No evidence of association between inherited thrombophilia and increased risk of liver fibrosis

BACKGROUND

Preliminary evidence suggests that inherited hypercoagulable disorders can lead to an increased risk of significant liver fibrosis.

OBJECTIVE

We aimed to investigate the prevalence of significant fibrosis in patients with inherited thrombophilia, assessed by using liver stiffness (LS), and to compare this prevalence to that found in a large population-based cohort from the same region.

METHODS

This was a single-center, cross-sectional study. A complete laboratory analysis for liver disease, LS by transient elastography and an abdominal ultrasound were performed in patients with inherited thrombophilia diagnosed between May 2013-February 2017. These patients were propensity score matched (ratio 1:4) with a population-based cohort from the same region (PREVHEP-ETHON study; NCT02749864; N = 5988).

RESULTS

Of 241 patients with inherited thrombophilia, eight patients (3.3%) had significant fibrosis (LS ≥8 kPa). All of them had risk factors for liver disease and met diagnostic criteria for different liver diseases. After matching 221 patients with thrombophilia with 884 patients of the PREVHEP-ETHON cohort, the prevalence of significant fibrosis was similar between both cohorts (1.8% vs. 3.6%, p = 0.488). Multivariate analysis showed that age and liver disease risk factors, but not belonging to the thrombophilia cohort, were associated with the presence of significant fibrosis. The magnitude of the increased risk of significant fibrosis in patients with risk factors for liver disease was also similar in both cohorts.

CONCLUSIONS

Our findings do not provide evidence supporting an association between inherited thrombophilia and an increased risk of significant liver fibrosis, independent of the presence of liver-related causes of fibrosis.

Risk of Recurrence of Hepatocarcinoma after Liver Transplantation: Performance of Recurrence Predictive Models in a Cohort of Transplant Patients

Liver transplantation (LT) is a curative treatment for early-stage hepatocellular carcinoma (HCC) unsuitable for surgical resection. However, tumor recurrence (TR) rates range from 8% to 20% despite strict selection criteria. The validation of new prognostic tools, such as pre-MORAL or RETREAT risks, is necessary to improve recurrence prediction. A retrospective study was conducted at Marqués de Valdecilla University Hospital in Cantabria, Spain, between 2010 and 2019 to determine the rate of TR in LT patients and identify associated factors. Patients with liver-kidney transplantation, re-transplantation, HIV infection, survival less than 90 days, or incidental HCC were excluded. Data on demographic, liver disease-related, LT, and tumor-related variables, as well as follow-up records, including TR and death, were collected. TR was analyzed using the Log-Rank test, and a multivariate Cox regression analysis was performed. The study was approved by the IRB of Cantabria. TR occurred in 13.6% of LT patients (95% CI = 7.3-23.9), primarily as extrahepatic recurrence (67%) within the first 5 years (75%). Increased TR was significantly associated with higher Body Mass Index (BMI) (HR = 1.3 [95% CI = 1.1-1.5]), vascular micro-invasion (HR = 8.8 [1.6-48.0]), and medium (HR = 20.4 [3.0-140.4]) and high pre-MORAL risk (HR = 30.2 [1.6-568.6]). TR also showed a significant correlation with increased mortality. Conclusions: LT for HCC results in a 13.6% rate of tumor recurrence. Factors such as BMI, vascular micro-invasion, and medium/high pre-MORAL risk are strongly associated with TR following LT.

Portal Vein Thrombosis in the Setting of Cirrhosis: A Comprehensive Review

Portal vein thrombosis constitutes the most common thrombotic event in patients with cirrhosis, with increased rates in the setting of advanced liver disease. Despite being a well-known complication of cirrhosis, the contribution of portal vein thrombosis to hepatic decompensation and overall mortality is still a matter of debate. The incorporation of direct oral anticoagulants and new radiological techniques for portal vein recanalization have expanded our therapeutic arsenal. However, the lack of large prospective observational studies and randomized trials explain the heterogenous diagnostic and therapeutic recommendations of current guidelines. This article seeks to make a comprehensive review of the pathophysiology, clinical features, diagnosis, and treatment of portal vein thrombosis in patients with cirrhosis.

