Search Results (3,700)

Background: Static cold storage (SCS) remains the conventional standard for liver graft preservation; however, ischemia–reperfusion injury during storage may contribute to graft dysfunction, particularly with extended criteria and marginal donors. Machine perfusion (MP) has emerged as a promising alternative, yet existing systematic reviews are limited by their focus on individual perfusion modalities or selected donor populations. We performed a comprehensive systematic review and meta-analysis with pre-specified modality-specific subgroup analyses comparing all MP strategies with SCS in adult liver transplantation. Methods: This study was conducted in accordance with PRISMA 2020 guidelines and registered in PROSPERO (CRD420261355605). MEDLINE, Embase, and PubMed were systematically searched for comparative studies published between 2015 and 2025. Primary outcomes were early allograft dysfunction (EAD), primary non-function (PNF), and 1-year graft survival. Secondary outcomes included biliary complications, hepatic artery thrombosis (HAT), and postoperative transaminase levels. Pre-specified subgroup analyses were performed according to perfusion modality (NMP versus HMP/HOPE). Results: A total of 1448 records were identified. After removal of 309 duplicates and screening, 21 studies comprising 3665 patients were included. Compared with SCS, MP was associated with a significantly lower risk of EAD (RR 0.67, 95% CI 0.48–0.94; p = 0.020), PNF (RR 0.31, 95% CI 0.11–0.84; p = 0.020), and graft loss at one year (RR 0.54, 95% CI 0.36–0.81; p = 0.003; I² = 0%). Subgroup analysis demonstrated that reductions in EAD and PNF were driven by HMP/HOPE strategies (EAD: RR 0.66, 95% CI 0.45–0.98; PNF: RR 0.23, 95% CI 0.07–0.79), whereas NMP did not achieve statistical significance for these endpoints. No significant differences were observed in biliary complications or HAT. Conclusions: Machine perfusion is associated with improved early graft function, reduced primary non-function, and superior 1-year graft survival compared with static cold storage. The benefit for early graft outcomes is driven by hypothermic strategies. These findings provide modality-specific evidence to guide preservation strategy selection in clinical practice. Full article

Metabolic dysfunction-associated steatotic liver disease (MASLD) is clinically heterogeneous. Patients with similar body mass index, waist circumference, or noninvasive fibrosis stratum may differ markedly in histologic activity, fibrosis trajectory, and progression risk. Adipose tissue dysfunction helps explain this variation. Adipose dysfunction has been characterized by direct depot quantification, measurement of subcutaneous adipose tissue fibrogenesis, adipose tissue insulin resistance, and circulating adipokine profiles. These measures capture different features of adipose biology and have each been linked to liver injury or fibrosis severity. Clinically recognizable body-composition phenotypes—lean MASLD, sarcopenic visceral obesity, myosteatosis, and the hypertriglyceridemic waist—differ in accessibility, mechanistic specificity, and prognostic value. Recent therapeutic developments in metabolic dysfunction-associated steatohepatitis (MASH), including resmetirom, semaglutide, tirzepatide, fibroblast growth factor 21 (FGF21) analogs, and older adipose-directed agents such as pioglitazone, illustrate the importance of distinguishing adipose-mediated, weight-mediated, and liver-directed mechanisms. This review summarizes the literature on adipose tissue dysfunction in MASLD, the body-composition phenotypes associated with it, and recent therapeutic data in the context of adipose–liver–muscle biology. Full article

