Portal vein preparation for inflow anastomosis is a critical step in liver transplantation. Although portal vein thrombosis is well documented and classified according to Yerdel grading, calcification or sclerosis of the portal vein is rarely reported. Segmental or diffuse calcification of portal vein compromises its structural integrity and may even result in flow obstruction, rendering it unsuitable for reconstruction and necessitating alternative inflow strategies. This case report describes a patient with portal vein tearing around chronic calcification who underwent successful living donor liver transplantation using a cryopreserved iliac vein graft anastomosed to gastric varices.

Background: Liver transplantation (LT) is the standard treatment for end-stage liver disease; however, it can lead to biliary strictures in 25%–30% of cases. We aimed to develop a biodegradable stent loaded with paclitaxel that could be inserted during surgery without requiring removal. We evaluated the safety and efficacy of this stent using a porcine model. Methods: Fourteen pigs underwent simulated ischemic injury during LT, and a biodegradable paclitaxel-eluting stent was inserted after duct-to-duct anastomosis.Pigs were divided into four groups: no stent (n=3), bare stent (n=3), 300 µg paclitaxel stent (n=4), and 900 µg paclitaxel stent (n=4). After 3 months of follow-up, autopsies were conducted to obtain common bile duct tissue samples, and inflammation and fibrosis thicknesses were assessed under a microscope. Results: Most tissues had resolved the inflammatory reactions by the 3-month mark. The thinnest fibrosis thickness was observed in the 900 µg group (359.08±167.23 µm); however, no statistical significance was observed. Conclusion This study demonstrated the safety of paclitaxel-eluting biodegradable biliary stents and their positive effects on fibrosis in an ischemic bile duct porcine model. This biodegradable stent represents a potential approach for overcoming the complications associated with biliary strictures after LT.

Background/Aims: Pneumocystis jirovecii pneumonia (PJP) is a rare but potentially fatal infection. This study was conducted to investigate the risk factors for PJP in inflammatory bowel disease (IBD) patients. Methods: This nationwide, population-based study was conducted in Korea using claims data.Cases of PJP were identified in patients diagnosed with ulcerative colitis (UC) or Crohn’s disease (CD) between 2010 and 2017, and the clinical data of each patient was analyzed. Dual and triple therapy was defined as the simultaneous prescription of two or three of the following drugs: steroids, calcineurin inhibitors, immunomodulators, and biologics. Results: During the mean follow-up period (4.6±2.3 years), 84 cases of PJP were identified in 39,462 IBD patients (31 CD and 53 UC). For CD patients, only age at diagnosis >40 years (hazard ratio [HR], 6.12; 95% confidence interval [CI], 1.58 to 23.80) was significantly associated with the risk of PJP, whereas in UC patients, diagnoses of diabetes (HR, 2.51; 95% CI, 1.19 to 5.31) and chronic obstructive pulmonary disease (HR, 3.41; 95% CI, 1.78 to 6.52) showed significant associations with PJP risk. Triple therapy increased PJP risk in both UC (HR, 3.90; 95% CI, 1.54 to 9.88) and CD patients (HR, 5.69; 95% CI, 2.32 to 14.48). However, dual therapy increased PJP risk only in UC patients (HR, 2.53; 95% CI, 1.36 to 4.70). Additionally, 23 patients (27%) received intensive care treatment, and 10 (12%) died within 30 days. Conclusions PJP risk factors differ in CD and UC patients. Considering the potential fatality of PJP, prophylaxis should be considered for at-risk IBD patients

Objectives: ：This study aimed to explore the association between depression and perceived stress, viral anxiety, reassurance-seeking behavior, and poor sleep quality among the general population in Bangladesh, withself-efficacy as a possible mediator. Methods: ：Data on stress and anxiety during the pandemic in Bangladesh were collected through an online survey from September 16, 2021 to October 4, 2021. Viral anxiety and depression were measured using the Bangla version of Stress and Anxiety to Viral Epidemic-6 (SAVE-6) and Patient Health Questionnaire-9 (PHQ-9), re-spectively. Self-efficacy was measured by the General Self-efficacy (GSE) scale. Reassurance-seeking behavior related to the coronavirus disease 2019 infection was measured by the Coronavirus Reassurance-Seeking Behav-iors Scale (CRBS). Results: ：The CRBS showed a significant correlation with SAVE-6 (r=0.281, p<0.001) and PHQ-9 (r=0.227, p<0.001). People with higher anxiety, reassurance-seeking behavior, and poor sleep quality had lower self-effi-cacy, which led to depression. In contrast, perceived stress increased self-efficacy. The psychological factors im-pacted depression directly as well as indirectly, and self-efficacy mediated the association. Conclusions ：Viral anxiety, reassurance-seeking behavior, perceived stress, and poor sleep quality have a close correlation with depression both directly and indirectly. Self-efficacy can be a mediating factor in the asso-ciation between psychological distress and depression. Viral anxiety, reassurance-seeking behavior, and poorsleep quality reduce self-efficacy. On the other hand, perceived stress can strengthen self-efficacy.

