Clinical perspectives on post-cholecystectomy syndrome: a narrative review

INTRODUCTION

Post-cholecystectomy syndrome (PCS) is a complex condition characterized by persistent or new symptoms following gallbladder removal, affecting up to 47% of patients. Despite being recognized since 1947, there is still no consensus on its etiology, diagnosis, and treatment.

AREAS COVERED

This narrative review explores the multifactorial etiology of PCS, including biliary and extra-biliary factors, and its varied clinical manifestations. A systematic literature search was conducted using keywords like 'etiology', 'clinical manifestations', 'diagnostic challenges', and 'management strategies'. The review covers traditional diagnostic methods, recent insights into pathophysiology, and current management approaches, such as dietary modifications, pharmacological treatments, and endoscopic interventions, with a focus on patient selection.

EXPERT OPINION

PCS presents significant clinical challenges due to its diverse presentations and lack of standardized diagnostic and therapeutic protocols. Effective management starts with careful patient selection before cholecystectomy to prevent unnecessary surgeries and reduce postoperative complications. Future research should aim to refine diagnostic criteria and develop predictive models for identifying at-risk patients. Personalized management strategies incorporating genetic, biological, and clinical factors are essential for improving outcomes. An integrated, patient-centered approach is crucial for addressing PCS complexities and enhancing the quality of life for affected patients.

Indian National Association for the Study of Liver (INASL) Guidance Statements for Determining Futility in Liver Transplantation

Liver transplantation (LT) is a life-saving procedure for patients with end-stage liver disease; however, with the growing shortage of organ donors, the need to identify futile transplants has become increasingly urgent. Futility in liver transplantation refers to situations where the expected post-transplant survival or quality of life is poor, making the procedure unlikely to yield a meaningful benefit. Various definitions of futility are used across different countries and transplant centers, with criteria often based on clinical factors such as age, comorbidities, MELD score, and functional status. For hepatologists and transplant surgeons, clearer guidelines are essential to make informed decisions and avoid unnecessary transplants that may place patients at risk without improving their prognosis. While some studies have proposed futility scores, there is currently no universal consensus on a standardized definition or set of criteria. This highlights the need for further prospective trials to evaluate the predictors of futility in liver transplantation, aiming to refine decision-making processes, optimize organ allocation, and improve patient outcomes. Future research should focus on the development of universally accepted futility criteria and explore interventions to mitigate the factors contributing to transplant futility.

Molecular identification of Trichuris species in long-tailed macaques from Dong Ling Don Chao Pu Park and Kumphawapi Monkey Garden, Northeast Thailand: First report suggesting possible Trichuris ovis infection in non-human primates

This study aimed to molecularly identify Trichuris spp. in long-tailed macaques from two key habitats in Northeast Thailand: Dong Ling Don Chao Pu Park, Amnat Charoen Province, and Kumphawapi Monkey Garden, Udon Thani Province. Genomic DNA was extracted from 13 Trichuris spp. egg samples collected from 13 infected long-tailed macaques, and PCR amplification targeting partial sequences of the 18S rRNA gene and ITS2 region was performed for phylogenetic analysis. Of the 13 Trichuris spp. egg samples, the partial 18S rRNA gene was successfully amplified from six, while ITS2 amplification was unsuccessful. Phylogenetic analysis indicated that four specimens sequenced from Dong Ling Don Chao Pu Park were T. trichiura. In contrast, two specimens sequenced from Kumphawapi Monkey Garden clustered with the only confirmed T. ovis from goat, as well as unconfirmed Trichuris spp. from other ruminant hosts. These findings suggest that the Trichuris spp. in macaques are likely T. ovis; however, the evidence remains inconclusive. Therefore, accurate species identification in this region requires further molecular analysis using additional genetic markers. This study provides the first molecular identification of T. trichiura in long-tailed macaques from Northeast Thailand. Additionally, it is the first report suggesting the possible T. ovis infection in non-human primates. These findings highlight the potential for Trichuris spp. transmission across diverse host species, underscoring the need for enhanced surveillance of parasitic infections in wildlife and livestock, particularly in regions with close human-animal interactions. Continued molecular investigations are essential to elucidate Trichuris spp. transmission dynamics and zoonotic potential, aiding in public health risk mitigation.

Antiviral resistance and barrier integrity at the maternal-fetal interface restrict hepatitis E virus from crossing the placental barrier

Hepatitis E virus (HEV) genotype 1 (HEV-1) infection in pregnant women is associated with adverse outcomes of pregnancy including fulminant hepatic failure, fetal loss, premature birth, and neonatal mortality, although the underlying mechanisms remain largely unclear. In this study, we first demonstrated that HEV-1 robustly infects pregnant gerbils and causes pregnancy-associated adverse outcomes, which were recorded in 4/6 HEV-1-infected but only 1/5 in PBS-inoculated pregnant gerbils. However, vertical transmission of HEV-1 from mothers to newborns is not evident, as HEV-1 RNA was not detected in uterus tissues or in newborn pups. To further determine whether HEV-1 can cross the placental barrier, we established an in vitro blood-placental barrier by coculturing human placental trophoblast cells (BeWo) and umbilical vein endothelial cells (HUVEC) in Transwell inserts. By using the placental barrier under the conditions in this study, we showed that quasi-enveloped or nonenveloped HEV-1, HEV-3, or HEV-4 virions do not readily cross the barrier prior to 4 d postinoculation when it has high barrier integrity. Importantly, we demonstrated that the placental barrier induces local antiviral resistance at the maternal-fetal interface, that interactions between maternal- and fetal-derived cocultured cells are important for induction of antiviral resistance, and that anti-HEV resistance can be transferred to nonplacental HepG2 liver cells. We also revealed that the main effectors of antiviral resistance at the placental barrier are type III interferons (IFN-λ1, λ2/3) and the chemokine CXCL10. The findings have important implications in understanding the mechanisms leading to HEV-1-associated maternal and fetal adverse outcomes in pregnant women.

Systematic Literature Review on the Burden of Human Papillomavirus Infection and Related Diseases in India

Human papillomavirus (HPV)-related diseases pose public health concerns for both genders, yet their understanding remains limited in India. This review outlines HPV incidence and prevalence, genotype distribution, and attribution rates across different HPV-related disease types. A comprehensive literature search was performed to identify observational studies on individuals aged 15 years and older, and a total of 3702 publications were identified. A total of 139 studies were included in this review, involving 607,425 subjects aged 15.8-82.2 years, with a gender distribution of 38.13% males and 61.86% females. The prevalence of HPV infection in the anogenital area among healthy males and females was 41.07% and between 0.4% and 41.8%, respectively. Among individuals with HPV-related diseases, HPV infection prevalence was 26.1%-100% in unhealthy cervixes and cervical lesions, 3.1%-41% in anal lesions, 71.4% in vulva and vaginal lesions, and 0%-92.3% in head and neck cancer. The review highlights the variability in HPV prevalence across genders and age groups in India, likely due to population heterogeneity and testing differences. This study highlights the need for rigorous and uniform studies in India on the HPV disease burden and the importance of gathering evidence with a special focus on males.

Guidelines for endoscopic management of nonvariceal upper gastrointestinal bleeding (second edition)

The Japan Gastroenterological Endoscopy Society has prepared Guidelines for Endoscopic Practice in Nonvariceal Upper Gastrointestinal Bleeding as part of the initiative to develop evidence-based endoscopic practice guidelines. Hemorrhagic gastroduodenal (peptic) ulcers are the primary cause of nonvariceal upper gastrointestinal bleeding. With the advent of a super-aged society, the cases caused by Helicobacter pylori are on the decline, whereas those caused by drugs (e.g. aspirin) have been increasing. Endoscopic hemostasis is currently the first-line treatment for nonvariceal upper gastrointestinal bleeding, and various methods have been devised for this purpose. It is recommended to stabilize the vital signs of the patient before and after endoscopic hemostasis with appropriate management based on an assessment of the severity of illness, in addition to the administration of acid secretion inhibitors. These guidelines describe the evaluation and initial treatment of nonvariceal upper gastrointestinal bleeding, as well as the selection of endoscopic hemostasis for nonvariceal upper gastrointestinal bleeding and its management after endoscopic hemostasis. This is achieved by classifying nonvariceal upper gastrointestinal bleeding into two main categories, namely, peptic ulcer and other types of gastrointestinal bleeding. We prepared statements for any available literature with supporting evidence, including the levels of evidence and recommendations. New evidence has been pooled since the publication of the first edition in this area; however, the levels of evidence and recommendations mostly remain low.