Excessive intake of high-fructose corn syrup (HFCS) contributes to pediatric metabolic dysfunction-associated steatotic liver disease, but the mechanisms linking fructose exposure to inflammatory cell death remain incompletely defined. This study investigated whether dexpanthenol (DEX) attenuates HFCS-induced liver injury by modulating oxidative stress, apoptosis, and nucleotide-binding domain-like receptor protein 3 (NLRP3) inflammasome-associated pyroptotic signaling. Thirty-two young adult male Wistar rats were assigned to control, HFCS, HFCS+DEX, and DEX groups (n = 8 each). HFCS-induced liver injury was established with 20% HFCS-55 in drinking water for 8 weeks. DEX (500 mg/kg/day, intraperitoneally) was administered from the end of week 4 to week 8. Liver tissues were assessed by histopathology; immunohistochemistry for caspase-3, malondialdehyde, and proliferating cell nuclear antigen; biochemical measurement of total antioxidant and oxidant status; and RT-qPCR analysis of Nlrp3, caspase-1, gasdermin D, and interleukin-1β. HFCS exposure caused steatosis, inflammation, and necrosis; increased histopathological scores; enhanced caspase-3, malondialdehyde, and proliferating cell nuclear antigen expression; elevated total oxidant status; and markedly upregulated inflammasome-related genes. Total antioxidant status did not differ among groups. DEX significantly improved hepatic architecture; reduced immunohistochemical markers of oxidative stress, apoptosis, and injury-associated proliferation; and downregulated NLRP3, caspase-1, gasdermin D, and interleukin-1β expression. These findings suggest that DEX attenuates HFCS-induced liver injury through a multi-target mechanism involving suppression of oxidative damage, apoptosis, and inflammasome-associated pyroptotic signaling in young adult rats. Full article

Acute hepatitis B virus (HBV) infection is rare during infancy, and severe symptomatic HBV-associated hepatitis is even less common. We describe two siblings who developed severe HBV-associated liver injury during infancy, two years apart, but experienced markedly divergent clinical outcomes. Clinical, laboratory, virological, microbiological, imaging, therapeutic, and follow-up data were retrospectively reviewed. Household members were subsequently tested for HBV and HDV. The first infant, a 5-month-old girl, presented with HBsAg positivity, negative serological markers for HAV, HCV, and HEV, and severe acute liver injury with a fulminant clinical course that resulted in death. Because anti-HBc IgM, HBV DNA, repeat HBsAg testing, and follow-up serology were unavailable, acute HBV infection could not be confirmed, and the episode was therefore classified as presumed HBV-associated fulminant hepatitis. The rapidly fatal clinical course precluded a comprehensive etiological evaluation, and the available medical records did not fully document the diagnostic work-up. The second patient, a 4-month-old boy, presented with serological and molecular evidence of acute HBV infection, including low-level HBV DNA, total anti-HDV positivity of uncertain clinical significance, and positive CMV IgM/IgG serology. He also had a urinary tract infection (UTI) caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. Without HDV RNA and CMV DNA testing, active HDV infection and clinically significant CMV disease could not be definitively confirmed, while passive transfer of maternal anti-HDV antibodies could not be excluded. The patient required prolonged hospitalization, during which he received supportive, replacement, and antimicrobial therapy. He recovered, and long-term follow-up demonstrated HBsAg clearance with undetectable HBV DNA. Testing of household members revealed chronic HBV infection in the mother and maternal grandmother, both of whom had detectable HDV RNA, consistent with ongoing HBV/HDV circulation within the family. However, without viral sequence data from the infants, the source, route, timing, and direction of transmission could not be established. These cases illustrate the potential severity of HBV-associated hepatitis during infancy and its highly variable clinical outcomes. They also underscore the importance of antenatal HBV screening, timely immunoprophylaxis, and cautious interpretation of suspected viral coinfections when molecular confirmation is unavailable. Full article

