methods Using high-throughput screening of 754 miRNAs, serum samples from 45 patients with compensated cirrhosis, decompensated cirrhosis, or ACLF were compared with those from healthy individuals (n = 15). miRNA levels were correlated with clinical parameters, organ failure, and disease progression and outcome. Dysregulated miRNAs were evaluated in portal and hepatic vein samples (n = 33), liver tissues (n = 17), and peripheral blood mononuclear cells (PBMCs) (n = 16). Results miRNA screening analysis revealed that circulating miRNAs are dysregulated in cirrhosis progression, with 51 miRNAs being differentially expressed among all groups of patients. Unsupervised clustering and principal component analysis indicated that the main differences in miRNA expression occurred at decompensation, showing similar levels in patients with decompensated cirrhosis and those with ACLF. Of 43 selected miRNAs examined for differences among groups, 10 were differentially expressed according to disease progression. Moreover, 20 circulating miRNAs were correlated with model for end-stage liver disease and Child-Pugh scores. Notably, 11 dysregulated miRNAs were associated with kidney or liver failure, encephalopathy, bacterial infection, and poor outcomes. The most severely dysregulated miRNAs (i.e. miR-146a-5p, miR-26a-5p, and miR-191-5p) were further evaluated in portal and hepatic vein blood and liver tissue, but showed no differences. However, PBMCs from patients with cirrhosis showed significant downregulation of miR-26 and miR-146a, suggesting a extrahepatic origin of some circulating miRNAs. Conclusions This study is a repository of circulating miRNA data following cirrhosis progression and ACLF. Circulating miRNAs were profoundly dysregulated during the progression of chronic liver disease, were associated with failure of several organs and could have prognostic utility. Lay summary Circulating miRNAs are small molecules in the blood that can be used to identify or predict a clinical condition. Our study aimed to identify miRNAs for use as biomarkers in patients with cirrhosis or acute-on-chronic liver failure. Several miRNAs were found to be dysregulated during the progression of disease, and some were also related to organ failure and disease-related outcomes.
Circulating miRNAs are dysregulated with cirrhosis progression and in patients with ACLF. Patient decompensation is associated with important changes in the levels of circulating miRNAs. A total of 11 circulating miRNAs were identified as associated with organ failure and 7 with poor outcome. The miRNAs most dysregulated during cirrhosis progression were miR-146a, miR-26a, and miR-191. miR-146a was dysregulated in PBMCs of patients with decompensated cirrhosis vs. compensated cirrhosis.
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Key Words
- ACLF, acute-on-chronic liver failure
- ALT, alanine aminotransferase
- AST, aspartate aminotransferase
- Biomarkers
- CXCL10, C-X-C motif chemokine ligand 10
- Chronic liver disease
- EF CLIF, European Foundation for the Study of Chronic Liver Failure
- FoxO, forkhead box O
- INR, International Normalised Ratio
- LDH, lactate dehydrogenase
- Liver decompensation
- MAPK, mitogen-activated protein kinase
- MELD, model for end-stage liver disease
- NASH, non-alcoholic steatohepatitis
- Non-coding RNAs
- PBMCs, peripheral blood mononuclear cells
- PCA, principal component analysis
- TGF, transforming growth factor
- TIPS, transjugular intrahepatic portosystemic shunt
- qPCR, quantitative PCR
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Briggler A, Simmons LQ, Lane M. The Importance of Sonographic Imaging With Alcoholic Liver Disease: A Case Study. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2021. [DOI: 10.1177/8756479320944150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Alcoholic liver disease (ALD), a precursor to alcohol-induced cirrhosis, is a disease caused by excessive ingestion of alcoholic substances that directly affects liver functions. Abnormal liver function can cause the liver to damage other organs within the abdomen. This case study examines the physiological nature of alcohol-induced cirrhosis and its pathogenesis, external and internal clinical presentations, and treatment options. Treatments for alcohol-induced cirrhosis include liver transplant for permanent correction as well as varied options to manage symptoms. This case study analyzes alcoholic liver disease within one male patient whose condition highlights the importance of sonography in routinely monitoring patients with ALD.
