Sonographic and Anatomical Evaluation of the Liver and Portal Vein Reference Values / Evaluación Ecográfica y Anatómica de los Valores de Referencia del Hígado y la Vena Porta

SUMMARY: This paper's aim is a morphometric evaluation of liver and portal vein morphometry using ultrasonography in healthy Turkish population. This study was carried out with 189 subjects (107 females, 82 males). The demographic data and the body surface area were calculated. The longitudinal axis of the liver for two lobes, diagonal axis or liver span, anteroposterior diameter of the liver and portal vein, portal vein transverse diameter, caudate lobe anteroposterior diameter, and portal vein internal diameters as well as longitudinal liver scans in an aortic plane, sagittal plane, transverse plane, and kidney axis were measured. All measurements were analyzed according to age, sex, body mass index, obesity and alcohol consumption. The mean values of the age, height, weight and body mass index were calculated as 44.39 years, 167.05 cm, 74.23 kg, and 27.06kg/m2 in females, respectively. The same values were 44.13 years, 167.70 cm, 75.93 kg and 26.71 kg/m2 in males, respectively. There was significant difference between demographic characteristics, gender, and alcohol consumption in terms of anteroposterior diameter of the liver, portal vein transverse diameter of the right side and liver transverse scan. Also, some measurements including portal vein transverse diameter, liver transverse scan and at kidney axis longitudinal scan of liver showed significant difference between the age groups. There was significant difference in diagonal axis and anteroposterior diameter of liver, portal vein internal diameter, and longitudinal liver scans of the aortic plane parameters between obesity situation. The findings obtained will provide important and useful reference values as it may determine some abnormalities related liver diseases. Also, age, sex, obesity and body mass index values can be effective in the liver and portal vein morphometry related parameters.

El objetivo de este artículo fue realizar una evaluación de la morfometría del hígado y la vena porta mediante ecografía en una población turca sana. Este estudio se llevó a cabo en 189 sujetos (107 mujeres, 82 hombres). Se calcularon los datos demográficos y la superficie corporal. Se midió eleje longitudinal del de dos lóbulos del hígado, el eje diagonal o la extensión del hígado, los diámetros anteroposterior del hígado y de la vena porta, el diámetro transversal de la vena porta, anteroposterior del lóbulo caudado y los diámetros internos de la vena porta, así como las exploraciones longitudinales del hígado en un plano aórtico. Se midieron el plano sagital, el plano transversal y el eje del riñón. Todas las mediciones se analizaron según edad, sexo, índice de masa corporal, obesidad y consumo de alcohol. Los valores medios de edad, talla, peso e índice de masa corporal se calcularon como 44,39 años, 167,05 cm, 74,23 kg y 27,06 kg/m2 en las mujeres, respectivamente. Las mismas variable fueron 44,13 años, 167,70 cm, 75,93 kg y 26,71 kg/m2. Hubo diferencias significativas entre las características demográficas, el sexo y el consumo de alcohol en términos de diámetro anteroposterior del hígado, diámetro transversal de la vena porta del lado derecho y exploración transversal del hígado. Además, algunas mediciones, incluido el diámetro transversal de la vena porta, la exploración transversal del hígado y la exploración longitudinal del hígado en el eje del riñón, mostraron diferencias significativas entre los grupos de edad. Hubo diferencias significativas en el eje diagonal y el diámetro anteroposterior del hígado, el diámetro interno de la vena porta y los parámetros de las exploraciones hepáticas longitudinales del plano aórtico entre situaciones de obesidad. Los hallazgos obtenidos proporcionarán valores de referencia importantes y útiles ya que pueden determinar algunas anomalías relacionadas con enfermedades hepáticas. Además, los valores de edad, sexo, obesidad e índice de masa corporal pueden ser eficaces en los parámetros relacionados con la morfometría del hígado y la vena porta.

Hilar Anatomy in 3035 Living Liver Donors: A Novel Classification for Donor Surgery and Suitability, Hepatic Surgeries, and Hepatobiliary Interventions.

BACKGROUND: This study examines the vascular and biliary variations in 3035 liver donors. We propose a novel classification of hepatic arteries, portal veins, and bile ducts and clinically relevant donor classification. METHODS: Preoperative imaging and operative details of 3035 donors from 2005 to 2020 were reviewed. Hilar anatomical variations were identified and grouped on the basis of incidence and clinical relevance. RESULTS: Hilar structures are classified according to the numbers supplying or draining the graft: for the hepatic artery, right (R) and left (L), RA1/LA1 (1 artery), RA2/LA2 (2 arteries), and RA3/LA3 (3 arteries), respectively, further defined on the basis of the inflow trunk into C (for common hepatic artery), S (for superior mesenteric artery), and L (for left gastric artery); for the portal vein, RP1 (1 vein) and RP2 (2 veins) for the right lobe; and for the hepatic duct, RB1/LB1 (1 duct), RB2/LB2 (2 ducts), RB3 (3 right ducts), and RB4 (4 right ducts). Donors were classified on the basis of anatomical variations into 3 groups: class 1 and class 2 donors, who can donate liver with acceptable risks, and class 3 donors, who are high-risk donors because they are anatomically unacceptable ( Figures S1 to S4, SDC , http://links.lww.com/TP/C918 ). CONCLUSIONS: Defining hilar anatomical variations and donor grouping into anatomy-based clinical classes helps in operative planning of donors, hepatobiliary surgeries, and interventional procedures.

