The Herald Bleed-A Fortunate Endoscopic Diagnosis of an Aorto-Duodenal Fistula Secondary to a Mycotic Aortic Aneurysm With Abscess Formation.

Aorto-duodenal fistula is a rare but catastrophic cause of gastrointestinal bleeding. A high index of suspicion is required for diagnosis. Reviewing previous imaging provides essential hints.

Altered blood-brain barrier permeability is associated with abnormal distant connectivity and regional homogeneity in covert hepatic encephalopathy-A cross-sectional study.

Background And Aims: Covert hepatic encephalopathy (CHE) is clinically underrecognized. Using MRI, we explored the relationship between functional connectivity as a marker of executive dysfunction and the blood-brain barrier permeability marker K TRANS in a cross-sectional cohort of CHE, no hepatic encephalopathy (NHE), and healthy controls (HCs).

Approach And Results: This study was a single-center prospective cohort study conducted between 2018 and 2021.

Activation of the kynurenine pathway identified in individuals with covert hepatic encephalopathy.

Background: HE is a neuropsychiatric complication of liver disease characterized by systemic elevation in ammonia and proinflammatory cytokines. These neurotoxins cross the blood-brain barrier and cause neuroinflammation, which can activate the kynurenine pathway (KP). This results in dysregulated production of neuroactive KP metabolites, such as quinolinic acid, which is known to cause astrocyte and neuronal death.

A potential novel treatment for cirrhosis-related ascites: Empagliflozin is safe and tolerable in advanced chronic liver disease.

Aims: Advanced chronic liver disease and advanced chronic liver disease-related ascites have a high mortality. The pharmacological treatment of ascites and fluid overload has changed little over time. Empagliflozin, a sodium-glucose cotransporter type 2 inhibitor is an untested potential novel treatment in cirrhosis, as it has survival benefits in heart failure, which has similar pathophysiological fluid overload mechanisms.

Temporal change in aetiology and clinical characteristics of hepatocellular carcinoma in a large cohort of patients in New South Wales, Australia.

Background: Viral hepatitis, alcohol-related liver disease (ARLD) and nonalcoholic fatty liver disease (NAFLD) are the main risk factors for hepatocellular carcinoma (HCC) in many countries. In Australia, given the access to hepatitis C virus (HCV) direct-acting antiviral (DAA) therapy since 2016, a temporal change in HCC aetiology was hypothesized. This study evaluated the temporal change in the aetiology and characteristics of HCC in New South Wales (NSW).

Novel magnetic resonance KTRANS measurement of blood-brain barrier permeability correlated with covert HE.

Background: Using dynamic contrast-enhanced (DCE) MR perfusion and MR spectroscopy this study aimed to characterize the blood-brain barrier permeability and metabolite changes in patients with cirrhosis and without covert HE.

Methods: Covert HE was defined using psychometric HE score (PHES). The participants were stratified into 3 groups: cirrhosis with covert HE (CHE) (PHES<-4); cirrhosis without HE (NHE) (PHES≥-4); and healthy controls (HC).

Selective internal radiation therapy for hepatocellular carcinoma: A 15-year multicenter Australian cohort study.

Background And Aim: The exact place for selective internal radiation therapy (SIRT) in the therapeutic algorithm for hepatocellular carcinoma (HCC) is debated. There are limited data on its indications, efficacy, and safety in Australia.

Methods: We performed a multicenter retrospective cohort study of patients undergoing SIRT for HCC in all Sydney hospitals between 2005 and 2019.

HCC incidence after hepatitis C cure among patients with advanced fibrosis or cirrhosis: A meta-analysis.

Background And Aims: HCV cure reduces but does not eliminate the risk of HCC. HCC surveillance is recommended in populations where the incidence exceeds 1.5% per year.

Systematic review with meta-analysis: The effects of non-steroidal anti-inflammatory drugs and anti-platelet therapy on the incidence and recurrence of hepatocellular carcinoma.