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Affiliation(s)
- Amber Briggler
- Imaging & Radiation Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Layla Q. Simmons
- Imaging & Radiation Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Megan Lane
- Imaging & Radiation Sciences, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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Translational insight into prothrombotic state and hypercoagulation in nonalcoholic fatty liver disease. Thromb Res 2020; 198:139-150. [PMID: 33340925 DOI: 10.1016/j.thromres.2020.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/17/2020] [Accepted: 12/07/2020] [Indexed: 02/08/2023]
Abstract
Non-alcoholic fatty liver disease (NAFLD) is an emerging and threatening pathological condition, ranging from fatty liver (FL) to chronic steatohepatitis (NASH), liver cirrhosis, and eventually to hepatocellular carcinoma (HCC). Recent findings suggest that patients with NAFLD have a higher risk of cardiovascular events and thromboembolism and that this risk is independent of metabolic diseases that are frequently associated with NAFLD, such as diabetes, hyperlipidaemia, and obesity. The vascular involvement of NAFLD might be considered its systemic burden, conditioning higher mortality in patients affected by the disease. These clinical findings suggested the existence of a prothrombotic state in NAFLD, which is partially unexplored and whose underlying mechanisms are to date not completely understood. Here, we review the mechanisms involved in the pathogenesis of the prothrombotic state in NAFLD across the progression from the healthy liver through the different stages of the disease. We focused on the possible role of several metabolic features of NAFLD possibly leading to hypercoagulation other than endothelial and platelet activation, such as insulin-resistance, nitric oxide production regulation, and gut microbiota homeostasis. Also, we analysed the involvement of plasminogen activator inhibitor-1 (PAI-1) and thromboinflammation taking place in NAFLD. Finally, we described factors striking a prothrombotic imbalance in NASH cirrhosis, with a particular focus on the pathogenesis of portal vein thrombosis.
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Baz AAM, Mohamed RM, El-kaffas KH. Doppler ultrasound in liver cirrhosis: correlation of hepatic artery and portal vein measurements with model for end-stage liver disease score in Egypt. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2020. [DOI: 10.1186/s43055-020-00344-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Liver cirrhosis is a multi-etiological entity that alters the hepatic functions and vascularity by varying grades. Hereby, a cross-sectional study enrolling 100 cirrhotic patients (51 males and 49 females), who were diagnosed clinically and assessed by model for end-stage liver disease (MELD) score, then correlated to the hepatic Doppler parameters and ultrasound (US) findings of hepatic decompensation like ascites and splenomegaly.
Results
By Doppler and US, splenomegaly was evident in 49% of patients, while ascites was present in 44% of them. Increased hepatic artery velocity (HAV) was found in70% of cases, while 59% showed reduced portal vein velocity (PVV).
There was a statistically significant correlation between HAV and MELD score (ρ = 0.000), but no significant correlation with either hepatic artery resistivity index (HARI) (ρ = 0.675) or PVV (ρ =0.266).
Moreover, HAV had been correlated to splenomegaly (ρ = 0.000), whereas HARI (ρ = 0.137) and PVV (ρ = 0.241) did not significantly correlate.
Also, ascites had correlated significantly to MELD score and HAV (ρ = 0.000), but neither HARI (ρ = 0.607) nor PVV (ρ = 0.143) was significantly correlated.
Our results showed that HAV > 145 cm/s could confidently predict a high MELD score with 62.50% and 97.62 % sensitivity and specificity.
Conclusion
Doppler parameters of hepatic vessels (specifically HAV) in addition to the US findings of hepatic decompensation proved to be a non-invasive and cost-effective imaging tool for severity assessment in cirrhotic patients (scored by MELD); they could be used as additional prognostic parameters for improving the available treatment options and outcomes.
