Chronic hepatic injury and inflammation from various causes can lead to fibrosis and cirrhosis, potentially predisposing to hepatocellular carcinoma. The molecular mechanisms underlying fibrosis and its progression remain incompletely understood. Using a proteo-transcriptomics approach, we analyze liver and plasma samples from 330 individuals, including 40 healthy individuals and 290 patients with histologically characterized fibrosis due to chronic viral infection, alcohol consumption, or metabolic dysfunction-associated steatotic liver disease. Our findings reveal dysregulated pathways related to extracellular matrix, immune response, inflammation, and metabolism in advanced fibrosis. We also identify 132 circulating proteins associated with advanced fibrosis, with neurofascin and growth differentiation factor 15 demonstrating superior predictive performance for advanced fibrosis(area under the receiver operating characteristic curve [AUROC] 0.89 [95% confidence interval (CI) 0.81-0.97]) compared to the fibrosis-4 model (AUROC 0.85 [95% CI 0.78-0.93]). These findings provide insights into fibrosis pathogenesis and highlight the potential for more accurate non-invasive diagnosis.
The antiphospholipid antibody syndrome (APA) is characterized by an increased incidence of venous and arterial thrombosis. APA syndrome has some gastroenterological manifestations such as Budd-Chiari syndrome, hepatic infarction, esophageal necrosis, intestinal ischemia, pancreatitis and colonic ulceration. We report a 34-year-old man with APA syndrome complicated by hepatic venous thrombosis (Budd-Chiari) and colonic ulcers. The clinical and laboratory findings were compatible with APA syndrome that developed secondary to systemic lupus erythematosus. In order to initiate anticoagulant therapy, he was heparinized. Since lower gastrointestinal bleeding developed, heparin was discontinued and the patient was followed up with baby aspirin and steroids. This case report extends the gastroenterological manifestations of the APA syndrome to include colonic ulceration, which may outweigh the efficacy of initial anticoagulant therapy.
Background: Hepatocellular carcinoma (HCC) is the fifth most common fatal cancer and an important healthcare problem worldwide.There are many studies describing the prognostic and predictive effects of epidermal growth factor receptor 2 (c-erb-B2) and epidermal growth factor receptor 1 (EGFR), transmembrane tyrosine kinases that influence cell growth and proliferation in many tumors.Objectives: The current study aimed to investigate the expression levels of c-erb-B2, EGFR, PTEN, mTOR, PI3K, p27, and ERCC1 in hepatocellular carcinoma (HCC) and their correlation with other clinicopathologic features.Patients and Methods: Fifty HCC cases were stained immunohistochemically with these markers.Correlations between the markers and clinicopathologic characteristics and survival rates were analyzed.Results: No membranous c-erb-B2 staining was seen, whereas cytoplasmic positivity was present in 92% of HCC samples, membranous EGFR was observed in 40%, PI3K was found in all samples, and mTOR was seen in 30%, whereas reduced or absent PTEN expression was observed in 56% of samples and loss of p27 was seen in 92% of the cases.c-erb-B2 and mTOR overexpression, as well as reduced expression of p27, all correlated with multiple tumors (P = 0.041, P < 0.001, and P < 0.001, respectively).P27 loss, and mTOR and EGFR positivity were significantly correlated with AFP (P = 0.047, P = 0.004, and P = 0.008, respectively).Angiolymphatic invasion was more commonly seen in EGFR-and ERCC1positive cases (P = 0.003 and P = 0.005).EGFR was also correlated with histological grade (P = 0.039).No significant correlations were found among PTEN , PI3K, and the clinicopathological parameters.Disease-free or overall survival rates showed significant differences among therapy modalities, AFP levels, angiolymphatic or lymph node invasions, and ERCC1 and p27 expression levels (P < 0.05).Conclusions: c-erb-B2, EGFR, mTOR, ERCC1 overexpression levels, and loss of p27 may play roles in hepatocarcinogenesis and may be significant predictors of aggressive tumor behavior.These markers were found to be correlated with certain clinicopathologic features, therapy modalities, and survival rates in the current study.These findings may help in planning new, targeted treatment strategies .
FH is an autosomal dominant genetic disorder characterized by increased TC and LDL level, which leads to xanthomas, atherosclerosis, and cardiac complications even in childhood. The treatment options are diet, medical treatment, lipid apheresis, and LT. The aim of our study was to analyze our data of patients with FH. Between 2004 and 2015, there were 51 patients who underwent pediatric LT at our center. All patients with FH were identified, and the data were retrospectively analyzed. There were eight patients with homozygous FH in the median age of 10 years (IQR 6-12) who underwent LT. The median pre-operative TC and LDL levels were 611 mg/dL (IQR: 460-844) and 574 mg/dL (IQR: 398-728) and decreased to normal levels 1 week after LT (TC: 193 mg/dL and LDL: 141 mg/dL). Two patients died two and 18 months after LT due to sudden cardiac arrest. Both patients were diagnosed with cardiovascular disease pre-operatively. The LT is the only curative treatment for this disease. To achieve an excellent outcome, it should be performed before the development of cardiovascular disease, because the regression of severe cardiovascular disease after transplantation is limited.