Objective: While Sanzi Sijun Formula (SSF) has exhibited preliminary efficacy against metabolic dysfunction-associated steatotic liver disease (MASLD), its mode of action remains undefined. This study therefore aimed to unravel its core therapeutic mechanisms. Methods: UPLC-MS was employed to characterize the major components of SSF. Male C57BL/6J mice were fed a high-fat diet combined with high-fructose/glucose drinking water (HFD-HF/G) for 10 weeks to establish a MASLD model, followed by SSF intervention. After 8-week treatment, body and liver weight, hepatic histopathological alterations, serum levels of lipids, transaminase, and inflammatory cytokines were detected, and transcriptomic sequencing was performed on mouse liver tissues for mechanistic exploration. AML12 hepatocytes stimulated with palmitic acid (PA) were treated with SSF alone or in combination with AMPK or SIRT1 specific inhibitors. RT-qPCR and Western blotting were used to detect the expression or activation levels of AMPK, SIRT1, and key lipid metabolism-related molecules. Results: A total of 77 active components were identified in SSF by UPLC-MS analysis. In MASLD model mice, SSF significantly reduced body and liver weight, serum levels of total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-c), and alanine aminotransferase (ALT), suppressed the pro-inflammatory cytokines including TNF-α and IL-6, and elevated adiponectin levels. Histopathological staining demonstrated that SSF effectively alleviated hepatic steatosis, ballooning, and inflammatory cell infiltration. Transcriptomic profiling analysis verified the major regulatory effect of SSF on lipid metabolism and identified the AMPK/SIRT1 signaling pathway as a potential mechanism. Further experiments confirmed that SSF restored the levels of AMPK/ACC phosphorylation and SIRT1 expression, thereby modulating downstream lipid metabolism-related genes in liver tissues. In PA-induced AML12 cells, SSF significantly reduced intracellular accumulation of lipid and reactive oxygen species (ROS), which were partially abrogated by the inhibitors of AMPK or SIRT1. Conclusions: SSF exerts prominent effects against MASLD in both in vivo and in vitro models. Modulation of the AMPK/SIRT1 signaling pathway primarily contributes to its therapeutic mechanism against lipid metabolism disorder and lipotoxic liver injury. These findings provide experimental evidence to support the clinical application of SSF for MASLD treatment. Full article

Since inflammation is a fundamental process involved in tissue injury and repair, the evaluation of the anti-inflammatory potential of novel compounds is of considerable importance. Acute toxicity evaluation in Swiss albino mice revealed that the synthesized thiazolidin-4-one derivatives of ferulic acid possess moderate toxicity. The in vivo biological activity of synthesized thiazolidin-4-one derivatives (1a–j) was assessed through a model of acute inflammation induced by carrageenan in rats and in a chronic inflammation model induced in rats using the granuloma test. The compounds exhibited significant anti-inflammatory effects, with maximum activity observed 24 h after administration, suggesting a prolonged duration of action. In the acute inflammation model, compound 1g exhibited the highest anti-inflammatory activity, achieving 97.43% inhibition of inflammatory edema after 24 h. In the chronic inflammation model, all derivatives reduced granulation tissue formation, indicating inhibition of the proliferative component of inflammation, with compound 1e showing the highest inhibition (79.85%). Safety evaluation was complemented by biochemical and hematological investigations performed on blood samples collected from the experimental animals. Hepatic function was assessed by measuring serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT), together with renal and hematological parameters, revealing no significant toxicity. In addition, biochemical analysis of liver homogenates demonstrated modulation of oxidative stress markers, including malondialdehyde (MDA), superoxide dismutase (SOD), and catalase (CAT) activities, indicating that the investigated thiazolidin-4-one derivatives do not induce marked oxidative imbalance under the experimental conditions. Overall, compound 1g emerged as the most promising derivative based on its balanced anti-inflammatory efficacy and favorable oxidative stress profile. Full article

