Rather paradoxically, the personal and intellectual roots of Sir Isaiah Berlin, an influential contributor to liberal political theory and Western political thought, stem from East-European autocra...

The main aim of this article is to analyze the social circulation of discourses on non-hegemonic cultural practices, in particular, on what is called “trash TV”, and how they are connected to struggles over cultural and social hierarchies. To do so, it takes a specific event as starting point: the injunction that the CNMC (the Spanish broadcasting regulatory body) filed against Mediaset (a commercial TV operator) to adjust the contents of Sálvame Diario (a celebrity gossip program frequently associated with “trash (...) TV”) to the requirements of what is known as the “child protection time slot”. This paper uses constructionist framing to analyze how this event was discussed by different social actors. Our analysis shows that while the CNMC and the press painted the conflict as a legal issue, Sálvame and social media users focused their discussion on the social acceptability of celebrity gossip media and their viewers (specifically working-class women). (shrink)

Despite the emphasis placed by most curricula in the development of social and emotional competencies in education, there seems to be a general lack of knowledge of methods that integrate strategies for assessing these competencies into existing educational practices. Previous research has shown that the development of social and emotional competencies in children has multiple benefits, as they seem to contribute to better physical and mental health, an increase in academic motivation, and the well-being and healthy social progress of children. (...) This study aims at assessing the possible changes in children’s self-esteem, socio-emotional competencies, and school-related variables after participating in the Learning to Be project (L2B) project.Methods:This quasi-experimental study included an intervention group (L2B) and a control group. The participants were 221 students in primary education (55.2% girls) between the ages of eight and 11 (M= 9.31; SD = 0.89). The L2B intervention program took place over a period of 5 months. The assessment was carried out twice, before and after the intervention through three main evaluation instruments: the Rosenberg’s Self-Esteem questionnaire, the Socio-Emotional competence questionnaire (SEQ), and self-report scales for measuring school difficulties, school engagement, opinions about school, and school absence. Ten schools from different Spanish provinces participated.Results:The results indicate that those participants in the experimental group show higher self-esteem, better responsible decisions, and higher self-awareness than those in the control group. There were no other statistical differences between groups.Conclusions:The results of this work suggest that the implementation of the L2B program did not improve social and emotional competencies in primary school students. Further research related to how include formative assessment in SEL programs is needed. (shrink)

This paper presents a qualitative-quantitative method of analysis for semiotic narrative, applied to a case study of the image projected by immigrants in Spanish television series. The results contain five narrative prototypes in which immigrant characters tend to appear in Spanish television series. We consider the possible effects of recurring narrative settings on the construction of a public image of immigration in Spain.

Cryopreservation‐enabled workflows decouple tissue acquisition from organoid generation, allowing archived biopsies and surgical explants to be revisited as renewable experimental models. This shift expands access to patient‐specific material, reduces the logistical and batch variability inherent in fresh‐tissue pipelines, and enables retrospective and longitudinal studies anchored in real‐world clinical cohorts. Proof‐of‐concept studies show that liver organoids can be derived from cryopreserved human tissues that retain viability and disease‐relevant phenotypes, but performance remains sensitive to the source material, culture lines, and protocol (...) details. The field remains fragmented, lacking broadly adopted standard operating procedures, shared post‐thaw quality benchmarks, and interoperable data infrastructures linking organoid biobanks to clinical metadata.In this work, we argue that cryopreservation‐enabled organoid biobanking should be treated as foundational infrastructure for precision hepatology, and we outline a pragmatic roadmap for coordinated implementation over the next decade. (shrink)

Splitting livers allows two people (usually an adult and a child) to receive a liver transplant from one donated adult liver, but the risks to the adult recipient are greater than if they had received the equivalent whole liver. It has been suggested, therefore, that splitting livers harms adult recipients. Without liver splitting, however, there would be few livers available for children, and paediatric waiting time and waiting list mortality would significantly increase. In this paper, we (...) argue that although splitting livers makes adults worse off, this should be considered sub-optimal benefit rather than harm. We explore justifications for sub-optimally benefitting adults in this way and consider alternatives to the current approach. We argue that splitting livers masks the more fundamental problem of low paediatric donation rates and that increasing the number of paediatric donations would improve the situation for both adult and paediatric liver patients. (shrink)

