Prolonged QTc interval is a common electrophysiological abnormality in patients with chronic liver disease, but limited evidence exists regarding its occurrence in acute-on-chronic liver failure (ACLF), particularly in hepatitis B virus-related ACLF (HBV-ACLF). Given the rapid progression, high mortality, and severe complications associated with ACLF, understanding cardiac electrophysiological changes is clinically important. This study aimed to determine the incidence of QTc prolongation in patients with HBV-ACLF and to identify independent factors associated with QTc abnormalities. A retrospective study was conducted on 206 consecutive patients with HBV-ACLF admitted between January 2016 and December 2023. Heart rate and QT interval data were obtained from 12-lead electrocardiograms performed at admission. QTc was calculated using Bazett's formula. Patients were categorized into prolonged and non-prolonged QTc groups using a cutoff of 440 ms. Demographic, clinical, and laboratory variables were compared, and significant factors (P < .05) were entered into multivariate logistic regression to determine independent predictors. Of the 206 patients included, 68 (33%) exhibited prolonged QTc intervals. Univariate analysis revealed significant differences in red blood cell count (RBC), total cholesterol (CHOL), creatinine (CRE), potassium (K), fibrinogen (FIB), ascites, HBV-DNA level, and Child-Pugh classification (all P < .05). Multivariate logistic regression identified K, CRE, HBV-DNA, and ascites as independent predictors of QTc prolongation (P < .05 for all). Approximately one-third of patients with HBV-ACLF demonstrated prolonged QTc intervals. Electrolyte imbalance, renal dysfunction, viral replication activity, and ascites were independently associated with QTc prolongation. Routine QTc monitoring may provide a simple and noninvasive tool for early identification of patients at increased risk of cardiac complications.

Portal vein thrombosis (PVT) in cirrhosis is associated with adverse outcomes, but determinants of PVT and its impact on short-term outcomes in hospitalized patients across global regions remain unclear. The multinational CLEARED consortium prospectively enrolled adults with cirrhosis admitted non-electively after consent. Patients were followed during hospitalization and 30 days post-discharge. Radiologically diagnosed PVT was analyzed in relation to demography, etiology, clinical features, hospital course, and 30-day outcomes, including mortality. Among 7721 patients, etiologies included alcohol-associated (41.3%), MASH/cryptogenic (24.4%), hepatitis B (19.4%), and hepatitis C (11.3%). PVT was present in 773 patients (10.0%). Prevalence was higher in MASH/cryptogenic and viral cirrhosis compared with alcohol etiology (11.9%, 11.7% vs. 7.3%). Alcohol etiology was associated with lower odds of PVT [OR 0.64 (95% CI 0.5-0.8), p <0.001]. PVT was more common in patients with diabetes (37.4% vs. 28.9%) and in high-income countries (all p <0.001). Independent predictors of PVT included MASH/cryptogenic etiology [OR 1.59 (95% CI 1.2-2.1), p <0.01], prior portal hypertension-related complications (ascites, variceal bleeding, overt HE, hydrothorax), and non-selective beta-blocker use. PVT is associated with higher rates of acute kidney injury, grade 3-4 hepatic encephalopathy, 30-day readmission, and liver transplantation (all p <0.05). Thirty-day mortality was higher in patients (22.1% vs. 18.0%; p =0.001), and PVT independently predicted mortality (OR 1.5; 95% CI 1.1-1.9; p <0.001). PVT affects 1 in 10 patients in a global inpatient cirrhosis cohort, and independently predicts short-term mortality and major complications, identifying a high-risk subgroup requiring intensified inpatient and post-discharge care.

ObjectiveTo identify predictors of 30-day catheter-related complications after percutaneous transhepatic cholangial drainage in patients with malignant obstructive jaundice and to develop and internally validate an individualized risk-prediction nomogram.MethodsThis single-center retrospective study included consecutive patients with malignant obstructive jaundice who underwent percutaneous transhepatic cholangial drainage between January 2020 and December 2025. The primary outcome was the occurrence of catheter-related complications within 30 days after percutaneous transhepatic cholangial drainage. Univariable and multivariable logistic regression analyses were used to identify candidate predictors and construct the final model. Model performance was assessed using the area under the receiver operating characteristic curve, calibration analysis, the Hosmer-Lemeshow goodness-of-fit test, the Brier score, decision curve analysis, and bootstrap internal validation with 1000 resamples.ResultsA total of 380 patients were included, of whom 122 (32.1%) developed catheter-related complications within 30 days. The final model incorporated prior biliary intervention, high biliary obstruction, ascites, C-reactive protein level, bilateral drainage, and catheter size. Prior biliary intervention (adjusted odds ratio = 2.06; 95% confidence interval: 1.24-3.42), ascites (adjusted odds ratio = 1.88; 95% confidence interval: 1.12-3.15), and higher C-reactive protein level (adjusted odds ratio per 10 mg/L increase, 1.19; 95% confidence interval: 1.09-1.30) were associated with an increased risk of complications, whereas larger catheter size was associated with a lower risk (adjusted odds ratio per 2-Fr increase, 0.60; 95% confidence interval: 0.40-0.92). The nomogram achieved an area under the receiver operating characteristic curve of 0.710, an optimism-corrected area under the receiver operating characteristic curve of 0.688, and a Brier score of 0.192. Calibration was satisfactory, with no evidence of poor fit (Hosmer-Lemeshow p = 0.923). Decision curve analysis indicated potential clinical net benefit across relevant threshold probabilities.ConclusionsCatheter-related complications were common after percutaneous transhepatic cholangial drainage. A nomogram based on routinely available clinical, inflammatory, and procedural variables showed acceptable internal performance and may assist in the early identification and targeted management of patients at high risk.

