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https://www.readbyqxmd.com/read/29769038/impact-of-new-daa-therapy-on-real-clinical-practice-a-multicenter-region-wide-cohort-study
#1
Simone Lanini, Paola Scognamiglio, Alessandra Mecozzi, Lorella Lombardozzi, Vincenzo Vullo, Mario Angelico, Antonio Gasbarrini, Gloria Taliani, Adolfo Francesco Attili, Carlo Federico Perno, Adriano De Santis, Vincenzo Puro, Fabio Cerqua, Gianpiero D'Offizi, Adriano Pellicelli, Orlando Armignacco, Francesco Saverio Mennini, Massimo Siciliano, Enrico Girardi, Vincenzo Panella, Giuseppe Ippolito
BACKGROUND: Management of chronic hepatitis C (CHC) has significantly accelerated in the last few years. Currently, second generation direct acting antivirals (DAAs) promise clearance of infection in most of patients. Here we present the results of the first analysis carried out on data of Lazio clinical network for DAAs. METHODS: The study was designed as a multicenter cohort: a) to assess the evolution of treatment during the first 24 months of the activity of the Clinical Network; b) to report overall efficacy of treatments; c) to analyze potential factors associated with lack of virological response at 12 weeks after therapy (SVR12); d) to evaluate the variation of ALT at baseline and 12 weeks after therapy in those who achieved SVR12 in comparison to those who did not...
May 16, 2018: BMC Infectious Diseases
https://www.readbyqxmd.com/read/29765248/preoperative-neutrophil-to-lymphocyte-ratio-as-a-prognostic-predictor-after-curative-intent-surgery-for-hepatocellular-carcinoma-experience-from-a-developing-country
#2
Danijel Galun, Aleksandar Bogdanovic, Jelena Djokic Kovac, Predrag Bulajic, Zlatibor Loncar, Marinko Zuvela
Purpose: The aim of the study was to evaluate a prognostic value of preoperative neutrophil-to-lymphocyte ratio (NLR) on long-term survival of cirrhotic and noncirrhotic hepatocellular cancer (HCC) patients managed by a curative-intent liver surgery in a developing country. Patients and methods: During the study period between November 1, 2001, and December 31, 2012, 109 patients underwent potentially curative hepatectomy for HCC. Data were retrospectively reviewed from the prospectively collected database...
2018: Cancer Management and Research
https://www.readbyqxmd.com/read/29761168/outcomes-of-surgical-management-of-familial-intrahepatic-cholestasis-1-and-bile-salt-export-protein-deficiencies
#3
Laura N Bull, Ludmila Pawlikowska, Sandra Strautnieks, Irena Jankowska, Piotr Czubkowski, Jennifer L Dodge, Karan Emerick, Catherine Wanty, Sami Wali, Samra Blanchard, Florence Lacaille, Jane A Byrne, Albertien M van Eerde, Kaija-Leena Kolho, Roderick Houwen, Steven Lobritto, Vera Hupertz, Patricia McClean, Giorgina Mieli-Vergani, Etienne Sokal, Philip Rosenthal, Peter F Whitington, Joanna Pawlowska, Richard J Thompson
Progressive familial intrahepatic cholestasis (PFIC) with normal circulating gamma-glutamyl transpeptidase levels can result from mutations in the ATP8B1 gene (encoding familial intrahepatic cholestasis 1 [FIC1] deficiency) or the ABCB11 gene (bile salt export protein [BSEP] deficiency). We investigated the outcomes of partial external biliary diversion, ileal exclusion, and liver transplantation in these two conditions. We conducted a retrospective multicenter study of 42 patients with FIC1 deficiency (FIC1 patients) and 60 patients with BSEP deficiency (BSEP patients) who had undergone one or more surgical procedures (57 diversions, 6 exclusions, and 57 transplants)...
May 2018: Hepatology Communications
https://www.readbyqxmd.com/read/29758331/liver-regeneration-requires-yap1-tgf%C3%AE-dependent-epithelial-mesenchymal-transition-in-hepatocytes
#4
Seh-Hoon Oh, Marzena Swiderska-Syn, Mark L Jewell, Richard T Premont, Anna Mae Diehl
BACKGROUND: Chronic failure of mechanisms that promote effective regeneration of dead hepatocytes causes replacement of functional hepatic parenchyma with fibrous scar and ultimately results in cirrhosis. Therefore, defining and optimizing mechanisms that orchestrate effective regeneration might prevent cirrhosis. We hypothesized that effective regeneration of injured livers requires hepatocytes to evade the growth inhibitory actions of TGF-β since TGF-β signaling inhibits mature hepatocyte growth but drives cirrhosis pathogenesis...