Hepatic portal vein branching patterns according to different liver assessment methods and classifications of branching type.

BACKGROUND: It is known that there are varying frequencies of hepatic portal vein branching patterns found in the literature. Studies use different methods and classifications to evaluate the anatomy of the portal vein, which limits accurate comparison between studies and the determination of true frequency of branching patterns in different populations. The aim of the present study was to investigate the intrahepatic branching of the portal vein in corrosive samples using different methods - somatoscopic and computed tomography (CT) and compare with similar studies as well as compare the reclassified data according to the most popular classifications used in the literature. METHODS: A total of 105 liver corrosion specimens from the 1960-1980 period (51 male and 54 female individuals; min-max age variation - 21-90 y., M=59,46 y.) were investigated. The branching patterns of the hepatic portal vein (HPV), left (HPV-LB) and right branch of hepatic portal vein (HPV-RB), and their segmental branches were examined and scanned by CT. Standard HPV ramification was considered, when HPV divided into HPV-LB and HPV-RB, HPV-RB bifurcated to the anterior and posterior branches, and further segmental ramification into the superior and inferior branches was considered standard. We compared the HPV main branch length and diameter measurements between manual and CT method. A review of the literature was performed on portal vein branching variations. RESULTS: The standard HPV ramification pattern was detected in 85.7% of the cases in both somatoscopic and CT evaluation. Variations related to the main branches were HPV trifurcation - 7.6%, posterior branch of right branch of hepatic portal vein from HPV - 4.8% and 5.7%, HPV quadrifurcation 1.9% and 1% respectively, in somatoscopic and CT evaluation. There was a significant difference between HPV-LB length and diameter in CT and manual measurements. According to the literature, more variations are seen using the CT method versus somatoscopic corrosion cast evaluation. The varying frequency in studies may be explained by a lack of one unanimous classification of branching patterns (some authors do not consider segmental variations as standard HPV ramification) and different evaluation methods. CONCLUSION: Somatoscopic evaluation of the branching patterns of the hepatic portal vein in corroded specimens and their CT reconstructions did not differ significantly (which allows relatively accurate comparison of old specimens with newer data). However, the ability to evaluate the reconstructed 3D images of the specimens allowed a more accurate assessment of segmental branching and measurements of lengths and diameters. Standard HPV branching (according to a self-developed classification) in this study was 85.7%. Depending on the classification, the rate of standard branching in the same corrosive samples varied from 63.8% to 84.8% of all cases, indicating that the lack of a unified and stable classification makes it difficult to compare the results of different studies. Deviations from standard branching are very important in surgical procedures and liver transplantation.

Alterations of serum biochemical parameters and tyrosine phosphorylation in kidney and liver of chronic stress-induced rats / Alterações dos parâmetros bioquímicos séricos e fosforilação da tirosina em rim e fígado de ratos induzidos por estresse crônico

Chronic stress (CS) can contribute to dysfunction in several organs including liver and kidney. This study was performed to investigate the changes in serum biochemistry, histological structure, as well as in localization of tyrosine phosphorylated proteins (TyrPho) and Heat shock protein 70 (Hsp-70) in liver and kidney tissues of CS rats induced by two stressors (restrained and force swimming) for 60 consecutive days. Samples of blood, liver, and kidney were collected from adult male Sprague-Dawley rats in each group. Our results showed that serum biochemical parameters including corticosterone, blood sugar, urea nitrogen, creatinine, cholesterol, triglyceride, HDL-C, LDL-C, ALT, AST, alkaline phosphatase in CS group were significantly different from that in normal group in both liver and kidney tissues. Although histological structure was not changed. TyrPho expression was significantly increased in liver lysate but significantly decreased in kidney. Hsp-70 expression in liver increased whereas in kidney decreased. In conclusion, CS can induce changes in liver and kidney functions.

O estresse crônico (SC) pode contribuir para a disfunção em vários órgãos, incluindo fígado e rim. Este estudo foi realizado para investigar as alterações na bioquímica sérica, estrutura histológica, bem como na localização de proteínas tirosina fosforiladas (TyrPho) e proteína de choque térmico 70 (Hsp-70) em tecidos hepáticos e renais de ratos CS induzidas por dois estressores (restrito e natação forçada) por 60 dias consecutivos. Amostras de sangue, fígado e rim foram coletadas de ratos Sprague-Dawley machos adultos em cada grupo. Nossos resultados mostraram que os parâmetros bioquímicos séricos, incluindo corticosterona, glicemia, nitrogênio ureico, creatinina, colesterol, triglicerídeos, HDL-C, LDL-C, ALT, AST, fosfatase alcalina no grupo CS foram significativamente diferentes do grupo normal em ambos os fígados e tecidos renais. Embora a estrutura histológica não tenha sido alterada, a expressão de TyrPho aumentou significativamente no lisado hepático, mas diminuiu significativamente no rim. A expressão de Hsp-70 no fígado aumentou, enquanto que no rim diminuiu. Em conclusão, a CS pode induzir alterações nas funções hepáticas e renais.

Causal associations between liver traits and Colorectal cancer: a Mendelian randomization study.

