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Tithof J, Pruett TL, Rao JS. Lumped parameter liver simulation to predict acute haemodynamic alterations following partial resections. J R Soc Interface 2023; 20:20230444. [PMID: 37876272 PMCID: PMC10598422 DOI: 10.1098/rsif.2023.0444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023] Open
Abstract
Partial liver resections are routinely performed in living donor liver transplantation and to debulk tumours in liver malignancies, but surgical decisions on vessel reconstruction for adequate inflow and outflow are challenging. Pre-operative evaluation is often limited to radiological imaging, which fails to account for post-resection haemodynamic alterations. Substantial evidence suggests post-surgical increase in local volume flow rate enhances shear stress, signalling hepatic regeneration, but excessive shear stress has been postulated to result in small for size syndrome and liver failure. Predicting haemodynamic alterations throughout the liver is particularly challenging due to the dendritic architecture of the vasculature, spanning several orders of magnitude in diameter. Therefore, we developed a mathematical lumped parameter model with realistic heterogeneities capturing inflow/outflow of the human liver to simulate acute perfusion alterations following surgical resection. Our model is parametrized using clinical measurements, relies on a single free parameter and accurately captures established perfusion characteristics. We quantify acute changes in volume flow rate, flow speed and wall shear stress following variable, realistic liver resections and make comparisons with the intact liver. Our numerical model runs in minutes and can be adapted to patient-specific anatomy, providing a novel computational tool aimed at assisting pre- and intra-operative surgical decisions for liver resections.
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Affiliation(s)
- Jeffrey Tithof
- Department of Mechanical Engineering, University of Minnesota, 111 Church Street SE, Minneapolis, MN 55455, USA
| | - Timothy L. Pruett
- Division of Solid Organ Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Joseph Sushil Rao
- Division of Solid Organ Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, USA
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Song XJ, Wang SY, Jia SY, Wang GJ, Zhang WB. In vivo evaluation of liver function by multimodal imaging in an alcohol-induced liver injury model. Quant Imaging Med Surg 2023; 13:6434-6445. [PMID: 37869294 PMCID: PMC10585574 DOI: 10.21037/qims-23-122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 07/26/2023] [Indexed: 10/24/2023]
Abstract
Background Visually evaluating liver function is a hot topic in hepatology research. There are few reliable and practical visualization methods for evaluating the liver function in vivo in experimental studies. In this study, we established a multimodal imaging approach for in vivo liver function evaluation and compared healthy mice with chronic alcoholic liver injury (cALI) model mice to explore its potential applicability in experimental research. Methods In vivo fluorescence imaging (IVFI) technology was utilized to visually represent the clearance of indocyanine green from the liver of both healthy mice and mice with cALI. The reserve liver function was evaluated via IVFI using the Cy5.5-galactosylated polylysine probe, which targets the asialoglycoprotein receptor of hepatocytes. Hepatic microcirculation was assessed through laser speckle perfusion imaging of hepatic blood perfusion. The liver microstructure was then investigated by in vivo confocal laser endomicroscopy imaging. Finally, hepatic asialoglycoprotein receptor expression, histology, and the levels of serum alanine aminotransferase and aspartate aminotransferase were measured. Results In vivo multimodal imaging results intuitively and dynamically showed that indocyanine green clearance [mean ± standard deviation (SD): 30.83±14.71, 95% confidence interval (CI): 20.3 to 41.35], the fluorescence signal intensity (mean ± SD: 1,217.92±117.63; 95% CI: 1,148.38 to 1,290.84) and fluorescence aggregation area (mean ± SD: 5,855.80±1,271.81; 95% CI: 5,051.57 to 6,653.88) of Cy5.5-galactosylated polylysine targeting the asialoglycoprotein receptor, and hepatic blood perfusion (mean ± SD: 1,494.86±299.33; 95% CI: 1,316.98 to 1,690.16) in model mice were significantly lower than those in healthy mice (all P<0.001). Compared to healthy mice, the model mice exhibited a significant decline in liver asialoglycoprotein receptor expression (mean ± SD: 219.03±16.34; 95% CI: 208.97 to 230.69; P<0.001), increased serum alanine aminotransferase (mean ± SD: 149.70±47.89 U/L; 95% CI: 81.75 to 128.89; P=0.01) and aspartate aminotransferase levels (mean ± SD: 106.30±36.13 U/L; 95% CI: 122.01 to 180.17; P=0.021), hepatocyte swelling and deformation, disappearance of the hepatic cord structure, partial necrosis, and disintegration of hepatocytes. The imaging features of fluorescence signals in liver regions, hepatic blood perfusion and microstructure were biologically related to hepatic asialoglycoprotein receptor expression, serum indices of liver function, and histopathology in model mice. Conclusions Utilizing in vivo multimodal imaging technology to assess liver function is a viable approach for experimental research, providing dynamic and intuitive visual evaluations in a rapid manner.
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Affiliation(s)
- Xiao-Jing Song
- Department of Biomedical Engineering, Institute of Acupuncture & Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shu-You Wang
- Department of Biomedical Engineering, Institute of Acupuncture & Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shu-Yong Jia
- Department of Biomedical Engineering, Institute of Acupuncture & Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guang-Jun Wang
- Department of Biomedical Engineering, Institute of Acupuncture & Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei-Bo Zhang
- Department of Biomedical Engineering, Institute of Acupuncture & Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
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Karseeva E, Kolokolnikov I, Medvedeva E, Savchenko E. Joint Methodology Based on Optical Densitometry and Dynamic Light Scattering for Liver Function Assessment. Diagnostics (Basel) 2023; 13:diagnostics13071269. [PMID: 37046487 PMCID: PMC10092963 DOI: 10.3390/diagnostics13071269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/12/2023] [Accepted: 03/13/2023] [Indexed: 03/30/2023] Open
Abstract
A pressing health problem, both in clinical and socio-economic terms, is the increase in the number of patients with liver damage caused by viral diseases (hepatitis), cancer, toxicological damage, or metabolic disorders. Liver function assessment is a complex task, for which various existing diagnostic methods are used. Unfortunately, they all have several limitations which frequently make prompt and accurate diagnosis impossible. The high level of disability and mortality caused by liver diseases makes the development of new liver diagnostic methods very urgent. In this paper, we describe a new joint methodology for studying liver function based on optical densitometry and dynamic light scattering. This will help to diagnose and predict the dynamics of liver function during treatment with greater efficiency, due to including in consideration the individual characteristics of the cardiovascular system and tissue metabolism. In this paper, we present a laboratory model of a combined sensor for optical densitometry and dynamic light scattering. We also developed special software for controlling the sensor and processing the recorded data. Modeling experiments and physical medical studies were carried out to adjust and calibrate the sensor and software. We also assessed the sensor resolution when registering the concentration of dye in the human body and the minimum measured flow rate.