Edema is defined as a palpable swelling on the body produced by expansion of the interstitial fluid volume. This accumulation of fluid in the interstitial space occurs as the capillary filtration exceeds the amount of fluid take out by lymphatic drainage. When Edema is massive and generalized, it is called anasarca. It is caused by a variety of clinical conditions like heart failure, renal failure, liver failure, or problems with the lymphatic system. Edema usually becomes clinically apparent as the interstitial volume exceeds 2.5 -3 liters.

This study investigates the clinical and abdominal computed tomography (CT) characteristics of pneumatosis intestinalis (PI). This retrospective single-center study included 58 patients with PI. Clinical data and CT images were reviewed. CT findings included location, extent, and associated features, and PI was classified into 3 morphological patterns: bandlike, grapelike, and beadlike. Inter-observer agreement was evaluated, and subgroup analysis was performed using analysis of variance and chi-square tests. The mean age of the patients was 68 years. The most common comorbidities were diabetes (44.8%) and hypertension (42.4%). Abdominal pain (62.1%) was the predominant symptom. Inter-observer agreement for CT findings was excellent (kappa 0.88-0.95). The beadlike pattern was most frequent (48.3%), followed by bandlike (34.5%) and grapelike (17.2%). The surgical group (n = 10) was older and had more frequent abdominal pain, peritoneal signs, and ascites (60.0% vs 20.8%, P = .033) than the conservative group (n = 48). Overall prognosis was favorable (96.6% recovery), but both deaths were associated with concurrent portal and mesenteric venous gas. After treatment, a follow-up CT scan obtained 2 to 4 weeks later demonstrated resolution of PI. We propose a novel CT morphological classification method for PI. Clinical signs and specific CT findings (e.g., ascites and portomesenteric venous gas) guide management. While most patients recover with conservative care, concurrent portal and mesenteric venous gas signifies a high mortality risk. CT plays a key role in the follow-up of patients with PI.

Acute pancreatitis (AP) is an uncommon but important cause of abdominal pain in children. Pediatric AP has a broad range of etiologies, including biliary disease, infections, trauma, metabolic abnormalities, genetic disorders, and medications. Drug-induced pancreatitis is rare, and metronidazole has been reported as a potential trigger, with most published cases occurring in adults. Reports in children remain exceedingly uncommon. A previously healthy three-year-old boy (weight: 15 kg) developed AP six days after completing a 10-day course of oral metronidazole, 150 mg (10 mg/kg/dose) three times daily prescribed for amoebic gastroenteritis diagnosed by stool microscopy. He presented with severe upper abdominal pain and non-bilious vomiting. Laboratory investigations demonstrated markedly elevated pancreatic enzymes, with a serum amylase level of 3251 IU/L and serum lipase >1,000 U/L. Abdominal ultrasonography revealed mild pancreatic enlargement with edematous changes and a small volume of ascites, consistent with AP. Evaluation for alternative etiologies, including biliary disease, trauma, metabolic abnormalities, systemic illness, and infectious causes (repeat stool microscopy, respiratory viral PCR panel, and urinalysis were negative), did not identify another cause. The patient was managed conservatively with intravenous fluids, analgesia, temporary bowel rest due to persistent vomiting and severe abdominal pain, and gradual reintroduction of oral feeding as tolerated. His symptoms resolved, pancreatic enzyme levels declined markedly during recovery, and follow-up ultrasonography demonstrated complete resolution of the inflammatory changes. This report describes a rare case of suspected metronidazole-associated AP in a young child following treatment for amoebic gastroenteritis. Although a definitive causal relationship cannot be established, the temporal association with metronidazole exposure, together with the systematic exclusion of more common pediatric etiologies, supports the possibility of a drug-related adverse event. Clinicians should consider AP in children presenting with persistent vomiting and upper abdominal pain during or after metronidazole therapy while recognizing that causality cannot be confirmed from a single case report.

Pyogenic liver abscess (PLA) is one of the most common and severe infectious diseases encountered in clinical practice. It is characterized by rapid progression, and failure to recognize and treat the condition promptly may readily result in septic shock and multiple organ dysfunction syndrome (MODS), thereby posing a serious threat to the patient's life. However, clinical research focusing on the development of MODS in patients with liver abscess remains limited. Therefore, this study aimed to develop and validate a predictive model for MODS in patients with PLA, identify associated risk factors and clinical characteristics, and facilitate the identification of high-risk patients at admission and during the early stage of hospitalization, thereby supporting timely clinical decision-making and management.

LRP1 encodes the low-density lipoprotein (LDL) receptor-related protein 1 (LRP1), a transmembrane protein involved in endocytosis and activation of multiple signaling pathways. LRP1 variants have been implicated in the pathogenesis of congenital heart defects (CHD), Alzheimer's disease, and neurodevelopmental disorders (NDD). Biallelic LRP1 variants have also been reported in two siblings with CHD, hypotonia, dysmorphology, corneal clouding, and ascites. However, conclusive evidence supporting the role of LRP1 in human disease is still lacking. Individuals with heterozygous variants in LRP1 (NM_002332.3) were identified through genetic testing. GeneMatcher facilitated identification of participants and international collaboration. Comprehensive clinical and genotypic data were collected. Fifteen participants with heterozygous predicted loss-of-function (pLOF) or missense variants in LRP1 were identified. The most common phenotypes include NDD, CHD, musculoskeletal and gastrointestinal issues, and dysmorphic features. CHD was more common in participants with pLOF variants. Our findings suggest that LRP1 haploinsufficiency is associated with a syndromic NDD. Phenotypic differences in cardiac and neurologic involvement between participants with pLOF and missense variants suggest the possibility of alternate disease mechanisms.