This study presents an idiographic, qualitative autoethnographic analysis of narrative identity in the context of severe illness and liver transplantation. Drawing on Dan McAdams’ model of narrative identity, the paper examines how the self is reconstructed across three critical phases: an early episode of liver dysfunction, a later-life crisis culminating in transplantation, and post-transplant recovery. The dataset consists of longitudinal personal journal entries spanning over 15 years, providing temporally situated accounts of lived experience. Adopting a cognitive linguistic approach, (...) the analysis focuses on the role of metaphor, grammatical agency, and temporal structuring in the construction of identity. The findings demonstrate that identity is systematically reconfigured through phase-specific linguistic patterns. The early episode is characterized by low agency and process-oriented descriptions, the pre-transplant phase by an agentic identity disrupted through a contamination sequence, and the post-transplant phase by the reassertion of agency and the emergence of vitality-based metaphor. The study argues that identity reconstruction following transplantation is not only narratively organized but linguistically enacted. By showing how shifts in agency, metaphor, and discourse structure correspond to transformations in self-construction, the paper contributes to research in applied linguistics, particularly in the areas of discourse, identity, and health-related narratives. (shrink)

This paper discusses the views of 17 healthcare practitioners involved with transplantation on the ethics of live liver donations . Donations between emotionally related donor and recipients increased the acceptability of an LLD compared with those between strangers. Most healthcare professionals disapproved of altruistic stranger donations, considering them to entail an unacceptable degree of risk taking. Participants tended to emphasise the need to balance the harms of proceeding against those of not proceeding, rather than calculating the harm-to-benefits ratio of (...) donor versus recipient. Participants’ views suggested that a complex process of negotiation is required, which respects the autonomy of donor, recipient and HCP. Although they considered that, of the three, donor autonomy is of primary importance, they also placed considerable weight on their own autonomy. Our participants suggest that their opinions about acceptable risk taking were more objective than those of the recipient or donor and were therefore given greater weight. However, it was clear that more subjective values were also influential. Processes used in live kidney donation were thought to be a good model for LLD, but our participants stressed that there is a danger that patients may underestimate the risks involved in LLD if it is too closely associated with LKD. (shrink)

The canonical version of the Babylonian omen series concerned with barûtu: extispicy (divination from entrails of sheep), consisted of ten chapters or sub-series, and are among the first intellectual adventures of Ancient Man into the field of science. Three of these chapters, all concerned with the front of the liver, are edited here for the first time. Also, the book contains a complete analysis of the Akkadian terms used in divination, a complete index of texts and words, copies of (...) the new-found texts, and photographic plates assisting the reader. By a thorough analysis terminology involved in Assyrian and Babylonian scientific thought, the author for the first time opens up the vast and relatively virgin field of pre-Greek science for the general scholar. The presentation is an indispensable source for all who work with the history and languages of the Ancient Near East, biblical studies, studies in ancient religion, and the history of science and philosophy. The author is associate professor at the Carsten Niebuhr Institute, University of Copenhagen. (shrink)

Living donation provides important access to organ transplantation, which is the optimal therapy for patients with end-stage liver or kidney failure. Paired exchanges have facilitated thousands of kidney transplants and enable transplantation when the donor and recipient are incompatible. However, frequently willing and otherwise healthy donors have contraindications to the donation of the organ that their recipient needs. Trans-organ paired exchanges would enable a donor associated with a kidney recipient to donate a lobe of liver and a donor (...) associated with a liver recipient to donate a kidney. This article explores some of the ethical concerns that trans-organ exchange might encounter including unbalanced donor risks, the validity of informed consent, and effects on deceased organ donation. (shrink)

The ethics committee of the University of São Paulo Medical College Hospital and Clinics has authorized partial liver transplantation from living donors. The request for this type of transplantation was brought to the committee by a team of professors of surgery operating at the university, headed by Dr. Silvano Raia. Their request and justification are presented here, with discussion following.

The allocation of any scarce health care resource, especially a lifesaving resource, can create profound ethical and legal challenges. Liver transplant allocation currently is based upon urgency, a sickest-first approach, and does not utilize capacity to benefit. While urgency can be described reasonably well with the MELD system, benefit encompasses multiple dimensions of patients’ well-being. Currently, the balance between both principles is ill-defined. This survey with 502 participants examines how urgency and benefit are weighted by different stakeholders. Liver (...) transplant patients favored the sickest-first allocation, although all other groups tended to favor benefit. Criteria of a successful transplantation were a minimum survival of at least 1 year and recovery of functional status to being ambulatory and capable of all self-care. An individual delisting decision was accepted when the 1-year survival probability would fall below 50%. Benefit was found to be a critical variable that may also trigger the willingness to donate organs. The strong interest of stakeholder for successful liver transplants is inadequately translated into current allocation rules. (shrink)