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Revising Pharmacokinetics of Oral Drug Absorption: I Models Based on Biopharmaceutical/Physiological and Finite Absorption Time Concepts. Pharm Res 2020. [DOI: 10.1007/s11095-020-02894-w 10.1007/s11095-020-02935-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Revising Pharmacokinetics of Oral Drug Absorption: I Models Based on Biopharmaceutical/Physiological and Finite Absorption Time Concepts. Pharm Res 2020; 37:187. [PMID: 32888087 DOI: 10.1007/s11095-020-02894-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/24/2020] [Indexed: 02/08/2023]
Abstract
ABSRACT PURPOSE: To demonstrate that oral drug absorption is terminated in finite time. To develop models based on biopharmaceutical/physiological and finite absorption time concepts. METHODS The models are based on i) the passive drug diffusion mechanism under the sink conditions principle ii) the rate limiting role of the drug's properties solubility and permeability and iii) the relevant restrictions associated with the gastrointestinal transit times of drug in the stomach, the small intestines and the colon. Two input functions of constant rate are considered for the absorption of drug from i) the stomach/small intestines with an upper limit of 5 h and ii) the colon with an upper limit of 30 h. Branched differential equations were written for the time course of drug in the body. RESULTS Simulations were performed using different scenarios, assuming a variety of drug properties and limited or non-existent absorption from the colon. Literature oral data of cephradine, ibuprofen, flurbiprofen and itraconazole were analyzed. For all drugs examined, nice fittings of the branched differential equations to the experimental data were observed. CONCLUSIONS For all drugs the absorption process was terminated in the small intestine. The meaning of partial AUCs, Cmax, tmax are questioned. Applications of these models to IVIVC are anticipated.
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An Update on Hepatobiliary Ultrasound. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00357-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Coppin LCF, Smets F, Ambroise J, Sokal EEM, Stéphenne X. Infusion-related thrombogenesis by liver-derived mesenchymal stem cells controlled by anticoagulant drugs in 11 patients with liver-based metabolic disorders. Stem Cell Res Ther 2020; 11:51. [PMID: 32028991 PMCID: PMC7006410 DOI: 10.1186/s13287-020-1572-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/17/2019] [Accepted: 01/26/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Mesenchymal stem cell (MSC) transplantation is a fast-developing therapy in regenerative medicine. However, some concerns have been raised regarding their safety and the infusion-related pro-coagulant activity. The aim of this study is to analyze the induced thrombogenic risk and the safety of adding anticoagulants during intraportal infusions of liver-derived MSCs (HepaStem), in patients with Crigler-Najjar (CN) and urea cycle disorders (UCD). METHODS Eleven patients (6 CN and 5 UCD patients) were included in this partially randomized phase 1/2 study. Three cell doses of HepaStem were investigated: low (12.5 × 106 cells/kg), intermediate (50 × 106 cells/kg), and high doses (200 × 106 cells/kg). A combination of anticoagulants, heparin (10 I.U./5 × 106cells), and bivalirudin (1.75 mg/kg/h) were added during cell infusions. The infusion-related thrombogenic risk and anticoagulation were evaluated by clinical monitoring, blood sampling (platelet and D-dimer levels, activated clotting time, etc.) and liver Doppler ultrasound. Mixed effects linear regression models were used to assess statistically significant differences. RESULTS One patient presented a thrombogenic event such as a partial portal vein thrombus after 6 infusions. Minor adverse effects such as petechiae, epistaxis, and cutaneous hemorrhage at the site of catheter placement were observed in four patients. A significant decrease in platelet and increase in D-dimer levels were observed at the end of the infusion cycle, normalizing spontaneously after 7 days. No significant and clinically relevant increase in portal vein pressure could be observed once the infusion cycle was completed. CONCLUSIONS The safety- and the infusion-related pro-coagulant activity remains a concern in MSC transplantation. In our study, a combination of heparin and bivalirudin was added to prevent the thrombogenic risk induced by HepaStem infusions in 11 patients. A significant decrease in platelet and increase in D-dimer levels were observed, suggesting the activation of coagulation in these patients; however, this was spontaneously reversible in time. We can conclude that adding this combination of anticoagulants is safe and limits infusion-related thrombogenesis to subclinical signs in most of the patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01765283-January 10, 2013.
