Enfermedades vasculares del hígado. Guías Clínicas de la Sociedad Catalana de Digestología y de la Asociación Española para el Estudio del Hígado / Vascular diseases of the liver. Clinical Guidelines from the Catalan Society of Digestology and the Spanish Association for the Study of the Liver

Las enfermedades vasculares hepáticas, a pesar de su relativamente baja prevalencia, representan un problema de salud importante en el campo de las enfermedades hepáticas. Una característica común a muchas de estas enfermedades es que pueden causar hipertensión portal, con la elevada morbimortalidad que ello conlleva. Con frecuencia estas enfermedades se diagnostican en pacientes jóvenes y el retraso en su diagnóstico y/o un tratamiento inadecuado pueden reducir de forma importante la esperanza de vida. El presente artículo revisa la evidencia actual en el síndrome de Budd-Chiari, la trombosis venosa portal en pacientes no cirróticos, la hipertensión portal idiopática, el síndrome de obstrucción sinusoidal, las malformaciones vasculares hepáticas en la telangiectasia hemorrágica hereditaria, la trombosis portal en la cirrosis, otras patologías vasculares menos frecuentes como las fístulas arterioportales, así como un apartado sobre el diagnóstico por imagen de las enfermedades vasculares hepáticas y su tratamiento desde el punto de vista hematológico (estudio de la diátesis trombótica y tratamiento anticoagulante). Las recomendaciones se han realizado de acuerdo a los estudios publicados extraídos de Pubmed. La calidad de la evidencia y la intensidad de las recomendaciones fueron graduadas de acuerdo al sistema Grading of Recommendations Assessment Development and Evaluation (GRADE). Cuando no existían evidencias suficientes, las recomendaciones se basaron en la opinión del comité que redactó la guía.

Despite their relatively low prevalence, vascular diseases of the liver represent a significant health problem in the field of liver disease. A common characteristic shared by many such diseases is their propensity to cause portal hypertension together with increased morbidity and mortality. These diseases are often diagnosed in young patients and their delayed diagnosis and/or inappropriate treatment can greatly reduce life expectancy. This article reviews the current body of evidence concerning Budd-Chiari syndrome, non-cirrhotic portal vein thrombosis, idiopathic portal hypertension, sinusoidal obstruction syndrome, hepatic vascular malformations in hereditary haemorrhagic telangiectasia, cirrhotic portal vein thrombosis and other rarer vascular diseases including arterioportal fistulas. It also includes a section on the diagnostic imaging of vascular diseases of the liver and their treatment from a haematological standpoint (study of thrombotic diathesis and anticoagulation therapy). All recommendations are based on published studies extracted from PubMed. The quality of evidence and strength of recommendations were rated in accordance with the GRADE system (Grading of Recommendations, Assessment Development and Evaluation). In the absence of sufficient evidence, recommendations were based on the opinion of the committee that produced the guide.

The macrophage activation marker sCD163 combined with markers of the Enhanced Liver Fibrosis (ELF) score predicts clinically significant portal hypertension in patients with cirrhosis.

BACKGROUND: Noninvasive identification of significant portal hypertension in patients with cirrhosis is needed in hepatology practice. AIM: To investigate whether the combination of sCD163 as a hepatic inflammation marker and the fibrosis markers of the Enhanced Liver Fibrosis score (ELF) can predict portal hypertension in patients with cirrhosis. METHODS: We measured sCD163 and the ELF components (hyaluronic acid, tissue inhibitor of metalloproteinase-1 and procollagen-III aminopeptide) in two separate cohorts of cirrhosis patients that underwent hepatic vein catheterisation. To test the predictive accuracy we developed a CD163-fibrosis portal hypertension score in an estimation cohort (n = 80) and validated the score in an independent cohort (n = 80). A HVPG ≥10 mmHg was considered clinically significant. RESULTS: Both sCD163 and the ELF components increased in a stepwise manner with the patients' Child-Pugh score (P < 0.001, all), and also with increasing HVPG (P < 0.001). receiver operator characteristics (ROC) analyses showed that each one of the individual components predicted a HVPG >10 mmHg with AUROC's of approximately 0.80. The combined score optimised by logistic regression analyses improved the AUROC to 0.91 in the estimation cohort and 0.90 in the validation cohort. Furthermore, a high value of the combined score was associated with a high short-term mortality. CONCLUSIONS: The combination of the macrophage activation marker sCD163 and the fibrosis markers predicted significant portal hypertension in patients with cirrhosis. This score may prove useful for screening purposes and highlights the importance of both the inflammatory and the fibrotic components of cirrhotic portal hypertension.

