The Mechanisms and Physiological Consequences of Diurnal Hepatic Cell Size Fluctuations: A Brief Review.

Liver size in mammals fluctuates throughout the day and correlates with changes in hepatocyte size. However, the role of these daily changes in liver and hepatocyte size and the underlying molecular mechanisms remain largely unknown. In this review, we highlight the view that hepatocyte size, and thus, overall organ size, is subject to regulation by the circadian clock and feeding/fasting cycles. To that end, we provide an overview of the current literature dealing with this phenomenon and elaborate the role of feeding and nutrients in this process. We will discuss the role of hepatic protein content and synthesis, which are both subject to diurnal regulation, in daily hepatocyte and liver size fluctuations. Although there is evidence that changes in hepatocyte and liver size are associated with daily variations in macromolecule content, there is also evidence that these changes in size may be actively regulated by modifications of the cells' osmotic environment. Future research will need to examine the intriguing possibility that hepatocyte and liver size fluctuations may be required for normal liver function and to reveal the underlying molecular mechanisms behind this process.

Maternal and fetal outcome in liver disorders in pregnancy

Background: Liver disorders comprise 3% of all pregnancy complications. All liver disorders, pregnancy specific, pregnancy related and pregnancy unrelated disorders have both maternal and fetal effects. The aim of the study was to determine the effect of liver disorders in pregnancy. The objective of this study was to determine the effect of liver disorders on pregnancy outcome.Methods: All pregnant patients with clinical and biochemical evidence of liver dysfunction were taken as cases. Pregnant women with normal liver function tests were taken as controls. All patients were followed during pregnancy and postpartum. Maternal and fetal outcome was studied.Results: A total of 140 patients were included- 70 cases and 70 controls. Maternal and fetal outcome was studied in both the groups. PPH and oligohydroamnios were most frequent among cases with p value of 0.034 and 0.035 respectively. Similarly, pre-term birth, RDS and perinatal asphyxia was more common in cases with a p value of 0.011, 0.001 and 0.005 respectively.Conclusions: Study concludes that liver disorders in pregnancy have adverse maternal and fetal complications.

A Case Series on Suspected Remdesivir Induced Hyperammonemia

Remdesivir is a broad spectrum anti-viral drug that has shown to inhibit SARS-CoV-2. In absence of any effective treatment for SARS-CoV-2 infection (COVID-19), Remdesivir has been tried for a compassionate use in severe COVID-19. Remdesivir has shown promise in the management of patients with COVID-19 although recent studies have shown concerns with its effectiveness and safety in practice. Despite this there is a need to document potential Adverse drug Reaction (ADR) to guide future decisions. We describe 2 cases of Suspected Remdesivir-induced hyperammonemia (SRIH) in patients with normal liver function. Serum ammonia levels was raised much above the baseline after a fortnight of therapy. After completion of the therapy, there was gradual improvement and normalization of serum ammonia levels. This suggested a causal relationship which was possibly due to the administration of Remdesivir drug. With the increasing use, physicians should be aware of this potential ADR of Remdesivir and evaluate ammonia levels in patients taking Remdesivir who present with alterations in mental status.

Volumetric Assessment and Clinical Predictor of Cirrhotic Livers With Normal Liver Function Undergoing Hepatectomy

Aim: Indocyanine green retention rate at 15 minutes (ICGR15) is a frequently-used indicator of liver function. However, cirrhotic liver is sometimes observed intraoperatively despite a normal preoperative ICGR15 (<10 %). Herein, we conducted clinical and volumetric assessments of cirrhotic livers with normal ICGR15.Methods: Patients undergoing hepatectomy for hepatocellular carcinoma were divided into 3 groups: non-cirrhotic livers (Group A, n=112): cirrhotic livers with ICGR15 <10% (Group B, n=71): and cirrhotic livers with ICGR15 >10% (Group C, n=296). Background characteristics and surgical outcomes were compared between groups. Functional liver volume (FLV) was computed using total liver volume and signal intensity ratio. Liver parenchymal cell volume ratio was measured in non-cancerous tissue obtained from resected specimens. Univariate and multivariate analyses were performed to detect clinical characteristics correlating with cirrhotic liver pathology with normal ICGR15.Results: There was no significant difference between groups in TLV. FLV was gradually reduced from Group A toward Group C. Liver parenchymal cell volume ratio was also gradually reduced from Group A toward Group C. Multivariate analysis revealed that platelet count (<12 x104/mm3) (P = 0.001) and prothrombin time (<80 %) (P = 0.025) were significantly associated with cirrhotic liver pathology among patients with normal ICGR15.Conclusion: Our results suggested that cirrhotic liver pathology despite normal liver function was characterized by slightly decreasing liver parenchyma as well as slight degree of fibrosis. Platelet count and PT% are useful for predicting liver cirrhosis with normal ICGR15.

Multiple Hepatic Micro-Hypodensities as a Presenting Sign in Systemic Lupus Erythematosus- A Case Report

Systemic Lupus Erythematosus (SLE) is a chronic multisystemic inflammatory disorder that can present with a wide array of signs and symptoms. Hepatic involvement is commonly limited to a subclinical biochemical transaminitis while clinically significant liver disease is rare. A case of a 22-year-old female who presented with abdominal pain, fevers, arthralgia, and several hepatic hypodense lesions with normal liver function tests is reported in this study. She failed to improve with antibiotics and infectious workup was largely unrevealing. She was found to have a positive ANA, high titers of anti-double-stranded DNA antibody, and was ultimately diagnosed with new-onset SLE with hepatic aseptic micro-abscesses. Her symptoms were self-limiting, and she was later started on a low-dose prednisone taper and hydroxychloroquine. This case demonstrates that hepatic involvement, despite normal liver function tests, should be considered in SLE patients presenting with abdominal pain.

Effects of grade B liver dysfunction on the level of free hexafluoroisopropanol of sevoflurane metabolites in patients with abdominal surgery

Background: Study shows the metabolite, hexafluoroisopropanol (HFIP) from sevoflurane, has a strong inhibition on the central nervous system. This study aims to compare the level of free HFIP in the blood after inhaled a same concentration of sevoflurane in patients with normal liver function versus grade B liver dysfunction and observe its effect on patients’ recovery quality.Methods: Twenty four patients with normal liver function and twenty four patients with grade B liver dysfunction undergoing elective abdominal surgery were selected and assigned to group A and group B, respectively. All patients were inhaled sevoflurane (1.5MAC) for anesthesia about 3 h. The free HFIP concentration was determined at the time points of 0.5 h, 1 h, 2 h, 3 h after inhaled sevoflurane and 0.5 h, 1 h, 2 h, 4 h after discontinuation of sevoflurane, respectively. Patients’ eyes opening time, orientation recovery time, command response time and extubation time were observed after operation. The visual analogue scale (VAS) and Ramsay sedation score (RSS) were also evaluated at different time points after extubation. Results: Although the peak time of free HFIP in group B was 1 h later than that in group A, no significant differences were found in the peak concentration and other corresponding time points’ free HFIP concentrations between the two groups (P<0.05). All the eyes opening time, orientation recovery time, command response time and extubation time in group B were longer than those in group A (P<0.05). Compared to group A, a lower VAS score and a higher RSS score were found in group B at 0 min, 15 min, 30 min,1 h, 2 h and 3 h after extubation, respectively (P<0.05). Conclusion: The status of patients with grade B liver dysfunction does not affect the degree of sevoflurane metabolism. However, it can significantly prolong the peak time of free HFIP when compared with normal liver function.Trial registry number: Identified as ChiCTR 2000028901at http://www.chictr.org.cn/