Search Results (142)

Background and Clinical Significance: Adrenohepatic fusion (AHF) represents a developmental anatomical variant chracterised by direct continuity between the right adrenal cortex and hepatic parenchyma, often accompanied by partial or complete absence of the intervening fibrous capsule and periadrenal fat plane. In contrast, adrenohepatic adhesion (AHA) denotes a close apposition of the two organs with a shared capsule, but without actual parenchymal intermingling. AHF/AHA becomes most clinically relevant when a lesion arises in the right adrenal gland. In this setting, cross-sectional imaging frequently demonstrates apparent continuity of the lesion across the interface. These features are conventionally interpreted as signs of local invasion, and this may lead to diagnostic misclassification as hepatocellular carcinoma, adrenocortical carcinoma, or metastatic disease, resulting in unnecessarily extensive hepatectomy in cases of benign disease. Case presentation: Herein we report two female patients, 27 and 63 years old, who underwent right antero-lateral laparoscopic adrenalectomy. In the first patient, a heterogeneous, partly calcified haemorrhagic cyst was connected to the hepatic capsule, and AHA was the final finding. In the second patient, a cortical adenoma at the liver–adrenal interface was diagnosed as AHF. Conclusions: AHF and AHA should be considered when right adrenal mass is inseparable from hepatic segment VI or VII, particularly when other imaging and biochemical characteristics do not support malignancy. Close coordination between radiology and pathology can help reduce unnecessary liver resections, improve surgical strategies, and support appropriately conservative adrenal resection. Full article

Background: Metastatic liver tumors (MLT) and parasitic liver cysts (PLC) are common liver conditions that often exhibit similar imaging characteristics, making accurate diagnosis challenging using imaging alone. This overlap can result in diagnostic errors and delayed treatment, particularly in resource-limited settings or when invasive procedures such as biopsies are not feasible due to risk or unavailability. This study aimed to develop a reliable and transparent machine learning approach to distinguish MLT from PLC using radiomic features derived from computed tomography (CT). Methods: We propose an explainable radiomics-based machine learning framework for the non-invasive, accurate, and interpretable discrimination of MLT and PLC, designed to assist radiologists in reducing diagnostic ambiguity and expediting patient management. This retrospective study included 30 adult patients, comprising 15 with liver metastases and 15 with pathologic hepatic cysts. Radiomic features were extracted from pre-treatment CT scans using PyRadiomics. Feature selection was performed using three complementary methods: Mutual Information, Lasso regression, and LightGBM importance ranking. HistGradientBoosting classifiers were then trained on each selected feature set. Results: Model performance was evaluated using 5-fold cross-validation and assessed with ROC AUC, accuracy, precision, recall, and F1-score. SHAP analysis was applied to interpret the models and identify key radiomic biomarkers. Statistical comparisons were performed using DeLong’s test for AUCs, McNemar’s test for classification agreement, and paired t-tests for metrics such as accuracy and F1-score. The Mutual Information-based model achieved the highest mean AUC (0.9717 ± 0.0267), significantly outperforming the other models (p < 0.035). Key features contributing to classification included texture entropy, interquartile range, and gray level non-uniformity. Conclusion: We developed a robust and interpretable machine learning framework for differentiating metastatic liver tumors from parasitic liver cysts using CT-derived radiomic features. The integration of Mutual Information feature selection, ensemble learning, and SHAP explainability ensured high diagnostic accuracy, strong calibration, and transparency. The proposed framework demonstrates substantial clinical relevance and holds promise for real-world implementation. Full article

Background/Objectives: In resource-limited settings, where access to advanced imaging modalities such as magnetic resonance imaging (MRI) and histopathological confirmation may be limited, differentiating between hepatic cysts and metastatic lesions based solely on computed tomography (CT) remains challenging. This limitation may affect diagnostic confidence and increase the risk of misclassification, potentially impacting clinical decision making and patient management. In this study, we aimed to explore a more direct and automated approach for classifying hepatic lesions from CT images. Methods: We developed a deep learning-based framework combining transfer learning, decision fusion, and a stacking strategy by integrating five CNN architectures. The study included 100 patients, equally divided between metastatic liver tumors and pathological hepatic cysts. The dataset was built from both public data (LiTS) and internal clinical cases, and then split into training and testing sets. Results: The proposed stacking model provided the most consistent results, reaching an accuracy of 0.98, with high precision and sensitivity. The improvements in individual models, although moderate, were observed across all evaluation metrics. Conclusions: Overall, this approach offers a practical and reliable way to classify hepatic lesions with minimal manual intervention. It may help improve consistency in diagnosis and could be integrated into clinical workflows to support decision making in low-resource areas. Full article