Characterization of typo-, regio-, and stereo-selectivities of babaco latex lipase in aqueous and organic media.

The unripe fruit of babaco (Vasconcellea x heilbornii; syn. Carica pentagona) contains a latex, similar to that in Carica papaya, which exhibits lipolytic activity. Herein, the regioselectivity, stereoselectivity and typoselectivity in both hydrolysis and acyltransfer reactions of babaco latex lipases were studied and compared to those of Carica papaya latex. In hydrolysis, both biocatalysts are 1,3-regioselective with ratios for 1,2-2,3-diacylglycerols/1,3-diacylglycerol of 6.5 and 21 for babaco and papaya, respectively. In contrast, papaya latex had a slight sn-3 stereopreference. Babaco latex displayed a higher activity on triacylglycerols with short chain and unsaturated fatty acids.

Toward the synthesis of pyroglutamate lauroyl ester: biocatalysis versus chemical catalysis.

The synthesis of dodecyl pyroglutamate (or pyroglutamate lauroyl ester) was achieved in a two-step process involving a pyroglutamic acid alkyl ester intermediate. The reaction was carried out either by lipase or by chemical catalysis using ion exchange resin. Among the various tested lipases, the one from Candida antarctica B gave the best results allowing 73% formation of the desired ester after 6 h. Comparing the efficiency of this latter lipase with the one of Amberlyst IR120H resin in catalyzing this reaction, the biocatalyst gave a molar yield of pyroglutamate lauroyl ester of 79% compared to 69% when using the ion exchange resin starting with 1.04 mmol substrate in each case.

Acyl migration incidence on accuracy of a triacylglycerol regioanalysis--a theoretical evaluation.

We will consider the Grignard chemical deacylation to study the regioanalysis of triacylglycerols (TAGs). Using a given TAG structure, a cross-contamination model is developed and used for evaluating the incidence of the acyl migration and its influence on the accuracy of a regiospecific analysis of the molecule. Despite unavoidable isomerization, the newly formed alpha,beta-diacylglycerols are considered as most representative of the original TAG composition. In this paper, we present evidence that in conditions of limited acyl migration, the regiospecific distribution could more accurately be determined from the alpha-monoacylglycerol rather than through calculations based on the alpha,beta-diacylglycerols fraction.

A direct method for regiospecific analysis of TAG using alpha-MAG.

An analytical procedure was developed for regiodistribution analysis of TAG using alpha-MAG prepared by an ethyl magnesium bromide deacylation. In the present communication, the deacylation procedure is shown to lead to representative alpha-MAG, allowing the composition of the native TAG in the alpha-position to be determined directly. The composition in the beta-position can then be estimated from the composition of the alpha-MAG and TAG according to the formula 3 x TAG - 2 x alpha-MAG. The estimates are superior to those obtained using the alpha,beta-DAG and Brockerhoff calculations as they come closer to the theoretical value and have smaller SD. The present procedure, first demonstrated on a synthetic TAG, was then successfully applied to the analysis of borage oil, milkfat, and tuna oil.

Nonlinearity effects in the pure phase correlation method in multiobject scenes.

The nonlinearity used in the pure phase correlation method can improve pattern recognition, but it causes high-order harmonics in the correlation plane in the case of multiobject scenes. High-order harmonics and the presence of aliasing may cause false alarms. We show that these effects are strongly diminished when the periodicity in the scene is broken (by different objects, random distribution, etc.).

Pattern recognition with quantized computer-generated filters.

The influence of the quantization levels used in the computer-generated filter on the correlation is studied. Two types of objects, binary characters and gray-tone objects, are used in the scene and in the test. The filters are codified by the method proposed by Burckhardt. Three different filters (a classical matched filter, a high-frequency-enhanced filter, and an amplitude-encoded phase-only filter) are generated, and the influence of the quantization levels in such cases is studied. Numerical and experimental results are obtained.