GIRIS Ilk defa 1963 yilinda Starzl tarafindan kadavra vericiden gerceklestirilen karaciger nakli daha sonraki yillarda hizla tum dunyada uygulanmaya baslamis olup, canli vericili karaciger nakli 1989 yilinda ilk kez eriskinden cocuk hastaya yapilmistir. 1993 yilinda yapilan eriskinden eriskine sol lob karaciger naklini, 1996 yilinda baslanan sag lob karaciger nakli izlemistir. Ulkemizde kadavradan karaciger naklinin ilk kez 1988 yilinda Haberal ve arkadaslari tarafindan gerceklestirilmesini takiben, 1990 yilinda yine ayni ekip ilk canli vericiden pediatrik karaciger naklini ve hemen ardindan ilk canli vericiden eriskin sol lob karaciger naklini gerceklestirmistir (1). Son 10 yilda endikasyon yonunden de buyuk ilerlemeler olmus olup hepatoselluler karsinoma (HCC), noroendokrin tumorler, Budd-Chiari hastaligi, alveoler hidatik kist gibi bircok hastaligin tedavisinde karaciger nakli yaygin olarak uygulanir hale gelmistir.
BACKGROUND AND AIMS: The American College of Surgeons' National Surgical Quality Improvement Program (NSQIP) risk tool and Revised Cardiac Risk Index (RCRI) are recommended tools for cardiovascular assessment before non-cardiac surgery to predict early postoperative cardiac morbidity and mortality.Their predictive value for postoperative cardiovascular morbidity and mortality after liver transplantation is unknown.We aimed to evaluate the validity of these two risk tools to predict early (30-day) cardiovascular complications and inhospital all-cause mortality.METHODS: Patients who underwent living donor liver transplantation were retrospectively analyzed.Consecutive 278 adult patients were included and their NSQIP and RCRI scores were calculated.RESULTS: Cardiovascular morbidity occurred in 5 (1.8 %) patients.In-hospital all-cause mortality occurred in 18 (6.4%) patients.None-of the patients died from cardiac complications.Causes of cardiac morbidity were as follows; acute coronary syndrome in 1 patient, intraoperative cardiac arrest with successful resuscitation in 1 patient, heart failure in 3 patients.Neither the NSQIP nor the RCRI score were associated with cardiovascular morbidity.Only RCRI medium-high score, DM and Nonalcoholic steatohepatitis as transplant indications were associated with in-hospital all-cause mortality (p = 0.001).CONCLUSIONS: The NSQIP risk calculator and RCRI scores failed to accurately predict the risk of perioperative cardiac complications (Tab.3, Ref. 30).
BACKROUND: The aim of this study is to identify the preoperative variables associated with prediction of intraoperative blood transfusion as well as analyze the influence of intraoperative blood transfusion on postoperative outcomes. MATERIALS and METHOD: Between June 2004 and May 2006 a total of 81 liver transplantation (16 CDLT, 65 LDLT) were performed on 81 patients (56 male and 25 female) who had end stage liver at our hospital. The patients were split in two groups, as similar previous studies. High transfusion group (HTG) (g4 RBC) was compaired againts the low transfusion group (LTG) (l 4RBC). Univariate analysis was performed with the independent student's t- test for quantitative variables and chi-square test was used for qualitative variables after data categorization and calculation. RESULTS: The mean transfused units of red blood cell (RBC) was 5.41. Patient's age, availabity of HCV and elevated Child score had significance for intraoperative blood transfusion requirement. Postoperative mortality and reoperation rate had significantly elevated in HTG patients also HTG patients had more infectious. CONCLUSION: We concluded that high blood transfusion has major effect on posttransplant complications and postoperative mortality Key words: Liver transplantation, Blood transfusion, Postoperative outcomes
Intraduodenal haematoma (IDH) has been noted usually after blunt abdominal trauma. It has been recognized as a complication of endoscopic biopsy and the risk is high in patients with bleeding disorders. History of bone marrow transplantation seems to be relevant risk factor. The incidence is estimated to be 1/1250 upper gastrointestinal endoscopies. The diagnosis is likely if symptoms of acute abdominal pain and vomiting occur within 48 hours after duodenal biopsy. The symptoms are usually caused by duodenal obstruction. Pancreatitis may develop. Conservative management is the preferred approach if perforation is excluded. Complete resolution generally occurs within 2-3 weeks. A-18-year old girl with acute lymphoblastic leukemia underwent allogeneic peripheral blood stem cell transplantation. Diarrhea developed on the third month and gastrointestinal endoscopic biopsies were performed for GVHD evaluation. The mucosa of stomach was reddish and edematous but other parts looked normal. Three hours later the patient had severe vomiting, intense abdominal tenderness and massive haematemesis which required red cell transfusions. A second look revealed active hemorrhage from biopsy side at the cardioesophageal junction. Epinephrine injection was performed and the clinical status was related to Mallory-Weiss tear due to severe vomiting. However her complaints persisted despite full supportive treatment. Abdominal CT scan revealed a 9 cm mass with diameter of 5 cm within the second and third duodenal portions consistent with an intramural haematoma. There was also hemoperitoneum. Since perforation was excluded conservative management was initiated including bowel rest, parenteral nutrition and nasogastric decompression. On day 14 serum bilirubin levels reached 7.5 mg/dl with GGT:393 U/L, ALP:329 U/L values. MRI revealed 8x4 cm haematoma compressing the ampulla of Vater. She improved in the following days. Haematoma regressed to 3 cm on the 4th week and the patient was discharged. In our patient blood counts and coagulation tests were within normal limits at the time of endoscopic intervention. Biopsies were consistent with GVHD and the mucosal damage caused by this condition may have been contributed to duodenal vulnerability. Depending on other reported cases with bone marrow transplantation we can conclude that endoscopic interventions should be carefully employed in this subgroup of patients.
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