Objectives: ：This study aimed to explore the association between depression and perceived stress, viral anxiety, reassurance-seeking behavior, and poor sleep quality among the general population in Bangladesh, withself-efficacy as a possible mediator. Methods: ：Data on stress and anxiety during the pandemic in Bangladesh were collected through an online survey from September 16, 2021 to October 4, 2021. Viral anxiety and depression were measured using the Bangla version of Stress and Anxiety to Viral Epidemic-6 (SAVE-6) and Patient Health Questionnaire-9 (PHQ-9), re-spectively. Self-efficacy was measured by the General Self-efficacy (GSE) scale. Reassurance-seeking behavior related to the coronavirus disease 2019 infection was measured by the Coronavirus Reassurance-Seeking Behav-iors Scale (CRBS). Results: ：The CRBS showed a significant correlation with SAVE-6 (r=0.281, p<0.001) and PHQ-9 (r=0.227, p<0.001). People with higher anxiety, reassurance-seeking behavior, and poor sleep quality had lower self-effi-cacy, which led to depression. In contrast, perceived stress increased self-efficacy. The psychological factors im-pacted depression directly as well as indirectly, and self-efficacy mediated the association. Conclusions ：Viral anxiety, reassurance-seeking behavior, perceived stress, and poor sleep quality have a close correlation with depression both directly and indirectly. Self-efficacy can be a mediating factor in the asso-ciation between psychological distress and depression. Viral anxiety, reassurance-seeking behavior, and poorsleep quality reduce self-efficacy. On the other hand, perceived stress can strengthen self-efficacy.

Primary malignant fibrous histiocytoma (MFH) is a malignant tumor of mesenchymal origin that rarely occurs in the urinary tract, particularly in the urinary bladder. Unlike urothelial carcinoma, which accounts for most bladder cancers, it occurs in the submucosal portion of the bladder wall and consists of the lamina propria, muscularis propria, and adventitia.It is presumed to originate from poorly differentiated pluripotent mesenchymal cells in which fibroblasts and histiocytes are partially differentiated. Radiologically, it is known as the “non-papillary tumor” and is commonly diagnosed as a large mass without necrosis, which shows invasion beyond the muscularis propia. Although the prognosis of this rare malignancy depends on pathological parameters, it generally has a poor prognosis with high local tumor recurrence. Here, we present a case of primary MFH in the urinary bladder with clinical symptoms of lower abdominal pain without gross hematuria that recurred rapidly and showed an aggressive disease course.

Objectives: ：This study aimed to explore the association between depression and perceived stress, viral anxiety, reassurance-seeking behavior, and poor sleep quality among the general population in Bangladesh, withself-efficacy as a possible mediator. Methods: ：Data on stress and anxiety during the pandemic in Bangladesh were collected through an online survey from September 16, 2021 to October 4, 2021. Viral anxiety and depression were measured using the Bangla version of Stress and Anxiety to Viral Epidemic-6 (SAVE-6) and Patient Health Questionnaire-9 (PHQ-9), re-spectively. Self-efficacy was measured by the General Self-efficacy (GSE) scale. Reassurance-seeking behavior related to the coronavirus disease 2019 infection was measured by the Coronavirus Reassurance-Seeking Behav-iors Scale (CRBS). Results: ：The CRBS showed a significant correlation with SAVE-6 (r=0.281, p<0.001) and PHQ-9 (r=0.227, p<0.001). People with higher anxiety, reassurance-seeking behavior, and poor sleep quality had lower self-effi-cacy, which led to depression. In contrast, perceived stress increased self-efficacy. The psychological factors im-pacted depression directly as well as indirectly, and self-efficacy mediated the association. Conclusions ：Viral anxiety, reassurance-seeking behavior, perceived stress, and poor sleep quality have a close correlation with depression both directly and indirectly. Self-efficacy can be a mediating factor in the asso-ciation between psychological distress and depression. Viral anxiety, reassurance-seeking behavior, and poorsleep quality reduce self-efficacy. On the other hand, perceived stress can strengthen self-efficacy.