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Affiliation(s)
- Louise C F Coppin
- Service de Gastro-Entérologie et Hépatologie Pédiatrique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av Hippocrate 10, B-1200, Brussels, Belgium.
| | - Françoise Smets
- Service de Gastro-Entérologie et Hépatologie Pédiatrique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av Hippocrate 10, B-1200, Brussels, Belgium
| | - Jérome Ambroise
- Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Etienne E M Sokal
- Service de Gastro-Entérologie et Hépatologie Pédiatrique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av Hippocrate 10, B-1200, Brussels, Belgium
| | - Xavier Stéphenne
- Service de Gastro-Entérologie et Hépatologie Pédiatrique, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Av Hippocrate 10, B-1200, Brussels, Belgium
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da Silva Franco KMV, Vieira WB, Dias ARN, Falcão ASC, Falcão LFM, Quaresma JAS. Doppler ultrasonography: A non-invasive method used to diagnose and follow up patients with chronic hepatitis C. J Gastroenterol Hepatol 2020; 35:314-319. [PMID: 31335991 DOI: 10.1111/jgh.14793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 05/14/2019] [Accepted: 07/18/2019] [Indexed: 12/09/2022]
Abstract
BACKGROUND AND AIM This study aimed to investigate the association between the findings of Doppler ultrasonography and transient elastography using FibroScan and to determine the cut-off points, sensitivity, and specificity of resistance indices, and pulsatility of the hepatic vessels to predict significant hepatic fibrosis. METHODS This is a transversal, observational, and analytical study that includes 30 patients with chronic hepatitis C who were admitted at a public referral hospital. Transient elastography and ultrasonographic data were collected, and the linear association between these methods was evaluated using the Pearson test. Various Doppler velocimetric indices were compared according to the presence/absence of significant (≥ F2) fibrosis. RESULTS There was a moderate-strong linear association between the FibroScan data and the Doppler velocimetric indices and splenic index in the hepatic vessels; the mean values of the indices differed between groups with absent/mild (F0/F1) and significant (≥ F2) hepatic fibrosis. There was an association between the monophasic and biphasic wave pattern of the suprahepatic veins and the stratification of hepatic fibrosis estimated by the values of kilopascal in FibroScan. CONCLUSION Doppler ultrasonography is a non-invasive method used to evaluate liver fibrosis, and it presents acceptable sensitivity/specificity for the prediction of fibrosis ≥ F2 in patients with chronic hepatitis C.