Background and aims: Liver transplantation provides an opportunity of survival for patients with liver failure, however, this procedure is known to be psychologically and physically fatiguing for patients and their informal caregivers. The aim of this study was to investigate how perceived social support and the distribution of dependency were associated with the psychological wellbeing of patients waiting for liver transplantation and their caregivers, as a dyad. Methods: The present was a cross sectional study. 95 participants were (...) recruited at a hospital in Northern Italy, during the psychological evaluation for inclusion in the transplantation list: 51 patients (19 with alcohol-related illness), and 44 family caregivers. Both patients and caregivers filled in a Symptom Checklist and Kelly's Dependency Grids. Patients also compiled the Medical Outcomes Study Social-Support Survey, and caregivers the Family Strain Questionnaire Short- Form. Results: Caregivers reported important levels of strain, also strongly related to a worsening of their own and patients’ symptoms Patients with alcohol-related pathologies had a narrower social network, which corresponded to an increase in family strain. On the sample as a whole, regression analyses showed that perceived social support and dependency measures did not predict patients’ and caregivers’ symptoms. Nevertheless, cluster analysis identified a group of caregivers who distributed their dependency more and experienced lower levels of depression, anxiety and strain. Conclusions: These results suggest the usefulness of a dyadic approach in the research, prevention and care of liver diseases. A deeper comprehension of the functioning of dyads will help practitioners in the identification of situations at risk. (shrink)

Background: Allocation of scarce organs for transplantation is ethically challenging. Artificial intelligence (AI) has been proposed to assist in liver allocation, however the ethics of this remains unexplored and the view of the public unknown. The aim of this paper was to assess public attitudes on whether AI should be used in liver allocation and how it should be implemented. Methods: We first introduce some potential ethical issues concerning AI in liver allocation, before analysing a pilot survey (...) including online responses from 172 UK laypeople, recruited through Prolific Academic. Findings: Most participants found AI in liver allocation acceptable (69.2%) and would not be less likely to donate their organs if AI was used in allocation (72.7%). Respondents thought AI was more likely to be consistent and less biased compared to humans, although were concerned about the “dehumanisation of healthcare” and whether AI could consider important nuances in allocation decisions. Participants valued accuracy, impartiality, and consistency in a decision-maker, more than interpretability and empathy. Respondents were split on whether AI should be trained on previous decisions or programmed with specific objectives. Whether allocation decisions were made by transplant committee or AI, participants valued consideration of urgency, survival likelihood, life years gained, age, future medication compliance, quality of life, future alcohol use and past alcohol use. On the other hand, the majority thought the following factors were not relevant to prioritisation: past crime, future crime, future societal contribution, social disadvantage, and gender. Conclusions: There are good reasons to use AI in liver allocation, and our sample of participants appeared to support its use. If confirmed, this support would give democratic legitimacy to the use of AI in this context and reduce the risk that donation rates could be affected negatively. Our findings on specific ethical concerns also identify potential expectations and reservations laypeople have regarding AI in this area, which can inform how AI in liver allocation could be best implemented. (shrink)

Many believe that it is morally wrong to give lower priority for a liver transplant to alcoholics with end-stage liver disease than to patients whose disease is not alcohol-related. Presumably, alcoholism is a disease that results from factors beyond one's control and therefore one cannot be causally or morally responsible for alcoholism or the liver failure that results from it. Moreover, giving lower priority to alcoholics unfairly singles them out for the moral vice of heavy drinking. I (...) argue that the etiology of alcoholism may involve enough control for the alcoholic to be responsible for his condition and accordingly have a weaker claim to receive a new liver than someone who acquires the disease through no fault of his own. In addition, I show why it is more plausible to reframe the question of priority in terms of control and responsibility rather than virtue and vice. Given that medical resources like livers are scarce, some people may justifiably be given lower priority than others in receiving these resources. (shrink)

In a provocative 1991 paper, Alvin Moss and Mark Siegler argued that it may be fair to give individuals with alcohol-related end-stage liver disease lower priority for a liver transplant than those who develop end-stage liver disease from other factors. Like other organs, there is a substantial gap between the available livers for transplantation and the number of people who need liver transplants. Yet, unlike those with end-stage renal disease, who can survive for some time on (...) dialysis before receiving a kidney transplant, those with liver failure will die without a liver transplant. (shrink)