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Affiliation(s)
- Elina Karseeva
- Higher School of Applied Physics and Space Technologies, Institute of Electronics and Telecommunications, Peter the Great St. Petersburg Polytechnic University, Saint Petersburg 195251, Russia
- Correspondence: (E.K.); (I.K.); (E.M.)
| | - Ilya Kolokolnikov
- Higher School of Applied Physics and Space Technologies, Institute of Electronics and Telecommunications, Peter the Great St. Petersburg Polytechnic University, Saint Petersburg 195251, Russia
- Correspondence: (E.K.); (I.K.); (E.M.)
| | - Ekaterina Medvedeva
- Higher School of Applied Physics and Space Technologies, Institute of Electronics and Telecommunications, Peter the Great St. Petersburg Polytechnic University, Saint Petersburg 195251, Russia
- Correspondence: (E.K.); (I.K.); (E.M.)
| | - Elena Savchenko
- Computer Information Systems Department, International University of Kyrgyzstan, Bishkek 720010, Kyrgyzstan
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Tustumi F, Coelho FF, Herman P. Novel preoperative strategies to improve hepatocellular carcinoma resectability. Hepatobiliary Surg Nutr 2023; 12:140-141. [PMID: 36860257 PMCID: PMC9944542 DOI: 10.21037/hbsn-22-384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 11/01/2022] [Indexed: 01/18/2023]
Affiliation(s)
- Francisco Tustumi
- Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil;,Department of Surgery, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Paulo Herman
- Department of Gastroenterology, Universidade de São Paulo, São Paulo, Brazil
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Mukund A, Choudhury SP, Tripathy TP, Ananthashayana VH, Jagdish RK, Arora V, Singh SP, Mishra AK, Sarin SK. Influence of shunt occlusion on liver volume and functions in hyperammonemic cirrhosis patients having large porto-systemic shunts: a randomized control trial. Hepatol Int 2023; 17:150-158. [PMID: 36094625 DOI: 10.1007/s12072-022-10418-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Accepted: 08/24/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS Spontaneous-portosystemic-shunts (SPSS) in cirrhosis deprive the liver of nutrient-rich portal blood and contribute to recurrent hepatic encephalopathy (HE). We evaluated the effects of shunt occlusion and redirecting portal blood to liver on its volume and functions. METHODS Cirrhosis patients presenting with recurrent HE and having SPSS were randomized to receive standard medical treatment (SMT) or shunt occlusion (SO). The later was performed by plug-assisted or balloon-occluded retrograde transvenous obliteration. The primary endpoint was change in liver volume after a minimum follow-up of 3 months. Secondary objectives included clinical course, liver disease severity indices, arterial ammonia levels and bone density. RESULTS Of 40 enrolled patients, 4 in SMT and 2 in SO group were lost to follow-up. The SO was complete in 17 and partial in one, achieving non-recurrence of HE in 17 (94.4%). In these patients, the mean liver volume increased (baseline 1040 ± 335 ml to 1132 ± 322 ml, 8.8% increase, p < 0.001) and was observed in 16/18 (88.89%) patients. In the SMT group, the liver volume decreased (baseline 988 ± 270 ml to 904 ± 226 ml, 8.6% reduction, p = 0.009) during the same period. Serum albumin increased in SO group (2.92 ± 0.40 g/dl to 3.30 ± 0.49 g/dl, p = 0.006) but reduced in SMT group (2.89 ± 0.43 g/dl to 2.59 ± 0.65 g/dl, p = 0.047). After SO, the patients showed a reduction in serum-ammonia levels (181.06 ± 86.21 to 107.28 ± 44.53 μ/dl, p = 0.001) and an improvement in MELD-Na and bone density compared to SMT group. There were no major adverse events following shunt occlusion. CONCLUSION Occlusion of large SPSS results in improving the volume and synthetic functions of the liver by restoring hepato-petal portal flow besides reducing serum-ammonia level and recurrence of HE. CLINICALTRIALS gov number, NCT03293459.
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Affiliation(s)
- Amar Mukund
- Department of Intervention Radiology, ILBS, New Delhi, India
| | - Shakti Prasad Choudhury
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India
| | | | | | - Rakesh Kumar Jagdish
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India
| | - Vinod Arora
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India
| | - Satender Pal Singh
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India
| | - Ajay Kumar Mishra
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India
| | - Shiv Kumar Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, ILBS, New Delhi, 110070, India.
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Blank V, Heni M, Karlas T. Quantification of Portal Vein Vascularization Using an Automated Post-Processing Video Analysis Tool. Ultrasound Int Open 2023; 9:E2-E10. [PMID: 36950090 PMCID: PMC10027440 DOI: 10.1055/a-1999-7818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 12/03/2022] [Indexed: 03/22/2023] Open
Abstract
Purpose Blood flow dynamics represent a diagnostic criterion for many diseases. However, no established reference standard is available. In clinical practice, ultrasound pulsed-wave Doppler (PW-Doppler) is frequently used to assess visceral blood flow, despite its well-known limitations. A quantitative analysis of conventional color Doppler patterns can be performed using an innovative ultrasound-based algorithm (pixel flow analysis, PFA). This tool already shows promising results in obstetrics, but the technique has not yet been evaluated for portal venous blood flow assessment. Methods This prospective exploratory research study evaluated the applicability of PFA in the portal venous system. Measurements of portal venous flow using PFA and PW-Doppler were compared in healthy volunteers (n=20) and in patients with hepatic steatosis (n=10) and liver cirrhosis (n=10). Results In healthy volunteers (60% female, mean age 23 years, BMI 21.5 kg/m 2 [20.4-23.8]), PFA and PW-Doppler showed a strong positive correlation in fasting conditions (r=0.69; 95% CI 0.36-0.87), recording a median blood flow of 834 ml/min (624-1066) and 718 ml/min (620-811), respectively. PFA was also applicable in patients with chronic liver diseases (55% female, age 65 years (55-72); BMI 27.8 kg/m 2 (25.4-30.8)), but the correlation between PFA and PW-Doppler was poor (r=- 0.09) in the subgroup with steatosis. A better correlation (r=0.61) was observed in patients with liver cirrhosis. Conclusion PFA and PW-Doppler assessment of portal venous vascularization showed high agreement in healthy volunteers and patients with liver cirrhosis. Therefore, PFA represents a possible alternative to conventional PW-Doppler sonography for visceral blood flow diagnostics and merits further evaluation.
