Pharmacological ascorbate inhibits pancreatic cancer metastases via a peroxide-mediated mechanism

Pharmacological ascorbate (P-AscH-, high-dose, intravenous vitamin C) is cytotoxic to tumor cells in doses achievable in humans. Studies in pancreatic cancer have demonstrated increases in progression free survival, suggesting a reduction in metastatic disease burden. In vitro and in vivo, P-AScH- significantly decreased formation of ascites, tumor burden over time, circulating tumor cells, and hepatic metastases.

Randomised clinical trial: palliative long-term abdominal drains vs large-volume paracentesis in refractory ascites due to cirrhosis

Palliative care remains suboptimal in end-stage liver disease. Study assessed palliative long-term abdominal drains in liver disease to determine recruitment, attrition, safety/potential effectiveness, questionnaires/interview uptake/completion and cost comparison. Median (IQR) fortnightly community/hospital/social care ascites-related costs and percentage study time in hospital were lower in the long- term abdominal drain group than the large-volume paracentesis group. The REDUCe study demonstr

Randomised clinical trial: standard of care versus early-transjugular intrahepatic porto-systemic shunt (TIPSS) in patients with cirrhosis and oesophageal variceal bleeding

Early-transjugular intrahepatic porto-systemic shunt (TIPSS) recommended in international guidelines for high-risk patients with oesophageal variceal bleeding. After one year, 7 patients died in the standard of care group and six in the early-TIPSs group, a 1-year survival of 75.9% vs 79.3% respectively. Serious adverse events were similar in both treatment groups, except rates of hepatic encephalopathy were higher in patients receiving TIPSS.

A prospective, randomized trial of thrombin versus cyanoacrylate injection in the control of acute gastric variceal hemorrhage

Acute gastric variceal hemorrhage (AGVH) is a serious complication of portal hypertension. Glue injection is standard therapy for acute hemostasis, but it may be associated with serious complications. This study compared endoscopic thrombin and glue injections in the hemostasis of AGVH. Complications occurred in 4 (12.1%) and 18 (51.4%) patients in the thrombin and glue groups, respectively.

Diagnostic accuracy of spleen stiffness to evaluate portal hypertension and esophageal varices in chronic liver disease: a systematic review and meta-analysis

A total of 32 studies assessing 3952 patients were included in this meta-analysis. SSM was quite useful for ruling out the presence of HREV thereby avoiding unnecessary endoscopy. The pooled sensitivities of SSM were 0.85 (95% CI, 0.74-0.93) for CSPH and 0.84 (95%) for SPH. The SSM could be used as a helpful surveillance tool in management of CLD patients.

Systematic review with meta-analysis: liver manifestations and outcomes in COVID-19

Elevated liver chemistries and pre-existing chronic liver disease (CLD) have been reported in COVID-19. The presence of CLD does not alter the outcome of the illness. Further studies are needed to analyse the outcomes of compensated and decompensated liver disease, including those with compensated liver disease.

Contrast-Enhanced Subharmonic Aided Pressure Estimation (SHAPE) using Ultrasound Imaging with a Focus on Identifying Portal Hypertension

Contrast agents for ultrasound imaging are gas-filled, encapsulated microbubbles that traverse the entire vasculature. They enhance signals by up to 30dB and produce nonlinear oscillations at frequencies ranging from the subharmonic (half of the transmit frequency) to higher harmonics. The utility of the SHAPE procedure for identifying portal hypertension in the liver is the emphasis here, but the technique has applicability across many clinical scenarios

Efficacy of Oral, Topical, or Combined Oral and Topical 5-Aminosalicylates, in Ulcerative Colitis: Systematic Review and Network Meta-Analysis

5-aminosalicylates (5-ASAs) are the mainstay of treatment for ulcerative colitis (UC) The optimum preparation, dose, and route of administration for UC remains unclear. High-dose oral mesalazine was found to be more efficacious than lower doses. Future RCTs should better establish the role of combined therapy for induction of remission, as well as optimal doses of oral 5-ASA to prevent relapse.

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