High risk and low incidence diseases: Pediatric intussusception

INTRODUCTION

Pediatric intussusception is a serious condition that carries with it a high risk of morbidity and mortality.

OBJECTIVE

This review highlights the pearls and pitfalls of pediatric intussusception, including the presentation, diagnosis, and management in the emergency department (ED) based on current evidence.

DISCUSSION

Intussusception is one of the most common pediatric abdominal emergencies. This is associated with one part of the intestine telescoping into another, resulting in bowel edema. If the intussusception remains untreated, obstruction, ischemia, necrosis, and perforation may result. Most cases are idiopathic, with 10-25 % associated with a pathologic mass or lead point. The most common age group affected includes those between 3 months to 5 years. The triad of intermittent abdominal pain, currant jelly stool, and sausage-shaped mass is uncommon, though most patients will present with intermittent abdominal pain. Nonbilious emesis and bloody stools (gross blood or guaiac positive) are also common. Younger patients can present atypically, including altered mental status or lethargy. Thus, intussusception should be considered in pediatric patients with abdominal pain, emesis, and a sausage-shaped mass, as well as those with atypical presentations such as altered mental status or lethargy if there is no other etiology found on testing. The diagnostic modality of choice is ultrasound. Plain radiography may assist in evaluating for obstruction and perforation. Treatment includes prompt reduction of the intussusception. In patients who are stable and have no evidence of perforation, non-operative reduction with hydrostatic or pneumatic reduction should be attempted. Operative intervention is necessary in those who are unstable, peritonitic, or have a focal lead point. Discharge may be appropriate for patients following successful non-operative reduction if the patient is able to tolerate clear fluids, is asymptomatic, and can return for any recurrence of symptoms.

CONCLUSION

An understanding of pediatric intussusception and its many potential mimics can assist emergency clinicians in diagnosing and managing this high risk disease.

Assessing Hepatitis E Virus Seroprevalence among Slaughterhouse Workers in Western Saudi Arabia: Zoonotic Threats in Focus

HEV, primarily known for its waterborne transmission, is increasingly recognized for its zoonotic potential, raising public health concerns for individuals in close contact with animals or animal products. This study aims to evaluate the seroprevalence of Hepatitis E Virus (HEV) among slaughterhouse workers in Saudi Arabia and compare it to a control group of blood donors, emphasizing potential occupational risks and associated factors.This comparative cross-sectional study included 239 slaughterhouse workers (study group) and 250 blood donors (control group). HEV IgG antibodies were detected using an in-house ELISA. Sociodemographic data, occupational exposure duration, and animal contact details were analyzed.The HEV seroprevalence was significantly higher in slaughterhouse workers (49.7%) compared to blood donors (22.1%) (p < 0.0001). Age and duration of occupational exposure were strongly predictive of HEV infection, with workers exposed for over one year showing higher odds of seropositivity. Geographic region and type of animal contact showed no significant associations.The findings suggest that prolonged occupational exposure to animals demonstrated increased the risk of HEV infection among slaughterhouse workers. Public health interventions, including improved hygiene measures, health screenings, and potential vaccination, could mitigate the risk of HEV transmission in high-exposure occupations.

Substantial spillover burden of rat hepatitis E virus in humans

The emergence of Rocahepevirus ratti genotype 1 (rat hepatitis E virus; rat HEV) in humans presents an unprecedented threat; however, the risk of rat HEV transmission to humans is not well understood. Here, we report the "Distinguishing Antibody Response Elicitation (DARE)" method, which distinguishes exposure to rat HEV. We use four study sets from China for large-scale population analysis: set 1 (hospital visit) and set 3 (ALT abnormality) from Yunnan province, a biodiversity hotspot, and set 2 (received physical examination) and set 4 (ALT abnormality) from Jiangsu province, a non-hotspot control region. rat HEV exposure risk is significantly higher in Yunnan, with 21.97% (190 of 865) in set 1 and 13.97% (70 of 501) in set 3, compared to 0.75% (9 of 1196) in Jiangsu's set 2. Six spillover infections for rat HEV are identified in set 1, with one case of abnormal ALT. The rat-1d strains carried by rats are closely related to those human infections. Our study reveals the substantial spillover burden posed by rat HEV in biodiversity hotspots and highlights the utility of DARE method for proactive surveillance of public health emergencies.

Hepatitis E Virus in the Role of an Emerging Food-Borne Pathogen

Viral hepatitis E represents an important global health problem caused by the hepatitis E virus (HEV). Cases of HEV infection are increasingly associated with food-borne transmissions after the consumption of raw or undercooked food products from infected animals in high-income regions. Although most cases of infection are asymptomatic, severe courses of infection have been reported in specific groups of people, predominantly among pregnant women and immunocompromised patients. The viral nucleic acid of HEV is increasingly being reported in food-producing animals and different products of an animal origin. Even though the incubation period for HEV infection is long, several direct epidemiological links between human cases and the consumption of HEV-contaminated meat and meat products have been described. In this article, we review the current knowledge on human HEV infections, HEV in different food-producing animals and products of an animal origin, as well as the accumulation and resistance to HEV in farm and slaughterhouse environments. We also provide preventive measures to help eliminate HEV from animals, the human population, and the environment.

The Epidemiology of Hepatitis E in Israel and Potential Risk Factors: A Cross-Sectional Population-Based Serological Survey of Hepatitis E Virus in Northern Israel

Hepatitis E Virus (HEV) has gained public health attention as one of the causative agents of viral hepatitis. Our study aimed to provide data about HEV seropositivity in the Israeli general population, including its seroprevalence geographical distribution, and to identify variables as possible risk factors for HEV exposure. A seroprevalence cross-sectional study was conducted: HEV serological status was determined in 716 blood samples collected from the routine check-up blood samples. Demographic information was available for all samples. The overall prevalence of HEV IgG in an apparently healthy population in the north of Israel was 10.5%, with no evidence of positive HEV IgM. There was a significant association between HEV seropositivity and elderly age and low socioeconomic status (SES). The age-adjusted seroprevalence was significantly lower among Jews compared to Arabs with a rate ratio of 2.02. We identified clusters (hot spots) of HEV infection in three regions under study. Our results confirmed a high prevalence of anti-HEV in the country where clinical hepatitis E is not endemic. For the first time, this study showed that a hot spot analysis was able to provide new knowledge about actual exposure zones. As HEV infection is not a notifiable disease, it is probably underdiagnosed. Thus, better awareness among physicians is warranted.

Preduodenal portal vein causing symptomatic duodenal obstruction in an adult: a case report

Preduodenal portal vein (PDPV) is a congenital anomaly where the portal vein (PV) crosses anterior to the first part of the duodenum. It is commonly associated with other congenital anomalies, typically presenting as a duodenal obstruction in infancy. While rare, PDPV can be diagnosed in adulthood, but is usually asymptomatic and found incidentally during surgery or on imaging. We present a case of chronic postprandial abdominal pain, occasional vomiting, and early satiety in a middle-aged female due to PDPV causing a partial duodenal obstruction. She also had malrotation of the bowel, partial agenesis of the dorsal pancreas, and azygous continuation of the inferior vena cava. We performed a laparoscopic gastrojejunostomy to bypass the obstruction caused by PDPV, resolving the patient's preoperative symptoms, now with over 3 years' follow-up. Persistent and unexplained abdominal complaints in adults warrant thorough investigation for uncommon causes such as PDPV and other congenital anomalies.