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Affiliation(s)
- Valentin Blank
- Division of Gastroenterology, Department of Medicine II, University Hospital Leipzig, Leipzig, Germany
- Department of Gastroenterology and Division of Interdisciplinary Ultrasound, University Hospital Halle, Halle (Saale), Germany
| | - Maria Heni
- Division of Gastroenterology, Department of Medicine II, University Hospital Leipzig, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, University Hospital Leipzig, Leipzig, Germany
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Tadimalla S, Wang W, Haworth A. Role of Functional MRI in Liver SBRT: Current Use and Future Directions. Cancers (Basel) 2022; 14:cancers14235860. [PMID: 36497342 PMCID: PMC9739660 DOI: 10.3390/cancers14235860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022] Open
Abstract
Stereotactic body radiation therapy (SBRT) is an emerging treatment for liver cancers whereby large doses of radiation can be delivered precisely to target lesions in 3-5 fractions. The target dose is limited by the dose that can be safely delivered to the non-tumour liver, which depends on the baseline liver functional reserve. Current liver SBRT guidelines assume uniform liver function in the non-tumour liver. However, the assumption of uniform liver function is false in liver disease due to the presence of cirrhosis, damage due to previous chemo- or ablative therapies or irradiation, and fatty liver disease. Anatomical information from magnetic resonance imaging (MRI) is increasingly being used for SBRT planning. While its current use is limited to the identification of target location and size, functional MRI techniques also offer the ability to quantify and spatially map liver tissue microstructure and function. This review summarises and discusses the advantages offered by functional MRI methods for SBRT treatment planning and the potential for adaptive SBRT workflows.
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Affiliation(s)
- Sirisha Tadimalla
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Camperdown, NSW 2006, Australia
- Correspondence:
| | - Wei Wang
- Crown Princess Mary Cancer Centre, Sydney West Radiation Oncology Network, Western Sydney Local Health District, Sydney, NSW 2145, Australia
| | - Annette Haworth
- Institute of Medical Physics, School of Physics, Faculty of Science, The University of Sydney, Camperdown, NSW 2006, Australia
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Song XJ, Wang SY, Jia SY, Wang GJ, Zhang WB. Effects of electroacupuncture on liver function in mice with chronic alcoholic liver injury: visual display by in vivo fluorescence imaging. Acupunct Med 2022:9645284221125248. [PMID: 36263700 DOI: 10.1177/09645284221125248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Acupuncture can improve the symptoms of alcohol-induced bodily injury and has been accepted by the World Health Organization. In this study, in vivo fluorescence imaging (IVFI) was applied to display and evaluate the effect of electroacupuncture (EA) on liver function (LF) in mice with chronic alcoholic liver injury (cALI). METHODS IVFI of the Cy5.5-galactosylated polylysine (Cy5.5-GP) probe targeting the liver asialoglycoprotein receptor (ASGPR) and liver indocyanine green (ICG) clearance was performed to visually evaluate the effect of EA at ST36 and BL18 on liver reserve function and hepatic metabolism in mice with cALI. In addition, changes in ASGPR expression, serum indexes of LF, and hepatic morphology were observed. RESULTS After EA at ST36 and BL18, the ASGPR-targeted fluorescence signals (FS) in the liver increased significantly in cALI mice (p < 0.05) and exhibited relationships with liver ASGPR expression, liver ICG clearance, liver histology, and serum marker levels of LF in cALI mice undergoing EA intervention. CONCLUSIONS As displayed by IVFI, EA at ST36 and BL18 appears to improve liver reserve function and inhibit the development of liver injury in mice with cALI. EA may have potential as a treatment strategy to protect against ALI.
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Affiliation(s)
- Xiao-Jing Song
- Department of Biomedical Engineering, Institute of Acupuncture & Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shu-You Wang
- Department of Biomedical Engineering, Institute of Acupuncture & Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Shu-Yong Jia
- Department of Biomedical Engineering, Institute of Acupuncture & Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guang-Jun Wang
- Department of Biomedical Engineering, Institute of Acupuncture & Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wei-Bo Zhang
- Department of Biomedical Engineering, Institute of Acupuncture & Moxibustion, China Academy of Chinese Medical Sciences, Beijing, China
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Lee JH, Im SS. Function of gaseous hydrogen sulfide in liver fibrosis. BMB Rep 2022. [PMID: 36195563 PMCID: PMC9623240 DOI: 10.5483/bmbrep.2022.55.10.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Over the past few years, hydrogen sulfide (H2S) has been shown to exert several biological functions in mammalian. The endogenous production of H2S is mainly mediated by cystathione β-synthase, cystathione γ-lyase and 3-mercaptopyruvate sulfur transferase. These enzymes are broadly expressed in liver tissue and regulates liver function by working on a variety of molecular targets. As an important regulator of liver function, H2S is critically involved in the pathogenesis of various liver diseases, such as non-alcoholic steatohepatitis and liver cancer. Targeting H2S-generating enzymes may be a therapeutic strategy for controlling liver diseases. This review described the function of H2S in liver disease and summarized recent characterized role of H2S in several cellular process of the liver.
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Affiliation(s)
- Jae-Ho Lee
- Department of Physiology, Keimyung University School of Medicine, Daegu 42601, Korea
| | - Seung-Soon Im
- Department of Physiology, Keimyung University School of Medicine, Daegu 42601, Korea
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Shigefuku R, Takahashi H, Watanabe T, Hattori N, Ikeda H, Matsunaga K, Ehira T, Suzuki T, Matsumoto N, Okuse C, Iwasa M, Nakagawa H, Itoh F, Suzuki M. Effects of endoscopic injection sclerotherapy for esophagogastric varices on portal hemodynamics and liver function. BMC Gastroenterol 2022; 22:350. [PMID: 35864442 PMCID: PMC9306194 DOI: 10.1186/s12876-022-02422-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 07/06/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To identify patients suitable for endoscopic injection sclerotherapy (EIS) by evaluating their portal hemodynamics and liver function. METHODS We selected 58 patients with esophagogastric varices (EGV) and liver cirrhosis (LC) related to either hepatitis C virus (C) (n = 19), hepatitis B virus (n = 2), alcohol (AL) (n = 20), C + AL (n = 6), non-alcoholic steatohepatitis (n = 6), others (n = 3), or non-LC (n = 2). All patients underwent EIS. We measured their portal venous tissue blood flow (PVTBF) and hepatic arterial tissue blood flow (HATBF) using xenon computed tomography before and after EIS. We classified them into increased group and decreased group according to the PVTBF to identify the predictors that contribute to PVTBF increase post-EIS. RESULTS Low value of indocyanine green retention at 15 min (ICG-R15), the absence of paraesophageal veins, and low baseline PVTBF/HATBF (P/A) ratio predicted increased PVTBF in the multivariate logistic analysis (odds ratio (OR) 10.46, p = 0.0391; OR 12.45, p = 0.0088; OR 13.57, p = 0.0073). The protein synthetic ability improved 1 year post-EIS in increased group. Cox proportional hazards regression identified alcohol drinking (hazard ratio; 3.67, p = 0.0261) as an independent predictor of EGV recurrence. CONCLUSIONS Patients with low ICG-R15, low P/A ratio, and the absence of paraesophageal veins were probable predictors of PVTBF improvement post-EIS. In addition, the improvement of hepatic hemodynamics likely enhanced liver function following EIS.