Background: Inflammatory bowel disease is a complex intestinal inflammatory disorder linked to immune dysregulation, oxidative stress, and an imbalance in the gut microbiota. Grape seed flour (GSF), a winemaking by-product rich in polyphenols and fibres, displays antioxidant and anti-inflammatory properties and may help maintain gut homeostasis. Methods: The phenolic composition and antioxidant capacity of our GSF were evaluated. We assessed whether a diet containing 10% (w/w) GSF protects against dextran sulphate sodium (DSS)-induced acute colitis in BALB/c mice. Animals received either a standard diet or a GSF-supplemented diet before and during DSS exposure. Body weight and disease activity index were monitored. At sacrifice, colon length and colonic histology scoring were measured. The study of the faecal microbiota and predicted genome was performed using PICRUSt. Caecal metabolites, including short-chain fatty acids, were also quantified. Results: GSF is rich in fibres (64%) and exhibits a very high polyphenolic content and high antioxidant capacity. GSF supplementation attenuated DSS-induced weight loss and disease activity and limited colonic shortening and histological damage. It also improved biomarkers of colon, mesenteric lymph nodes (MLNs), and liver injury. At the molecular level, GSF downregulated key pro-inflammatory mediators in the colon and liver, while enhancing anti-inflammatory (e.g., IL-10) and antioxidant markers, indicating reinforcement of regulatory and redox-protective pathways along the gut–liver axis. At the gut microbiota level, GSF supplementation modulated α-diversity. Further analysis demonstrated that GSF reshaped the GM profile by preventing the blooming of some taxa, including UBA1819, Akkermansia, and Bacteroides caecimuris, and enriching butyrate-producing bacteria, such as Muribaculaceae and Ruminococcus. These shifts were accompanied by lower acetone and ethyl acetate levels and higher indole levels, which are known to support epithelial barrier integrity and mucosal homeostasis. Conclusions: Overall, GSF mitigates DSS-induced colitis through combined actions on inflammatory signalling, oxidative stress, immune regulation, microbiota composition and microbiota-derived metabolites, supporting its potential as a functional prebiotic ingredient for intestinal health. Full article

Acute liver failure (ALF) is a fulminant hepatic syndrome characterized by rapid hepatocellular destruction, severe impairment of liver function, and high mortality. Effective pharmacological interventions capable of limiting early hepatic injury remain lacking. Upadacitinib (UPA), a selective inhibitor for Janus kinase 1 (JAK1) with established anti-inflammatory activity, has not previously been investigated in experimental ALF. Consequently, the current study examined the hepatoprotective potential and underlying mechanisms of UPA in a lipopolysaccharide (LPS)/D-galactosamine (D-GalN)-induced ALF murine model. Mice were pretreated with UPA (10 or 20 mg/kg) prior to LPS/D-GalN challenge. UPA significantly attenuated liver injury, as demonstrated by marked reductions in serum ALT, AST, ALP, and γ-GT levels, together with substantial improvement in hepatic histopathology, attenuation of necroinflammation, and reduction in neutrophil accumulation. UPA also restored hepatic redox balance through reduction in lipid peroxidation and nitrosative stress, alongside enhancement of antioxidant capacity. Mechanistically, UPA suppressed IFN-γ/JAK1/STAT1 signaling and downregulated NF-κB p65 and inducible nitric oxide synthase (iNOS) expression, with subsequent reduction in hepatic TNF-α production. In parallel, UPA inhibited MAPK pathway activation, including ERK1/2, JNK, and p38 signaling. Moreover, UPA attenuated hepatocellular apoptosis through suppression of active caspase-3 and Bax expression with restoration of Bcl-2 levels. The 20 mg/kg dose consistently produced greater biochemical, molecular, and histopathological protection than the lower dose. In conclusion, UPA confers significant protection against LPS/D-GalN-induced ALF through coordinated suppression of oxidative stress, inflammatory signaling, and apoptosis, primarily associated with inhibition of the IFN-γ/JAK1/STAT1 and TNF-α/NF-κB/MAPK pathways and modulation of the Bax/Bcl-2 ratio, underscoring its viability as a promising therapeutic candidate for ALF. Full article

Gastrointestinal acute radiation syndrome (GI-ARS) is a deadly consequence of radiation exposure. We hypothesized that the peptide ghrelin is enteroprotective after radiation injury, and that ghrelin promotes intestinal stem cell regeneration via the vagus nerve. We subjected mice to 12-Gy partial body irradiation (PBI) with 5% bone marrow sparing. Some mice were vagotomized prior to PBI. We then injected the mice with human ghrelin (6 nmol/mouse) or vehicle at 24, 48, and 72 h post-irradiation, and collected blood and tissues at 96 h. PBI caused an 80% reduction in plasma citrulline, 32% shorter villi, 59% fewer crypts, a 14-fold increase in TUNEL⁺ cells, a 9-fold increase in intestinal permeability (FD4), and 4- to 30-fold increases in bacterial translocation (16S rRNA) to the liver and mesentery. Ghrelin significantly improved all these parameters. Remarkably, vagotomy attenuated ghrelin’s protective effects by 22–58%. Mechanistically, ghrelin increased proliferating crypt cells by 2.3-fold, Lgr5⁺ active stem cells by 2.6-fold, Clu⁺ revival stem cells by 3.3-fold (immunofluorescence), and Clu mRNA by 1.6-fold compared to PBI alone, and all these effects were significantly diminished by vagotomy. Thus, ghrelin mitigates GI-ARS through vagus nerve-dependent activation of Clu⁺ revival stem cells and Lgr5⁺ stem cells, identifying a novel vagal-dependent neuroenteric pathway that regulates intestinal crypt regeneration after radiation injury. Full article