Prevalence, genotype distribution, and risk factors of Hepatitis E virus in blood donors, HIV patients, and pregnant women in Southwest Cameroon

Most HEV infections are self-limiting, but pregnant women in their third trimester and immunocompromised individuals, such as those with HIV, face risks, including fatal liver failure and chronic infection. This study investigates HEV prevalence and genotypes in healthy blood donors and high-risk groups, such as HIV patients and pregnant women, in Southwest Cameroon, where surveillance is limited. A cross-sectional study conducted between March and June 2023 recruited 712 participants: 289 blood donors, 233 HIV patients, and 190 pregnant women. Serum and stool samples were tested for anti-HEV IgG and IgM antibodies using ELISA, and HEV RNA was detected by nested PCR targeting the ORF1 and ORF2 regions. HEV RNA-positive samples were sequenced, and genotypes identified. Among the 712 participants, 7 % tested positive for anti-HEV IgG and 2 % for anti-HEV IgM. Blood donors had the highest anti-HEV IgG prevalence (9 %). No significant associations were found between HEV seropositivity and demographic or dietary risk factors. The overall HEV RNA positivity rate was 1 %, with the highest rates in blood donors (2 %) and pregnant women (1 %), while no cases were found in HIV patients. Phylogenetic analysis revealed that 75 % of HEV RNA-positive samples belonged to genotype 3a, and 25 % to genotype 3e. The nucleotide diversity between human and pig HEV genotype 3 suggests the involvement of environmental or other indirect transmission routes, rather than direct pig-to-human transmission. This study highlights HEV risk in Cameroon, especially among blood donors and pregnant women, underscoring the need for enhanced surveillance in HBV-endemic regions.

A combined treatment regimen for Trichuris rhinopiptheroxella infection in Rhinopithecus roxellana in southern China

The Sichuan snub-nosed monkey (Rhinopithecus roxellana) is an endangered species in China and is susceptible to infection with Trichuris species. However, the worms are difficult to remove completely. A practical treatment regimen for trichuriasis was conducted over a seven-month period on 15 R. roxellana in a wildlife zoo in southern China. Initially, a combination of fecal examination, morphological observation, molecular identification of ITS1 and mitogenome, and infective pattern analysis revealed that R. roxellana was susceptible to Trichuris rhinopiptheroxella. Three rounds of treatment were administrated, with a dosage of 10 mg/kg albendazole or ivermectin in each. The initial administration of albendazole to 15 monkeys resulted in a reduction of fecal eggs per gram (EPG) by 7.8%-73.2%. The subsequent administration of albendazole to 9 monkeys demonstrated a reduction in fecal EPG by 52.6%-52.8%. The third administration of ivermectin to 5 monkeys resulted in a reduction of fecal EPG by 55.6%-96.6%. However, the EPG level increased in some monkeys after one month of these three anthelmintic administrations. Subsequently, improved strategies were implemented, including an increased dosage of albendazole, flame sterilization, the replacement of the sandy floor with concrete, and the hanging of food. Results showed that a reduction in the fecal EPG of 8 monkeys in the exhibition region, with a decrease from 5135 to 63. Additionally, 6 monkeys exhibited a negative EPG after one month. In the breeding region, the fecal EPG of 7 monkeys decreased from 7389 to 869. Additionally, 2 monkeys demonstrated a negative EPG after one month. This study provides evidence for the control of Trichuris infection in R. roxellana and offers a guideline for the treatment of trichuriasis in animals.

Resolving Taxonomic Ambiguities in Ascaris Species: Insights From a Scanning Electron Microscopy Study of Ascaris lumbricoides

Ascariasis, caused by the parasitic roundworm Ascaris lumbricoides, is a major public health issue, especially in developing nations such as Pakistan. It impacts millions, causing significant morbidity through starvation, stunted growth in children, and a variety of gastrointestinal issues. The taxonomy of the Ascaris genus, notably the distinction between A. lumbricoides and Ascaris suum, has led to ongoing debate among parasitologists. Consequently, the current study intends to provide morphological characterization of A. lumbricoides from Pakistan, using scanning electron microscopy to uncover precise anatomical traits that may aid in resolving the taxonomic controversy surrounding the Ascaris genus. A cross-sectional survey of 1641 individuals was undertaken. Participants filled out structured questionnaires and provided informed consent. After anthelmintic treatment, expelled worms were collected in sterile jars, washed, and preserved in a glycerin-alcohol solution for morphometric examination. Histological examination of transverse section of female worm reproductive system was performed. Scanning electron microscopy was used to investigate the head, cuticle, and caudal regions of the worms. Statistical analyses were performed using t-tests and ANOVA, with significance determined as p ≤ 0.05. When the worms were collected, they ranged in hue from light to pale pink to reddish, then grayish-white to creamy white. Female were distinguished on their large size, straight posterior end with no copulatory bursa and vulvar waist, while male worms were dorsally curved at posterior end. Of the 90 worms measured, 33 were males and 57 were females. The adult female Ascaris worms were significantly (p ≤ 0.0001) larger in body length and width as compared to adult male worms. Furthermore, adult females from different districts had significant differences in body length (p = 0.003) and width (p = 0.00004), although male body length did not differ substantially among districts (p = 0.243). Scanning electron microscopy of A. lumbricoides revealed a head with two subventral lips and a dorsal lip, as well as dentigerous ridges and a triradiate mouth. The cuticle had thick, transversely striated patterns, with clear contrasts between the ventral and dorsal surfaces. The male's caudal area contained mammiliform precloacal papillae and a rectangular anal orifice, but the female had a knob-like structure with uneven striation pattern. The transverse section of female reproductive system consists of two large uteri containing developing eggs, coiled ovaries, and oviducts. Overall, the study revealed valuable insights on this nematode's complicated morphology. By adding new data to the current body of knowledge, this study seeks to improve our understanding of ascariasis and its implications for public health in affected regions.

Synthesis, biological evaluation and molecular docking studies of flavonol-3-O-β-D-glycoside as a potential inhibitor of SARS-CoV-2 main protease (3CLpro) in drug development for COVID-19

The COVID-19 pandemic began in March 2020 and has affected many countries and infected over a million people. It has had a serious impact on people's physical and mental health, daily life and the global economy. Today, many drugs show limited efficacy in the treatment of COVID-19 and studies to develop effective drugs continue. Here, we aim to the synthesise and characterise of the flavonol-3-O-glycoside derivatives, the following and evaluated molecular docking studies with antimicrobial activity, inhibition of SARS-CoV-2 main protease enzyme (3CLpro) and nuclease activity. Molecular docking simulations of the synthesized flavonol-3-O-glycoside derivatives, especially compounds 5a, 5d, 5h, 5i and 5m, showed a stronger interaction with SARS-CoV-2 3CLpro in the active site. Two compounds from the target compounds, 5h and 5m, were found to be specifically effective against M. smegmatis and yeasts. In particular, compounds 5a, 5d, 5h, 5i and 5m, which exhibited high activity against the SARS-CoV-2 main protease enzyme, were found to be effective at low concentrations. We determined the IC50 values for the compounds that showed an inhibitory effect as well as their nuclease activities, which further emphasising the potential of our results. Among these, compound 5d showed a significant competitive inhibitor of 3CLpro. Furthermore, nuclease activity studies identified compound 5d as the most potent. The above results suggest that the flavonol-3-O-glycoside derivatives could be promising new antiviral agents for the development of 3CLpro inhibitors to combat COVID-19.

Environmental monitoring for Ascaris egg remediation: a critical review

Ascariasis affects up to 1.2 billion people globally, with a significant burden in low-income regions. Despite high prevalence and substantial morbidity, existing monitoring and intervention strategies are insufficient due to sample extraction and quantification inaccuracies. This review underscores the need for enhanced environmental monitoring to improve Ascaris egg remediation and reduce disease incidence. We critically reviewed existing environmental monitoring practices and explored advanced technologies like lab-on-a-disk for rapid detection and quantification of Ascaris eggs. A meta-analysis and meta-regression of studies on Ascaris egg recovery revealed significant variability in recovery rates, with the best methods achieving less than 60% efficiency. Advanced imaging analyses and lab-on-a-disk technologies show promise for rapid detection and viability assessment. By identifying gaps in current methodologies, we recommend more effective environmental interventions. The review incorporated high-quality data adhering to PRISMA guidelines, ensuring comprehensive coverage of the latest methodologies. Integrating improved detection methods and environmental control strategies can significantly reduce ascariasis incidence, especially in endemic regions. Future efforts should focus on refining these technologies and validating their application in real-world settings for sustainable disease control.

Long-Term Results of Modified Catheterization Technique in the Treatment of CE Type 2 and 3b Liver Hydatid Cysts

PURPOSE

To evaluate the long-term results of modified catheterization technique (Mo-CAT) for percutaneous treatment of liver CE2/CE3b hydatid disease in a large series.

MATERIALS AND METHODS

A total of 119 patients (F/M:73/59) and 132 liver CE2 and CE3b cysts who underwent percutaneous treatment by Mo-CAT from 2009 to 2020 were included in the study. Patients' age ranges from 8 to 78 years (mean: 39 years). Volume changes of all cysts after the procedure, success and complication rates, duration of hospital stay, catheterization time and recurrence rates were recorded. Technical success was defined as successful catheter introduction into the CE. Clinical success was defined as cases with no mortality and no recurrence.