Split liver transplantation (SLT) provides an opportunity to divide a donor liver, offering transplants to two small patients (one or both could be a child) rather than keeping it whole and providing a transplant to a single larger adult patient. In this article, we attempt to address the following question that is identified by the Organ Procurement and Transplant Network and United Network for Organ Sharing: ‘Should a large liver always be split if medically safe?’ This article (...) aims to defend an answer—‘not always’—and clarify under what circumstances SLT is ethically desirable. Our answer will show why a more dynamic approach is needed to the ethics of SLT. First, we discuss a case that does not need a dynamic approach. Then, we explain what is meant by a dynamic approach and why it is needed. (shrink)

The decline in organs donated after brain death has been countered by an increase in organs donated after circulatory death. Organs donated after circulatory death present an increased risk of complications for their eventual recipients when compared with organs donated after brain death, so the likelihood of successful transplantation is decreased. If organ donation is considered to be in the best interests of the patient, interventions that facilitate successful donation and transplantation might be permissible. This paper seeks to establish whether (...) it is ethically permissible to manage the end-of-life care of a dying patient to maximize the chances of successful transplantation, and if so, whether it is permissible to further maximize these chances by managing the potential donor to enable donation after brain death rather than donation after circulatory death. (shrink)

Liver transplantation (LT) activities during the COVID-19 pandemic have been curtailed in many countries. The impact of various policies restricting LT on outcomes of potential LT candidates is unclear. We studied all patients on the nationwide LT waitlists in Hong Kong and Singapore between January 2016 and May 2020. We used continuous time Markov chains to model the effects of different scenarios and varying durations of disruption on LT candidates.

The dominant model for bioethical inquiry taught in medical schools is that of principlism. The heritage of this methodology can be traced to the Enlightenment project of generating a universalizable justification for normative morality arising from within the individual, rational agent. This project has been criticized by Alasdair MacIntyre who suggests that its failure has resulted in a fragmented and incoherent contemporary ethical framework characterized by fundamental intractability in moral debate. This incoherence implicates principlist conceptions of bioethics. Medical ethics as (...) practiced, though, is partially in keeping with teleological alternatives to principlism. Nonetheless, the hegemony of principlism threatens to harm the practice of good medicine whenever it is used to provide justification for the sanction or prohibition of practices, despite not being equipped to grant moral authority to such justifications. An example of this failure and its resulting harm is expressed in the growing obsolescence of living donor liver transplantation. (shrink)

BackgroundSimilar to many other countries, in Germany patients with alcohol-related liver disease are obliged to prove their abstinence before being accepted on a waitlist for liver transplantation. Health care professionals (HCPs) must both treat patients and ensure that patients have proven their abstinence. The aim of this exploratory study was to develop a deeper understanding of how HCPs deal with this dual role.MethodsThe study used semi-structured interviews as the source of data. 11 healthcare professionals from ten of the (...) 22 German transplant centers were interviewed. After transcription, a qualitative content analysis was performed.ResultsWe found that these HCPs faced an ethical dilemma, as they must balance the roles of being both a treatment provider (the therapist role) and an assessor (the monitoring role). To solve this dilemma, the strategy seems to be a tendency for the HCPs to take on one dominant role amongst these two roles. HCPs who prefer to take on the therapist role seem to feel burdened by the 6-month abstinence rule and the obligation to monitor their patients. HCPs who prefer to take on the monitoring role tend to have negative assumptions about the patients. HCPs also reported the impression that patients perceive HCPs as more involved in monitoring and less open to the therapeutic role. From this it can be deduced that current regulations and structures lead both to stress for HCPs and to suboptimal therapy for those affected.ConclusionsThe results showed that current transplantation guidelines can have a negative impact on both patient care and the burdens on the HCPs. From our point of view, there are various changes that could be made to the current clinical practice that would help solve this dilemma. For instance, integrating other assessment criteria that are more closely adapted to the health status trajectory and psychosocial background of the individual patient would be both possible and would lead to improvements in practice. (shrink)

The world’s first living donor liver transplant from an HIV-positive mother to her HIV-negative child, performed by our team in Johannesburg, South Africa (SA) in 2017, was necessitated by disease profile and health system challenges. In our country, we have a major shortage of donor organs, which compels us to consider innovative solutions to save lives. Simultaneously, the transition of the HIV pandemic, from a death sentence to a chronic illness with excellent survival on treatment required us to rethink (...) our policies regarding HIV infection and living donor liver transplantation. Although HIV infection in the donor is internationally considered an absolute contraindication for transplant to an HIV-negative recipient, there have been a very small number of unintentional transplants from HIV-positive deceased donors to HIV-negative recipients. These transplant recipients do well on antiretroviral medication and their graft survival is not compromised. We have had a number of HIV-positive parents in our setting express a desire to be living liver donors for their critically ill children. Declining these parents as living donors has become increasingly unjustifiable given the very small deceased donor pool in SA; and because many of these parents are virally suppressed and would otherwise fulfil our eligibility criteria as living donors. This paper discusses the evolution of HIV and transplantation in SA, highlights some of the primary ethical considerations for us when embarking on this case and considers the new ethical issues that have arisen since we undertook this transplant. (shrink)

