Recurrent hepatic encephalopathy (HE) is a leading cause of readmission despite standard of care (SOC) associated with microbial dysbiosis. Fecal microbiota transplantation (FMT) may improve dysbiosis; however, it has not been studied in HE. We aimed to define whether FMT using a rationally-derived stool donor is safe in recurrent HE compared to SOC alone. An open-label, randomized clinical trial with a 5 month follow-up in outpatient cirrhotic men with recurrent HE on SOC was conducted with 1:1 randomization. FMT-randomized patients received 5-days of broad-spectrum antibiotic pre-treatment then a single FMT enema from the same donor with the optimal microbiota deficient in HE. Follow-up occurred on days 5, 6, 12, 35 and 150 post-randomization. The primary outcome was safety of FMT compared to SOC using FMT-related serious adverse events (SAE). Secondary outcomes were AEs, cognition, microbiota and metabolomic changes. Participants in both arms were similar on all baseline criteria and were followed till study-end. FMT with antibiotic pre-treatment was well-tolerated. Eight (80%) SOC participants had a total of 11 SAE compared to two (20%) FMT participants with SAEs (both FMT-unrelated, p=0.02). Five SOC and no FMT participants developed further HE (p=0.03). Cognition improved in FMT, but not SOC group. MELD score transiently worsened post-antibiotics, but reverted to baseline post-FMT. Post-antibiotics, beneficial taxa and microbial diversity reduction occurred with Proteobacteria expansion. However, FMT increased diversity and beneficial taxa. SOC microbiota and MELD score remained similar throughout. Conclusions: FMT from a rationally selected donor reduced hospitalizations, improved cognition and dysbiosis in cirrhosis with recurrent HE.

Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death worldwide and, owing to changes in the prevalence of the two major risk factors, hepatitis B virus and hepatitis C virus, its overall incidence remains alarmingly high in the developing world and is steadily rising across most of the developed world. Early diagnosis remains the key to effective treatment and there have been recent advances in both the diagnosis and therapy of HCC, which have made important impacts on the disease. This review outlines the epidemiological trends, risk factors, diagnostic developments and novel therapeutics for HCC, both in the developing and developed world.

The development of magnetic resonance imaging (MRI) for use in medical investigation has provided a huge forward leap in the field of diagnosis, particularly with avoidance of exposure to potentially dangerous ionizing radiation. With decreasing costs and better availability, the use of MRI is becoming ever more pervasive throughout clinical practice. Understanding the principles underlying this imaging modality and its multiple applications can be used to appreciate the benefits and limitations of its use, further informing clinical decisionmaking. In this article, the principles of MRI are reviewed, with further discussion of specific clinical applications such as parallel, diffusion-weighted, and magnetization transfer imaging. MR spectroscopy is also considered, with an overview of key metabolites and how they may be interpreted. Finally, a brief view on how the use of MRI will change over the coming years is presented. ( J CLIN EXP HEPATOL 2015;5:246-255) T he nuclear magnetic resonance (NMR) phenomenon was first described experimentally by both Bloch and Purcell in 1946, for which they were both awarded the Nobel Prize for Physics in 1952.1,2 The technique has rapidly evolved since then, following the introduction of wide-bore superconducting magnets (approximately 30 years ago), allowing development of clinical applications. The first clinical magnetic resonance images were produced in Nottingham and Aberdeen in 1980, and magnetic resonance imaging (MRI) is now a widely available, powerful clinical tool. 3,4 This article covers a brief synopsis of basic principles in MRI, followed by an overview of current applications in medical practice.All atomic nuclei consist of protons and neutrons, with a net positive charge. Certain atomic nuclei, such as the hydrogen nucleus, 1 H, or the phosphorus nucleus, 31 P, possess a property known as ''spin'', dependent on the number of protons. This can be conceived as the nucleus spinning around its own axis although this is a mathematical analogy. The nucleus itself does not spin in the classical meaning but by virtue of its constituent parts induces a magnetic moment, generating a local magnetic field with north and south poles. The quantum mechanical description of this dipolar magnet is analogous to classical mechanics of spinning objects. The dipole itself is analogous to a bar magnet, with magnetic poles aligning along its axis of rotation (Figure 1 , ). 5Application of a strong, external magnetic field (B 0 ) aligns the nucleus either in parallel with or perpendicular to the external field. A liquid solution containing many nuclear spins, placed within the B 0 field, will contain nuclear spins in one of two energy states: a low-energy state (oriented parallel to the magnetic field) or a high-energy state (orientated perpendicular to the magnetic field direction). In solids or liquids, there would tend to be an excess of spins in the same direction as B 0 . Although a bar magnet would orientate completely parallel or antiparallel to the field, the nucleus has an...

Specific urinary metabolites related to gut microbial metabolism differ between CD patients, UC patients, and controls. The emerging technique of urinary metabolic profiling with multivariate analysis was able to distinguish these cohorts.