Congestive Hepatopathy

Liver disease resulting from heart failure (HF) has generally been referred as “cardiac hepatopathy”. One of its main forms is congestive hepatopathy (CH), which results from passive venous congestion in the setting of chronic right-sided HF. The current spectrum of CH differs from earlier reports with HF, due to ischemic cardiomyopathy and congenital heart disease having surpassed rheumatic valvular disease. The chronic passive congestion leads to sinusoidal hypertension, centrilobular fibrosis, and ultimately, cirrhosis (“cardiac cirrhosis”) and hepatocellular carcinoma after several decades of ongoing injury. Contrary to primary liver diseases, in CH, inflammation seems to play no role in the progression of liver fibrosis, bridging fibrosis occurs between central veins to produce a “reversed lobulation” pattern and the performance of non-invasive diagnostic tests of liver fibrosis is poor. Although the clinical picture and prognosis is usually dominated by the underlying heart condition, the improved long-term survival of cardiac patients due to advances in medical and surgical treatments are responsible for the increased number of liver complications in this setting. Eventually, liver disease could become as clinically relevant as cardiac disease and further complicate its management.

Microenvironment Eradication of Hepatitis C: A Novel Treatment Paradigm

OBJECTIVES

Prisons are major reservoirs of hepatitis C virus (HCV) in which a therapeutic approach has been particularly difficult so far. Our aim was to create a permanent program of HCV elimination in a prison based on a "test and treat" strategy.

METHODS

This open-label clinical trial was conducted in the Spanish prison "El Dueso" between May 2016 and July 2017. Viremic patients were treated with a ledipasvir-sofosbuvir regimen (8-12 weeks) according to the 2015 Spanish Guidelines. A teleconsultation program was established to follow-up patients from the hospital. Non-responders were submitted for a phylogenetic analysis and offered retreatment. An evaluation of new cases of HCV infection was performed every 6 months and upon release in all inmates.

RESULTS

847 (99.5%) inmates accepted to participate. HCV antibodies were present in 110 (13.0%) and 86 (10.2%) had detectable viremia. Most of them were genotype 1 or 3 (82.6%) and had <F2 fibrosis (52.2%). Treatment was started in the 69 inmates whose stay in prison was longer than 30 days. Sustained virological response was achieved in 64 out of 66 patients (96.9%), three of whom were successfully rescued with a salvage regimen after treatment failure. Two patients were lost to follow-up and three are currently on treatment without viremia. As a result, by July 2017 none of the 409 imprisoned was viremic, and neither reinfections nor de novo infections were detected.

CONCLUSIONS

A sustained "test-and-treat" strategy against HCV in prisons is feasible and beneficial. Spreading this strategy should entail a public health impact.

Usefulness of addition of CT perfusion to CT angiography for brain death diagnosis in a child

CT perfusion is a new technique that is rapid, available and minimally invasive which provides functional vascular information and can be made after conventional CT and CT angiography at the same imaging session. CT perfusion applications have focused on ischemic stroke with only a short series of applications to brain death diagnosis. Instead, CT angiography is frequently performed as a confirmatory test of brain death, but it has not been completely validated yet. Hence CT perfusion may help in supporting the diagnosis of brain death. We present the case of a 12-year-old child with clinical criteria for brain death who required a confirmatory test. CT angiography and CT perfusion were performed. Both revealed the absence of any intracranial blood flow which supported the clinical diagnosis of brain death.

Necrotizing fasciitis secondary to diverticulitis

Necrotizing fasciitis is a rare, rapidly progressive infectious process primarily involving the fascia and the subcutaneous tissue, with thrombosis of the cutaneous microcirculation. We present a case of necrotizing fasciitis secondary to diverticulitis in an immunosuppressed patient with rheumatoid arthritis.

Antipunishment effects of diazepam on two levels of suppression of schedule-induced drinking in rats

Food-deprived Wistar rats were exposed to a fixed-time (FT) 60-s food delivery schedule until they developed schedule-induced drinking. Rats were matched in pairs according to their licking rates and were designated master or yoked at random. Every fifth lick by master rats was followed by an electric shock during two signalled 5-min periods, which ran concurrently with the food delivery schedule. For the master rats, shock intensities were adjusted to reduce licking to 5-30% (low suppression) or 50-75% (high suppression) of the unpunished licking rates. Yoked rats received the same shocks as master rats, but independently of their own licking. The drinking by yoked animals was not decreased by the presentation of these lick-independent shocks. Diazepam (0.3-10.0 mg/kg) was studied for its effects on punished and nonpunished schedule-induced drinking. Intermediate doses of the drug increased the punished behavior of master rats, but only when schedule-induced drinking was highly suppressed. Diazepam dose dependently decreased licking rates in all other conditions. The antipunishment effects of benzodiazepines may depend on the level of suppression of schedule-induced drinking, and this is in keeping with the results of other experimental preparations where behavior was under aversive control.

