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Conclusions Results of this study indicated that, in contrast to livestock mammals and poultry where creatine synthesis requires the interorgan cooperation of the kidneys and liver but is absent from skeletal muscle, creatine synthesis occurred primarily in skeletal muscles from Phase-I and Phase-II HSB

Methods: This double-blind, randomized, placebo-controlled trial was conducted from 2022 to 2024 and included forty-five patients aged 18-70 years with HPS (diagnosed by chronic liver disease with portal hypertension, arterial hypoxemia (PaO2 15 mm Hg), and evidence of intrapulmonary vascular dilatations (IPVDs) demonstrated by contrast-enhanced echocardiography or lung perfusion scans), randomized in a double-blind manner to 2:1 into two arms using the IVR system: Simvastatin 40mg and placebo

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