Background: The utilization of robot-assisted surgery in pediatric patients is increasing, with particularly notable advantages in complex reconstructive procedures. This study aims to evaluate the safety and efficacy of robotic-assisted resection of choledochal cysts in infants aged less than 3 months. Methods: A total of 73 infants with choledochal cysts who were admitted to the Department of General Surgery, Children’s Hospital of Zhejiang University School of Medicine, between April 2019 and December 2025 were included. The patients were divided into a robotic-assisted surgery (RAS) group (n = 39) and a laparoscopic-assisted surgery (LAS) group (n = 34). Clinical data, including demographic information, laboratory indexes, surgical data, and prognostic data, were retrospectively reviewed, and the Mann–Whitney U test, independent-samples t-test, and Fisher’s exact test were used for statistical analysis. Results: The groups were comparable in terms of age, sex, weight, pre- and postoperative biochemical markers, fasting time, cyst diameter, and operative time. Overall, 80.8% of cases were prenatally detected. The RAS group had a significantly shorter postoperative hospital stay (p = 0.004, Z = −2.864), drainage tube duration (p = 0.002, Z = −3.100), and hepaticojejunostomy time (p < 0.0001, df = 71, 95%CI (−5.70, −3.04)) compared to the LAS group. In the LAS group, three patients developed anastomotic fistulas, all of whom required reoperation, and one patient developed adhesive bowel obstruction, whereas in the RAS group, one patient developed incision infection, one developed cholangitis, one developed adhesive bowel obstruction, and one presented with postoperative liver function abnormalities. The hospitalization cost in the LAS group was significantly lower than that in the RAS group (p < 0.0001, Z = −5.468). Conclusions: In experienced pediatric centers, robotic-assisted resection of choledochal cysts is safe and effective for infants aged less than 3 months and deserves further exploration. Full article

Background: Hydatid disease, caused by Echinococcus granulosus, remains a significant public health concern in endemic regions. This study aimed to evaluate the role of ultrasound in the diagnosis, staging, and clinical management of liver hydatid cysts in the eastern city of Jalalabad, Afghanistan. Method: A cross-sectional study was conducted between February and November 2024 among 159 patients diagnosed with liver hydatid cysts. Demographic, clinical, laboratory, and imaging data were collected. Cysts were classified according to the WHO Informal Working Group on Echinococcosis (WHO-IWGE) and Gharbi systems. Ultrasound findings were compared with computed tomography (CT), and their association with treatment decisions was assessed. Result: A total of 159 patients with liver hydatid cysts were included in the study. Among them, 91 (57.2%) were female, 80 (50.3%) were aged 20–39 years, and 128 (80.5%) resided in rural areas. Most patients presented with a single cyst (144/159, 90.6%), while multiple cysts were observed in 15 (9.4%). The majority of cysts measured 5–9.9 cm in diameter (43.4%), followed by 1–4.9 cm (42.1%) and ≥10 cm (14.5%). According to the WHO-IWGE classification, CE1 (25.8%) and CE4 (24.5%) were the most common stages, followed by CE2 (17.6%), CE3a (13.8%), CE3b (11.3%), and CE5 (7.0%). Common exposure-related factors included dog ownership, poor hygiene practices, and consumption of raw vegetables. Ultrasound accurately identified cyst stages and demonstrated a significant association between WHO-IWGE staging and treatment modality (χ² = 63.56, p < 0.001). Almost perfect agreement was observed between ultrasound and CT for cyst classification (Cohen’s κ > 0.90), although CT provided additional anatomical information in selected complex cases. Conclusions: Ultrasound is an accessible, accurate, and reliable imaging modality for the diagnosis, staging, and management of liver hydatid cysts. In resource-limited settings, it serves as the primary imaging modality for guiding clinical decision-making, with CT reserved for complex or uncertain cases. Full article