OBJECTIVE: This study aimed to investigate the causal associations between several liver traits (liver iron content, percent liver fat, alanine transaminase levels, and liver volume) and colorectal cancer (CRC) risk using a Mendelian randomization (MR) approach to improve our understanding of the disease and its management. METHODS: Genetic variants were used as instrumental variables, extracted from genome-wide association studies (GWAS) datasets of liver traits and CRC. The Two-Sample MR package in R was used to conduct inverse variance weighted (IVW), MR Egger, Maximum likelihood, Weighted median, and Inverse variance weighted (multiplicative random effects) MR approaches to generate overall estimates of the effect. MR analysis was conducted with Benjamini-Hochberg method-corrected P values to account for multiple testing (P < 0.013). MR-PRESSO was used to identify and remove outlier genetic variants in Mendelian randomization (MR) analysis. The MR Steiger test was used to assess the validity of the assumption that exposure causes outcomes. Leave-one-out validation, pleiotropy, and heterogeneity testing were also conducted to ensure the reliability of the results. Multivariable MR was utilized for validation of our findings using the IVW method while also adjusting for potential confounding or pleiotropy bias. RESULTS: The MR analysis suggested a causal effect between liver volume and a reduced risk of CRC (OR 0.60; 95% CI, 0.44-0.82; P = 0.0010) but did not provide evidence for causal effects of liver iron content, percent liver fat, or liver alanine transaminase levels. The MR-PRESSO method did not identify any outliers, and the MR Steiger test confirmed that the causal direction of the analysis results was correct in the Mendelian randomization analysis. MR results were consistent with heterogeneity and pleiotropy analyses, and leave-one-out analysis demonstrated the overall values obtained were consistent with estimates obtained when all available SNPs were included in the analysis. Multivariable MR was utilized for validation of our findings using the IVW method while also adjusting for potential confounding or pleiotropy bias. CONCLUSION: The study provides tentative evidence for a causal role of liver volume in CRC, while genetically predicted levels of liver iron content, percent liver fat, and liver alanine transaminase levels were not associated with CRC risk. The findings may inform the development of targeted therapeutic interventions for colorectal liver metastasis (CRLM) patients, and the study highlights the importance of MR as a powerful epidemiological tool for investigating causal associations between exposures and outcomes.

Liver Size and its Correlation with Anthropometric Parameters and Age / El Tamaño del Hígado y su Correlación con los Parámetros Antropométricos y la Edad

SUMMARY: The liver has over 500 physiological and biochemical roles in our organism so checking of liver size and function is a part of every clinical examination. Aim of our research was to estimate liver size on computed tomography (CT) of the abdomen images and to determinate relations between liver dimensions and anthropometric parameters. The research included 99 patients, 49 men and 50 women, who were referred for CT of abdomen. We measured body height (BH) and body mass (BM), and calculated body mass index (BMI) and body surface area (BSA). Also, on CT images we measured anteroposterior (AP), laterolateral (LL) and two craniocaudal liver diameters (one at the level of midclavicular line - CCmcl, and the other was maximal - CCmax). Liver volume (LV) was calculated with formula. Our results showed that AP diameter positively correlated with BSA (r=0.30) in women. LL diameter positively correlated with BH (r=0.43), and BSA (0.31) in men. CCmcl diameter positively correlated with BH (r=0.33), BM (r=0.31), and BSA (r=0.34) in men, while in women it correlated only with BH (r=0.38). CCmax diameter positively correlated with BH (r=0.33) and BSA (r=0.33) in men. LV positively correlated with BH and BSA in both men (r=0.36, r=0.33, respectively) and women (r=0.42, r=0.31, respectively), and in men also with BM (r=0.34). LL, CCmcl, CCmax, and LV negatively correlated with aging in both sexes After the age of 60, there was a decrease in size of LL, CC diameters, as well as in LV. We concluded that liver dimensions decrease with aging, regardless of sex at the expanse of LL and CC diameters which are related to the size of body parameters, so that for a precise evaluation of liver size all three diameters should be measured, LV as well as BH, BM, and BSA.

El hígado desempeña más de 500 funciones fisiológicas y bioquímicas en nuestro organismo, por lo que comprobar el tamaño y la función de este órgano es parte de cada examen clínico. El objetivo de nuestra investigación fue estimar el tamaño del hígado mediante tomografía computarizada (TC) de imágenes del abdomen y determinar las relaciones entre las dimensiones del hígado y los parámetros antropométricos. La investigación incluyó a 99 pacientes, 49 hombres y 50 mujeres, que fueron remitidos para TC de abdomen. Medimos la altura corporal (BH) y la masa corporal (BM), y calculamos el índice de masa corporal (IMC) y el área de superficie corporal (BSA). Además, en las imágenes de TC medimos los diámetros hepáticos anteroposterior (AP), laterolateral (LL) y dos craneocaudales (uno a nivel de la línea medioclavicular - CCmcl, y el diámetro máximo - CCmax). El volumen del hígado (VI) se calculó con una fórmula. Nuestros resultados mostraron que el diámetro AP se correlacionó positivamente con BSA (r = 0,30) en mujeres. El diámetro de LL se correlacionó positivamente con BH (r=0,43) y BSA (0,31) en hombres. El diámetro CCmcl se correlacionó positivamente con BH (r=0,33), BM (r=0,31) y BSA (r=0,34) en hombres, mientras que en mujeres se correlacionó solo con BH (r=0,38). El diámetro CCmax se correlacionó positivamente con BH (r=0,33) y BSA (r=0,33) en hombres. El VI se correlacionó positivamente con BH y BSA tanto en hombres (r=0,36, r=0,33, respectivamente) como en mujeres (r=0,42, r=0,31, respectivamente), y en hombres también con BM (r=0,34). LL, CCmcl, CCmax y LV se correlacionaron negativamente con el envejecimiento en ambos sexos. Después de los 60 años, hubo una disminución en el tamaño de los diámetros LL, CC y LV. Concluimos que las dimensiones del hígado disminuyen con la edad, independientemente del sexo, en la extensión de los diámetros LL y CC que están relacionados con el tamaño de los parámetros corporales, por lo que para una evaluación precisa del tamaño del hígado se debe medir LV como BH, BM y BSA.