In this work, a system for the classification of liver dynamic contest- enhanced CT images is presented. The system simultaneously analyzes the images with the same slice location, corresponding to three typical acquisition moments. At first, the texture features are extracted separately for each acquisition mo- ment. Afterwards, they are united in one “multiphase” vector, characterizing a triplet of textures. The work focuses on finding the most appropriate features that characterize a multi-image texture. At the beginning, the features which (...) are unstable and dependent on ROI size are eliminated. Then, a small subset of remaining features is selected in order to guarantee the best possible classification accuracy. In total, 9 extraction methods were used, and 61 features were calculated for each of three acquisition moments. 1511 texture triplets, corresponding to 4 hepatic tissue classes were recognized. As a classifier, an adaptive boosting algorithm with a C4.5 tree was used. Experiments show that a small set of 12 features is able to ensure classification accuracy exceeding 90%, while all of the 183 features provide an accuracy rate of 88.94%. (shrink)

The United Network for Organ Sharing recently changed the policy by which donor livers are allocated to liver failure patients in the United States. Formerly, all liver failure patients were characterized as status 1 and placed at the top of the transplant list. Under the new policy, only patients with liver failure due to acute illness () are eligible for status 1; patients with liver failure due to chronic liver disease () are characterized as status (...) 2. Since donor organs are allocated first to status 1 patients and then to status 2 patients, the new policy moves all CLF patients down on the waiting list relative to all ALF patients. This means that some livers that would have gone to CLF patients under the old policy will now go to ALF patients. Accordingly, while the new policy will likely increase the number of ALF patients saved, it will also increase the number of deaths among CLF patients waiting for a transplant. (shrink)

Over eighty years ago, a third, previously unidentified copy of the Anglo-Norman prose chronicle, Le Livere de Reis de Engleterre,was discovered in John Rylands French MS 64. Despite this discovery, and the paucity of witnesses to this chronicle, scholars of LRE generally pass over the version contained in the John Rylands manuscript. Through an examination of the sources and variant readings of LRE, this article argues that this previously overlooked copy of LRE is more authoritative than the other two. The (...) superiority of the John Rylands manuscript enables us to determine best text readings of LRE with improved accuracy. It also allows us to date the chronicle with greater precision than previously possible, and provides grounds for tentatively locating the origins of the chronicle to northeastern England. (shrink)

Responsibility continues to shape how many transplant programs evaluate liver transplantation for patients with Alcohol Use Disorder (AUD), even in settings where the traditional 6‐month abstinence rule has been abandoned. This article argues that using past drinking to lower transplant priority, or to break ties between candidates, is ethically mistaken and clinically harmful. Appeals to personal responsibility often misrepresent the nature of addiction and overestimate the degree of knowledge and control individuals possess when harmful drinking patterns begin and escalate. (...) Early onset of alcohol use, trauma, and psychiatric comorbidity frequently constrain the range of meaningful options available long before transplantation becomes relevant. When these histories are treated primarily as evidence of blameworthy behavior, stigma is reinforced and patients may have fewer incentives to be honest about relapse risk or struggles in treatment. The article examines several influential arguments that defend the use of responsibility in transplant allocation and explains why they fail in practice. It then proposes an alternative framework. Allocation should rely on forward‐looking criteria that are relevant to clinical outcomes and fairness, including medical urgency, expected benefit, engagement in treatment, reliability in follow‐up care, and the presence of social support. These considerations can be assessed more transparently than retrospective judgments about deservingness and avoid penalizing patients for circumstances that contributed to their illness. The article concludes by considering the implications for transplant committees. Policies should reward engagement in care and support recovery rather than rely on retrospective moral judgments about past behavior. Doing so strengthens trust between clinicians and patients, improves adherence to treatment, and allocates a scarce resource on grounds that are ethically relevant to the success of transplantation. (shrink)