Background: Hydatid disease, caused primarily by Echinococcus granulosus, remains a significant public health challenge in endemic regions. While hepatic (80–85%) and pulmonary (15–20%) involvements are common, multi-organ dissemination involving rare sites such as the pericardium, diaphragm, and mediastinum occurs in less than 0.1–2% of cases. Case presentation: We present a rare case of a 26-year-old male, a farmer for 10 years, with occupational exposure to dogs and horses, with a personal history of multiple surgically treated abdominal cysts in 2016, admitted after abdominal computed tomography revealed liver cysts greater than 5 cm, as well as mediastinal and diaphragmatic cysts. Histopathological examination of the surgically resected hepatic cyst material confirmed echinococcosis. Serology was also positive for echinococcosis. Echocardiography revealed a pericardial cyst, posterior to the left atrium. Under these circumstances, antiparasitic treatment was initiated by an infectious disease specialist, followed by surgical treatment of the abdominal cysts, confirming the final diagnosis of hydatid disease, and subsequently, surgical treatment of the thoracic hydatid cysts was performed. The postoperative course was complicated by bronchial superinfection with Stenotrophomonas maltophilia, identified from bronchial aspirate culture after extended incubation and managed with trimethoprim–sulfamethoxazole. Conclusions: This case underscores the necessity of lifelong surveillance in hydatid disease, the potential role of postoperative antiparasitic therapy in preventing long-term recurrence, and the vital role of a multidisciplinary team in managing complex, disseminated relapses. Full article

Cystic echinococcosis (CE) is a zoonotic disease caused by the larval stage of the Echinococcus granulosus sensu lato (s.l.) complex. The disease is globally distributed, with particularly high prevalence in Central Asian countries, including Kazakhstan. Despite its significant impact on public health and livestock production, data on CE in sheep in Kazakhstan remain limited. This study investigated the prevalence and genetic diversity of Echinococcus granulosus sensu stricto (s.s.) in sheep across Kazakhstan, addressing an important zoonotic disease affecting both livestock and human health. Over the course of one year, a total of 31,389 sheep were examined, and cystic echinococcosis cysts were collected from the livers and lungs of 550 infected sheep across 14 regions of Kazakhstan. Molecular analyses targeting mitochondrial genes (nad1, cox1) were performed to determine genetic diversity. The results revealed a higher occurrence of CE in the southern regions of the country. Among the genotyped isolates (57), genotype G1 was dominant, accounting for 84.2% (48) of the samples, whereas genotype G3 (9) was detected at a lower frequency in three regions. A total of 11 distinct haplotypes were identified, indicating considerable genetic diversity among the isolates. Haplotype network analysis suggested gene flow among populations and revealed the widespread presence of the most common haplotype (EgKZ-2) across multiple regions. These findings highlight the need for continuous monitoring and targeted control strategies for cystic echinococcosis, emphasizing the importance of understanding parasite genetic diversity for public health interventions and livestock management in endemic areas. Overall, this study contributes to the understanding of the genetic diversity and transmission dynamics of E. granulosus s.s. in Central Asia. Full article

Toxoplasma gondii is an obligate intracellular parasite that infects virtually all warm-blooded animals, progressing through acute and chronic stages. The Akt/mTOR signaling axis plays critical roles in cell survival, proliferation, and metabolism, making it a key target for intracellular pathogens. This study investigated how T. gondii infection modulates this pathway during both infections. Outbred CD-1 mice were infected intraperitoneally with the virulent GT1 strain of T. gondii. Mice for acute studies were sacrificed five days post-infection, while those for chronic studies were treated with sulfadiazine and sacrificed five months post-infection. Phosphoprotein expression of eight Akt/mTOR pathway components was measured in liver tissues using a multiplexed bead-based immunoassay. Acute T. gondii infection caused broad suppression of Akt/mTOR signaling, with 6 of 8 markers significantly downregulated, including pS6RP^Ser235/236, pAKT^S473, pBAD^Ser136, pIRS1^S636/639, pPTEN^Ser380, and pGSK-3α/β^Ser21/9. In contrast, chronic infection related to cyst burden selectively activates specific nodes of the pathway, including pBAD^Ser136, pmTOR^Ser2448, and pGSK-3α/β^Ser21/9. Infection induced strong correlations between inter-components, which reflect coherent and coordinated pathway-level reprogramming rather than random perturbation. These findings show that acute and chronic T. gondii infections have opposing effects on host Akt/mTOR signaling for their own benefit, which may present new therapeutic targets. Full article