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Affiliation(s)
- Ryuta Shigefuku
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan. .,Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, St. Marianna University, Kawasaki, 216-8511, Japan.
| | - Hideaki Takahashi
- Department of Gastroenterology and Hepatology, Yokohama City Seibu Hospital, St. Marianna University, Yokohama, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, St. Marianna University, Kawasaki, 216-8511, Japan
| | - Tsunamasa Watanabe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, St. Marianna University, Kawasaki, 216-8511, Japan
| | - Nobuhiro Hattori
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, St. Marianna University, Kawasaki, 216-8511, Japan
| | - Hiroki Ikeda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, St. Marianna University, Kawasaki, 216-8511, Japan
| | - Kotaro Matsunaga
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, St. Marianna University, Kawasaki, 216-8511, Japan
| | - Takuya Ehira
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, St. Marianna University, Kawasaki, 216-8511, Japan
| | - Tatsuya Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, St. Marianna University, Kawasaki, 216-8511, Japan
| | - Nobuyuki Matsumoto
- Department of Gastroenterology and Hepatology, Yokohama City Seibu Hospital, St. Marianna University, Yokohama, Japan
| | - Chiaki Okuse
- Division of General Internal Medicine, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
| | - Motoh Iwasa
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Hayato Nakagawa
- Department of Gastroenterology and Hepatology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
| | - Fumio Itoh
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, St. Marianna University, Kawasaki, 216-8511, Japan
| | - Michihiro Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, School of Medicine, St. Marianna University, Kawasaki, 216-8511, Japan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kawasaki, Japan
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Yu KM, Yang P, Huang TY, Shen TYS, Lau JYN, Hu OYP. A novel galactose electrochemical biosensor intended for point-of-care measurement of quantitative liver function using galactose single-point test. Anal Bioanal Chem 2022; 414:4067-4077. [PMID: 35524003 DOI: 10.1007/s00216-022-04051-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
Liver disease has emerged as a healthcare burden because of high hospitalization rates attributed both to steatohepatitis and to severe hepatic toxicity associated with changes of drug exposure. Early detection of hepatic insufficiency is critical to preventing long-term liver damage. The galactose single-point test is recommended by the US FDA as a sensitive means to quantify liver function, yet the conventional method used for quantitation of circulating galactose still relies on the standard colorimetric method, requiring time-consuming and labor-intensive processes, and is confined to the medical laboratory, thus limiting prevalence. To facilitate time- and cost-effective disease management particularly during a pandemic, a pocket-sized rapid quantitative device consisting of a biosensor and electrochemical detection has been developed. An in vitro validation study demonstrated that the coefficient of variation was less than 15% and deviations were between -4 and 14% in the range of 100-1500 μg/mL. The device presented good linear fit (correlation coefficient, r = 0.9750) over the range of 150-1150 µg/mL. Moreover, the device was found to be free from interference of common endogenous and exogenous substances, and deviated hematocrit, enabling a direct measurement of galactose in the whole blood without sample pre-treatment steps. The clinical validation comprising 118 subjects showed high concordance (r = 0.953) between the device and the conventional colorimetric assay. Thus, this novel miniaturized device is reliable and robust for routine assessment of quantitative liver function intended for follow-up of hepatectomy, drug dose adjustment, and screening for galactosemia, allowing timely and cost-effective clinical management of patients.
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Affiliation(s)
- Kuo-Ming Yu
- Avalon HepaPOC Limited, Hong Kong, Hong Kong
| | - Ping Yang
- Sinew Pharma Inc., Taipei, Taiwan, Republic of China
| | - Tien-Yu Huang
- Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | | | - Johnson Yiu-Nam Lau
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hong Kong, Hong Kong
| | - Oliver Yoa-Pu Hu
- Taipei Medical University, Taipei, Taiwan, Republic of China. .,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan, Republic of China. .,School of Pharmacy, National Defense Medical Center, Taipei, Taiwan, Republic of China.
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Wu J, Xie F, Ji H, Zhang Y, Luo Y, Xia L, Lu T, He K, Sha M, Zheng Z, Yong J, Li X, Zhao D, Yang Y, Xia Q, Xue F. A Clinical-Radiomic Model for Predicting Indocyanine Green Retention Rate at 15 Min in Patients With Hepatocellular Carcinoma. Front Surg 2022; 9:857838. [PMID: 35402498 PMCID: PMC8987271 DOI: 10.3389/fsurg.2022.857838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose: The indocyanine green retention rate at 15 min (ICG-R15) is of great importance in the accurate assessment of hepatic functional reserve for safe hepatic resection. To assist clinicians to evaluate hepatic functional reserve in medical institutions that lack expensive equipment, we aimed to explore a novel approach to predict ICG-R15 based on CT images and clinical data in patients with hepatocellular carcinoma (HCC). Methods In this retrospective study, 350 eligible patients were enrolled and randomly assigned to the training cohort (245 patients) and test cohort (105 patients). Radiomics features and clinical factors were analyzed to pick out the key variables, and based on which, we developed the random forest regression, extreme gradient boosting regression (XGBR), and artificial neural network models for predicting ICG-R15, respectively. Pearson's correlation coefficient (R) was adopted to evaluate the performance of the models. Results We extracted 660 CT image features in total from each patient. Fourteen variables significantly associated with ICG-R15 were picked out for model development. Compared to the other two models, the XGBR achieved the best performance in predicting ICG-R15, with a mean difference of 1.59% (median, 1.53%) and an R-value of 0.90. Delong test result showed no significant difference in the area under the receiver operating characteristic (AUROCs) for predicting post hepatectomy liver failure between actual and estimated ICG-R15. Conclusion The proposed approach that incorporates the optimal radiomics features and clinical factors can allow for individualized prediction of ICG-R15 value of patients with HCC, regardless of the specific equipment and detection reagent (NO. ChiCTR2100053042; URL, http://www.chictr.org.cn).