May 11, 2018: Journal of Hepatology
https://www.readbyqxmd.com/read/29757897/coagulation-defects-in-the-cirrhotic-patient-undergoing-liver-transplantation
#5
Arabesque Parker, Constantine J Karvellas
Patients with cirrhosis undergoing liver transplantation have unique challenges with regard to the prevention and management of thrombosis and hemorrhage. Patients with cirrhosis have an unstable balance of the coagulation system due to defects in both prothrombotic and antithrombotic components. These changes make laboratory monitoring challenging, prophylaxis against bleeding and thrombosis controversial, and therapy for the same uncertain. When cirrhotic patients undergo liver transplantation they frequently have significant transfusion requirements...
May 7, 2018: Transplantation
https://www.readbyqxmd.com/read/29755125/clinical-narrative-autoimmune-hepatitis
#6
REVIEW
Paul A Schmeltzer, Mark W Russo
Autoimmune hepatitis (AIH) is an inflammatory liver disease that is characterized by circulating autoantibodies, hypergammaglobulinemia, and a lymphoplasmocytic infiltration with interface hepatitis on liver biopsy. Treatment with corticosteroids and other immunosuppressive agents is effective and early diagnosis can result in near-normal life expectancy. Untreated patients, however, can progress to cirrhosis and liver failure. The clinical presentation is heterogeneous and may pose diagnostic and therapeutic dilemmas...
May 14, 2018: American Journal of Gastroenterology
https://www.readbyqxmd.com/read/29743790/safety-and-efficacy-of-sofosbuvir-and-daclatasvir-for-hepatitis-c-virus-infection-in-patients-with-%C3%AE-thalassemia-major
#7
Rajiv Mehta, Mayank Kabrawala, Subhash Nandwani, Pankaj Desai, Vishwa Bhayani, Sanjay Patel, Viral Parekh
Background and Aims: β-thalassemia major patients are susceptible to Hepatitis C Virus (HCV) infection owing to life-long dependency for blood-transfusion. Moreover, this patient population is at risk of progression of liver fibrosis or development of cirrhosis as a consequence of both iron overload and HCV infection. Hence, this study was carried out to evaluate efficacy and safety of the combination regimen of sofosbuvir and daclatasvir for HCV infection in β-thalassemia major patients...
March 2018: Journal of Clinical and Experimental Hepatology
https://www.readbyqxmd.com/read/29741240/follow-up-magnetic-resonance-imaging-3d-magnetic-resonance-cholangiopancreatography-in-patients-with-primary-sclerosing-cholangitis-challenging-for-experts-to-interpret
#8
R Zenouzi, T Liwinski, J Yamamura, C Weiler-Normann, M Sebode, S Keller, A W Lohse, C Schramm
BACKGROUND: In patients with primary sclerosing cholangitis follow-up magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP) is performed by many centres, particularly for the early detection of biliary malignancies and strictures. Clinically meaningful MRI-based definitions of primary sclerosing cholangitis related complications are, however, lacking. AIM: To investigate how primary sclerosing cholangitis experts interpret follow-up MRI/MRCP with a focus on conclusions that may impact clinical decision-making in primary sclerosing cholangitis...
May 9, 2018: Alimentary Pharmacology & Therapeutics
https://www.readbyqxmd.com/read/29739414/psychiatric-consultation-requests-by-inpatient-medical-teams-an-observational-study
#9
Carla Pezzia, Jacqueline A Pugh, Holly J Lanham, Luci K Leykum
BACKGROUND: We describe the way psychiatric issues are addressed by inpatient medical teams through analysis of discussions of patients with behavioral health concerns and examination of teams' subsequent consultation practices. METHODS: We observed morning rounds for nine inpatient medical teams for approximately month-long periods, for a total of 1941 observations. We compared discussions of patients admitted for behavioral health related medical conditions between those who did and did not receive a psychiatric consultation, developing categories to describe factors influencing consultation or other management...
May 8, 2018: BMC Health Services Research
https://www.readbyqxmd.com/read/29738332/anesthetic-care-of-2-siblings-with-neonatal-ichthyosis-and-sclerosing-cholangitis-syndrome-case-reports
#10
Céline Khalifa, Geoffrey Boliaki Botombe, Xavier Stephenne, Francis Veyckemans
We report for the first time the anesthetic management of 2 sisters suffering from neonatal ichthyosis and sclerosing cholangitis syndrome. They both presented with neonatal cholestatic jaundice and ichthyosis. The first was admitted for orthotopic liver transplantation at the age of 1 year, and the second patient underwent open pyeloplasty for a pyeloureteric junction syndrome at the age of 4 years. These 2 case reports highlight that, except for the potential difficulties with securing the catheters, dressings and endotracheal tube to the skin, the anesthetic implications of neonatal ichthyosis and sclerosing cholangitis syndrome are mainly related to the liver disease: cirrhosis and portal hypertension...
