Successful results of early nucleos(t)ide analogue treatment for liver transplantation candidates with severe acute hepatitis B infection.

BACKGROUND: Early treatment of severe acute hepatitis B virus (HBV) infection with nucleos(t)ide analogues may prevent progression to acute liver failure (ALF). PATIENTS AND METHODS: The charts of 24 patients who were treated for severe acute HBV infection (either INR ≥ 1.5 or INR≥ 1.4 and total bilirubin ≥ 20 mg/dL at the referring institution or after admission) between April 2021 and May 2023 (inclusive) were evaluated retrospectively. Twelve patients were women; median [range] age: 48 [35-68]. Entecavir (0.5 mg/day) (n = 16) or tenofovir disoproxil fumarate (245 mg/day) (n =8) were used depending on availability. RESULTS: Two patients required liver transplant which was performed successfully in one (no suitable donor for the other). Deterioration to ALF was prevented in 22 of the 24 cases (92%); these patients could be discharged after median (range) 12 (5-24) days following initiation of the antiviral drug. There was no significant difference in efficacy between the two antiviral agents. The anti-HBsAg antibody became positive in 16 patients (73%); one other patient became HBsAg negative at 1 month after discharge but was lost to follow up. Five patients (23%) are still HBsAg positive but all except one have started treatment in the last 6 months. One of the recently treated 4 patients stopped taking the antiviral drug at his own will and one has become anti-HIV antibody positive during follow up. CONCLUSION: Early treatment of severe acute HBV infection with entecavir or tenofovir disoproxil fumarate prevents the need for liver transplant and consideration of living donors.

Spontaneous regression of liver hemangiomas: a single-institution analysis of 46 patients.

OBJECTIVE: The aim of this study was to determine the nature of spontaneous regression of liver hemangiomas. PATIENTS AND METHODS: The records of the liver hemangioma patients who attended the out-patient clinic between 1988 and 2018 were evaluated. The data of the 716 adult patients who were followed for at least 3 years with cross-sectional imaging were analyzed. RESULTS: Spontaneous regression was documented in 46 patients (6.4%). Twenty-eight patients had a single hemangioma (61%), eight (17%) had two hemangiomas; the other 10 patients had 3-6 hemangiomas. Of the 87 lesions in 46 patients, 69 actually regressed during the study. Twelve patients with more than one lesion exhibited discordant courses - one of the hemangiomas of a patient with multiple lesions regressed, whereas the other enlarged or remained stable. Eleven of the regressed hemangiomas exhibited enlargement first, followed by spontaneous regression. Fourteen (20%) of the regressed hemangiomas acquired atypical characteristics that would have suggested a malignancy had the original films been unavailable. CONCLUSION: Spontaneous regression of liver hemangiomas is an underrecognized phenomenon. Enlargement should not be a straightforward indication for intervention because it may be followed by regression. A regressed hemangioma should be considered in the differential diagnosis of liver lesions suspicious for malignancy.

Effects of Rhizophagus clarus and biochar on growth, photosynthesis, nutrients, and cadmium (Cd) concentration of maize (Zea mays) grown in Cd-spiked soil.

Cadmium (Cd) toxicity in agricultural crops is a widespread problem. Little is known about biochar and arbuscular mycorrhizal fungi (AMF) effect on Cd concentration in maize plant either applied separately or in combination. Current study was performed to demonstrate effects of biochar and Rhizophagus clarus on plant growth, photosynthesis activity, nutrients (P, Ca, Mg, Fe, Cu, and Mn), and Cd concentration in maize grown in Cd-spiked soil. The alkaline soil was spiked by Cd factor at three levels: 0 (Cd 0), 5 (Cd 5), and 10 (Cd 10) mg/kg; biochar factor at two levels: 0 and 1%; and mycorrhizal inoculum factor at two levels: MF0 and MF1 (R. clraus). Plants were harvested after 70 days of seed germination, and various morphological and physiological parameters, as well as elemental concentration and root colonization, were recorded. Addition of biochar increased plant biomass by 21% (Cd 5) and 93% (Cd 10), MF1 enhanced by 53% (Cd 0) and 69% (Cd 10), while biochar + MF1 enhanced dry plant biomass by 70% (Cd 0) and 94% (Cd 10). Results showed maximum increase of 94% (Cd 10) in plant biomass was observed in Cd-spiked soil. Root colonization decreased proportionally by increasing Cd concentration and at Cd 10, colonization was 36.7% and 31.7% for MF1 and biochar + MF1 treatments, respectively. Besides that, addition of biochar enhanced root attributes (root length, volume, and surface area) by 34-58% compared to control in Cd 10. The MF1 increased these attributes by 11-78% while biochar + MF1 enhanced by 32-61% in Cd-spiked soil. However, biochar + MF1 neutralized Cd stress in maize plant for gaseous attributes (assimilation rate, transpiration rate, intercellular CO2, and stomatal conductance). The MF1 enhanced Cd concentration in plant as it was 3.32 mg/kg in Cd 5 and 6.73 mg/kg in Cd 10 treatments while addition of biochar phytostabilized Cd and reduced its concentration in plants by 2.0 mg/kg in Cd 5 and 4.27 mg/kg in Cd 10. The biochar + MF1 had 2.9 mg/kg and 4.8 mg/kg Cd concentration in Cd 5 and Cd 10 plants, respectively. Phosphorus concentration was augmented in shoots (up to 26%) and roots (up to 20%) of maize plant in biochar-amended soil than control plants. In biochar + MF1, concentration of P was 1.01% and 0.73% in Cd 5 and Cd 10, respectively. It is concluded that biochar + MF1 treatment enhances plant biomass while addition of sole biochar reduced Cd uptake, slightly indifferent to earlier treatment.