Effects of d-amphetamine, diazepam and buspirone on schedule-induced polydipsia suppressed by response-dependent and response-independent shock

Food deprived Wistar rats were exposed to a fixed time 60 s food schedule until they developed schedule-induced polydipsia. Rats were matched in pairs according to their licking rate, being designated experimental or yoked control at random. Every fifth lick by experimental rats was then followed by an electric shock (0.05, 0.1, or 0.2 mA) while the food schedule continued in operation. Yoked-control rats received the same shocks as experimental rats, but independently of their own licking. Drugs were then tested on the suppressed rates of licking. Diazepam (0.5-2.0 mg/kg) increased punished schedule-induced polydipsia, a result not observed in yoked controls. No increases in the licks per minute of experimental or control animals were found after d-amphetamine (0.25-4.0 mg/kg) or buspirone (0.5-8.0 mg/kg). In comparison with previous results it is concluded that the antipunishment effects of drugs on schedule-induced behaviour depend on the type of punishment contingency.

Effects of d-amphetamine on temporal distributions of schedule-induced polydipsia

Food-deprived rats were divided into four groups according to the equal interval and time durations of a multiple fixed-interval, fixed-time schedule (15, 30, 60, and 120 s). Fixed-time components were signaled by a tone and lever withdrawal. d-Amphetamine (0.25-4.0 mg/kg) produced similar dose-dependent reductions in the drinking and licking induced by fixed-interval and fixed-time schedules. These dose-dependent decrements were a function of the interfood interval length. More licks occurred early in the interfood intervals with doses of d-amphetamine. Dose-dependent shifts to the left were observed in the distribution of licking, and there were dose-dependent decreases in the quarter-life, which were a function of fixed-interval and fixed-time lengths. The maximum lick rate within interfood intervals occurred at about the same absolute time in schedules up to 60 s; therefore, the effects of d-amphetamine were not mediated by its effects on temporal discrimination.

Food deprivation and food-delay effects on the development of adjunctive drinking

Twelve rats were food-deprived to 90% or 70% of their free-feeding weights. Food pellets were then delivered every 60 s (Fixed Time 60-s schedule), and the development of adjunctive drinking was measured by the water consumed and the number of licks. For "master" rats, each lick was followed by 10-s delays in food delivery. Yoked control rats received food at the same time as their master rats and independently of their own behavior. At 70% deprivation, both master and control rats developed similar levels of schedule-induced licking, but the master rats drank less water. At 90% deprivation, master animals showed little drinking and licking, but the development of adjunctive drinking was not completely prevented. Drinking by yoked control rats did not differ as a function of deprivation level. In showing that lick-dependent delays in food delivery reduce the asymptotic development of adjunctive drinking as a function of the rats' level of food deprivation, these results support the view that environmental influences on schedule-induced drinking are modulated by motivational factors.

Food-deprivation effects on punished schedule-induced drinking in rats

Food-deprived rats (at 80% of their free-feeding weights) were exposed to a fixed-time 60-s schedule of food-pellet presentation and developed schedule-induced drinking. Lick-dependent signaled delays (10 s) to food presentation led to decreased drinking, which recovered when the signaled delays were discontinued. A major effect of this punishment contingency was to increase the proportion of interpellet intervals without any licks. The drinking of yoked control rats, which received food at the same times as those exposed to the signaled delay contingency (masters), was not consistently reduced. When food-deprivation level was changed to 90%, all master and yoked control rats showed decreases in punished or unpunished schedule-induced drinking. When the body weights were reduced to 70%, most master rats increased punished behavior to levels similar to those of unpunished drinking. This effect was not observed for yoked controls. Therefore, body-weight loss increased the resistance of schedule-induced drinking to reductions by punishment. Food-deprivation effects on punished schedule-induced drinking are similar to their effects on food-maintained lever pressing. This dependency of punishment on food-deprivation level supports the view that schedule-induced drinking can be modified by the same variables that affect operant behavior in general.

Food-delay duration and the development of schedule-induced polydipsia in rats

Twelve rats were exposed to a schedule that delivered a food pellet every 60 s (fixed time 60 s). The development of schedule-induced polydipsia was measured in terms of the water consumed and the licks per interpellet interval. Every lick by master rats initiated an unsignalled delay of 2 or 50 s in food delivery. Yoked-control rats received food at the same time as their masters, being unaffected by their own licking. Schedule-induced polydipsia developed in master rats exposed to 2-s delays, but more slowly and to a lesser extent than control animals. The development of polydipsia was prevented in master rats exposed to 50-s delays, however. When these delays were discontinued, polydipsia was obtained by master rats. The finding that the effect of the delays was modulated by their duration supports the view that the development of schedule-induced polydipsia is sensitive to control by its environmental consequences.