Background: Liver cancers are a major cause of morbidity and mortality in patients where effective, non-invasive treatment options remain limited. Objective: Histotripsy is a non-invasive, non-thermal, image-guided focused ultrasound method of ablation that mechanically disrupts cells and offers a range of potential advantages over other ablation modalities. The lack of physiologically and anatomically relevant animal models of human liver cancer has significantly hindered biomedical device development, including histotripsy. Methods: To address these limitations, we developed a clinically relevant large animal orthotopic, dual-tumor model of human liver cancer and utilized these unique animals to evaluate the safety and efficacy of histotripsy. Here, we utilized immunocompromised pigs with genetic modifications in their IL-2RG and RAG2 genes and orthotopically engrafted human hepatocellular carcinoma (HepG2/C3A) and pancreatic adenocarcinoma (Panc-1) cells within the liver. The models were designed to recapitulate primary and metastatic liver tumor phenotypes. Results: Histotripsy enabled real-time visualization of the treatment by the formation of bubble clouds and accurate targeting of the lesions. Histological analysis confirmed the engraftment of tumor cells and the ablation of targeted tissue. Serum biomarkers demonstrated no significant differences in bilirubin, ALT, ALKP, or CK post-treatment, suggesting that histotripsy treatment was well tolerated with minimal hepatic dysfunction or hepatocellular injury. Conclusions: These findings establish a novel, clinically relevant porcine model of primary and metastatic liver tumors and demonstrate the safety and feasibility of using this model for evaluating histotripsy as a noninvasive modality for precise tumor ablation. Full article

The pharmacological treatment of endometriosis using SPRMs requires improvement. The pure PR-agonist dienogest (DNG), a clinically established progestin, can serve as a reference compound for comparison. Its efficacy and safety have been well characterised in preclinical in vitro and in vivo studies, as well as in qualified pivotal clinical studies for the treatment of endometriosis. The pharmacodynamic profile of Dienogest (DNG) is compared with the experience of using the pure PR antagonist Vilaprisan and the mixed PR agonist/antagonist Asoprisnil to treat endometriosis. Unfortunately, the clinical development of Vilaprisan was suspended due to long-term toxicology findings in animals that require further clarification. The clinical development of Asoprisnil, however, was discontinued due to concerns regarding SPRM-associated endometrial changes, although the interpretation of PAEC has been debated. Additionally, another SPRM, Ulipristal acetate, has been associated with rare but serious cases of liver injury. However, Vilaprisan is primarily supported by fibroid-related clinical development, whereas Asoprisnil has limited Phase II endometriosis evidence. Nevertheless, this new mesoprogestin, Asoprisnil, has shown signs of tissue-selective activity in limited clinical and preclinical studies. Continuing the strategy of using mixed PR agonists/antagonists could inspire further drug development. The preclinical profile of the new mesoprogestin EC313 has been presented, showing a higher PR agonistic/antagonistic quotient than Asoprisnil, with comparatively elevated anti-endometriotic activity. Furthermore, EC313 increases the progesterone receptor isoform B/A ratio, but its clinical efficacy remains unproven as it is still in the early stages of development. Based on the preclinical data currently available, the next generation of mesoprogestins warrants further investigation for the treatment of endometriosis and related gynaecological disorders. This prompts consideration of whether there is potential to enhance the effectiveness of drug discovery strategies within this particular pharmacological class. Full article