The 11 original regions for organ allocation in the United States were determined by proximity between hospitals that provided deceased donors and transplant programs. As liver transplants became more successful and demand rose, livers became a scarce resource. A national system has been implemented to prioritize liver allocation according to disease severity, but the system still operates within the original procurement regions, some of which have significantly more deceased donor livers. Although each region prioritizes its sickest patients to (...) be liver transplant recipients, the sickest in less liver-scarce regions get transplants much sooner and are at far lower risk of death than the sickest in more liver-scarce regions. This has resulted in drastic and inequitable regional variation in preventable liver disease related death rate.A new region districting proposal – an eight district model – has been carefully designed to reduce geographic inequities, but is being fought by many transplant centers that face less scarcity under the current model. The arguments put forth against the new proposal, couched in terms of fairness and safety, will be examined to show that the new system is technologically feasible, will save more lives, and will not worsen socioeconomic disparity. While the new model is likely not perfect, it is a necessary step toward fair allocation. (shrink)

China accounts for approximately 50% of global new liver cancer cases, predominantly driven by hepatitis B virus (HBV)-related hepatocellular carcinoma. The disease presents a distinctive socio-medical profile characterized by a prolonged etiological chain (chronic hepatitis B—cirrhosis—liver cancer), late-stage diagnosis, and a cultural norm of family-first disclosure—whereby physicians typically inform family members before patients themselves. These features position family caregivers, rather than patients, as the primary information seekers and communicators in online health discourse. Drawing on the Comprehensive Model of (...) Information Seeking (CMIS) and Communication Privacy Management (CPM) theory, this study analyzes 1,857 liver cancer-related user comments collected from Xiaohongshu (Little Red Book)—a Chinese lifestyle-oriented social media platform with over 300 million monthly active users—between December 2024 and February 2026. BERTopic, a neural topic modeling framework suited to short Chinese social media texts, was employed for inductive topic extraction. The analysis yielded 15 interpretable topics, organized into five thematic categories: clinical diagnosis and treatment (34.8%), emotional support and caregiving (26.3%), upstream chronic disease management (14.2%), symptom and tumor assessment (12.5%), and online health consultation (9.6%). Notably, hepatitis B and cirrhosis medication management emerged as the second-largest topic, directly mirroring the HBV-dominant etiological chain characteristic of Chinese liver cancer. Family-role terms ("father," "mother," "husband") and Buddhist prayer language appeared as high-salience keywords across multiple topics, underscoring the caregiver-driven and culturally embedded nature of the discourse. The study proposes the concept of "proxy information seeker" as a theoretical extension of CMIS, reveals privacy boundary tensions arising from caregivers' routine public disclosure of patient health information under China's non-disclosure culture, and provides empirical grounding for caregiver-oriented platform governance and digital health literacy interventions. (shrink)

Caffeine, a known CNS stimulant is given as an adjunct component in most abused drugs which could be fatal with repeated administration in many circumstances. This paper presents a study to investigate the effect of repeated administration of caffeine at high dose on rat liver, and discusses ethical and policy issues of caffeine use. Long Evans rats were treated with pure caffeine solution in distilled water through intragastric route once daily for consecutive 56 days. Three groups of rats recognized (...) as low dose, high dose and control group received 6mg caffeine / kg BW, 12mg caffeine / kg BW and distilled water, respectively. Rat plasma was examined for liver transaminases and alkaline phosphatases concentrations which were significantly increased in plasma as compared to the control. Both rat plasma and liver homogenate were subjected to estimate malondialdehyde, advanced oxidation protein product, nitric oxide, antioxidant enzyme catalase, glutathione and superoxide dismutase activity. MDA, AOPP, NO levels increased and SOD activity decreased significantly in both plasma and liver as compared to those of control where as CAT and GSH activity remain unchanged. Rat liver tissues were studied histochemically with Hematoxylin and Eosin, and Picro Sirius Red staining. Significantly increased infiltration of inflammatory cells and progressive deposition of collagen fibre were visible in liver tissue of caffeine treated both dose groups as compared to the control. Long term administration of caffeine at higher dose, significantly contributes to liver inflammation and consequent fibrogenesis. This raises significant ethical and policy issues. (shrink)

Organ transplantation has increased worldwide while the number of organ donors have not increased similarly. Consequently, the waiting period for transplant candidates is prolonged. Patient narratives have uncovered physical and psychosocial suffering in the transplantation process. However, relatively few studies have explored patients’ experiences in the actual waiting period. This qualitative study was conducted in Norway and aimed to describe patients’ experiences of being accepted as recipients of a new liver and their waiting following this decision. A sample of (...) 21 patients with end‐stage liver disease, placed on the ordinary waiting list for a liver transplant, were interviewed in the hospital before they went home to wait for a compatible liver. Uncertainty related to life and death was a major issue, both in the waiting period and as a response to being put on the waiting list. Another central issue was their overwhelming lack of energy. Patients inferred a linear relationship between lack of energy, physical limitations and mental distress. Despite major advances in medical treatment, little follow‐up was given during the waiting period and most of the patients seemed resigned to the inevitability of their suffering. This raises issues of health personnel responsibility and a need to heighten awareness about patient suffering during the waiting period. (shrink)