RESULTS

Among all patients, the mean reduction in the cyst volume was 65.84% (range 6.29-100%). The mean length of hospital stay was 3.88 ± 4.73 days (range 1-36 days). A total of 107 (89.9%) of 119 patients were discharged from the hospital in first the week after the procedure. Major complications were observed in 12 of 119 patients (10.08%) and 12 out of 132 cysts (9.09%). Recurrence was detected in 6 (4.5%) cysts in 6 patients (4.5%) who needed additional procedures. Among all 119 patients, the mean follow-up duration was 51.66 ± 35.56 months (median, 49.00 months; range 0-131 months).

CONCLUSIONS

Treatment of liver CE2/3b with Mo-CAT appears to be a safe, reliable and efficient technique which is associated with low recurrence and complication rates.

[Hepatitis E: Epidemiology, pathology and prevention]

Hepatitis E virus (HEV) is a major cause of acute hepatitis. HEV genotypes 1 and 2 are associated with oro-faecal epidemics and fulminant hepatitis in pregnant women. HEV genotypes 3 and 4 are a zoonosis transmitted by uncooked pork. Infection is usually spontaneously resolutive. Chronic hepatitis may occur in immunocompromised patients. Extrahepatic disease is also possible. Prevention is based on hygiene, especially in high-risk patients, and access to safe drinking water for all. A recombinant vaccine against HEV has been developed and is currently being validated by the WHO.

Diversity of Hepatitis E Viruses in Rats in Yunnan Province and the Inner Mongolia Autonomous Region of China

Hepatitis E virus (HEV) is one of the most common pathogens causing acute hepatitis. Rat HEV, a member of the genus Rocahepevirus, infects mainly rat but can also cause human zoonotic infection. A survey of the virome of rats via next-generation sequencing (NGS) was performed in Yunnan Province and Inner Mongolia in China. Further screening of rat HEV was conducted by nested PCR. The complete genome of six representative strains were obtained by NGS and RT-PCR. The virome analysis revealed that multiple reads were annotated as Hepeviridae. The screening results showed that HEV was detected in 9.6% (34 of 355) of the rat samples and phylogenetically classified into three lineages. The sequences from Yunnan clustered with Rocahepevirus ratti, named the YnRHEV group, and those from Inner Mongolia were separated into two lineages, named the NmRHEV-1 and NmRHEV-2 groups. Complete sequence analysis showed that YnRHEV had very high sequence identity to a human HEV strain identified in immunosuppressed patients (88.7% to 94.3%), a reminder of the risk of cross-species transmission of rodent HEV. Notably, NmRHEV-1 and the most closely related rat HEV, RtCb-HEV/HeB2014, were divergent from other HEV. The phylogenetic analyses and lower sequence identities of the complete genome suggested the NmRHEV-1 to be a novel putative genus of the subfamily Orthohepevirinae. NmRHEV-2 shared the highest sequence identities (70.6% to 72.0%) with the species Rocahepevirus eothenomi, which may represent a putative novel genotype. This study revealed high genetic diversity of Hepeviridae in rats in China and a potentially zoonotic Rocahepevirus ratti strain.

Therapeutic treatment of hepatitis E virus infection in pigs with a neutralizing monoclonal antibody

Hepatitis E virus (HEV) poses a significant risk to human health. In Europe, the majority of HEV infection are caused by the zoonotic genotype 3 (HEV-3), which can cause chronic hepatitis E in immunocompromised patients and those with pre-existing liver disease, and may eventually develop into fatal liver cirrhosis. In this study, we examined the effectiveness of a monoclonal antibody (MAb) treatment strategy using a well established HEV-3 pig model with intravenous infection. For this purpose, nine MAbs raised against the viral capsid protein were generated and the neutralizing activities were compared using in vitro assays. The antibody with the highest neutralizing activity, MAb 5F6A1, was selected for an in vivo study in pigs infected with HEV-3. Following the initial infection of pigs with HEV-3, MAb 5F6A1 was administered intravenously one and seven days post-infection. The results suggest MAb 5F6A1 significantly reduced viremia and virus shedding in pigs infected with HEV-3. This study provides significant insight into the dynamics of HEV infection in pigs and highlights the efficacy of MAb based therapy as an option for treating HEV in porcine hosts and, potentially, humans.

Biosecurity Risk Factors and Predictive Index for Hepatitis E Virus Serological Status in Belgian Pig Farms: Conventional and Free-Range Systems

Hepatitis E viruses (HEV) cause hepatitis E in humans. In industrialized countries, sporadic HEV infections, typically caused by HEV genotypes 3 or 4, can become chronic and progress to liver cirrhosis in immunocompromised individuals. Pigs are a significant animal reservoir, implicating raw or undercooked pork products as potential sources of human infection. To better understand HEV dissemination in the Belgian pig population, potential risk factors were investigated by linking farm-level HEV serological status to biosecurity questionnaire data. Farrow-to-finish herd type, free-range systems, and poor boot hygiene were significantly associated with higher within-herd prevalences. This enabled an initial risk profiling of various farming types and the development of predictions for all Belgian pig farms. When combined with the census of the Belgian wild boar population, the predicted HEV status of all professional Belgian pig farms (based on these associations) does not suggest that the proximity of wild boars is a main source of HEV in free-ranging herds. Identifying risk factors for increased circulation of HEV between and within pig farms is critical to controlling its spread and reducing human infection.

Micro-elimination initiative for hepatitis C screening: insight into gender gaps and undiagnosed individuals

In 2023, the Italian healthcare system launched HCV screening targeting subjects born in 1968-1989. However, subjects > 50 yrs also need screening. In addition, existence of gender gaps in HCV diagnosis and treatment has been suggested. Our aim was to identify undiagnosed individuals outside the age groups to whom the screening is offered and to gather data about gender gaps. This is a prospective, opportunistic micro-elimination initiative based on a network between 24 Apulian pharmacies and our center. Between 01/07/2022 and 01/03/2024, subjects aged 55 to 85, accessing pharmacies were offered HCVOraQuick tests (F/M 1:1) and administered ad-hoc questionnaires. In total, 13,042 screening were carried out. Mean age was 64.9 (± 7.6), 51.1% females. Overall, 1.1% were anti-HCV positive: mean age 68.3 (± 10.3), 44.9% females. Seroprevalence was higher in males (p < 0.00001), elderly (p < 0.00001) and unknown transmission route (p = 0.0009). HCV-RNA was detectable in 67.4% of seropositive. They were 67.5 (± 10.7) yrs old, mainly males (55.1%). HCV-RNA prevalence was 0.8%, higher in elderly (p = 0.0003) and unknown transmission route (p = 0.0007). Overall, 90% were linked-to-treatment. Differences in patients profiles should be considered to guide policy and more inclusive treatment approaches. Gender differences in screening response and rates of active infections underscore the need for gender-targeted intervention.

Proteasomal processing of the viral replicase ORF1 facilitates HEV-induced liver fibrosis

Chronic infections with hepatitis E virus (HEV), especially those of genotype 3 (G3), frequently lead to liver fibrosis and cirrhosis in patients. However, the causation and mechanism of liver fibrosis triggered by chronic HEV infection remain poorly understood. Here, we found that the viral multiple-domain replicase (ORF1) undergoes unique ubiquitin-proteasomal processing leading to formation of the HEV-Derived SMAD Activator (HDSA), a viral polypeptide lacking putative helicase and RNA polymerase domains. The HDSA is stable, non-HSP90-bound, localizes to the nucleus, and is abundant in G3 HEV-infected hepatocytes of various origins. Markedly, the HDSA in hepatocytes potentiates the fibrogenic TGF-β/SMAD pathway by forming compact complexes with SMAD3 to facilitate its promoter binding and coactivator recruitment, leading to significant fibrosis in HEV-susceptible gerbils. Virus infection-induced liver fibrosis in HEV-susceptible gerbils could be prevented by mutating the residues P989C, A990C, and A991C (PAA-3C) within ORF1, which are required for proteasomal processing. Thus, we have identified a viral protein derived from host proteasomal processing, defined its notable role in liver fibrosis and highlighted the nature of an unanticipated host-HEV interaction that facilitates hepatitis E pathogenesis.