Liver Anatomy 2.0 Quiz: Test Your Knowledge.

The liver is one the largest organs in the abdomen and the most frequent site of metastases for gastrointestinal tumors. Surgery on this complex and highly vascularized organ can be associated with high morbidity even in experienced hands. A thorough understanding of liver anatomy is key to approaching liver surgery with confidence and preventing complications. The aim of this quiz is to provide an active learning tool for a comprehensive understanding of liver anatomy and its integration into clinical practice.

Histomorphological, Histochemical and Ultrastructural Studies on the Healthy Liver of Yemen Veiled Chameleon (Chamaeleo calyptratus) in Southern Saudi Arabia / Estudios Histomorfológicos, Histoquímicos y Ultraestructurales en el Hígado Sano del Camaleón Velado de Yemen (Chamaeleo calyptratus) en el Sur de Arabia Saudita

SUMMARY: The livers of reptiles are being studied as a model for the link between the environment and hepatic tissue. There have been few investigations on the histology of reptile livers, and very few or no studies have examined the histology of liver of veiled chameleon (Chamaeleo calyptratus). This paper describes the histomorphological, histochemical and ultrastructural characterization of the liver of veiled chameleons in southern Saudi Arabia. Seven Chamaeleo calyptratus were captured in the summer season in Abha City, Aseer region, southern Saudi Arabia. Chamaeleon liver samples were processed for histomorphology, histochemistry and ultrastructure analyses. Morphologically liver of Chamaeleo calyptratus was observed as a large dark brown organ with lighter speckles, which represent melanin deposits. It located at the ventral part of abdominal cavity forward of the stomach. Its dimensions approximately were 3.7 x 2 cm. The liver was a bilobed organ divided into two lobes, right and left lobes. The right one was bigger than the others. The gallbladder was well developed and had an elongated shape, situated between the two lobes and contained the bile for the digestion. Microscopically, the liver was found to be covered by a thick layer of connective tissue, which formed the hepatic capsule. Hepatic parenchyma probably appeared in cross sections as hepatic glandular-like alveoli "acini" or follicular structures with various diameters, each acinus contains approximately four to six hepatocytes, surrounded by sinusoidal capillaries filled with abundant melanomacrophages, which are absent in birds and mammals. Melanomacrophages are common in the hepatic parenchyma's perisinusoidal areas, particularly near portal spaces. Hepatocytes are polyhedral or pyramidal with and mostly contained large, rounded nuclei mostly peripherally located, with prominent dark oval nucleoli. Some of nuclei are eccentric or central position. The cytoplasm appeared spongy or vacuolated and more eosinophilic when stained by hematoxylin-eosin and strongly reactive to PAS staining technique, indicating abundant glycogen content. The reticular fibers that surround hepatocytes, blood arteries, and sinusoids supported the hepatic parenchyma. The blood sinusoids are seen interspersed among hepatocytes of varying sizes. The sinusoidal lumen was bordered by flattened endothelial cells and includes elliptical nucleated erythrocytes and liver macrophages as phagocytes, which are also known as Kupffer cells. Branches of the portal vein, hepatic artery, small bile duct, and lymph vessels were detected in the hepatic portal area "tract" or triad which made up of connective. Hematopoietic tissue was observed in subcapsular region and portal triads. Ultrastructurally, the hepatocyte appeared polyhedric containing a single large rounded basal or eccentric vesicular nucleus with prominent nucleolus. Extensive network of rough endoplasmic reticulum (RER) often arranged in an array parallel to the nuclear membrane with many mitochondria, and Golgi apparatus were described. The cytoplasm contained glycogen granules, vesicles or vacuoles scattered throughout the cytoplasm especially at the apical region were reported. The bile canaliculi and the hepatic "Kupffer" cells were also discussed. This is the first study on the histological characterization of the healthy liver of Yemen veiled chameleon in southern Saudi Arabia. The findings reported here should be used as a reference to compare with the pathological abnormalities of the liver in this animal.

está disponible en el texto completo

Periphery of porcine hepatic lobes has the smallest length density of hepatic sinusoids and bile canaliculi: A stereological histological study with implications for liver biopsies.