China carries approximately half of the global new burden of primary liver cancer, and the extended disease trajectory of "hepatitis B – cirrhosis – hepatocellular carcinoma" places patients and family caregivers in a state of sustained, stage-specific health information-seeking needs. With the popularisation of user-generated-content (UGC) platforms such as Xiaohongshu (also known as Rednote), a growing number of users bypass or supplement formal medical consultation by treating these platforms as informal "clinics". However, existing research has largely focused on post-diagnosis (...) caregiver discourse and emotional support, while paying insufficient attention to the pre-diagnosis behaviour of users uploading imaging reports and soliciting lay diagnostic judgement—what we term diagnostic health information seeking (DHIS)—and to the quality of the replies they receive. Drawing on health information-seeking behaviour (HISB) models and information quality theory, this study integrates two independently scraped Xiaohongshu datasets ("liver cancer" and "liver lesion"), yielding 2,761 texts (2,218 question-oriented comments and 543 platform-side replies). A c-TF-IDF–based BERTopic-style pipeline combined with rule-based coding is applied to a three-track design. Three findings emerge. First, diagnostic seeking accounts for 31.5% of pre-diagnosis comments (liver-lesion context) but only 3.4% of post-diagnosis comments (liver-cancer context), a nearly tenfold gap (χ²(1) = 333.84, p <.001). Second, emotional seeking shows the reverse pattern (11.5% vs. 20.7%, χ²(1) = 31.68, p <.001). Third, among 543 question–reply dyads, 40.1% of diagnostic questions received no response; among those that were answered, only 13.6% received professional medical advice, while 15.2% received low-quality reassurance or deflection. We propose the concept of platform medicalisation and offer implications for platform governance, credential verification for content creators, and digital health-literacy interventions. (shrink)

ObjectiveThis study aims to investigate anxiety and its influencing factors in patients with drug-induced liver injury (DILI).Materials and MethodsNinety-four patients with DILI were enrolled and evaluated with a self-rating anxiety scale (SAS). According to the anxiety score, they were divided into four groups: the non-anxiety, mild anxiety, moderate anxiety, or severe anxiety groups, and the scores were analyzed based on demographic and biochemical indicators.ResultsOf the 94 patients with DILI, 63 did not have anxiety and 31 had anxiety (32.9%), of (...) which 27 had mild, 3 had moderate, and 1 had severe anxiety. There were no statistically significant differences in gender, age, occupation, and level of education between the groups (F= 1.42,H= 2.361,H= 6.751,H= 1.796, andP> 0.05); anxiety score and degree of anxiety between the types of drugs that led to the liver injury (H= 0.812,H= 1.712, andP> 0.05); anxiety score between the different degrees of liver injury (H= 2.836,H= 4.957,P> 0.05); or length of hospital stay or prognosis between the degrees of anxiety (F= 1.487,H= 0.761,P> 0.05). However, there were statistically significant differences in the degree of anxiety between different degree and types of liver injury (H= 7.981,H= 8.208,P< 0.05).ConclusionPatients with DILI may have anxiety, especially mild anxiety. The occurrence of anxiety in patients with DILI is not related to gender, age, occupation, or level of education but may be related to the degree and type of liver injury. Anxiety has no impact on the length of stay in hospital or the prognosis of the DILI. These findings may contribute to the development of management strategies for patients with DILI. (shrink)

There is a long-standing debate concerning the eligibility of patients suffering from alcohol-related end-stage liver disease (ARESLD) for deceased donor liver transplantation. The question of retrospective and/or prospective responsibility has been at the center of the ethical discussion. Several authors argue that these patients should at least be regarded as partly responsible for their ARESLD. At the same time, the arguments for retrospective and/or prospective responsibility have been strongly criticized, such that no consensus has been reached. A third (...) option was proposed as a form of compromise, namely that responsibility should only be used as a tiebreaker in liver allocation. The present study provides an ethical investigation of this third option. First, we will provide an overview of the main arguments that have been offered for and against the use of responsibility as an allocation criterion. Second, we will explore the concept of responsibility as a tiebreaker in detail and discuss several types of situations, in which responsibility could be used as a tiebreaker, as well as the main ethical challenges associated with them. As we will show, an ethical justified use of responsibility as a tiebreaker is limited to a very restricted number of cases and is associated with a number of ethical concerns. For this reason, waiting time should be preferred as a tiebreaker in liver allocation, even though the criterion of waiting time, too, raises a number of equity-related concerns. (shrink)