Pharmacological analysis of the scratching produced by dopamine D2 agonists in squirrel monkeys

Several dopamine agonists, administered i.m., produced persistent, excessive and non-localized scratching in squirrel monkeys (Saimiri sciureus). Studies were conducted with a series of drugs to determine the pharmacological mechanisms responsible for this effect. All of the dopamine D2 agonists studied produced dose-related increases in scratching, whereas several dopamine D1 receptor agonists, indirect dopamine agonists and drugs acting on other receptors failed to produce dose-related increases in scratching. The scratching produced by D2 agonists was stereospecific; (-)-NPA produced scratching whereas its (+)-enantiomer was inactive up to doses 300-fold higher. Scratching induced by quinpirole was attenuated by both D2 and D1 antagonists, and this antagonism was stereospecific, with the D2 antagonist (-)-eticlopride, but not its enantiomer, active. Sensitivity developed to the effects of D2 agonists with the quinpirole dose-effect curve shifting to the left by a factor of approximately 64. Two partial D2 receptor agonists (SDZ 208-911 and SDZ 208-912) had limited efficacy in producing scratching, however, one partial D2 receptor agonist (terguride) was fully efficacious, suggesting that there are spare receptors for this effect. The peripherally active dopamine antagonist domperidone and the histamine antagonist diphenhydramine also reduced the scratching induced by D2 agonists, but not to the same extent as centrally acting D2 antagonists. Scratching in squirrel monkeys is an effect that appears to be due to agonist actions at D2 receptors, and may be mediated by a release of histamine. This behavioral activity may be useful as an in vivo indication of D2 receptor activity in primates.

Rate-dependency hypothesis and the rate-decreasing effects of d-amphetamine on schedule-induced drinking

The high levels of drinking induced by intermittent food-reinforcement schedules are dose-dependently reduced by acute doses of d-amphetamine. The present study evaluated whether the effects of d-amphetamine on this schedule-induced drinking reflect the reduction of high rates of responding. Twenty-four rats were divided into six groups (n = 4) according to the interval and time durations of a multiple fixed-time (FT) fixed-interval (FI) schedule (15s, 30s, 60s, 120s, 240s and 480s). FT components were signalled by a tone and by lever withdrawal. Doses of 0.25 to 4.0mg/kg of d-amphetamine were administered i.p. 10min before test sessions. d-amphetamine produced similar dose-dependent reductions in rate of licking induced by FT and FI schedules. Rate-decreasing effects on operant lever pressing were also found after administrations of d-amphetamine. The dose-dependent decrements produced by d-amphetamine were a function of the inter-food interval length in both schedule-induced and operant behaviours. These rate-decreasing effects were rate-dependent, but d-amphetamine interacted differentially with control rates of adjunctive and operant behaviours, causing a greater suppression of the lower rates of adjunctive licking and the higher rates of operant lever pressing.

Hepatoprotective effects of lobenzarit disodium on acetaminophen-induced liver damage in mice

We have studied the effects of the immunomodulator drug lobenzarit in the model of acute hepatotoxicity induced by a high oral dose (600 mg/kg) of acetaminophen in mice. Lobenzarit at doses of 25, 50 and 100 mg/kg i.p. decreased significantly the activity of alanine aminotransferase in serum, which was increased by acetaminophen alone, and increased the concentration of reduced glutathione in mice liver, which is depleted by acetaminophen. Lobenzarit also reduced liver damage induced by acetaminophen in mice, which was observed by electron microscopy. The hepatoprotective effects of lobenzarit were dose-dependent and they were produced when lobenzarit was administered 30 min before acetaminophen or 2 and 4 h after it. It is concluded that lobenzarit exerts some effects which resemble those of an antidote of acetaminophen such as N-acetylcysteine.

Studies on mutagenicity of 2 bronchodilators under development in Cuba

2 pyridoquinazolones, 2-amino-11H-pyrido[2,1-b]quinazolin-11-one (2-APQ) and 11H-pyrido[2,1-b]quinazolin-11-one (PQ), under development as anti-asthma drugs, were studied for mutagenicity. 2-APQ was found to be a strong mutagen in 5 strains of Salmonella typhimurium and a mild one in the forward-mutation system of the yeast Schizosaccharomyces pombe. Furthermore, 2-APQ had strong clastogenic effects in mouse bone marrow. Because of these results, development of 2-APQ as a bronchodilator was stopped. PQ, on the other hand, did not induce mutation in the 5 Salmonella strains or in S. pombe. S9 mix generally increased the response of 2-APQ in Salmonella dramatically. On the contrary, the mutagenic effectiveness of this compound in S. pombe was only slightly higher in the presence of S9 than without it, suggesting that metabolic activation was not effective in this system.