No abstract

The causal effects of chondroitin, glucosamine, and vitamin/mineral supplement intake on kidney function remain unknown, despite being commonly used. We conducted a two-sample summary-level Mendelian randomization (MR) analysis to test for causal associations between regular dietary supplement intake and kidney function. Genetic instruments for chondroitin, glucosamine, and vitamin/mineral supplement intake were obtained from a genome-wide association study of European ancestry. Summary statistics for the log-transformed estimated glomerular filtration rate (log-eGFR) were provided by the CKDGen consortium. The multiplicative random-effects inverse-variance weighted method showed that genetically predicted chondroitin and glucosamine intake was causally associated with a lower eGFR (chondroitin, eGFR change beta = −0.113%, standard error (SE) = 0.03%, p-value = 2 × 10−4; glucosamine, eGFR change beta = −0.240%, SE = 0.035%, p-value = 6 × 10−12). However, a genetically predicted vitamin/mineral supplement intake was associated with a higher eGFR (eGFR change beta = 1.426%, SE = 0.136%, p-value = 1 × 10−25). Validation analyses and pleiotropy-robust MR results for chondroitin and vitamin/mineral supplement intake supported the main results. Our MR study suggests a potential causal effect of chondroitin and glucosamine intake on kidney function. Therefore, clinicians should carefully monitor their long-term effects.

Introduction: Patients after liver surgery are classified into the high-risk group for deep vein thrombosis (DVT) and pulmonary embolism (PE) according to the Japanese guidelines. However, few reports have mentioned about pharmacologic thromboprophylaxis and postoperative thrombotic complications after liver surgery. Methods: From September 2015 to August 2017, 113 patients underwent postoperative pharmacologic thromboprophylaxis with enoxaparin after liver surgery. Of these, 60 patients with postoperative enhanced CT during the hospital stay were included and estimated about thrombotic complications.Results: The patients were 44 males and 16 females with a median age of 72 years. Enoxaparin was administered in 49 patients (82%), heparin in 1 patient (1.7%) and none in 10 patients (17%). 10 patients (17%) had postoperative thrombotic complications (DVT/PE in 1 patient, thrombosis of the internal jugular vein in 1 patient, inferior vena cava in 1 patient and portal vein in 7 patients) with no clinical symptoms. Postoperative pharmacologic thromboprophylaxis reduced thrombotic complications (P=0.083). On the other hand, 4 patients had adverse events (bleeding through placed abdominal drains in 3 patients, thrombocytopenia in 1 patient) and all were improved after stopping administration. Assessing perioperative factors, preoperative chemotherapy increased the risk (P=0.083) and preoperative serum albumin, intraoperative blood loss, postoperative total bilirubin were significantly higher (P=0.02/0.037/0.066) and prothrombin percentage activity was significantly lower (P=0.0006) in patients with thrombotic complications. Antithrombotic drugs were administered and thrombosis regressed in all complicated patients. Conclusion: Further investigation in more patients will reveal individual appropriate prevention and treatment for thrombotic complications after liver surgery.

Overall survival curve of the study groups Introduction: Portal vein thrombosis (PVT) is a common complication for patients with end-stage liver disease. The presence of PVT used to be a contraindication to LDLT. This is related to technical difficulties of PV reconstruction, increased blood loss, and the risk for postoperative PV complications. Methods: We reviewed the data of LDLT patients at Liver Transplantation Unit, Mansoura University, Egypt during the period between May 2004 till March 2017. Patients were divided into three groups. Group I: patients without PVT, Group II: attenuated PV patients (PV diameter <8 mm), and Group III PVT patients. Results: During the study period, 500 cases underwent LDLT. Group I included 446 patients (89.2%), Group II included 26 patients (5.2%), and Group III included 28 patients (5.6%). Higher incidence of hematemesis and encephalopathy was detected in Group III. Longer anhepatic phase duration was found in Group III. There were no significant differences regarding operation time, blood loss, and transfusion requirements. Higher incidence of postoperative vascular complications was found in Group III. The median OS was 33 months (4-169). The 1-, 3-, and 5years OS survival rates of Group I were 80.5%, 77.7%, and 75%, while for Group II were 84.6%, 79.6%, and 73.5%, and for Group III were 88.3%, 64.4%, and 64.4% respectively. There was no significant difference between the groups regarding OS rates (Log-Rank: 0.793). Conclusion: Preoperative PVT increases the complexity of LDLT operation and the operative trauma to the patient, but it does not reduce the OS rates.