Aim: To establish and validate a quantitative transporter-mediated imaging framework based on gadoxetic acid-enhanced T1 mapping for assessing liver functional reserve (LFR) and to investigate the physiological significance of the relative change in longitudinal relaxation rate (ΔR1%) as a quantitative imaging biomarker. Methods: Female C57BL/6J mice (6–8 weeks old) representing five experimental liver conditions (control, transporter-deficient Slco1b2/Slco1a5 double-knockout, carbon tetrachloride-induced fibrosis, methionine–choline-deficient diet-induced steatohepatitis, and alcohol-associated fatty liver disease; n = 6 per group) underwent serial Gd-EOB-DTPA-enhanced T1 mapping. Quantitative ΔR1% was calculated to characterize hepatobiliary enhancement kinetics. Liver functional reserve was independently evaluated using multispectral optoacoustic tomography of indocyanine green (ICG) pharmacokinetics and serum ICG retention assays, with histopathological and hepatocellular transporter analyses performed for mechanistic validation. Longitudinal data were analyzed using restricted maximum likelihood (REML)-based mixed-effects models. Intergroup comparisons were performed using one-way ANOVA or Kruskal–Wallis tests with appropriate post hoc analyses, and associations between imaging and functional parameters were evaluated using Spearman rank correlation analysis. A two-sided p < 0.05 was considered statistically significant. Results: Five experimental liver models exhibited distinct transporter-dependent hepatobiliary enhancement patterns. The transporter-deficient knockout mice showed minimal enhancement, whereas fibrosis and steatotic liver injury models demonstrated intermediate but clearly distinguishable functional profiles. Longitudinal mixed-effects analysis identified significant effects of time, experimental group, and time-by-group interaction on ΔR1% dynamics (all p < 0.0001). Although MRI-derived ΔR1% parameters were not significantly correlated with regional optoacoustic ICG kinetics, ΔR1% area under the curve showed a strong inverse correlation with serum ICG retention at 600 s (r = −0.729, p < 0.0001), indicating that MRI-derived ΔR1% and ICG-based measurements provide complementary rather than interchangeable assessments of liver function. Histological and molecular analyses further demonstrated marked heterogeneity in fibrosis, steatosis, and hepatobiliary transporter expression across models, whereas transporter abundance alone did not consistently predict imaging-derived functional performance. Conclusions: Quantitative Gd-EOB-DTPA-enhanced T1 mapping provides a transporter-mediated imaging framework for evaluating hepatic functional reserve across mechanistically distinct liver injury models. As a normalized quantitative imaging biomarker, ΔR1% captures the integrated functional consequences of hepatobiliary transport dysfunction and complements established liver function tests. These findings support the translational potential of quantitative T1 mapping as a standardized, noninvasive approach for assessing liver functional reserve. Full article

Microplastics (MPs) can adsorb and transport heavy metals, but their influence on cadmium (Cd)-induced hepatotoxicity in mammals remains unclear. Forty-eight male Kunming mice were assigned to control, Cd, MP, and Cd + MP groups and exposed by oral gavage for 42 days. Growth performance, liver injury, oxidative stress, and inflammation were assessed, and transcriptomic and metabolomic analyses were integrated with qPCR, mitochondrial DNA (mtDNA) copy number, and ATP measurements. Compared with Cd alone, combined exposure resulted in greater reductions in body weight gain, the liver index, and antioxidant enzyme activities, together with more severe hepatic lesions and higher levels of liver injury markers and inflammatory cytokines. Co-exposure also induced broader transcriptional and metabolic disturbances than Cd alone. Integrated omics analyses converged on the dysregulation of AMPK–FOXO signaling and related energy metabolic processes. qPCR confirmed more pronounced alterations in pathway-related genes after co-exposure, while reductions in mtDNA copy number and ATP content indicated aggravated mitochondrial dysfunction and impaired energy metabolism. Collectively, these results demonstrate that MPs exacerbate Cd-induced liver injury and suggest that disruption of AMPK–FOXO-associated energy metabolism is a key molecular feature underlying the enhanced hepatotoxicity observed under combined exposure. Full article