BACKGROUND: Porcine liver is widely used in hepatologic research as a large animal model with many anatomical and physiological similarities with humans. However, only limited information on porcine liver spatial microstructure has been published, especially regarding the hepatic sinusoids and bile canaliculi. The aim of our study was to quantify the sinusoidal and bile canalicular network in healthy male and female porcine livers and to map the variability of these structures with heterogenous distribution to improve the evaluability of liver biopsy samples. METHODS: Livers from 12 healthy piglets (6 females and 6 neutered males) were sampled into 36 tissue samples per organ, representing six hepatic lobes and three different regions related to the hepatic vasculature (peripheral, paracaval and paraportal region). Histological sections were processed with a random orientation of the cutting plane. The endothelium and the bile canaliculi were stained using Ricinus communis agglutinin I lectin histochemistry. The length densities of hepatic sinusoids LV(sinusoids,liver), of bile canaliculi LV(bile canaliculi,liver) and volume fraction VV(sinusoids,liver) and surface density SV(sinusoids,liver) of sinusoids were estimated using stereological methods. The newly acquired morphometric data were compared with previously published data on density of porcine hepatocytes and fractions of connective tissue. RESULTS: The peripheral region had smallest LV(sinusoids,liver), smallest LV(bile canaliculi,liver) and greatest VV(sinusoids,liver). The six hepatic lobes had statistically comparable length densities of both sinusoids and bile canaliculi, but the left lateral lobe had smallest VV(sinusoids,liver). Regions with greater LV(sinusoids,liver) had also greater LV(bile canaliculi,liver) and SV(sinusoids,liver) and were accompanied by greater density of smaller hepatocytes. Regions with smaller LV(sinusoids,liver) and LV(bile canaliculi,liver) contained a greater fraction of interlobular connective tissue. CONCLUSIONS: The length density of hepatic sinusoids is smaller in the peripheral regions of the porcine liver than in other regions related to the hepatic vasculature - paracaval and paraportal regions, and smaller in castrated males than in females. Greater length density of liver sinusoids was linked with greater local density of bile canaliculi, with local increase in the density of smaller hepatocytes and, simultaneously, with smaller fractions of hepatic connective tissue. The intrahepatic and inter-sexual variability of the porcine liver morphology needs to be taken into account when designing and interpreting experiments involving the histological quantification of the microvascular network. The complete primary morphometric data describing the distribution of morphometric parameters within porcine liver were made available in a form facilitating the power analysis to justify the minimal number of tissue samples or animals required when designing further histological evaluation studies. The macroscopic map of microvessels and bile canaliculi variability facilitates their assessment in liver biopsies in the pig.

Changes of biliary cilia, smooth muscle tissue distribution, innervation and extracellular matrices during morphological evolution of hepatic architectures in vertebrates.

BACKGROUND: The liver architecture of vertebrates can be classified into two types, the portal triad type (having periportal bile ducts) and the non-portal triad type (having bile ducts independent of the course of portal veins). The former is typically detectable in livers of tetrapods and cartilaginous fish, and its ancestral state is found in the hagfish, an earliest diverged lineage among vertebrates. Teleosts other than osteoglossomorphs have the latter. The aim of the present study is to reveal the changes of the hepatic innervation, biliary cilia and smooth muscle distribution, and extracellular matrices along vertebrate evolution with attention to the two types of liver architectures. METHODS: The hepatic innervation, biliary cilia and smooth muscle distribution, and collagen deposition were immunohistochemically and histochemically compared among livers of various vertebrates, using anti-acetylated tubulin and anti-α-smooth muscle actin antibodies, and Sirius red staining. These were also ultrastructurally examined. RESULTS: Although the hagfish liver had periportal intrahepatic bile ducts and ductules as detected in mammalian livers, it lacked smooth muscles around bile ducts and portal veins. Extracellular matrices in their connective tissues had thick collagen fibers. Its innervation was restricted to intrahepatic bile ducts and portal veins in the hilum. In livers of other vertebrates, including teleosts, the innervation was broadly detectable, especially around bile ducts, hepatic arteries and portal veins (afferent vessels), but not around central veins (efferent vessels). The chondrichthyans ultrastructurally had smooth muscle tissue around bile ducts. Cilia distribution was confirmed in intrahepatic bile ducts of tetrapods and basal actinopterygians. Teleosts other than osteoglossomorphs lacked cilia in their intrahepatic bile ducts. CONCLUSIONS: The liver architecture of the hagfish may be unique for innervation and extracellular matrices. Hepatic innervation may not have occurred in vertebrate ancestors. Hepatic innervation in bile ducts, hepatic arteries and portal veins may have been conserved among the extant jawed vertebrates. Cilia distribution in bile ducts may have changed during evolution of actinopterygians.

ARR-GCN: Anatomy-Relation Reasoning Graph Convolutional Network for Automatic Fine-Grained Segmentation of Organ's Surgical Anatomy.

Anatomical resection (AR) based on anatomical sub-regions is a promising method of precise surgical resection, which has been proven to improve long-term survival by reducing local recurrence. The fine-grained segmentation of an organ's surgical anatomy (FGS-OSA), i.e., segmenting an organ into multiple anatomic regions, is critical for localizing tumors in AR surgical planning. However, automatically obtaining FGS-OSA results in computer-aided methods faces the challenges of appearance ambiguities among sub-regions (i.e., inter-sub-region appearance ambiguities) caused by similar HU distributions in different sub-regions of an organ's surgical anatomy, invisible boundaries, and similarities between anatomical landmarks and other anatomical information. In this paper, we propose a novel fine-grained segmentation framework termed the "anatomic relation reasoning graph convolutional network" (ARR-GCN), which incorporates prior anatomic relations into the framework learning. In ARR-GCN, a graph is constructed based on the sub-regions to model the class and their relations. Further, to obtain discriminative initial node representations of graph space, a sub-region center module is designed. Most importantly, to explicitly learn the anatomic relations, the prior anatomic-relations among the sub-regions are encoded in the form of an adjacency matrix and embedded into the intermediate node representations to guide framework learning. The ARR-GCN was validated on two FGS-OSA tasks: i) liver segments segmentation, and ii) lung lobes segmentation. Experimental results on both tasks outperformed other state-of-the-art segmentation methods and yielded promising performances by ARR-GCN for suppressing ambiguities among sub-regions.