Non-infectious cardiac failure in feedyard cattle has become more frequently diagnosed. There is limited research assessing gross and histologic lesions in grossly abnormal hearts of harvested cattle. Cases were stratified by heart score (HS) using a scale of 1–5, with 1 representing a normal heart and 5 representing severely remodeled ventricles. Cattle were evaluated for gross lesions of the heart, lung, and liver. Samples collected from each animal for histology included cardiac (n = 4), pulmonary (n = 4), and hepatic (n = 1) tissues. Histologic evaluation scored cardiac and hepatic fibrosis and necrosis, embedded myocardial protozoal cysts (EMPCs) were quantified, and pulmonary lesions were categorized based on histologic patterns. Of 103 cases, 40 had normal HSs (NHSs) (1 or 2), and 63 had abnormal HSs (AHSs) (3, 4, or 5). There were 64 cases with normal lung deflation scores, and 39 cases with abnormal lung deflation scores. At least one cardiac section contained EMPCs in 67 cases. Cattle with abnormal lung deflation scores were more likely to have an AHS (0.76 ± 0.07, p ≤ 0.01) compared with cattle with normal deflation scores (0.52 ± 0.06). Cattle with EMPCs present in at least one cardiac section were more likely to also have an AHS (0.73 ± 0.05, p ≤ 0.1) compared with cattle without EMPCs (0.39 ± 0.08). No histological findings for the lungs or liver were associated with abnormal heart score; however, lung deflation and EMPCs were associated with abnormal heart score. Full article

Background: Hydatid disease poses unique management challenges in pediatric populations due to developing anatomy and growth considerations. This systematic review evaluates the efficacy and safety of medical, surgical, and combination therapies for pediatric hydatid liver disease. Methods: A comprehensive search of PubMed, Scopus, Web of Science, and Cochrane Library from inception to January 2025 identified studies investigating treatment outcomes in pediatric hydatid liver disease. Data was synthesized through qualitative analysis of treatment effectiveness, complications, and patient outcomes. Results: Fifteen studies were included, comprising controlled trials, cohort studies, and cross-sectional studies. Treatment efficacy correlated significantly with cyst size: small cysts (<5 cm) responded well to albendazole monotherapy (88.3–97.6% success at 6–12 months); medium-sized cysts (5–6 cm) benefited from percutaneous interventions (PAIR) with 97.1% technical success; large cysts (>6 cm) required surgical management. Laparoscopic approaches demonstrated advantages over open surgery, including shorter hospitalization (5.6 ± 2.2 vs. 12.1 ± 1.5 days) and reduced analgesic requirements. Omentoplasty emerged as superior for residual cavity management with fewer complications than tube drainage approaches. Conclusions: This review supports personalized treatment algorithms based primarily on cyst characteristics. The findings recommend standardized protocols incorporating cyst size, location, and complexity as key decision points, with expanded access to minimally invasive techniques. Future research should focus on prospective comparative studies with standardized outcome measures. Full article

Giardiasis, caused by Giardia duodenalis, is a common gastrointestinal infection. This study aimed to evaluate the effects of Hedera helix leaf extract (HLE) and HLE-loaded chitosan nanoparticles (HLE-CsNPs) against Giardia duodenalis isolates from individuals with gastrointestinal issues, using an experimental rat model. Stool samples from 147 participants were analyzed for Giardia duodenalis, with positive samples further characterized by nested PCR-RFLP, revealing a 4.8% prevalence, all belonging to assemblage B. Ten groups of male albino rats were used to evaluate the antigiardial activity of various treatments. This included five non-infected groups [one untreated and four treated with HLE, HLE-CsNPs, CsNPs, and metronidazole (MTZ)] and five infected groups [one untreated and four similarly treated]. Treatment efficacy was assessed using parasite counts, intestinal histopathology, CD117 immunohistochemistry, and markers of liver and kidney function. HLE-CsNPs markedly reduced Giardia cysts by 88.8%, approaching the 99.2% reduction achieved by MTZ, while also improving intestinal architecture and reducing inflammation. Importantly, HLE and HLE-CsNPs provided superior protection for the liver and kidneys compared to MTZ. In conclusion, HLE-CsNPs exhibited significant antigiardial activity and organ protection in rats, suggesting a potential alternative treatment for Giardia duodenalis isolated from individuals with gastrointestinal issues. Full article