Fundamentals of diagnostic ultrasonography in sheep and goat medicine: a comprehensive illustrated overview

This illustrated review emphasizes the fundamentals of diagnostic ultrasonography in sheep and goat medicine. The procedure can effectively assess the thoracic and abdominal organs in both healthy and diseased states. The review discusses five main sections. The first one clarifies the principles of pulmonary sonography in sheep and goats followed by image finding in animals with respiratory disorders including pneumonia, pleuropneumonia, lung abscessation and pleuritis. Second section shows the fundamentals of echography in sheep and goats followed by scanning of animals with cardiovascular disorders including heart failure, fibrinous pericarditis, endocarditis and nutritional muscular dystrophy. Third section of this review discusses the principles of gastrointestinal sonography in sheep and goats followed by picture in some digestive disorders including peritonitis, enteritis and retroperitoneal abscessation. Fourth part shows the basics in hepatic and biliary tissue followed by sonography of sheep and goats with hepatic and biliary disorders including fatty liver, hepatitis cysticercosis, cholangitis, cholecystitis, cholestasis and choledocholithiasis. Last section of this review discusses the fundamentals of urinary system ultrasonography followed by imaging of the urinary disorders including renal failure, hydronephrosis, pyelonephritis, obstructive urolithiasis, cystitis and paralysis of the urinary bladder. In conclusion, ultrasonography of either healthy or diseased sheep or goats is very useful for assessing the normal structure and function of both healthy and dysfunctional organs. It is highly recommended to adopt this procedure as a standard preliminary method for examining sheep and goats with any medical condition.

Portal Vein Thrombosis in Patients Without Cirrhosis: Current Practical Approaches and Treatment Strategies

Portal vein thrombosis in non-cirrhotic individuals, although uncommon, is an increasingly explored condition that affects mainly young people, consequently representing a significant disease burden. Reports primarily including western European populations have recently shed light regarding the pathophysiology, risk factors, natural history, treatment, and prognosis of this entity. Underlying predisposing conditions are documented in ~70% of cases, encompassing local risk factors, inherited and acquired thrombophilia, cancer, and systemic inflammatory conditions. Non-cirrhotic portal vein thrombosis can cause significant portal hypertension in the acute setting, but, more frequently, significant portal hypertension-related complications arise when the condition becomes chronic and portosystemic collaterals develop, increasing the risk for variceal bleeding and ascites. The diagnostic approach to screen for underlying thrombophilia remains a challenge, and recommendations in this regard, although scarce and backed by scarce evidence, have changed notably in the last years, leaning toward a universal screen in patients who develop this condition without a clear provoking factor. Recently, studies have shown that long-term anticoagulation may be appropriate even in the absence of clear provoking factors or underlying thrombophilia. Future studies should address which patients may benefit from this approach, which patients may not need it, and what the most appropriate strategies are to approach patients who do not recover portal vein patency with anticoagulation to further prevent portal hypertension-related complications.

Reassessing the role of nitric oxide in the pathogenesis of sphincter of Oddi dysfunction

The pathogenic mechanisms underlying sphincter of Oddi dysfunction (SOD) remain incompletely understood, and it often leads to severe symptoms encompassing nausea, vomiting, and abdominal pain. New evidence now suggests correlations between nitric oxide (NO) and SOD. In this review, we summarized the factors influencing SOD pathogenesis via NO and its derivative, the peroxynitrite anion. NO appears to enhance SOD progression by modulating sphincter of Oddi (SO) contractions via NO-sGC-cGMP signaling or inducing the apoptosis of enteric neurons, interstitial cells of Cajal, smooth muscle cells, and other cellular components via peroxynitrite anion-mediated organelle damage. Thus, a comprehensive understanding of SOD will provide a foundation for the identification of potential drugs and treatment approaches.

Investigation of the molecular basis of halogenated Schiff base derivative by combined crystallographic and computational studies

Halogenated Schiff base derivatives are gaining more popularity in supramolecular chemistry due to the synergistic effect of hydrogen and halogen-based noncovalent interactions, which helps to design novel therapeutic materials. In this work, we have examined the nature of molecular interactions to investigate the structure-functional relationship of a halogen-based derivative. The FTIR, HRMS and NMR spectroscopic techniques confirmed the formation of the desired novel Schiff base compound. Further, crystal structure studies showed an infinite 1D supramolecular chain formed by type-I halogen…halogen interaction. The Hirshfeld surface and enrichment ratio analyses were performed to visualize and assess the role of diverse interactions involved in crystal packing. The QTAIM, NCI, LOL and ELF studies were conducted extensively to comprehend the strength of interaction constructed based on electron density distribution. The global and local reactive indices were determined using DFT studies to analyze the molecular properties of the compound. Antibacterial activity against MRSA bacteria was performed and showed a good zone of inhibition. The docking analysis was performed for 1mwt protein and validated. The in silico molecular docking studies of the halogenated Schiff base structure with the penicillin-binding protein showed a good docking affinity of -7.5 kcal/mol and supported by in vitro studies. The ligand binding stability within the protein's active site was further demonstrated by molecular dynamics (MD) simulation studies for the Schiff base molecule.

Definition, diagnosis and epidemiology of acute-on-chronic liver failure

This narrative review addresses the definition of acute-on-chronic liver failure, a condition associated with high short-term mortality in patients with chronic liver disease and/or cirrhosis. We provide two major points of view: the East and the West perspective. Both definitions vary regarding the underlying patient population and organ failure(s) definition. Nevertheless, all the definitions have their clinical utility: from the core concept of having the "liver" as a conditio sine qua non, the syndrome cannot exist (Asian Pacific Association for the Study of the Liver); a data-driven, robust definition (European Association for the Study of the Liver); a bedside tool that can quickly identify patients at high risk of dying (North American Consortium for the Study of End-stage Liver Disease [NACSELD]). In each section, we provide the overall definitions, the criteria of organ failure(s), and some epidemiological data illustrating how these apply in each area of the world.

Hepatitis E Virus Infection in Vietnamese Pregnant Women with Hepatitis B: Prevalence and Clinical Outcomes

Background

Hepatitis E virus (HEV) infection during pregnancy is associated with obstetric complications and adverse maternal and neonatal outcomes. This study aimed to determine the seroprevalence of HEV and RNA positivity in both healthy pregnant women and women coinfected with hepatitis B virus (HBV).

Methods

A cross-sectional study was conducted involving 528 pregnant women (278 with and 250 without hepatitis B surface antigen [HBsAg]) in their third trimester. Anti-HEV specific immunoglobulin (Ig) G and IgM antibodies were tested for using enzyme-linked immunosorbent assay, while HEV RNA was detected by means of nested polymerase chain reaction. The status of anti-HEV antibodies was analyzed regarding pregnancy outcomes and the risks of obstetric complications.

Results

The results indicated that 24% of participants (127 of 528) tested positive for anti-HEV IgG, while 2.5% (13 of 528) showed detectable anti-HEV IgM. Among HBV-positive women, 26% (55 of 250) had anti-HEV IgG, comparable to 22% (61 of 278) in HBV-negative controls. Notably, 28% (140 of 501) of cord blood samples were positive for anti-HEV IgG. No cases of HEV RNA were detected. The prevalence of anti-HEV IgG increased with maternal age and was associated with higher infant birth weights. Anti-HEV IgM positivity was associated with an increased risk of neonatal infections (odds ratio, 20.6; P = .05). Among HBsAg-positive women, those with anti-HEV IgG (26%) had higher gestational age at delivery and higher infant birth weights but lower platelet counts and prothrombin times (P < .05).

Conclusions

These findings highlight the endemic nature of HEV in Vietnam and underscore the potential risks of coinfection with HBV during pregnancy, which may lead to adverse obstetric outcomes.

Hepatic abscess and hydatid liver cyst: European infectious disease point of view

This manuscript is based on a recent study by Pillay et al that was published in recently. Liver abscesses can be caused by rare potentially life-threatening infections of either bacterial or parasitic origin. The incidence rate in Europe is lower than in developing countries, but it is a major complication with high morbidity, particularly in immunocompromised patients. They are most frequently caused by Enterobacterales infections, but hypervirulent Klebsiella strains are an emerging problem in Western countries. Amoebiasis has been a public health problem in Europe, primarily imported from other endemic foci. At the same time, this infection is becoming an emerging disease, as the number of infected patients who have not traveled to endemic areas is rising. Treatment options for hydatid liver cyst include chemotherapy, open or laparoscopic surgery, percutaneous treatment (percutaneous aspiration, re-aspiration and injection and its modification) and ''wait and watch'' strategy. Most hydatid liver cyst patients in Pillay et al's study received surgical treatment, but several studies have confirmed the safety and efficacy of percutaneous aspiration, re-aspiration and injection.