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Affiliation(s)
- Ji Wu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Xie
- Department of Instrument Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Hao Ji
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yiyang Zhang
- Department of Instrument Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
| | - Yi Luo
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lei Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tianfei Lu
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kang He
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Meng Sha
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhigang Zheng
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Junekong Yong
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xinming Li
- Department of Medical Imaging, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Di Zhao
- Institute of Computing Technology, Chinese Academy of Sciences, Beijing, China
| | - Yuting Yang
- Department of Instrument Science and Engineering, School of Electronic Information and Electrical Engineering, Shanghai Jiao Tong University, Shanghai, China
- *Correspondence: Yuting Yang
| | - Qiang Xia
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Feng Xue
- Department of Liver Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Feng Xue
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Shu X, Sun H, Yang X, Jia Y, Xu P, Cao H, Zhang K. Correlation of effective hepatic blood flow with liver pathology in patients with hepatitis B virus. LIVER RESEARCH 2021. [DOI: 10.1016/j.livres.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Christ B, Collatz M, Dahmen U, Herrmann KH, Höpfl S, König M, Lambers L, Marz M, Meyer D, Radde N, Reichenbach JR, Ricken T, Tautenhahn HM. Hepatectomy-Induced Alterations in Hepatic Perfusion and Function - Toward Multi-Scale Computational Modeling for a Better Prediction of Post-hepatectomy Liver Function. Front Physiol 2021; 12:733868. [PMID: 34867441 PMCID: PMC8637208 DOI: 10.3389/fphys.2021.733868] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/26/2021] [Indexed: 01/17/2023] Open
Abstract
Liver resection causes marked perfusion alterations in the liver remnant both on the organ scale (vascular anatomy) and on the microscale (sinusoidal blood flow on tissue level). These changes in perfusion affect hepatic functions via direct alterations in blood supply and drainage, followed by indirect changes of biomechanical tissue properties and cellular function. Changes in blood flow impose compression, tension and shear forces on the liver tissue. These forces are perceived by mechanosensors on parenchymal and non-parenchymal cells of the liver and regulate cell-cell and cell-matrix interactions as well as cellular signaling and metabolism. These interactions are key players in tissue growth and remodeling, a prerequisite to restore tissue function after PHx. Their dysregulation is associated with metabolic impairment of the liver eventually leading to liver failure, a serious post-hepatectomy complication with high morbidity and mortality. Though certain links are known, the overall functional change after liver surgery is not understood due to complex feedback loops, non-linearities, spatial heterogeneities and different time-scales of events. Computational modeling is a unique approach to gain a better understanding of complex biomedical systems. This approach allows (i) integration of heterogeneous data and knowledge on multiple scales into a consistent view of how perfusion is related to hepatic function; (ii) testing and generating hypotheses based on predictive models, which must be validated experimentally and clinically. In the long term, computational modeling will (iii) support surgical planning by predicting surgery-induced perfusion perturbations and their functional (metabolic) consequences; and thereby (iv) allow minimizing surgical risks for the individual patient. Here, we review the alterations of hepatic perfusion, biomechanical properties and function associated with hepatectomy. Specifically, we provide an overview over the clinical problem, preoperative diagnostics, functional imaging approaches, experimental approaches in animal models, mechanoperception in the liver and impact on cellular metabolism, omics approaches with a focus on transcriptomics, data integration and uncertainty analysis, and computational modeling on multiple scales. Finally, we provide a perspective on how multi-scale computational models, which couple perfusion changes to hepatic function, could become part of clinical workflows to predict and optimize patient outcome after complex liver surgery.
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Affiliation(s)
- Bruno Christ
- Cell Transplantation/Molecular Hepatology Lab, Department of Visceral, Transplant, Thoracic and Vascular Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Maximilian Collatz
- RNA Bioinformatics and High-Throughput Analysis, Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany
- Optisch-Molekulare Diagnostik und Systemtechnologié, Leibniz Institute of Photonic Technology (IPHT), Jena, Germany
- InfectoGnostics Research Campus Jena, Jena, Germany
| | - Uta Dahmen
- Experimental Transplantation Surgery, Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
| | - Karl-Heinz Herrmann
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Sebastian Höpfl
- Faculty of Engineering Design, Production Engineering and Automotive Engineering, Institute for Systems Theory and Automatic Control, University of Stuttgart, Stuttgart, Germany
| | - Matthias König
- Systems Medicine of the Liver Lab, Institute for Theoretical Biology, Humboldt-University Berlin, Berlin, Germany
| | - Lena Lambers
- Faculty of Aerospace Engineering and Geodesy, Institute of Mechanics, Structural Analysis and Dynamics, University of Stuttgart, Stuttgart, Germany
| | - Manja Marz
- RNA Bioinformatics and High-Throughput Analysis, Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany
| | - Daria Meyer
- RNA Bioinformatics and High-Throughput Analysis, Faculty of Mathematics and Computer Science, Friedrich Schiller University Jena, Jena, Germany
| | - Nicole Radde
- Faculty of Engineering Design, Production Engineering and Automotive Engineering, Institute for Systems Theory and Automatic Control, University of Stuttgart, Stuttgart, Germany
| | - Jürgen R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Jena, Germany
| | - Tim Ricken
- Faculty of Aerospace Engineering and Geodesy, Institute of Mechanics, Structural Analysis and Dynamics, University of Stuttgart, Stuttgart, Germany
| | - Hans-Michael Tautenhahn
- Department of General, Visceral and Vascular Surgery, Jena University Hospital, Jena, Germany
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Yang S, Han D, Wang L, Gong L, Xiang C. Reconstruction of the middle hepatic vein using a vein graft from the resected portion of the liver. Surg Case Rep 2020; 6:277. [PMID: 33130994 PMCID: PMC7604275 DOI: 10.1186/s40792-020-01057-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 10/22/2020] [Indexed: 12/12/2022] Open
Abstract
Background The middle hepatic veins are often infiltrated by intrahepatic cholangiocarcinoma. Reconstruction of the hepatic vein plays a critical role in preserving more of the residual liver volume and reducing the risk of postoperative liver failure in extreme hepatectomy. We here report a novel way to reconstruct middle hepatic vein by using vessel grafts from wasted liver. Case presentation Case 1: A 64-year-old man was diagnosed with intrahepatic cholangiocarcinoma. The bifurcation and left branch of the portal vein were stenosed, and the root of the middle hepatic vein was infiltrated by the tumor. An extended left hepatectomy was performed, the portal vein was resected and reconstructed, and the middle hepatic vein was reconstructed by anastomosing the proximal left hepatic vein to the distal middle hepatic vein. Case 2: A 69-year-old woman was diagnosed with intrahepatic cholangiocarcinoma. The tumor was located in the left lobe of the liver and the left and middle hepatic veins were infiltrated by the tumor. An extended left hepatectomy was performed, and the left portal vein was used as a vein graft to reconstruct the middle hepatic vein. Both of the two patients’ postoperative ultrasound showed vessel graft patency. Conclusion Using a vein graft from the resected portion of the liver to reconstruct the middle hepatic vein was a useful technique and showed good result.
