Arterio-Biliary Fistula as a Rare Life-Threatening Complication of Transjugular Intrahepatic Portosystemic Shunt: A Case Report.

A 46-year-old male with alcoholic liver cirrhosis underwent a transjugular intrahepatic portosystemic shunt (TIPS) for refractory ascites. On the 9th day after the procedure, he presented with melena and decreasing hemoglobin levels. Hemobilia due to fistula formation between the right intrahepatic bile duct and right hepatic artery was suspected on computed tomography. Angiography revealed a fistula of the small branches of the hepatic segmental arteries, and right intrahepatic bile duct was confirmed; embolization was successfully performed with a coil for the eighth segmental hepatic artery, a glue-lipiodol mixture for the fifth segmental hepatic artery, and gelfoam slurry for the right anterior hepatic artery. However, 2 days after embolization, the patient died owing to aggravated disseminated intravascular coagulopathy. When gastrointestinal bleeding occurs after TIPS, careful evaluation is immediately required, and hemobilia should be considered.

Prediction of insufficient hepatic enhancement during the Hepatobiliary phase of Gd-EOB DTPA-enhanced MRI using machine learning classifier and feature selection algorithms.

PURPOSE: The purpose of this study was to reveal the usefulness of machine learning classifier and feature selection algorithms for prediction of insufficient hepatic enhancement in the HBP. METHODS: We retrospectively assessed 214 patients with chronic liver disease or liver cirrhosis who underwent MRI enhanced with Gd-EOB-DTPA. Various liver function tests, Child-Pugh score (CPS) and Model for End-stage Liver Disease Sodium (MELD-Na) score were collected as candidate predictors for insufficient hepatic enhancement. Insufficient hepatic enhancement was assessed using liver-to-portal vein signal intensity ratio and 5-level visual grading. The clinico-laboratory findings were compared using Student's t-test and Mann-Whitney U test. Relationships between the laboratory tests and insufficient hepatic enhancement were assessed using Pearson's and Spearman's rank correlation coefficient. Feature importance was assessed by Random UnderSampling boosting algorithms. The predictive models were constructed using decision tree(DT), k-nearest neighbor(KNN), random forest(RF), and support-vector machine(SVM) classifier algorithms. The performances of the prediction models were analyzed by calculating the area under the receiver operating characteristic curve(AUC). RESULTS: Among four machine learning classifier algorithms using various feature combinations, SVM using total bilirubin(TB) and albumin(Alb) showed excellent predictive ability for insufficient hepatic enhancement(AUC = 0.93, [95% CI: 0.93-0.94]) and higher AUC value than conventional logistic regression(LR) model (AUC = 0.92, [95% CI; 0.92-0.93], predictive models using the MELD-Na (AUC = 0.90 [95% CI: 0.89-0.91]) and CPS (AUC = 0.89 [95% CI: 0.88-0.90]). CONCLUSION: Machine learning-based classifier (i.e. SVM) and feature selection algorithms can be used to predict insufficient hepatic enhancement in the HBP before performing MRI.

Functional recovery by colon organoid transplantation in a mouse model of radiation proctitis.

Radiation proctitis is the collateral damage that occurs to healthy cells during radiation treatment of pelvic malignancies. Conservative treatment of radiation proctitis can mitigate inflammatory symptoms, but, to date, no therapeutic options are available for direct recovery of the damaged colonic epithelium. The present study assessed the ability of colon organoid-based regeneration to treat radiation proctitis. Radiation proctitis was induced in mice by irradiating their recta, followed by enema-based transplantation of mouse colon organoids. The transplanted colon organoids were found to successfully engraft onto the damaged rectal mucosa of the irradiated mice, reconstituting epithelial structure and integrity. Lgr5+ stem cells were shown to be pivotal to colon organoid mediated regeneration. Endoscopic examination showed the efficacy of localized transplantation of colon organoids with fibrin glue to irradiated sites. These findings provide useful insights into the use of colon organoid-based regenerative therapy for the treatment of radiation proctitis.

Synthetic Ligand-Coated Starch Magnetic Microbeads for Selective Extraction of Food Additive Silicon Dioxide from Commercial Processed Food.