Liver diseases: epidemiology, causes, trends and predictions

As a highly complex organ with digestive, endocrine, and immune-regulatory functions, the liver is pivotal in maintaining physiological homeostasis through its roles in metabolism, detoxification, and immune response. Various factors including viruses, alcohol, metabolites, toxins, and other pathogenic agents can compromise liver function, leading to acute or chronic injury that may progress to end-stage liver diseases. While sharing common features, liver diseases exhibit distinct pathophysiological, clinical, and therapeutic profiles. Currently, liver diseases contribute to approximately 2 million deaths globally each year, imposing significant economic and social burdens worldwide. However, there is no cure for many kinds of liver diseases, partly due to a lack of thorough understanding of the development of these liver diseases. Therefore, this review provides a comprehensive examination of the epidemiology and characteristics of liver diseases, covering a spectrum from acute and chronic conditions to end-stage manifestations. We also highlight the multifaceted mechanisms underlying the initiation and progression of liver diseases, spanning molecular and cellular levels to organ networks. Additionally, this review offers updates on innovative diagnostic techniques, current treatments, and potential therapeutic targets presently under clinical evaluation. Recent advances in understanding the pathogenesis of liver diseases hold critical implications and translational value for the development of novel therapeutic strategies.

Detection of hepatitis B virus surface antigen, IgM and IgG antibodies to hepatitis B virus core antigen in the clinical classification and epidemiological surveillance of HBV infection

Hepatitis B virus surface antigen (HBsAg), IgM and IgG antibodies to hepatitis B virus core antigen (anti-HBcIgM and anti-HBcIgG) comprise serological markers of hepatitis B virus (HBV) infection of great importance in the epidemiological surveillance of hepatitis B, since they have been routinely considered for classifying the acute and chronic clinical forms of HBV infection. This classification is established according to the expression and dynamics of these markers in the infected person's bloodstream, which serves as the basis for the differential diagnosis between the two clinical entities. However, in certain circumstances, both acute and chronic infection, the detection of these markers may not occur in the bloodstream, favoring the occurrence of atypical serological profiles of infection, and compromising the correct infection clinical classification. In addition, the complex and varied nature of hepatitis B serological profiles may compromise the health professional's ability to analyze the case and, thus, correctly classify the infection's clinical form. Since the expression of these markers in the bloodstream occurs dynamically, with consequent changes in the patient's serological profile as he progresses towards recovery or chronicity, the diagnosis of acute or chronic infection may also be compromised, if it is established based on the collection of a single sample and without knowing the patient's clinical history and their epidemiological antecedents. This manuscript addresses the sensitivity and specificity of HBsAg, anti-HBcIgM, and anti-HBcIgG serological markers detection in the clinical classification of HBV infection and in the epidemiological surveillance of hepatitis B. This review is covering the clinical and epidemiological interpretations of the markers in and of themselves, not in reference to any specific assays.

Delayed Diagnosis of Imported Cystic Echinococcosis and Successful Treatment With Percutaneous Drainage and Albendazole in Korea: A Case Report

Echinococcosis, caused by the tapeworm Echinococcus, is rare in Korea and is primarily imported from endemic areas. We report a case of a 37-year-old Korean man with multiple large hepatic cysts, initially diagnosed as simple cysts at a local clinic in 2018. The patient had lived in Oman, an endemic area, for several months in 2016. Upon referral to a tertiary hospital in 2023, due to progressive cyst enlargement, liver magnetic resonance imaging revealed three large cysts with a water lily sign. Serum IgG against Echinococcus was positive by enzyme-linked immunosorbent assay. After diagnosis of echinococcosis, treatment with albendazole and puncture-aspiration-injection-reaspiration (PAIR) was performed. Microscopic and molecular analysis of cyst aspirates confirmed Echinococcus granulosus infection. Follow-up computed tomography demonstrated a reduction in cyst size, yet the emergence of a new right pleural effusion and consolidation in the left lower lobe of the lung necessitated the continuation of albendazole therapy. This case highlights the importance of thorough travel history, imaging findings, and the effectiveness of PAIR combined with albendazole in treating imported echinococcosis.

Potential common targets of music therapy intervention in neuropsychiatric disorders: the prefrontal cortex-hippocampus -amygdala circuit (a review)

As life becomes more stressful, neurological disorders, psychiatric disorders, and comorbidities of the two are becoming more and more of a concern. Multiple neuropsychiatric disorders share the same mental and somatic dysfunction and may involve common brain circuits and mechanistic targets. Music therapy, as an art form with proven efficacy, low cost and few side effects, is promoted for use in interventions for neuropsychiatric disorders. This may be closely related to the release of signaling molecules such as monoamine neurotransmitters, the glutamatergic system, the gut-microbiota-brain axis, pro-inflammatory cytokines and the endogenous opioid peptide system. However, fewer studies have mentioned the main targets of music to promote functional changes in brain regions. Therefore, this paper is a review of the mechanisms by which music therapy interacts with the prefrontal cortex-hippocampus-amygdala circuit through the aforementioned molecules. It is also hypothesized that glial cells, mitochondria and microRNAs are microscopic targets for musical intervention in neuropsychiatric disorders. The aim is to give new ideas for future research into the biological mechanisms of music therapy intervention in neuropsychiatric disorders.

Current status of etiology and outcomes of acute liver failure in India-A multicentre study from tertiary centres

BACKGROUND AND AIMS

Acute liver failure (ALF) is a medical emergency and liver transplantation (LT) may be required as definitive therapy. The etiology varies across geographical locations and is mostly viral dominant in India. We aimed at evaluating the spectrum, impact of interventions (plasma exchange [PLEx], continuous renal replacement therapy [CRRT]) and outcomes of ALF in India in recent times.

METHODS

A multicentre retrospective study across four major tertiary care centres.

RESULTS

As many as 183 ALF patients (median age, 23 years; females, 43.1%; model for end-stage liver disease [MELD], 32.7) from January 2021 to December 2023 were included. Nineteen per cent had infection and 40.4% of patients satisfied King's College criteria (KCC) at admission. Most common cause for ALF was hepatitis A virus (HAV) (44.2%) followed by rodenticide poisoning (10.3%). Approximately 35% of patients each received either PLEx or CRRT. The 7, 14 and 21-day transplant-free survival probability was 65.5%, 60.1%, and 57.3%, respectively. Only 3.8% of patients underwent liver transplantation. On multivariable Cox regression analysis, hemoglobin (HR, 0.74 [0.63-0.87]), lactate (HR, 1.14 [1.03-1.26]), advanced hepatic encephalopathy (HE) (HR, 4.87 [1.89-12.5]) and fulfilling KCC [HR, 10.04 [4.57-22.06]) at admission were the independent predictors of mortality. A model including KCC + lactate + HE ≥ 3 with or without hemoglobin had an AUROC of 0.81-0.84 to predict mortality. In those who underwent PLEx, advanced HE (HR, 4.13 [1.75-9.7]), procalcitonin (HR, 1.18 [1.07-1.30]) and KCC (HR, 4.6 [1.6-13.1), while for those who received CRRT, lactate (HR, 1.37 [1.22-1.54]) and KCC (HR, 6.4 [2.5-15.8]) independently predicted mortality.

CONCLUSIONS

Hepatitis A virus is currently the most common cause for ALF in India, emphasizing the need for universal vaccination programmes. Spontaneous survival in tertiary care centres is 57%. LT rates were low.

Hepatolithiasis pathogenesis update

Hepatolithiasis is prevalent in East Asian countries and not common in Western countries. In recent years, because of the increased number of immigrants from East Asia in Western countries, hepatolithiasis has gradually become a global problem. Although current surgical interventions for hepatolithiasis boast a high rate of stone clearance, the persistent challenges of the disease's refractory nature and high recurrence rate continue to complicate its treatment. Therefore, understanding its underlying pathogenesis is meaningful for effective treatment. In this review, we discuss the common risk factors: infection, cholangitis, environmental factors and diet habits, abnormal bile components, anatomical abnormalities, and bile stasis, and summarize the relevant mechanisms.