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Affiliation(s)
- ShiWei Yang
- Department of Hepatobiliary Surgery, Beijing Tsinghua Changgung Hospital, Tiantongyuan, Changping, Beijing, China
| | - DongDong Han
- Department of Hepatobiliary Surgery, Beijing Tsinghua Changgung Hospital, Tiantongyuan, Changping, Beijing, China
| | - Liang Wang
- Department of Hepatobiliary Surgery, Beijing Tsinghua Changgung Hospital, Tiantongyuan, Changping, Beijing, China
| | - Lei Gong
- Department of Hepatobiliary Surgery, Beijing Tsinghua Changgung Hospital, Tiantongyuan, Changping, Beijing, China
| | - CanHong Xiang
- Department of Hepatobiliary Surgery, Beijing Tsinghua Changgung Hospital, Tiantongyuan, Changping, Beijing, China.
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Plumb JO, Otto JM, Kumar SB, Wright M, Schmidt W, Grocott MP, Montgomery HE. Application of the optimized carbon monoxide rebreathing method for the measurement of total haemoglobin mass in chronic liver disease. Physiol Rep 2020; 8:e14402. [PMID: 32207243 PMCID: PMC7090373 DOI: 10.14814/phy2.14402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/20/2020] [Accepted: 02/23/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Anemia is common in liver cirrhosis. This generally infers a fall in total hemoglobin mass (tHb-mass). However, hemoglobin concentration ([Hb]) may fall due to an expansion in plasma volume (PV). The "optimized carbon monoxide rebreathing method" (oCOR) measures tHb-mass directly and PV (indirectly using hematocrit). It relies upon carboxyhemoglobin (COHb) distribution throughout the entire circulation. In healthy subjects, such distribution is complete within 6-8 min. Given the altered circulatory dynamics in cirrhosis, we sought in this pilot study, to assess whether this was true in cirrhosis. The primary aim was to ascertain if the standard timings for the oCOR were applicable to patients with chronic liver disease and cirrhosis. The secondary aim was to explore the applicability of standard CO dosing methodologies to this patient population. METHODS Sixteen patients with chronic liver parenchymal disease were studied. However, tHb-mass was determined using the standard oCOR technique before elective paracentesis. Three subjects had an inadequate COHb% rise. In the remaining 13 (11 male), mean ± standard deviation (SD) age was 52 ± 13.8 years, body mass 79.1 ± 11.4 kg, height 175 ± 6.8 cm. To these, mean ± SD dose of carbon monoxide (CO) gas administered was 0.73 ± 0.13 ml/kg COHb values at baseline, 6 and 8 min (and "7-min value") were compared to those at 10, 12, 15 and 20 min after CO rebreathing. RESULTS The "7-min value" for median COHb% (IQR) of 6.30% (6.21%-7.47%) did not differ significantly from those at subsequent time points (8 min: 6.30% (6.21%-7.47%), 10 min: 6.33% (6.00%-7.50%), 12 min: 6.33% (5.90%-7.40%), 15 min: 6.37% (5.80%-7.33%), 20 min: 6.27% (5.70%-7.20%)). Mean difference in calculated tHb-mass between minute 7 and minute 20 was only 4.1 g, or 0.6%, p = .68. No subjects reported any adverse effects. CONCLUSIONS The oCOR method can be safely used to measure tHb-mass in patients with chronic liver disease and ascites, without adjustment of blood sample timings. Further work might refine and validate appropriate dosing regimens.
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Affiliation(s)
- James O.M. Plumb
- Respiratory and Critical Care Research AreaNIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust / University of SouthamptonSouthamptonUK
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- Anaesthesia, Perioperative Medicine and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUK
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUK
| | - James M. Otto
- Respiratory and Critical Care Research AreaNIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust / University of SouthamptonSouthamptonUK
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- Anaesthesia, Perioperative Medicine and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUK
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUK
- University of Southampton Medical SchoolSouthamptonUK
| | - Shriya B. Kumar
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- University of Southampton Medical SchoolSouthamptonUK
| | - Mark Wright
- Department of HepatologyUniversity Hospital SouthamptonSouthamptonUK
| | - Walter Schmidt
- Department of Sports Medicine/Sports PhysiologyUniversity of BayreuthBayreuthGermany
| | - Michael P.W. Grocott
- Respiratory and Critical Care Research AreaNIHR Biomedical Research CentreUniversity Hospital Southampton NHS Foundation Trust / University of SouthamptonSouthamptonUK
- Centre for Human Integrative PhysiologyFaculty of MedicineUniversity of SouthamptonSouthamptonUK
- Anaesthesia, Perioperative Medicine and Critical Care Research UnitUniversity Hospital Southampton NHSFTSouthamptonUK
- Shackleton Department of AnaesthesiaUniversity Hospital Southampton NHSFTSouthamptonUK
- Department of AnesthesiologyDuke University School of MedicineDurhamNCUSA
| | - Hugh E. Montgomery
- Centre for Human Health and Performance/ Institute of Sport, Exercise and HealthUniversity College London, and NIHR University College London Hospitals Biomedical Research CentreLondonUK
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Assessing Liver Hemodynamics in Children With Cholestatic Cirrhosis by Use of Dual-Energy Spectral CT. AJR Am J Roentgenol 2020; 214:665-670. [PMID: 31967500 DOI: 10.2214/ajr.19.22035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The purpose of this study was to evaluate the value of dual-energy CT (DECT) in assessing liver hemodynamics in children with cholestatic cirrhosis. MATERIALS AND METHODS. The cases of 60 children with cholestatic cirrhosis (study group) and 15 children with inherited metabolic diseases but normal liver function (control group) were retrospectively evaluated. Enhanced CT scans were obtained in spectral imaging mode. Iodine concentration (IC) of hepatic parenchyma in the arterial phase (ICA) and portal venous phase (ICP) was measured on iodine-water material decomposition images. The hepatic arterial iodine fraction (AIF) was calculated as: AIF = ICA / ICP. The ICA, ICP, and AIF of children in the control and study groups were analyzed by one-way ANOVA and post hoc test with Bonferroni correction. The radiation dose was recorded. RESULTS. There were differences in ICA and AIF between the control and study groups. The values in patients in the Child-Pugh class C group were the highest and those in the control group the lowest (p < 0.05). Statistically significant differences in ICP were not found (p > 0.05). Specifically, the multiple comparison results indicated that there were differences in both ICA and AIF in most of the groups (p < 0.05). The volume CT dose index value for all patients was the same at 10.14 mGy for each enhanced phase, and the total dose-length product varied between 402.68 and 679.18 mGy-cm. CONCLUSION. ICA and AIF obtained at dual-energy CT can be used as semiquantitative indicators to evaluate the liver hemodynamics of children with cholestatic cirrhosis.