BackgroundThe German guidelines for liver transplantation stipulate that every patient with alcohol-related liver disease needs to prove evidence of a 6-month abstinence period before they can be admitted to the waiting list for liver transplantation. This internationally widespread abstinence rule has been criticised as it prevents patients at least temporarily from receiving an effective and potentially life-saving therapy. This poses the question of how this abstinence rule is depicted and justified by transplantation professionals.ArgumentsIn case of the 6‑month (...) abstinence rule, guidelines are used as a tool for rationing health care. Four frames of interpretation can be reconstructed from the ethical and medical literature. Each linguistically mediated frame offers a different representation of the 6‑month abstinence rule. According to these different framings, the 6‑month waiting period is depicted (1) as a diagnostic tool to determine the regenerative capacity of the liver, (2) as a prognostic tool to determine the prospects of success of a transplantation, and (3) to determine the drinking behaviour after transplantation. In a further context, the abstinence rule (4) is interpreted as an expression of an obligation to avoid behaviour harmful to health.ConclusionThese four frames provide linguistically mediated patterns of interpretation that are used by different actors to limit the indication for liver transplantation. They give rise to different ethical questions that allow a systematic ethical assessment of the 6‑month abstinence rule. (shrink)

Desires matter. How are we to understand the intentionality of desire? According to the two classical views, desire is either a positive evaluation or a disposition to act: to desire a state is to positively evaluate it or to be disposed to act to realize it. This Ph.D. Dissertation examines these conceptions of desire and proposes a deontic alternative inspired by Meinong. On this view, desiring is representing a state of affairs as what ought to be or, if one prefers, (...) as what should be. Desire involves a deontic manner of representing: a norm of the ought-to-be type features in desire’s intentional mode, as opposed to content. The dissertation is structured in three parts. In order to defend this conception, I formulate three main desiderata for a promising theory of the intentionality of desire in the introduction (§0). The first concerns desire’s direction of fit, i.e. the intuition that the world should conform to our desires. The second concerns the death of desire principle, i.e. the intuition that one cannot desire what one represents as actual. The last pertains to desire’s role in psychological explanations, i.e. the intuition that desires can explain some mental states and be explained by other mental states. The first part examines the main conceptions of desire in light of these desiderata. I argue that the classical pictures of desire do not adequately meet our desiderata. The first chapter is devoted to the evaluative conception (§1), while the second examines the motivational approach (§2). Following these criticisms, I then present the deontic view of desire (§3). In the second part, I defend this conception with the help of three arguments. The main idea is that appealing to norms of the ought-to-be type can satisfy our chief desiderata: the world should conform to norms (world-to-mind direction of fit, §4), norms are grounded on values and in turn ground obligations (explanation, §5), and norms are about non-actual states of affairs (death of desire principle, §6). In the last part, I develop the deontic view to draw a cartography of the various types of desire. Some desires are correct, while others are inappropriate. This distinction is explained by the deontic conception, as it matches that between states of affairs that ought to obtain and states that should not obtain (§7). Two study cases are examined: caprice and the impermissibility of desire aggregation. Intuitively, hopes, wishes, or urges are types of desire. The next chapter presents a typology inspired by the deontic view and the type of norms there are (§8). The last chapter discusses the main objections to the deontic approach (§9). In conclusion, I show the relevance of the deontic view for several debates in philosophy of mind and ethics. Desires are crucial because they are the ‘eye’ of what should be. (shrink)

Liver transplantation offers a lifesaving treatment for patients suffering from end-stage liver failure, but not all candidates in the United States are eligible owing to center-specific criteria. When a patient is rejected at a transplantation center for medical, surgical, or psychosocial issues, they are often referred to other centers. We focus on this practice of reevaluation at a second center when the candidate was rejected for psychosocial reasons. We review the criteria used by health professionals to determine psychosocial (...) eligibility and present three case examples from a large teaching hospital that demonstrate this phenomenon in practice. The cases illustrate the conflicts among autonomy, beneficence, nonmaleficence, and justice. We present arguments for and against this practice and provide concrete solutions as a path forward. (shrink)