Deciphering the hepatitis E virus ORF1: Functional domains, protein processing, and patient-derived mutations

Hepatitis E virus (HEV) is a major cause of acute and chronic hepatitis in humans. The HEV open reading frames (ORF1) encodes a large non-structural protein essential for viral replication, which contains several functional domains, including helicase and RNA-dependent RNA polymerase. A confusing aspect is that, while RNA viruses typically encode large polyproteins that rely on their enzymatic activity for processing into functional units, the processing of the ORF1 protein and the mechanisms involved remain unclear. The ORF1 plays a pivotal role in the viral life cycle, thus mutations in this region, especially those occurring under environmental pressures such as during antiviral drug treatment, could significantly affect viral replication and survival. Here, we summarize the recent advances in the functional domains, processing, and mutations of ORF1. Gaining a deeper understanding of HEV biology, particularly focusing on ORF1, could facilitate the development of new strategies to control HEV infections.

Experimental trichuriasis: Changes in the immune response and bacterial translocation during acute phase development illustrated with 3D model animation

Trichuriasis, a well-known type of soil-transmitted helminthiasis, is a neglected gastrointestinal nematode disease predominantly affecting children in tropical regions and is caused by Trichuris trichiura. The potential zoonotic transmission of this disease is indicated by its presence in nonhuman primates. Chronic infection leads to mucosal damage, bacterial translocation, and intense inflammatory infiltration; however, the progression of these processes remains poorly understood. This study tracks the acute phase of experimental trichuriasis, providing detailed insights into nematode tissue migration stages, inflammatory infiltration, cytokine production, and 2D/3D imaging of the bacterial translocation process. We showed a mixed immune response (Th1, Th2, and Th17) initiated by larval-induced lesions in the intestine tissue and modulated by L4 larvae and adult worms in the cecum, with systemic changes observed in the mesenteric lymph nodes, peritoneal macrophages, and spleen. Despite the disruption of the intestinal mucosa within the first 10 days post-infection (d.p.i.), bacterial invasion becomes evident only after the development of the nematode into the L3 larval stage (17 d.p.i.), intensifying with lesions caused by the L4 larvae (22 d.p.i.) and adult worms (35 d.p.i.). Our multidimensional approach, which incorporates microscopy tools, micro-CT, physiological evaluations, tissue/organ assessments, and immunological parameters, demonstrates the ability of larvae to breach the intestinal mucosa, further indicating the timing of extensive bacterial infiltration. Additionally, a 3D animation illustrates how adult worm attachment mechanisms may facilitate bacterial translocation. This study provides significant insights into the immunological and pathological mechanisms of trichuriasis progression, highlighting the complex interplay among host immune responses, the gut microbiome, and parasite survival strategies, all of which are crucial aspects for future therapeutic development.

Global vaccination against hepatitis E virus: position paper from the European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group

SCOPE

Hepatitis E virus (HEV) is a significant global health issue, impacting both low- and middle-income countries and industrialized nations. HEV genotypes 1 and 2, primarily transmitted through contaminated water, are endemic in low- and middle-income countries, whereas genotypes 3 and 4 are zoonotically transmitted in industrialized regions. Acute HEV infection poses severe risks, particularly to pregnant women and immunocompromised individuals, whereas chronic HEV infection leads to serious complications in those with pre-existing liver disease and transplant recipients. The development of an HEV vaccine offers new prevention opportunities, though its availability and integration into global immunization programmes remain limited.

METHODS

This position paper was developed by the European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group through an extensive review of clinical data, safety profiles, efficacy, and immunogenicity of HEV vaccines. The study group focused particularly on high-risk and special populations, synthesizing global health insights and incorporating recommendations from the Strategic Advisory Group of Experts to formulate strategies for wider HEV vaccination use.

QUESTIONS ADDRESSED IN THE POSITION PAPER

The position paper evaluates the efficacy and safety of HEV vaccines in both general and special populations. It identifies key barriers to the integration of HEV vaccines into routine immunization programmes, including infrastructure limitations, costs, and vaccine accessibility. The paper also proposes strategies to overcome these challenges and improve vaccine distribution. Furthermore, it addresses ways to enhance public awareness and international cooperation to promote HEV vaccination efforts globally.

IMPLICATIONS

European Society of Clinical Microbiology and Infectious Diseases Viral Hepatitis Study Group recommends HEV vaccination for high-risk groups, including women of childbearing age, patients with chronic liver diseases, and immunosuppressed individuals. Prioritizing investments in vaccine logistics, integrating diagnostics, and educational outreach can enhance uptake.

European guidelines for the diagnosis and treatment of pancreatic exocrine insufficiency: UEG, EPC, EDS, ESPEN, ESPGHAN, ESDO, and ESPCG evidence-based recommendations

Pancreatic exocrine insufficiency (PEI) is defined as a reduction in pancreatic exocrine secretion below the level that allows the normal digestion of nutrients. Pancreatic disease and surgery are the main causes of PEI. However, other conditions and upper gastrointestinal surgery can also affect the digestive function of the pancreas. PEI can cause symptoms of nutritional malabsorption and deficiencies, which affect the quality of life and increase morbidity and mortality. These guidelines were developed following the United European Gastroenterology framework for the development of high-quality clinical guidelines. After a systematic literature review, the evidence was evaluated according to the Oxford Center for Evidence-Based Medicine and the Grading of Recommendations Assessment, Development, and Evaluation methodology, as appropriate. Statements and comments were developed by the working groups and voted on using the Delphi method. The diagnosis of PEI should be based on a global assessment of symptoms, nutritional status, and a pancreatic secretion test. Pancreatic enzyme replacement therapy (PERT), together with dietary advice and support, are the cornerstones of PEI therapy. PERT is indicated in patients with PEI that is secondary to pancreatic disease, pancreatic surgery, or other metabolic or gastroenterological conditions. Specific recommendations concerning the management of PEI under various clinical conditions are provided based on evidence and expert opinions. This evidence-based guideline summarizes the prevalence, clinical impact, and general diagnostic and therapeutic approaches for PEI, as well as the specifics of PEI in different clinical conditions. Finally, the unmet needs for future research are discussed.

Peritoneal hydatidosis secondary to ruptured hepatic hydatid cyst-a rare presentation: a case report

Peritoneal hydatidosis (PH) secondary to rupture of hepatic cyst is an exceedingly rare clinical entity. We present a case of a 25-year-old male patient with PH with a hepatic hydatid cyst. The patient underwent laparotomy, total pericystectomy, segmentectomy, and cholecystectomy with a favorable postoperative course. This case highlights the challenges in diagnosing and managing these rare conditions. This is the first reported case in Ethiopia.

Presentation and management of pancreatic hydatid cyst: A comprehensive systematic review of the literature with meta-data

INTRODUCTION

Hydatid cysts are among many cysts that can develop in the pancreas. Both the size and location of these cysts significantly influence clinical presentation and surgical approach required for management. This study aims to review the literature concerning pancreatic hydatic cysts, their presentations, and management strategies.

METHODS

A comprehensive search was conducted across CINAHL, Pubmed/Medline, Cochrane Library, Web of Science, and EMBASE Databases to identify English-language studies published up to January 2nd, 2024.

RESULTS

The mean age of the patients was 35.4 ± 17.4years, with females comprising 92 (59.0 %) of the cohort. Abdominal pain was the most common complaint, reported by 92 (59.0 %) patients. Serological testing for the echinococcal antigen demonstrated highest sensitivity at 67.0 %, whereas computed tomography exhibited a sensitivity of 34.1 %, and ultrasonography showed a sensitivity of 27.7 %. Among surgical interventions, laparotomy was the most frequently performed approach, utilized in 42(26.9 %) of the cases.

CONCLUSION

Although pancreatic hydatid cysts are rare and can be challenging to diagnose, their prognosis is generally favorable when appropriate therapeutic measures are employed. Surgical intervention, often combined with Albendazole, remains the mainstay of treatment.

Transmission patterns of hepatitis E virus

Hepatitis E virus (HEV) causes sporadic cases in industrialized countries and endemic outbreaks in areas with lower sanitation standards. The wide host reservoir of HEV makes it a potential source of new zoonotic transmission and dissemination in humans. Thus, the perception of HEV as a confined ailment has shifted to one of global concern. Considering HEV's environmental stability and heterogeneity in the host range of HEV's genotypes, various transmission pathways and sources for HEV infections are plausible. Here, we provide an overview on HEV's transmission routes and discuss the role of HEV as a foodborne zoonosis, as well as preventive measures and open research questions.