Rare Relationship Between the Right Hepatic Artery and Common Hepatic Duct in Living Donor Right Hepatectomy.

In living donor liver transplant, it is vital to perceive the hepatic artery anatomy and its variants. In the normal hepatic artery pattern, the common hepatic artery originates from the celiac artery to form the proper hepatic artery and gastroduodenal artery. The proper hepatic artery divides into right and left branches that supply the right and left lobes of the liver, respectively. Here, we report a rare variation of the right hepatic artery that was detected during a living liver right lobe hepatectomy. A 59-year-old man with alcoholic liver cirrhosis underwent living donor liver transplant. The patient's niece (a 47-year-old woman) volunteered to be a living donor. During the hilar dissection, we noticed that the anterior and posterior branches of the right hepatic artery passed through points anterior and posterior to the common hepatic duct, respectively. The right anterior hepatic artery and the right hepatic artery were divided separately. Although previously defined classifications have described anatomical variations of origin, branching, and course of hepatic artery, the topographical relationship of the anterior right hepatic artery and the posterior right hepatic artery versus the common hepatic duct has not been a matter of concern. Awareness must be maintained of this rare anatomical course of the right hepatic artery, especially in living liver right lobe donors. In the event of donors with rare variations, living donor liver transplant should be performed by an experienced team.

Hepatic vein anatomy related to Laennec's capsule for liver resection.

BACKGROUND: Laennec's capsule is the proper membrane covering the entire surface of the liver parenchyma, including around the Glissonean pedicles and hepatic veins. Laennec's capsule around the hepatic veins has been clinically reported to comprise two layers: the hepatic and cardiac Laennec's capsules. However, where the cardiac Laennec's capsule is derived from and the two capsules' separability are still unclear. This study aimed to investigate the anatomy of the two capsules using cadaveric specimens. METHODS: Histopathological examinations of autopsy specimens from four cadavers were conducted. Each specimen was sliced in the longitudinal section to include the pericardium, right hepatic vein (RHV), and inferior vena cava (IVC). Additionally, long-axis specimens of the RHV were obtained to determine the separability of the capsules and to examine the extent to which the capsules extended along the RHV. Laennec's capsule was estimated using elastic fiber staining. RESULTS: The cardiac Laennec's capsule is derived from the pericardium (parietal and visceral) and diaphragm and runs parallel with the IVC and hepatic veins associated with the hepatic Laennec's capsule. The two capsules were separable micro- and macroscopically. The hepatic Laennec's capsule was observed from the root to the peripheral side and the cardiac Laennec's capsule from the root to the middle side of the hepatic vein. CONCLUSIONS: The existence of the two layers of Laennec's capsule around the hepatic veins was confirmed histologically and they were separable. Identification and decollement of these layers would contribute to establishing safe and feasible anatomic liver resection techniques.

Anatomical and histological traits of Brycon amazonicus liver cultivated in a semi-intensive system / Características anatômicas e histológicas do fígado de Brycon amazonicus cultivado em sistema semi-intensivo

The work aimed to evaluate the weight-length relationship and the condition factor, characterizing the biometry, anatomy, histology and volumetric density of the liver of Brycon amazonicus, in different stages of body growth. The experiment used twenty specimens in four stages of body growth (PI, PII, PIII and PIV) harvested every 90 days, containing five specimens, each group. The livers were dissected, weighed (g) and processed routinely using the hematoxylin and eosin technique. The data were submitted to analysis of variance, Pearson's correlation test and linear regression. The equation that represented the weight-length relation was W = 0.05902 x L2.63, with negative allometric growth, but with a relative condition factor equal to 1.0. The liver was divided into three lobes with the gallbladder close to the right lobe and its color varied from light red to dark red, not varying in relation to other fish species. The hepatosomatic relationship followed body growth until the PII group stage and then declined, demonstrating the behavior of its development in Brycon amazonicus. The organ consists predominantly of hepatocytes, followed by sinusoidal vessels and capillaries, with histological morphology similar to that of many species of fish. Melanomacrophage centers were found only in the most developed animals, but in small quantities, prompting the development of new research on this cell, in this species. In this way, research of this nature allows the characterization of fish species, helping to improve breeding methods, understanding pathological processes caused by diseases, and obtaining better productive capacity, serving an increasingly demanding and prosperous market.