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Amodio P. Current Diagnosis and Classification of Hepatic Encephalopathy. J Clin Exp Hepatol 2018; 8:432-437. [PMID: 30564001 PMCID: PMC6286442 DOI: 10.1016/j.jceh.2018.07.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/06/2018] [Indexed: 12/12/2022] Open
Abstract
Hepatic encephalopathy is a brain dysfunction caused by liver insufficiency and/or portal-systemic shunt; it manifests as a wide spectrum of neurological or psychiatric abnormalities ranging from subclinical alterations to coma. It should be differentiated from other neurological/psychiatric disorders that can occur in patients with liver disease. Its classification needs to take into account the underlying condition, severity, course, precipitating factors, and-possibly-sensitivity to ammonia-lowering agents.
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Affiliation(s)
- Piero Amodio
- Address for correspondence: Piero Amodio, MD, FRCP, Department of Medicine –DIMED- University of Padova, via Giustiniani, 2, 35128 Padova, Italy. Fax: +39 049 7960903.
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Changes in liver perfusion and function before and after percutaneous occlusion of spontaneous portosystemic shunt. Jpn J Radiol 2017; 35:366-372. [PMID: 28501975 DOI: 10.1007/s11604-017-0647-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 04/30/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE To evaluate changes in liver perfusion after occlusion of spontaneous portosystemic shunt and to analyze mechanisms of liver profile improvement. MATERIALS AND METHODS Liver function changes and portal venous and hepatic arterial blood flow were evaluated using perfusion CT before and after shunt occlusion in 23 patients who underwent percutaneous occlusion of spontaneous portosystemic shunt because of gastric varices (n = 15) or hepatic encephalopathy (n = 8). RESULTS Portal venous blood flow was significantly higher at 1 week (278.7 ml/min, 92.7-636.7, p = 0.012), 1 month (290.0 ml/min, 110.1-560.1, p < 0.001) and 3 months (299.6 ml/min, 156.7-618.5, p = 0.033) after shunt occlusion than the baseline (220.9 ml/min, 49.5-566.7). Hepatic arterial liver blood flow became lower than the baseline (132.3 ml/min, 47.9-622.3) after shunt occlusion, but a significant decrease was observed only at 1 month later (107.9 ml/min, 45.8-263.6 p = 0.027). Serum albumin concentration became significantly higher than the baseline (3.4 mg/dl, 1.9-4.5) at 1 month (3.8 mg/dl, 2.3-4.3, p = 0.018) and 3 months (3.9 mg/dl, 2.6-4.3, p = 0.024) after shunt occlusion. CONCLUSION Shunt occlusion increases portal venous blood flow and decreases hepatic arterial blood flow, thereby improving the liver profile.
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Shigefuku R, Takahashi H, Nakano H, Watanabe T, Matsunaga K, Matsumoto N, Kato M, Morita R, Michikawa Y, Tamura T, Hiraishi T, Hattori N, Noguchi Y, Nakahara K, Ikeda H, Ishii T, Okuse C, Sase S, Itoh F, Suzuki M. Correlations of Hepatic Hemodynamics, Liver Function, and Fibrosis Markers in Nonalcoholic Fatty Liver Disease: Comparison with Chronic Hepatitis Related to Hepatitis C Virus. Int J Mol Sci 2016; 17:E1545. [PMID: 27649152 PMCID: PMC5037819 DOI: 10.3390/ijms17091545] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/01/2016] [Accepted: 09/08/2016] [Indexed: 02/07/2023] Open
Abstract
The progression of chronic liver disease differs by etiology. The aim of this study was to elucidate the difference in disease progression between chronic hepatitis C (CHC) and nonalcoholic fatty liver disease (NAFLD) by means of fibrosis markers, liver function, and hepatic tissue blood flow (TBF). Xenon computed tomography (Xe-CT) was performed in 139 patients with NAFLD and 152 patients with CHC (including liver cirrhosis (LC)). The cutoff values for fibrosis markers were compared between NAFLD and CHC, and correlations between hepatic TBF and liver function tests were examined at each fibrosis stage. The cutoff values for detection of the advanced fibrosis stage were lower in NAFLD than in CHC. Although portal venous TBF (PVTBF) correlated with liver function tests, PVTBF in initial LC caused by nonalcoholic steatohepatitis (NASH-LC) was significantly lower than that in hepatitis C virus (C-LC) (p = 0.014). Conversely, the liver function tests in NASH-LC were higher than those in C-LC (p < 0.05). It is important to recognize the difference between NAFLD and CHC. We concluded that changes in hepatic blood flow occurred during the earliest stage of hepatic fibrosis in patients with NAFLD; therefore, patients with NAFLD need to be followed carefully.
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Affiliation(s)
- Ryuta Shigefuku
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Hideaki Takahashi
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
- Division of Gastroenterology, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Kanagawa, Yokohama 241-0811, Japan.
| | - Hiroyasu Nakano
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Tsunamasa Watanabe
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Kotaro Matsunaga
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Nobuyuki Matsumoto
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Masaki Kato
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Ryo Morita
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Yousuke Michikawa
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Tomohiro Tamura
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
- Division of Gastroenterology, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Kanagawa, Yokohama 241-0811, Japan.
| | - Tetsuya Hiraishi
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Kawasaki 214-8525, Japan.
| | - Nobuhiro Hattori
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Yohei Noguchi
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
- Division of Gastroenterology, St. Marianna University School of Medicine, Yokohama City Seibu Hospital, Kanagawa, Yokohama 241-0811, Japan.
| | - Kazunari Nakahara
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Hiroki Ikeda
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Toshiya Ishii
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Kawasaki 214-8525, Japan.
| | - Chiaki Okuse
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Kawasaki 214-8525, Japan.
| | - Shigeru Sase
- Anzai Medical Company, Ltd., Tokyo 141-0033, Japan.
| | - Fumio Itoh
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
| | - Michihiro Suzuki
- Division of Gastroenterology and Hepatology, St. Marianna University School of Medicine, Kanagawa, Kawasaki 216-8511, Japan.
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kawasaki Municipal Tama Hospital, Kanagawa, Kawasaki 214-8525, Japan.