(1) Background: Echinococcosis is a significant zoonotic disease that the World Health Organization (WHO) aims to eliminate by 2050. Current drug-based control faces challenges such as drug resistance, highlighting the urgent need to develop vaccines as a supplementary strategy. Although some progress has been made in the study of intermediate host vaccines using antigens such as Eg95, there is still no commercial vaccine available for the definitive host, canines—which are crucial for transmission—and it is not yet suitable for large-scale use. While vaccine studies targeting the key enzyme lactate dehydrogenase (LDH) in parasite energy metabolism remain scarce, they represent a promising area of potential. (2) Methods: The B cell antigen epitopes of LDH were analyzed, and prokaryotic (pET-28a-EgLDH) and eukaryotic (pVAX1-EgLDH) DNA vaccine expression vectors were constructed. After verifying expression and immunogenicity via qRT-PCR and WB, in vitro validation was performed in 293T cells. Mice were immunized with the vaccine and then challenged with the parasite; blood was collected from the orbital sinus, and IgG levels and cytokines were measured by ELISA. Protective effects were assessed through counting liver cysts and histopathological analysis. (3) Results: We constructed the pVAX1-EgLDH plasmid and immunized Kunming (KM) mice. Compared with the PBS control group, the vaccine group showed an 80.95% reduction in liver cysts (Quil-A group: 19.00%). Histopathological analysis indicated no significant liver damage, although the spleens in the vaccine group were smaller. ELISA results demonstrated an increase in total IgG (p < 0.05), and cytokine analysis showed elevated levels of IL-1 (p < 0.01), IL-4, and IL-10 (p < 0.001), whereas IL-5 and IFN-γ showed no significant changes (p > 0.05). (4) Conclusions: The EgLDH DNA vaccine can elicit a specific immune response and significantly reduce cyst burden, providing theoretical basis and data support for its use as a candidate vaccine for the prevention and control of Echinococcosis. Full article

Autosomal dominant polycystic kidney disease (ADPKD) is the most frequent monogenic kidney disease (≈4 cases per 10.000 inhabitants) and a major cause of end-stage kidney disease (ESKD). Beyond progressive cystic enlargement of the kidneys and frequent extrarenal involvement, adults with ADPKD often exhibit a distinctive “body phenotype” with central adiposity and marked abdominal distension due to renal and hepatic organomegaly. In this setting, conventional anthropometric indices such as body mass index (BMI) and crude body weight are of limited value, as they cannot distinguish nutritional tissues (muscle, subcutaneous fat) from non-nutritional mass (cyst fluid, fibrotic tissue, or expanded extracellular water). This review summarizes the current evidence on malnutrition and sarcopenia in adult ADPKD, with a focus on the impact of organomegaly and adiposity. Cross-sectional work using the modified Subjective Global Assessment (SGA) has shown that approximately one-third of ambulatory ADPKD patients are at risk of becoming, or have become, malnourished, and that height-adjusted total kidney and liver volume (htTKLV) is the strongest clinical predictor of malnutrition, whereas eGFR plays a secondary role. Bioelectrical impedance analysis (BIA) further demonstrates a disease-specific body composition phenotype, with increased total and extracellular body water, particularly in the trunk, a reduced phase angle and reduced lean mass, consistent with early malnutrition and sarcopenia. These alterations are present even at relatively preserved kidney function and, in matched analyses, distinguish ADPKD from non-ADPKD CKD. Prospective data from a multicenter cohort indicate that the baseline SGA-defined nutritional status independently predicts short-term eGFR decline in typical ADPKD, supporting malnutrition as a potential modifier of renal trajectory rather than a mere correlate of advanced disease. In parallel, narrative syntheses on adiposity highlight that a higher BMI, waist circumference and visceral fat are associated with larger total kidney volume, faster eGFR loss and greater symptom burden, and raise concern for a sarcopenic obesity phenotype in which excess fat and cystic mass coexist with low muscle mass. Collectively, these findings support a pathophysiological model in which organomegaly-driven mechanical effects (early satiety, gastrointestinal discomfort), systemic inflammation, insulin resistance and cyst-related metabolic reprogramming converge to produce “hidden malnutrition” in ADPKD, masked by apparent overweight. From a clinical perspective, malnutrition and sarcopenia should be regarded as central, disease-modifying components of the ADPKD phenotype. Routine nutritional screening (e.g., SGA/PG-SGA) and BIA-based body composition assessment, particularly in patients with severe organomegaly or symptomatic polycystic liver disease, should be integrated into ADPKD care pathways, and individualized, muscle-preserving nutritional strategies should be tested in future prospective studies. Full article