O trabalho objetivou avaliar a relação peso-comprimento e o fator de condição, caracterizando a biometria, anatomia, histologia e densidade volumétrica do fígado de Brycon amazonicus, em diferentes estágios de crescimento corporal. O experimento utilizou vinte espécimes em quatro fases de crescimento corporal (PI, PII, PIII e PIV) colhidos a cada 90 dias, contendo cinco espécimes, cada grupo. Os fígados foram dissecados, pesados (g) e processados rotineiramente pela técnica da hematoxilina e eosina. Os dados foram submetidos à análise de variância, teste de correlação de Pearson e regressão linear. A equação que representou a relação peso-comprimento foi W = 0,05902 x L2,63, com crescimento alométrico negativo, mas com fator de condição relativo igual a 1,0. O fígado apresentou-se dividido em três lobos com a vesícula biliar próxima ao lobo direito e sua cor variou de vermelho claro a vermelho escuro, não variando em relação a outras espécies de peixes. A relação hepatossomática acompanhou o crescimento corporal até a fase do grupo PII e então declinou, demonstrando o comportamento de seu desenvolvimento em Brycon amazonicus. O órgão constitui-se predominantemente por hepatócitos, seguido de vasos e capilares sinusoidais, com a morfologia histológica semelhante ao de muitas espécies de peixes. Centros melanomacrófagos foram encontrados apenas nos animais mais desenvolvidos, mas em pequena quantidade, instigando o desenvolvimento de novas pesquisas sobre esta célula, nesta espécie. Desta forma, pesquisas desta natureza permitem a caracterização de espécies de peixes, auxiliando no aperfeiçoamento de métodos de criação, compreensão de processos patológicos provocados por enfermidades, e obtenção de melhor capacidade produtiva, atendendo um mercado cada vez mais exigente e próspero.

Down-regulation of complement genes in lipopolysaccharidechallenged zebrafish (Danio rerio) larvae exposed to Indonesian propolis / Regulação negativa dos genes do complemento em larvas de peixe-zebra (Danio rerio) desafiadas com lipopolissacarídeo expostas à própolis indonésia

Although propolis has been reported for having anti-inflammatory activities, its effects on complement system has not been much studied. This research was conducted to find out the effects of Indonesian propolis on the expression levels of C3, C1r/s, Bf, MBL, and C6 in zebrafish larvae which were induced by lipopolysaccharide (LPS). Counting of macrophages migrating to yolk sac and liver histology were carried out. Larvae were divided into four groups: CON (cultured in E3 medium only), LPS (cultured in a medium containing 0.5 μg/L LPS), LPSIBU (cultured in a medium containing LPS, and then treated with 100 μg/L ibuprofen for 24 hours), and LPSPRO (cultured in a medium containing LPS, and then immersed in 14,000 μg/L propolis for 24 hours) groups. The results showed that complement gene expression in larvae from the LPSIBU and LPSPRO groups were generally lower than in larvae from the LPS group. The number of macrophage migrations to the yolk in the LPSPRO group was also lower than in the LPS group. Histological structure of liver in all groups were considered normal. This study shows that Indonesian propolis has the potential to be used as an alternative to the substitution of NSAIDs.

Embora a própolis tenha sido relatada por ter atividade anti-inflamatória, seus efeitos no sistema complemento, uma parte do sistema imunológico inato, não foram muito estudados. Esta pesquisa foi conduzida para descobrir os efeitos da própolis da Indonésia nos níveis de expressão de C3, C1r/s, Bf, MBL e C6 em larvas de peixe-zebra induzidas por lipopolissacarídeo (LPS). Foram realizadas contagens de macrófagos que migram para o saco vitelino e histologia do fígado. As larvas foram divididas em quatro grupos: CON (cultivadas apenas em meio E3), LPS (cultivadas em meio contendo 0,5 μg/L de LPS), LPSIBU (cultivadas em meio contendo LPS e, em seguida, tratadas com 100 μg/L de ibuprofeno por 24 horas) e LPSPRO (cultivado em meio contendo LPS, e então imerso em própolis 14,000 μg/L por 24 horas). Os resultados mostraram que a expressão do gene do complemento em larvas dos grupos LPSIBU e LPSPRO foi geralmente menor que em larvas do grupo LPS. O número de migrações de macrófagos para a gema no grupo LPSPRO também foi menor que no grupo LPS. A estrutura histológica do fígado em todos os grupos foi considerada normal. Este estudo mostra que a própolis indonésia tem potencial para ser utilizada como alternativa na substituição dos AINEs (anti-inflamatórios não esteroides).

Abdominal ultrasound in amazonian manatee (Trichechus inunguis) (Natterer, 1883) / Ultrassonografia abdominal em peixe boi amazônico (Trichechus inunguis (Natterer, 1883)

Morphophysiological species researches are fundamental, and diagnostic imaging is an excellent technique, already used in wild animals, with great application, not invasive and provide real-time information of each body. Amazonian manatees are on the list of endangered animals classified in the vulnerable category and knowledge of the normal pattern of ultrasound anatomy of organs and tissues is important for the maintenance and well-being of captive specimens contributing to reintroduction actions. The objective of the study was to standardize the examination technique and describe the ultrasound findings of the liver, gallbladder, stomach, urinary bladder and the subcutaneous tissue of the abdominal region in Trichechus inunguis, in order to contribute with the anatomical and sonographic knowledge and assist in the diagnosis and prognosis diseases. The study used 18 animals to describe the normal sonographic anatomy in the abdominal cavity of the Amazonian manatee. During abdominal scan, it was possible to visualize the features of the liver, gallbladder, stomach, urinary bladder obtained satisfactory results in this study. Therefore, other structures were not primarily identified by the reduced time, lots of fat and gases in intestines of animals.