Ascaris lumbricoides Emerging from a PleurX Draining Catheter: An Unexpected Diagnosis

Introduction

Ascaris lumbricoides is a common helminthic infection characterized by fecal-oral route of transmission. Commonly, it affects the gastrointestinal tract. However, in significantly rare cases, it can affect unexpected body regions, such as biliary tree, pancreas, and the lung.

Case presentation

A 68-year-old female patient underwent PleurX tube insertion due to malignant pleural effusion. On the third week of insertion, she complained of itching and pain at the site of insertion, a grayish-white worm was visualized at the insertion site. Ascaris lumbricoides was identified by microbiological examination. She received 400 mg of albendazole.

Conclusion

Our case describes a rare clinical situation of pleural ascariasis, emphasizing the importance of remaining aware of this rare complication of ascariasis.

Evaluation value of contrast enhanced ultrasound quantitative parameters in ischemic-type biliary lesions after liver transplantation-a prospectively study

PURPOSE

To explore the evaluation value of contrast enhanced ultrasound (CEUS) quantitative parameters in ischemic-type biliary lesions after liver transplantation to assist its early-diagnosis.

METHODS

Patients who underwent liver transplantation and intravenous CEUS at Beijing Friendship Hospital, Capital Medical University from June 25, 2020 to December 28, 2022 and were diagnosed with Ischemic-type biliary lesions (ITBLs) by Magnetic Resonance Cholangiopancreatography (MRCP) or Endoscopic Retrograde Cholangiopancreatography (ERCP) or Percutaneous Transhepatic Cholangiography (PTC) were prospectively enrolled. SonoLiver software was used to quantitatively analyze the contrast images, transplanted livers with normal biliary tracts as the control group. SPSS 25.0 software was used to analyze the data.

RESULTS

There was a total of 35 patients enrolled in the study, and 15 ITBLs and 30 normal biliary tract of transplanted livers, respectively. The dynamic vascular patterns (DVP) curve of the ITBLs group was negative wave, while the DVP curve of the normal biliary tract group was positive wave. Compared with the patients with normal biliary tract, the Maximum intensity (IMAX), Rise slope 50% (Rs50), Area under curve (AUC), Area under curve in Wash-in phase (WinAUC), Wash in Rate (WinR), Rise slope 10-90% (Rs1090), and Wash out Rate (WouR) of the ITBLs group were lower, while the Fall slope (Fs50) was higher. There was no significant difference in Rise time (RT), Time to Peak (TTP), Fall half time (FHT), Mean transit time (mTT), Fall time (FT), WioAUC ((WioAUC = WinAUC + WouAUC)), and Area under curve in Wash-out phase (WouAUC) between the two groups (P > 0.05). The ROC curve results showed that Fs50 > -2.64 was the cutoff value for predicting ITBLs, with an area under the curve of 0.816 (95%CI: 0.683-0.949), and a sensitivity and specificity of 0.846 and 0.607; Rs50 < 7.08, AUC < 39761.7050, WinR < 101.7 and WouR < 474.52 were the cutoff values ​​for predicting ITBLs, with areas under the curve of 0.853 (95%CI: 0.728-0.979), 0.911 (95%CI: 0.783-1.000), 0.756 (95%CI: 0.615-0.896) and 0.700 (95%CI: 0.536-0.864).

CONCLUSION

The quantitative parameters of CEUS imaging, such as IMAX, Rs50, AUC, WinAUC, WinR, Rs1090, WouR, and Fs50, are helpful in predicting ITBLs and improving the reproducibility of diagnosis. The threshold of these quantitative parameters will aid in the early diagnosis of ischemic-type biliary lesions after liver transplantation.

The feasibility of using liver function indices and FibroScan in combination to predict the occurrence of anti-tuberculosis drug-induced liver injury in Patients with liver disease

Background

The study aims to assess the feasibility of using a combined approach of liver function indices and FibroScan measurements as a predictive tool for the early detection of anti-tuberculosis drug-induced liver injury (DILI) in patients with existing liver disease.

Methods

A retrospective cohort study was conducted, including adult tuberculosis patients with documented liver disease. Liver function was assessed using standard biochemical parameters, and FibroScan examinations were performed to determine liver stiffness measurement (LSM). Patients were monitored for clinical and biochemical signs of DILI throughout treatment. Logistic regression models and Receiver Operating Characteristic (ROC) curves were used for data analysis. Statistical significance was set at P<0.05.

Results

Patients who developed DILI showed significantly higher levels of ALT, AST, total bilirubin, GGT, and LSM, with strong positive correlations between these markers and DILI occurrence. Logistic regression analysis revealed elevated ALT, AST, TBIL, and GGT were strongly associated with an increased likelihood of DILI. The area under the ROC curves indicated excellent predictive accuracy of these parameters. A nomogram for predicting DILI based on the combined biomarkers was established.

Conclusions

The study demonstrates the feasibility of combining liver function indices and FibroScan measurements to predict anti-tuberculosis DILI. The results highlight the importance of baseline liver health assessment and offer promising implications for clinical practice, aiding in individualized risk estimation and therapeutic decision-making for patients with liver disease initiating anti-tuberculosis therapy. Further validation in larger cohorts is warranted to strengthen the predictive model.

Reaching Syrian migrants through Dutch municipal registries for hepatitis B and C point-of-care testing

Undetected chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections can lead to cirrhosis and liver cancer. Syrian migrants are the largest non-European migrant group in the Netherlands with HBV and HCV prevalence rates above 2%. This study aimed to reach Syrian migrants for HBV and HCV testing using point-of-care tests (POCT). A multifaceted strategy was employed to reach Syrian migrants aged ≥16 years from two Dutch municipalities for free-of-charge HBsAg and anti-HCV POCT using finger prick blood at the regional Public Health Service. All were personally invited by the Public Health Service by postal mail, based on municipal registry data. Respondents' medical history data were analysed descriptively and data on age, sex, and municipality were compared with non-participating invitees, using Pearson's Chi-square test. Of the study population (N = 832), 32.3% (n = 269) attended the testing. The mean age of participants was 36 years (range 16-70), 59.1% were men, and 66.5% were unemployed. Non-participation was higher in the younger age groups (<30 years) (p < .001). The POCT using finger prick blood was well received. None tested HBsAg or anti-HCV positive. With approximately one-third of participation, this study demonstrated relatively high reach of Syrian migrants for testing, compared to studies with similar recruitment methods. However, while the reach could be considered successful, testing failed to demonstrate new infection in this key population. Thereby, other methods may be preferred to identify new HBV and HCV infections, such as opportunistic testing within existing care processes.

Liver stiffness: a novel imaging biomarker by ultrasound elastography for prediction of early allograft failure following liver transplantation

OBJECTIVES

The objective of this study was to evaluate the role of Liver Stiffness Measurement (LSM) and serum transaminase levels for predicting early allograft failure (EAF) after liver transplantation (LT).

METHODS

A total of 189 patients who underwent LT were prospectively recruited in the study. Of these patients, 13 cases died or received re-transplantation within 90 days after surgery were classified as EAF group, while rest 176 patients were included in the non-EAF group. LSM values and serum transaminase levels within 1 week after operation were recorded and compared between two groups. The area under the curve (AUC) was utilized to assess the performance of LSM, serum transaminase and their combination in predicting EAF.

RESULTS

The earliest significant difference in LSM between EAF and non-EAF group was observed on postoperative day 3 (POD-3) (p = 0.046). Comparing to non-EAF group, patients in the EAF group had higher aspartate-aminotransferase (AST) and alanine aminotransferase (ALT) on postoperative day 2 (POD-2)(p = 0.009, 0.033), and also demonstrated higher AST on POD-3 (p = 0.021). Furthermore, the reduction rate of AST/ALT from day 1 to day 3 (AST/ALT Red) were slower (p = 0.001, 0.014) in EAF group. Using a LSM value > 12.1 kPa and an AST level > 339U/L on POD-3 predicted EAF with a sensitivity of 89%, a specificity of 86%, and an AUC of 0.926, surpassing the traditional early allograft dysfunction (EAD) model.

CONCLUSIONS

The combination of LSM values and AST levels on the third day after LT can effectively predict EAF and facilitate timely interventions.