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Affiliation(s)
| | - Waldonio Brito Vieira
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil.,Santa Casa de Misericórdia, Belém, Brazil
| | - Apio Ricardo Nazareth Dias
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil.,Universidade do Estado do Pará, Belém, Brazil
| | | | | | - Juarez Antônio Simões Quaresma
- Núcleo de Medicina Tropical, Universidade Federal do Pará, Belém, Brazil.,Universidade do Estado do Pará, Belém, Brazil.,Instituto Evandro Chagas, Belém, Brazil
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Portal Venous Pulsatility Index: A Novel Biomarker for Diagnosis of High-Risk Nonalcoholic Fatty Liver Disease. AJR Am J Roentgenol 2020; 214:786-791. [PMID: 31939698 DOI: 10.2214/ajr.19.21963] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE. The purpose of this study was to assess the accuracy of portal vein pulsatility for noninvasive diagnosis of high-risk nonalcoholic fatty liver disease (NAFLD). MATERIALS AND METHODS. This retrospective study included patients with biopsy-proven diagnosis of NAFLD who underwent duplex Doppler ultrasound assessment of the main portal vein within 1 year of liver biopsy (January 2014 to February 2018). Doppler ultrasound images were reviewed. The spectral waveform was used to measure the maximum (Vmax) and minimum (Vmin) velocity of blood in the portal veins. Venous pulsatility index (VPI) defined as (Vmax - Vmin) / Vmax was calculated. ROC curve analysis was used to calculate AUC as a measure of accuracy to determine the value of this index for diagnosis of high-risk NAFLD and compared with that of the following four clinical decision aids: NAFLD fibrosis score (FS), fibrosis-4 index (FIB-4), BARD score (body mass index, aspartate aminotransferase [AST]-to-alanine aminotransferase ratio, diabetes mellitus), and AST-to-platelet ratio index (APRI). The value of adding VPI to these indexes was also investigated. RESULTS. Of 123 study subjects, 33 (26.8%) had high-risk NAFLD and were found to have a lower VPI than the other 90 subjects (0.19 vs 0.32; p < 0.001). VPI, NAFLD FS, FIB-4, and APRI had statistically significant diagnostic values for high-risk NAFLD. VPI had the highest optimism-corrected AUC (VPI, 0.84 [95% CI, 0.77-0.91]; NAFLD FS, 0.74 [95% CI, 0.63-0.83]; FIB-4, 0.81 [95% CI, 0.72-0.89]; APRI, 0.73 [95% CI, 0.61-0.82]). Addition of VPI to any of the four scoring systems significantly improved the diagnostic value of the score for high-risk NAFLD. CONCLUSION. VPI may be an accurate noninvasive biomarker for diagnosis of high-risk NAFLD.
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Correlation-based Doppler-angle estimation with plane-wave excitation. INFORMATICS IN MEDICINE UNLOCKED 2020. [DOI: 10.1016/j.imu.2020.100315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Liver Transplantation. THE CRITICALLY ILL CIRRHOTIC PATIENT 2020. [PMCID: PMC7122092 DOI: 10.1007/978-3-030-24490-3_14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The field of liver transplantation has changed since the MELD scoring system became the most widely used donor allocation tool. Due to the MELD-based allocation system, sicker patients with higher MELD scores are being transplanted. Persistent organ donor shortages remain a challenging issue, and as a result, the wait-list mortality is a persistent problem for most of the regions. This chapter focuses on deceased donor and live donor liver transplantation in patients with complications of portal hypertension. Special attention will also be placed on donor-recipient matching, perioperative management of transplant patients, and the impact of hepatic hemodynamics on transplantation.
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Jefkins M, Chan B. Hepatic and portal vein Dopplers in the clinical management of patients with right-sided heart failure: two case reports. Ultrasound J 2019; 11:30. [PMID: 31748951 PMCID: PMC6868079 DOI: 10.1186/s13089-019-0146-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/22/2019] [Indexed: 12/04/2022] Open
Abstract
Background Patients with right heart failure pose significant volume management challenges for hemodynamic optimization. We present two cases in which point of care ultrasound (POCUS) of the hepatic and portal veins contributed to the venous hypertension assessment and decongestive strategy for patients with right-sided heart failure. Case presentation Patient A was 91 years old with known pulmonary hypertension and right ventricular systolic dysfunction who presented in septic shock requiring vasopressor support. Hepatic and portal vein Dopplers were consistent with right heart failure and significant venous congestion, therefore, diuresis was initiated which resulted in portal flow normalization, renal recovery, and cessation of vasopressor support. Patient B was 82 years old with severe idiopathic pulmonary fibrosis on home oxygen who presented in decompensated right heart failure. Despite aggressive diuresis, a negative fluid balance was not achieved. The patient continued to deteriorate and prior to their death portal vein, Doppler showed significant flow reversal. Conclusion Hepatic and portal vein Doppler ultrasounds are venous hypertension assessment tools that can be readily used at the bedside by clinicians trained in POCUS that may contribute holistically to the hemodynamic profiling for patients with right heart failure and direct therapeutic interventions.
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