Long-term therapy with MMF or tacrolimus generally was well tolerated by patients with AIH. The agents were equally effective in previous complete responders who did not tolerate SOC therapy. Tacrolimus led to a complete response in a greater proportion of previous nonresponder patients compared with MMF.

Low 25(OH)D levels are associated with advance fibrosis and severe inflammation in AIH. Our study suggests that vitamin D may be a potential biomarker that predicts response to therapy and histological features in AIH.

Background and Aims A few case reports of autoimmune hepatitis–like liver injury have been reported after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) vaccination. We evaluated clinical features, treatment response and outcomes of liver injury following SARS‐CoV‐2 vaccination in a large case series. Approach and Results We collected data from cases in 18 countries. The type of liver injury was assessed with the R‐value. The study population was categorized according to features of immune‐mediated hepatitis (positive autoantibodies and elevated immunoglobulin G levels) and corticosteroid therapy for the liver injury. We identified 87 patients (63%, female), median age 48 (range: 18–79) years at presentation. Liver injury was diagnosed a median 15 (range: 3–65) days after vaccination. Fifty‐one cases (59%) were attributed to the Pfizer‐BioNTech (BNT162b2) vaccine, 20 (23%) cases to the Oxford‐AstraZeneca (ChAdOX1 nCoV‐19) vaccine and 16 (18%) cases to the Moderna (mRNA‐1273) vaccine. The liver injury was predominantly hepatocellular (84%) and 57% of patients showed features of immune‐mediated hepatitis. Corticosteroids were given to 46 (53%) patients, more often for grade 3–4 liver injury than for grade 1–2 liver injury (88.9% vs. 43.5%, p = 0.001) and more often for patients with than without immune‐mediated hepatitis (71.1% vs. 38.2%, p = 0.003). All patients showed resolution of liver injury except for one man (1.1%) who developed liver failure and underwent liver transplantation. Steroid therapy was withdrawn during the observation period in 12 (26%) patients after complete biochemical resolution. None had a relapse during follow‐up. Conclusions SARS‐CoV‐2 vaccination can be associated with liver injury. Corticosteroid therapy may be beneficial in those with immune‐mediated features or severe hepatitis. Outcome was generally favorable, but vaccine‐associated liver injury led to fulminant liver failure in one patient.

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RDW a new non-invasive marker that can be used to demonstrate the presence of NASH and indicate advanced fibrotic scores.

We assessed the effect of music on the level of sedation and the electroencephalograph bispectral index (BIS) during the preoperative period. Fifty-four ASA physical status I-II patients, scheduled for elective septo-rhinoplastic surgery, were included in the study. Subjects were assigned to receive either music (music group; n = 28) or no music (control group; n = 26) during the preoperative period. Sedative premedication was provided with midazolam 0.08 mg/kg IM. Observer's Assessment of Alertness/Sedation Scales (OAAS) scores and BIS values were recorded at specific time intervals. In the control group, there were more patients with an OAAS score of 1 than in the music group at 30 min after midazolam injection. In addition, there were more patients with an OAAS score of 2 in the control group than in the music group at 30-50 min. However, there were significantly more patients with an OAAS score of 3 in the music group than in the control group at 20-50 min. BIS values of the music group were also smaller than the control group at 30 and 40 min. BIS values were significantly decreased from baseline values at 10-50 min in the music group, whereas BIS values decreased at 30-50 min in the control group. In conclusion, listening to music during midazolam premedication is associated with an increase in sedation level in the preoperative period as reflected by a lower BIS value.

Serum TLR4 levels but not TLR2 were elevated in NASH patients in comparison with healthy controls. And in NASH patients, serum TLR4 levels both correlated with and were able to predict liver fibrosis.

The treatment of caustic esophageal strictures is a challenging topic. Although traditional therapies have limited efficacy, most of these patients eventually require surgery. Biodegradable (BD) stents are newly designed stents for benign conditions. This is a retrospective case series of seven patients with caustic esophageal stricture. BD esophageal stents were inserted for palliation of dysphagia. The position of the stent was checked at 1, 4, 8, 12 16, 20, and 24 weeks and at the end of follow-up period. The follow-up period was 60 ± 23 (36-102) weeks. Complete dissolution of the stent occurred at 16 ± 4 (12-20) weeks. Three patients had partial/complete relief of dysphagia. The remaining four patients experienced tissue hyperplasia at the edges of the stent and required serial dilations. At the end of follow-up, all patients had partial or complete relief of dysphagia. Although BD stents have some efficiency, tissue hyperplasia is the main limiting factor. Further randomized trials are needed to determine efficiency of BD stents for caustic damage.