• Middleton Mejia posted an update 6 months ago

    Liver cirrhosis is the end-stage of chronic liver disease and can affect the function of multiple organs. Gastrointestinal tract damage resulting from cirrhosis is more common in clinic, which may cause gastroparesis, affect the digestion and absorption of nutrients, and destroy the intestinal mucosal barrier function. In addition, it may be accompanied by a series of gastrointestinal complications that affect the patient’s prognosis. Clinically, more attention should be paid to early monitoring, early diagnosis and early treatment of cirrhosis-related gastrointestinal complications so to control the progression of liver cirrhosis condition, reduce advanced stage complications, and improve patient’s quality of life.The rare complications of cirrhosis, such as chylous ascites, hepatic hydrothorax, spontaneous bacterial peritonitis, cirrhotic cardiomyopathy, portopulmonary hypertension, cirrhotic nervous system damage, etc., have not yet been fully understood and/or promptly and effectively diagnosed and treated by clinicians. Therefore, this article aims to introduce the above-mentioned rare complications, clinical features, treatment and prognosis of liver cirrhosis in an attempt to improve the clinicians’ understanding and level of diagnosis and treatment.Liver cirrhosis can lead to a variety of complications, among which few are relatively rare or overlooked despite being more common, and are thus termed “rare complications”. However, these complications also affect the patient’s prognosis, and need attention. This article summarizes the relevant content of the present concept of diagnosis and treatment of rare complications of liver cirrhosis, and prospects the future direction of clinical research.Hepatitis B virus (HBV) cannot be eliminated completely from infected hepatocytes because of the presence of intrahepatic covalently closed circular DNA (cccDNA). As chronic hepatitis B (CHB) can progress to cirrhosis and hepatocellular carcinoma (HCC), it is important to manage CHB to prevent HCC development in high-risk patients with high viral replicative activity or advanced fibrosis. Serum biomarkers are noninvasive and valuable for the management of CHB. Hepatitis B core-related antigen (HBcrAg) correlates with serum HBV DNA and intrahepatic cccDNA. In CHB patients with undetectable serum HBV DNA or loss of HBsAg, HBcrAg still can be detected and the decrease in HBcrAg levels is significantly associated with hopeful outcomes. Therefore, HBcrAg can predict HCC occurrence or recurrence. Measurement of the Mac-2 binding protein glycosylation isomer (M2BPGi) has been introduced for the evaluation of liver fibrosis. Because elevated M2BPGi in CHB is related to liver fibrosis and the prediction of HCC development, monitoring its progression is essential. Because alpha fetoprotein (AFP) has insufficient sensitivity and specificity for early-stage HCC, a combination of AFP plus protein induced by vitamin K absence factor II, or AFP plus Lens culinaris agglutinin-reactive fraction of alpha-fetoprotein might improve the diagnosis of HCC development. Additionally, Dickkopf-1 and circulating immunoglobulin G antibodies are the novel markers to diagnose HCC or assess HCC prognosis. Remdesivir research buy This review provides an overview of novel HBV biomarkers used for the management of intrahepatic viral replicative activity, liver fibrosis, and HCC development.Background We evaluated the effectiveness of four upper airway ultrasonographic parameters in predicting difficult intubation (DI). The validity of models based on combined ultrasonography-based parameters was also investigated. Methods In a prospective, observational, double-blinded cohort trial, 1043 ASA-PS I-III patients without anticipated difficult airway, undergoing tracheal intubation under general anesthesia were enrolled. Preoperatively, their tongue thickness (TT), invisibility of hyoid bone (VH), and anterior neck soft tissue thickness from skin to thyrohyoid membrane (ST) and hyoid bone (SH) respectively, were measured under sublingual and submandibular ultrasonographic scans. Based on tracheal intubation, they were categorized as easy intubation (EI) or DI. The logistic regression, youden index, and receiver operator characteristic analysis were used. Results Overall, 985 (94.4%) patients had EI, while 58 (5.6%) encountered DI. The TT, SH, ST and VH had the accuracy of 78.4%, 85.0%, 84.7%, and 84.9%, respectively. The optimal criterion for TT, SH, and ST to predict DI was >5.8cm (sensitivity 84.5%, specificity 78.1%, AUC 0.880), >1.4cm (sensitivity 81%, specificity 85.2%, AUC 0.898), and >2.4 cm (sensitivity 75.9%, specificity 85.2%, AUC 0.885), respectively. VH had a sensitivity and specificity of 72.4% and 85.6% (AUC 0.790), respectively. The AUC of five models (based on combinations of 3 or 4 parameters) ranged from 0.975-0.992. The ST and VH had a significant impact on the individual models. Conclusions The SH had a better accuracy among the four ultrasonographic parameters. Although the individual parameters showed a limited validity, the model including all the four parameters offered better diagnostic profile.The one-anastomosis gastric bypass (OAGB) has been proven to provide good weight loss, comorbidity improvement, and quality of life with follow-up longer than five years. Although capable of improving many obesity-related diseases, OAGB is associated with post-operative medical complications mainly related to the induced malabsorption. A 52-year-old man affected by nephrotic syndrome due to a focal segmental glomerulosclerosis underwent OAGB uneventfully. At three months post-surgery, the patient had lost 40kg, reaching a BMI of 32. The patient was admitted to the nephrology unit for acute kidney injury with only mild improvement in renal function (SCr 9 mg/dl); proteinuria was still elevated (4g/24h), with microhaematuria. A renal biopsy was performed oxalate deposits were demonstrated inside tubules, associated with acute and chronic tubular and interstitial damage and glomerulosclerosis (21/33 glomeruli). Urinary oxalate levels were found to be elevated (72mg/24h, range 13-40), providing the diagnosis of acute kidney injury due to hyperoxaluria, potentially associated to OAGB.

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