Background and Objectives: Patients with cirrhosis and acute kidney injury (AKI) frequently receive albumin, although plasma volume expansion may contribute to pulmonary or venous congestion. Point-of-care ultrasound (POCUS) may complement bedside assessment when formal echocardiography or advanced hemodynamic monitoring is not immediately available. This study evaluated baseline pulmonary and venous congestion using POCUS in patients with cirrhosis and AKI receiving albumin therapy. Materials and Methods: This exploratory prospective cohort included adults with cirrhosis, ascites, and ICA-AKI stage 1B or higher who were managed under an institutional protocol prescribing intravenous 20% or 25% albumin at 1 g/kg/day for two consecutive days, capped at 100 g/day. Before albumin administration, B-line-defined pulmonary congestion was assessed using a 28-site lung protocol, and IVC-defined venous congestion was assessed using inferior vena cava (IVC) diameter and collapsibility. Serum creatinine was recorded within 12 h before treatment and 48 h after initiation. Complete renal response was defined as serum creatinine within 0.3 mg/dL of the pre-AKI baseline; partial response was defined as regression by at least one ICA-AKI stage without complete response. Results: Twenty-two patients were included. B-line-defined pulmonary congestion was present in 18/22 (81.8%). IVC assessment was technically evaluable in 20 patients, of whom 6/20 (30.0%) met the criteria for IVC-defined venous congestion. The Hodges–Lehmann estimate of the median paired creatinine difference was +0.03 mg/dL (95% CI, −0.52 to 1.31) without pulmonary congestion and −0.33 mg/dL (95% CI, −0.67 to −0.20) with pulmonary congestion. Renal response occurred in 1/4 (25.0%) and 12/18 (66.7%), respectively (two-sided Fisher exact p = 0.264). Among patients with evaluable IVC examinations, renal response occurred in 8/14 (57.1%) without and 3/6 (50.0%) with IVC-defined venous congestion (p = 1.000). Conclusions: Baseline POCUS frequently identified ultrasound-defined congestion, but congestion status did not clearly distinguish short-term renal response. These exploratory findings support the feasibility of bedside POCUS phenotyping but do not establish that congestion modifies albumin response or clinical outcomes. Full article

Background: Autoimmune hepatitis (AIH) represents a clinically challenging immune-mediated liver disease, owing to its complex pathogenesis and limited targeted therapeutic options. Growing evidence highlights the key role of lymphocyte-mediated hepatic inflammation, dysregulated cytokine milieu, and oxidative stress in AIH progression. Oridonin (ORI), a bioactive diterpenoid with well-established antioxidant, anti-inflammatory, and immunoregulatory effects, remains unexplored in AIH. The present work aims to survey the potential impacts of ORI in Concanavalin A (Con A)-prompted AIH in mice, with particular emphasis on TLR7/PKM2/NLRP3 inflammatory signaling and macrophage polarization. Methods: Male BALB/c mice (n = 30) were allocated into five groups: CTR group, ORI-CTR group, Con A group, ORI (5 mg/kg) + Con A group, and ORI (10 mg/kg) + Con A group. ORI was administered i.p. for 4 days before a single Con A injection (15 mg/kg i.v.). Serum liver enzymes, hepatic pathological changes, oxidative milieu, and varied immunological factors were assessed. Results: ORI markedly attenuated Con A-induced hepatic injury, as evidenced by the reduced liver transaminases, preserved hepatic architecture, and restored oxidative milieu. Moreover, ORI suppressed T-cell activation, modulated M1/M2 polarization, and reduced pro-inflammatory cytokines. These effects were accompanied by the suppression of TLR7/PKM2/NLRP3 inflammatory signaling. Conclusions: ORI exhibits hepatoprotective effects against Con A-induced AIH and these effects are associated with the modulation of inflammatory and immunometabolic responses as well as downregulating TLR7/PKM2/NLRP3 signaling. Full article