Advances in understanding and treating liver diseases during pregnancy:A review

Liver disease in pregnancy is rare but pregnancyrelated liver diseases may cause threat to fetal and maternal survival.It includes pre-eclampsia;eclampsia;haemolysis,elevated liver enzymes,and low platelets syndrome;acute fatty liver of pregnancy;hyperemesis gravidarum;and intrahepatic cholestasis of pregnancy.Recent basic researches have shown the various etiologies involved in this disease entity.With these advances,rapid diagnosis is essential for severe cases since the decision of immediate delivery is important for maternal and fetal survival.The other therapeutic options have also been shown in recent reports based on the clinical trials and cooperation and information sharing between hepatologist and gynecologist is important for timely therapeutic intervention.Therefore,correct understandings of diseases and differential diagnosis from the pre-existing and co-incidental liver diseases during the pregnancy will help to achieve better prognosis.Therefore,here we review and summarized recent advances in understanding the etiologies,clinical courses and management of liver disease in pregnancy.This information will contribute to physicians for diagnosis of disease and optimum management of patients.

Pulmonary tumor thrombotic microangiopathy of hepatocellular carcinoma: A case report and review of literature

BACKGROUND Pulmonary tumor thrombotic microangiopathy(PTTM)is a rare condition in patients with hepatocellular carcinoma(HCC);to date,few cases have been reported.While hepatic dysfunction has been focused on the later stages of HCC,the management of symptoms in PTTM is important for supportive care of the cases.For the better understanding of PTTM in HCC,the information of our recent case and reported cases have been summarized.CASE SUMMARY A patient with HCC exhibited acute and severe respiratory failure.Radiography and computed tomography of the chest revealed the multiple metastatic tumors and a frosted glass–like shadow with no evidence of infectious pneumonia.We diagnosed his condition as acute respiratory distress syndrome caused by the lung metastases and involvement of the pulmonary vessels by tumor thrombus.Administration of prednisolone to alleviate the diffuse alveolar damages including edematous changes of alveolar wall caused by the tumor cell infiltration and ischemia showed mild improvement in his symptoms and imaging findings.An autopsy showed the typical pattern of PTTM in the lung with multiple metastases.CONCLUSION PTTM is caused by tumor thrombi in the arteries and thickening of the pulmonary arterial endothelium leading to the symptoms of dyspnea in terminal staged patients.Therefore,supportive management of symptoms is necessary in the cases with PTTM and hence we believe that the information presented here is of great significance for the diagnosis and management of symptoms of PTTM with HCC.

Liver-targeted hydrodynamic gene therapy: Recent advances in the technique

One of the major research focuses in the field of gene therapy is the development of clinically applicable, safe, and effective gene-delivery methods. Since the first case of human gene therapy was performed in 1990, a number of gene-delivery methods have been developed, evaluated for efficacy and safety, and modified for human application. To date, viral-vectormediated deliveries have shown effective therapeutic results. However, the risk of lethal immune response and carcinogenesis have been reported, and it is still controversial to be applied as a standard therapeutic option. On the other hand, delivery methods for nonviral vector systems have been developed, extensively studied, and utilized in in vivo gene-transfer studies. Compared to viral-vector mediated gene transfer, nonviral systems have less risk of biological reactions. However, the lower gene-transfer efficiency was a critical hurdle for applying them to human gene therapy. Among a number of nonviral vector systems, our studies focus on hydrodynamic gene delivery to utilize physical force to deliver naked DNA into the cells in the living animals. This method achieves a high gene-transfer level by DNA solution injections into the tail vein of rodents, especially in the liver. With the development of genome editing methods, in vivo gene-transfer therapy using this method is currently the focus in this research field. This review explains the method principle, efficiency, safety, and procedural modifications to achieve a high level of reproducibility in large-animal models.

Case of severe alcoholic hepatitis treated with granulocytapheresis

Severe alcoholic hepatitis(AH) has a high mortality,and it is associated with encephalopathy,acute renal failure,sepsis,gastrointestinal bleeding,and endotoxemia.The 28-d mortality remains poor(34%-40%),because no effective treatment has been established.Recently,corticosteroids(CS) have been considered effective for significantly improving the prognosis of those with AH,as it prevents the production of pro-inflammatory cytokines.However,CS are not always appropriate as an initial therapeutic option,such as in cases with an infection or resistance to CS.We describe a patient with severe AH complicated by a severe infection caused by the multidrug resistance bacteria(Pseudomonas aeruginosa),and was successfully treated with granulocytapheresis monotherapy without using CS.The experience of this case will provide understanding of the disease and information treating cases without using CS.

New Rectangular-like Columns： Advanced Swing Jet Grouting Test and Quality Confirmation

Ordinary columns of jet grouting are circular or fan-shaped. But in recent years, such shapes as candy-shaped columns were put to practical use. They are constructed by switching the rotational speed of the stem in one rotation. We applied this method to swing jet grouting. That is, we changed the rotational speeds in the swing jet grouting to make elongated columns near rectangle. The test construction was succeeded and the columns’ shapes conformed to those designed. In addition, the quality was confirmed to be as good as ordinary columns. Radii （distances from center to outer ends） were 1.03 to 1.21 times as large as those designed. Improvement ratios were 95% or more in any position. Strengths were varied by location, but they satisfied design strength 1.5 kN/m2 at any position. We concluded that this new column can be applied to practice in the same way as ordinary columns.