Background/Objectives: Autosomal dominant polycystic kidney disease (ADPKD) is a major cause of end-stage kidney disease (ESKD), accounting for approximately 5–10% of patients receiving dialysis worldwide. The large and numerous cysts in the liver and kidneys cause abdominal distention and poor appetite. Previous studies showed that renal arterial embolization (RAE) reduces total kidney volume (TKV), increases appetite, and improves quality of life. This article aims to evaluate the efficacy of RAE in increasing psoas muscle (PM) and paraspinal muscle (PS) mass in patients with polycystic kidney disease. Methods: A retrospective study was conducted from May 2016 to December 2020. Thirty-five patients with PKD and ESKD who received RAE were enrolled. The clinical data, including age, sex, body weight, abdominal circumference, and laboratory results, including albumin, creatinine, estimated glomerular filtration rate, and dialysis vintage, were collected. TKV was calculated with the ellipsoid formula method, and muscle mass was measured with bilateral PM and PS areas at the third lumbar level. The associated clinical, laboratory, and imaging data were compared before and after RAE. Results: There were 19 females and 16 males with a mean age of 59.9 for the final analysis. There were significant changes between baseline and 3-month, 6-month, 12-month after RAE, such as a decrease in TKV (4684 ± 3361 vs. 4079 ± 3456, 3675 ± 3401, 2459 ± 1706 mL, all p < 0.001), an increase in the PM area (12.6 ± 5.8 vs. 13.3 ± 5.7, 14.7 ± 6.9, 14.3 ± 7.1 cm², all p < 0.05), but no difference in body weight, body mass index, albumin, hemoglobin, creatinine, or estimated glomerular filtration rate. The increase in the PM and PS was more obvious in the sarcopenic group than in the non-sarcopenic group in the 12-month follow-up (p = 0.001 and 0.016 vs. p = 0.205 and 0.259). Conclusions: RAE effectively reduces TKV, increases PM and PS mass, and serves as a candidate to reverse muscle loss in patients with PKD. Full article

Background: Cystic echinococcosis (CE) remains a significant zoonotic burden in the pastoral regions of China. Yili Prefecture in Xinjiang is a high-risk area, yet comprehensive data are lacking on the prevalence and molecular characteristics of Echinococcus granulosus in its primary intermediate host, sheep. Methods: From 2020 to 2024, a total of 2700 sheep livers were visually inspected for hydatid cysts infection at one randomly selected slaughterhouse in each of the nine counties of Yili Prefecture. Ninety cyst-positive samples were subjected to morphological examination and molecular genotyping by amplifying and sequencing the nad2 gene. Results: The overall prevalence of E. granulosus was 22.0% (594/2700). County-level prevalence ranged from 18.3% (Zhaosu County) to 25.7% (Huocheng County), with no significant differences observed among the counties (p > 0.05) except between Huocheng and Zhaosu. Temporally, the annual prevalence fluctuated between 20.2% and 24.2% without a consistent downward trend. Genotyping revealed that the G1 genotype was overwhelmingly dominant (95.2%, 79/83), with a minor circulation of the G3 genotype (4.8%, 4/83). Fourteen haplotypes were identified; Hap1 was the central and predominant haplotype (47.0%, 39/83), found in all counties. Network analysis suggested a recent population expansion of the parasite. Conclusion: This five-year surveillance study reveals a persistently high prevalence and complex genetic diversity of E. granulosus in sheep in Yili Prefecture. The dominance of the zoonotic G1 genotype indicates a substantial public health threat. Our findings provide crucial data for contributing to the development of local control strategies. However, the specific reasons for the high infection rate in sheep remain unclear, as this study did not include examinations of definitive hosts or environmental samples; this gap should be addressed in future research. Full article