Pesquisas morfofisiológicas em espécies selvagens são fundamentais, e o diagnóstico por imagem é uma excelente técnica, já usada e com grande aplicação, não invasiva e que fornece informações em tempo real de cada órgão. Peixes-boi-amazônico encontram-se na lista de animais ameaçados de extinção classificados na categoria vulnerável e o conhecimento do padrão normal da anatomia ultrassonográfica de órgãos e tecidos é importante para a manutenção e bem-estar de espécimes em cativeiro contribuindo para ações de reintrodução. O objetivo deste estudo foi padronizar a técnica de exame e descrever os achados ultrassonográficos do fígado, vesícula biliar, estômago, vesícula urinária e o tecido subcutâneo da região abdominal em Trichechus inunguis, de modo a contribuir com o conhecimento anátomo-sonográfico e auxiliar no diagnóstico e prognóstico de doenças. O estudo utilizou 18 animais para descrever a anatomia ultrassonográfica normal na cavidade abdominal de peixe-boi amazônico. Durante a varredura abdominal foi possível visualizar as características dos órgãos obtendo resultados satisfatórios neste estudo, concluindo ser uma técnica eficiente para avaliação de determinados órgãos abdominais em peixe-boi amazônico. Entretanto, outras estruturas não foram identificadas principalmente pelo tempo reduzido, muita gordura e gases nos intestinos dos animais.

A spatiotemporally resolved single-cell atlas of the Plasmodium liver stage.

Malaria infection involves an obligatory, yet clinically silent liver stage1,2. Hepatocytes operate in repeating units termed lobules, exhibiting heterogeneous gene expression patterns along the lobule axis3, but the effects of hepatocyte zonation on parasite development at the molecular level remain unknown. Here we combine single-cell RNA sequencing4 and single-molecule transcript imaging5 to characterize the host and parasite temporal expression programmes in a zonally controlled manner for the rodent malaria parasite Plasmodium berghei ANKA. We identify differences in parasite gene expression in distinct zones, including potentially co-adaptive programmes related to iron and fatty acid metabolism. We find that parasites develop more rapidly in the pericentral lobule zones and identify a subpopulation of periportally biased hepatocytes that harbour abortive infections, reduced levels of Plasmodium transcripts and parasitophorous vacuole breakdown. These 'abortive hepatocytes', which appear predominantly with high parasite inoculum, upregulate immune recruitment and key signalling programmes. Our study provides a resource for understanding the liver stage of Plasmodium infection at high spatial resolution and highlights the heterogeneous behaviour of both the parasite and the host hepatocyte.

Revisión Anatómica de Sistema Venoso Intrahepático. Hematoma Intrahepático Subcapsular en Colecistectomia Laparoscópica / Anatomical Review of Intrahepatic Venous System. Subcapsular Intrahepatic Hematoma In Laparoscopic Cholecystectomy

La aparición del hematoma intrahepático subcapsular (SHI) después de la colecistectomía laparoscópica es una complicación poco frecuente. El estudio anatómico de las venas suprahepáticas nos permitió observar que existen numerosos patrones de ramificación de estos. Presentamos el caso de una mujer de 37 años que, durante la intervención de colecistectomía laparoscópica, se observa en el acto quirúrgico, la formación espontánea de hematomas subcapsulares, secundario a la tracción forzada del fondo del órgano

The appearance of subcapsular intrahepatic hematoma (SHI) after laparoscopic cholecystectomy is an infrequent complication.The anatomical study of the suprahepatic veins allowed us to observe that there are numerous branching patterns of these. We present the case of a 37-year-old female who, during the laparoscopic cholecystectomy intervention, is observed in the surgical act, the spontaneous formation of subcapsular hematomas, secondary to forced traction of the fundus of the organ

Portal and Hepatic Venous Territorial Mapping in Healthy Human Livers: Virtual Three-Dimensional Computed Tomography Size-Shape-Topography Study.

OBJECTIVES: This study aimed to assess portal and hepatic venous volumes as related to the planning of complex liver resections and segmental liver transplant. MATERIALS AND METHODS: We analyzed 3-dimensional computed tomography of portal and hepatic vein territorial maps of 140 potential living related liver donors. Portal and hepatic vein maps were simulated both separately and in overlap (cross-mapping) to calculate inflow and outflow volumes. RESULTS: In total liver volume, the right hemiliver was always dominant (mean 64.7 ± 4.8%) and the right medial sector (mean 36.4 ± 6.8%) and segment 8 (mean 19.1 ± 4.3%) accounted for the largest volumes, whereas the left medial sector(mean 13.5 ± 3.1%) and segment 4A (mean 5.8 ± 1.8%) accounted for the smallest volumes (with exclusion of caudate lobe). The right hepatic vein was dominant for both right hemiliver and right lateral sector and had the largest drainage volume in total liver volume (mean 40.0 ± 11.2%). The left hepatic vein was dominant for both left hemiliver and left lateral sector but had the smallest drainage volume fortotal liver volume (mean 21.3 ± 5.0%). The middle hepatic vein drained 50.2 ± 12.5% of the right medial sector and 75.8 ± 15.4% of the left medial sector. In 67 cases, an accessory vein (inferior hepatic vein) drained 16.5 ± 13.2% ofthe right hemiliver, 31.4 ± 25.1% ofthe right lateral sector, 26.6 ± 23.2% of segment 7, and 37.4 ± 31.3% of segment 6. CONCLUSIONS: The portal and hepatic vein territorial anatomy was characterized by extensive individual variability. An extremely smallremnant volume (<25% of total liver volume) precluded a minority of virtual extended left and a majority of extended right hepatectomies. Left trisectionectomy was associated with risky drainage from the middle hepatic vein, extensive segment 6 remnant congestion volume in 8% of cases, and right lateral sector-favorable inferior hepatic vein large drainage pattern in 13% of livers.