Background: Chemoprevention with NSAIDs, including aspirin, and anti-platelet therapy (APT), has been suggested to reduce the incidence and recurrence of hepatocellular carcinoma (HCC).

Aim: To determine by meta-analysis whether NSAIDs and APT use affected HCC incidence, HCC recurrence and liver-related mortality in at-risk populations with chronic liver disease.

Method: Electronic databases including Pubmed, Scopus, Medline, Embase and Cochrane Library were searched (from inception to 31 May 2021) for eligible studies evaluating the impacts of NSAID or APT use on HCC incidence, recurrence and mortality.

Hepatitis C virus cure before hepatocellular carcinoma diagnosis is associated with improved survival.

The impact of hepatitis C virus (HCV) cure on survival in patients with HCV-related hepatocellular carcinoma (HCC) has been examined, although many studies have been subject to survivor treatment selection bias. We assessed the impact of HCV cure before HCC diagnosis on overall survival. Patients with HCV-related HCC at three referral hospitals in Australia were included retrospectively (January 2008 to December 2019).

Systematic review with meta-analysis: effectiveness of direct-acting antiviral treatment for hepatitis C in patients with hepatocellular carcinoma.

Background: Direct-acting antiviral (DAA) therapy for hepatitis C virus (HCV) infection is highly curative and tolerable. Among patients with hepatocellular carcinoma (HCC), optimal timing of DAA therapy remains unclear. Data on efficacy of DAA therapy in patients with HCC would inform this decision-making.

Cancer screening in Australia: future directions in melanoma, Lynch syndrome, and liver, lung and prostate cancers.

While Australia now has well-established national screening programs for breast, bowel and cervical cancers, research continues into the feasibility of developing systematic screening programs for a number of other cancers. In this paper, experts in their fields provide perspectives on the current state of play and future directions for screening and surveillance for melanoma, Lynch syndrome, and liver, lung and prostate cancers in Australia. Although the evidence does not support population screening, there may be opportunities to prevent thousands of deaths through systematic approaches to the early detection of lung cancer and melanoma, testing for Lynch syndrome, and organised surveillance for hepatocellular carcinoma among individuals at high risk - guided by targeted research.

Migration route of Fasciola into the liver.

Humans usually acquire Fasciola infection by eating contaminated aquatic vegetation, such as watercress. After ingestion, Fasciola metacercariae excyst in the duodenum. In contrast to other liver flukes (Clonorchis and Opisthorchis) that migrate through the ampulla of Vater and ascend the biliary tree, Fasciola metacercariae penetrate the duodenal wall, migrate through the peritoneal cavity, and enter the liver.

Sexually transmitted hepatitis C infection: the evolving epidemic in HIV-positive and HIV-negative MSM.

Purpose Of Review: The scale-up of direct-acting antiviral (DAA) therapy and introduction of preexposure prophylaxis (PrEP) has changed the epidemiology of sexually acquired hepatitis C virus (HCV) amongst HIV-positive and HIV-negative MSM.

Recent Findings: Sexually acquired HCV continues to occur predominantly amongst HIV-positive MSM. Despite an increased uptake of DAA therapy the incidence of acute HCV has not declined consistently amongst HIV-positive MSM, likely a result of high infection and reinfection rates.

Prevalence and associations of recent physical intimate partner violence among women attending an Australian sexual health clinic.

Background: The Sydney Sexual Health Centre in Australia uses a proforma tool to screen all new female clients for recent physical intimate partner violence (IPV). This study describes the prevalence and associations of recent physical IPV among women attending a sexual health clinic.

Method: The clinic database was used to identify all first visits by women reporting recent physical IPV between September 2003 and September 2007.

Is screening asymptomatic men who have sex with men for urethral gonorrhoea worthwhile?

We determined the prevalence of symptomatic and asymptomatic urethral gonorrhoea among men who have sex with men (MSM) at our Australian sexual health clinic. Asymptomatic MSM are screened using the Roche Amplicor((R)) PCR, whereas culture is used for symptomatic MSM. We analysed data from all MSM tested for urethral gonorrhoea from March 2006 to July 2008.