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Zhang D, Song XJ, Li SY, Wang SY, Chen BJ, Bai XD, Tang LM. Evaluation of liver function and electroacupuncture efficacy of animals with alcoholic liver injury by the novel imaging methods. Sci Rep 2016; 6:30119. [PMID: 27443832 PMCID: PMC4957079 DOI: 10.1038/srep30119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/29/2016] [Indexed: 12/12/2022] Open
Abstract
Imaging methods to evaluate hepatic microcirculation (HM) and liver function (LF) by directly monitoring overall liver tissue remain lacking. This study establish imaging methods for LF that combines Laser speckle perfusion imaging (LSPI) and in vivo optical imaging (IVOI) technologies to investigate changes of hepatic microcirculation and reserve function in the animals gavaged with 50% ethanol (15 ml/kg·bw) for a model of acute alcoholic liver injury (ALI), and for evaluation of electroacupuncture (EA) effect. The liver blood perfusion and indocyanine green (ICG) distribution were observe by LSPI and IVOI separately. After EA, the livers were collected to measure the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), thromboxane A (TXA2), prostacyclin (PGI2) and endothelin (ET). The acquisitions of newly established LSPI of liver and ICG in vivo fluorescence imaging (ICG-IVFI), combining the results of other indexes showed: hepatic microcirculation perfusion (HMP) significantly reduced, ICG metabolism reduced, and ALT/AST increased in animal model with acute ALI. EA can reverse these changes. The use of LSPI of liver and ICG-IVFI, which was novel imaging methods for LF established in this study, could display the LF characteristics of ALI and the EA efficacy.
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Affiliation(s)
- Dong Zhang
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Xiao-Jing Song
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Shun-Yue Li
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Shu-You Wang
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Bing-Jun Chen
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Xiao-Dong Bai
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Li-Mei Tang
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
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22
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Liao Y, Zou X, Wang C, Zhao X. Insect tea extract attenuates CCl 4-induced hepatic damage through its antioxidant capacities in ICR mice. Food Sci Biotechnol 2016; 25:581-587. [PMID: 30263309 DOI: 10.1007/s10068-016-0081-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 12/22/2015] [Accepted: 01/13/2016] [Indexed: 12/16/2022] Open
Abstract
The Insect tea extract (ITE) contained many polyphenols, the aim of the present study was to determine the preventive effects of ITE on CCl4-induced hepatic damage in mice. ITE treated mice could reduce hepatic injury compared to the control mice. The 200 mg/kg ITE increased TC, ALB, SOD, CAT, GSH-Px serum levels, and decreased ALT, AST, ALP, TG, BUN, NO, MDA levels compared to the control group. By histological observation, ITE reduced injury to hepatic cells, and these effects were close to that seen with the drug silymarin. The antioxidant related mRNA and protein expressions of Mn SOD, Gu/Zn SOD, CAT, and GSH-Px increased with ITE treatment in hepatic damage mice. ITE treated mice also showed higher IκB-α mRNA and protein expression, and lower NF-κB-p65, iNOS, COX-2 expressions than those of control mice. These results proved ITE has a prophylactic effect in protecting against hepatic injury through the antioxidant capacities.
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Affiliation(s)
- Yuanjiang Liao
- Department of Nephrology, The Ninth People's Hospital of Chongqing, Chongqing, 400700 China
| | - Xiaochuan Zou
- 2Department of Biological and Chemical Engineering, Chongqing University of Education, Chongqing, 400067 China.,3Chongqing Collaborative Innovation Center of Functional Food, Chongqing University of Education, Chongqing, 400067 China.,4Chongqing Engineering Technology Research Center for Functional Food, Chongqing University of Education, Chongqing, 400067 China.,5Chongqing Engineering Laboratory of Functional Food, Chongqing University of Education, Chongqing, 400067 China
| | - Cun Wang
- 2Department of Biological and Chemical Engineering, Chongqing University of Education, Chongqing, 400067 China.,3Chongqing Collaborative Innovation Center of Functional Food, Chongqing University of Education, Chongqing, 400067 China.,4Chongqing Engineering Technology Research Center for Functional Food, Chongqing University of Education, Chongqing, 400067 China.,5Chongqing Engineering Laboratory of Functional Food, Chongqing University of Education, Chongqing, 400067 China
| | - Xin Zhao
- 2Department of Biological and Chemical Engineering, Chongqing University of Education, Chongqing, 400067 China.,3Chongqing Collaborative Innovation Center of Functional Food, Chongqing University of Education, Chongqing, 400067 China.,4Chongqing Engineering Technology Research Center for Functional Food, Chongqing University of Education, Chongqing, 400067 China.,5Chongqing Engineering Laboratory of Functional Food, Chongqing University of Education, Chongqing, 400067 China
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23
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Zhu XS, Wang SS, Cheng Q, Ye CW, Huo F, Li P. Using ultrasonography to monitor liver blood flow for liver transplant from donors supported on extracorporeal membrane oxygenation. Liver Transpl 2016; 22:188-91. [PMID: 26334555 DOI: 10.1002/lt.24318] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/12/2015] [Accepted: 08/20/2015] [Indexed: 01/13/2023]
Abstract
Extracorporeal membrane oxygenation (ECMO) has been used to support brain-dead donors for liver procurement. This study investigated the potential role of ultrasonographic monitoring of hepatic perfusion as an aid to improve the viability of liver transplants obtained from brain-dead donors who are supported on ECMO. A total of 40 brain-dead patients maintained on ECMO served as the study population. Hepatic blood flow was monitored using ultrasonography, and perioperative optimal perfusion was maintained by calibrating ECMO. Liver function tests were performed to assess the viability of the graft. The hepatic arterial blood flow was well maintained with no significant changes observed before and after ECMO (206 ± 32 versus 241 ± 45 mL/minute; P = 0.06). Similarly, the portal venous blood flow was also maintained throughout (451 ± 65 versus 482 ± 77 mL/minute; P = 0.09). No significant change in levels of total bilirubin, alanine transaminase, and lactic acid were reported during ECMO (P = 0.17, P = 0.08, and P = 0.09, respectively). Before the liver is procured, ultrasonographic monitoring of hepatic blood flow could be a valuable aid to improve the viability of a liver transplant by allowing for real-time calibration of ECMO perfusion in brain-dead liver donors. In our study, ultrasonographic monitoring helped prevent warm ischemic injury to the liver graft by avoiding both overperfusion and underperfusion of the liver.
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Affiliation(s)
- Xian-Sheng Zhu
- Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
| | - Sha-Sha Wang
- Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
| | - Qi Cheng
- Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
| | - Chuang-Wen Ye
- Department of Ultrasound, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
| | - Feng Huo
- The Center for Liver Disease and Transplantation, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
| | - Peng Li
- The Center for Liver Disease and Transplantation, General Hospital of Guangzhou Military Command of People's Liberation Army, Guangzhou, China
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