The amorphous form of silicon dioxide has long been regarded as a safe food additive (E551) that is widely used in commercially processed food as an anticaking agent. However, starting with titanium dioxide, there have been growing safety concerns regarding to the use of nanoscale silicon dioxide particles in food as food additives. The size, morphology, and chemical properties of inorganic food materials are important parameters to determine its potential toxicity. Therefore, an effective means of extracting an intact form of SiO2 from food without altering the physicochemical property of SiO2 particles is of great need to accurately monitor its characteristics. Here, we report on an effective magnetic separation method to extract food additive SiO2 from food by utilizing a diatom-originated peptide with a specific affinity to SiO2 particles. The affinity-based magnetic separation was found to be specific to SiO2 particles over other types of inorganic food additives such as titanium dioxide and zinc oxide. The size and morphology of SiO2 were shown to not be affected by the extraction processes. This method was successfully applied to extract and characterize the food additive SiO2 from six different types of commercial food.

Angiographic Findings of an Isolated Meandering Pulmonary Vein: A Case Report.

A meandering pulmonary vein (MPV) is a rare pulmonary vascular anomaly characterized by an abnormal course of the pulmonary vein draining into the left atrium. We report the case of a 55-year-old female who was diagnosed with a right MPV on pulmonary angiography. Enhanced chest CT revealed a vascular structure with an abnormal course that drained into the right superior pulmonary vein in the right upper lobe, which resembled a pulmonary arteriovenous malformation (AVM). Pulmonary angiography performed to discriminate between an MPV and pulmonary AVM showed no feeding artery, normal parenchymal staining, and drainage to the left atrium via the culprit vessel. Thus, the patient was diagnosed with MPV. When an MPV is difficult to differentiate from other vascular anomalies on enhanced chest CT, pulmonary angiography can be helpful. By recognizing the angiographic findings of an MPV, unnecessary treatment can be prevented.

PCR Screening of Enterococcus faecalis from Mixture of Lactic Acid Bacteria Using Bile Salt Hydrolase Gene as a Selective Marker.

It is very important to rapidly detect the contamination of Enterococcus faecalis in fermented foods such as Korean Kimchi to maintain its freshness since Kimchi is exported to all over the world. However, gene sequence of E. faecalis is very similar among various Lactobacillus. So, there have been difficulties in its screening. We have designed primers based on Bile salt hydrolase gene of E. faecalis and applied them to PCR test. PCR band was identified only from E. faecalis and only from the mixture contaminated with E. faecalis. It means that the primers we designed are highly specific for distinguishing contamination of E. faecalis. It will be possible to precisely screen within 1 h, which will greatly contribute to the prevention of food poisoning and quick quarantine.

In vivo evaluation of scaffolds compatible for colonoid engraftments onto injured mouse colon epithelium.

Colon organoids (colonoids) are known to be similar to colon tissue in structure and function, which makes them useful in the treatment of intestinal de-epithelialized disease. Matrigel, which is used as a transplantation scaffold for colonoids, cannot be used in clinical applications because of its undefined composition and tumorigenicity. This study identifies clinically available scaffolds that are effective for colonoid transplantation in damaged intestinal mucosa. The colon crypt was isolated and cultured from C57BL/6-Tg[CAG enhanced green fluorescent protein (EGFP)131Osb/LeySopJ mice into EGFP + colonoids and subsequently transplanted into the EDTA colitis mouse model using gelatin, collagen, or fibrin glue scaffolds. To identify scaffolds suitable for colonoid engraftment in injured colon mucosa, the success rates of transplantation and secondary EGFP colonoid formation were measured, and the scaffolds' mediated toxicity in vitro and in vivo was observed in recipient mice. When colonoids were transplanted with gelatin, collagen, and fibrin glue into the EDTA colitis mouse model, all groups were found to be successfully engrafted. Fibrin glue, especially, showed significant increase in the engrafted area compared with Matrigel after 4 wk. The scaffolds used in the study did not induce colonic toxicity after transplantation into the recipients' colons and were thus deemed safe when locally administrated. This study suggests new methods for and provides evidence of the safety and utility of the clinical application of colonoid-based therapeutics. Furthermore, the methods introduced in this study will be helpful in developing cell treatment using the esophagus or a stomach organoid for various digestive-system diseases.-Jee, J., Jeong, S. Y., Kim, H. K., Choi, S. Y., Jeong, S., Lee, J., Ko, J. S., Kim, M. S., Kwon, M.-S., Yoo, J. In vivo evaluation of scaffolds compatible for colonoid engraftments onto injured mouse colon epithelium.