May 7, 2018: A&A practice
https://www.readbyqxmd.com/read/29738109/sarcopenic-obesity-in-cirrhosis-the-confluence-of-two-prognostic-titans
#11
Tannaz Eslamparast, Aldo J Montano-Loza, Maitreyi Raman, Puneeta Tandon
Sarcopenia and obesity are two major health conditions with a growing prevalence in cirrhosis. The concordance of these two conditions, sarcopenic obesity, is associated with higher rates of mortality and impact on the metabolic profile and physical function than either condition alone. To date, there is little consensus surrounding the diagnostic criteria for sarcopenia, obesity or as a result, sarcopenic obesity in patients with cirrhosis. Cross-sectional imaging, although the most accurate diagnostic technique, has practical limitations for routine use in clinical practice...
May 8, 2018: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/29736833/are-clinicians-ready-for-safe-use-of-stratified-therapy-in-primary-biliary-cholangitis-pbc-a-study-of-educational-awareness
#12
Laura Jopson, Amardeep Khanna, Patricia Peterson, Elaine Rudell, Margaret Corrigan, David Jones
BACKGROUND: Primary Biliary Cholangitis (PBC, formerly cirrhosis), is a chronic cholestatic liver disease which until spring 2016 had a single licensed therapy, Ursodeoxycholic acid (UDCA). Approximately 30% of patients do not respond to UDCA, and are high-risk for progressing to end stage liver disease, transplantation or death. A new era of stratified medicine with second-line therapies to treat high-risk disease is emerging, with the first such second-line agent obeticholic acid recently receiving FDA and EMA approval and entering practice...
May 8, 2018: Digestive Diseases and Sciences
https://www.readbyqxmd.com/read/29731186/a-novel-fibroscan-examination-dedicated-to-spleen-stiffness-measurement
#13
Cécile Bastard, Véronique Miette, Paul Calès, Horia Stefanescu, Davide Festi, Laurent Sandrin
Esophageal varices (EVs) are among the most severe complications of cirrhosis, with a prevalence of 50% to 60% among cirrhotic patients. International guidelines therefore recommend that cirrhotic patients should be screened for the presence of EVs. The main objective of this study was to introduce a new spleen-dedicated FibroScan (Echosens, Paris, France) examination and to assess its performance in detecting large EVs (grade 2 and 3). This novel examination has been validated in simulation and phantom studies and has been used in a population of patients with chronic liver disease...
May 3, 2018: Ultrasound in Medicine & Biology
https://www.readbyqxmd.com/read/29729119/palliative-care-in-end-stage-liver-disease-time-to-do-better
#14
REVIEW
Chiara Mazzarelli, Wendy M Prentice, Michael A Heneghan, Luca S Belli, Kosh Agarwal, Mary D Cannon
Optimal involvement of palliative care services in the management of patients with decompensated cirrhosis and end-stage liver disease is limited. This may result from both ignorance and the failure to recognize the spectrum and unpredictability of the underlying liver condition. Palliative care is a branch of medicine that focuses on quality of life by optimizing symptom management and providing psychosocial, spiritual, and practical support for both patients and their caregivers. Historically, palliative care has been underutilized for patients with decompensated liver disease...
May 5, 2018: Liver Transplantation
https://www.readbyqxmd.com/read/29722188/haemochromatosis-a-clinical-update-for-the-practising-physician
#15
Daniel E Radford-Smith, Elizabeth E Powell, Lawrie W Powell
Haemochromatosis is most commonly due to the autosomal recessive inheritance of a C282Y substitution in the HFE protein, whereby both alleles of the corresponding gene are affected. The disease is characterised by an inappropriate increase in intestinal iron absorption due to reduced expression of the iron regulatory protein, hepcidin. Progressive iron deposition in parenchymal tissues may ultimately lead to liver and other organ toxicity. The characteristic biochemical abnormalities are raised serum ferritin and transferrin saturation, which can be used in conjunction with genetic tests and emerging magnetic resonance imaging-based techniques to diagnose patients with the disorder...
May 2018: Internal Medicine Journal
https://www.readbyqxmd.com/read/29721399/emergency-management-of-spontaneous-bacterial-peritonitis-a-clinical-review
#16
REVIEW
Tracy MacIntosh
Spontaneous bacterial peritonitis (SBP) has a high mortality rate; early antimicrobial therapy is essential for improving patient outcomes. Given that cirrhotic patients are often coagulopathic, the perceived risk of bleeding may prevent providers from performing a paracentesis and ruling out this potentially deadly disease. We examine the pathophysiology and risk factors for SBP, and current guidelines for its diagnosis and treatment. We then review the time-sensitive nature of performing a paracentesis, and the current controversies and contraindications for performing this procedure in patients at risk for SBP...
March 1, 2018: Curēus
https://www.readbyqxmd.com/read/29720858/preoperative-elective-transjugular-intrahepatic-portosystemic-shunt-for-cirrhotic-patients-undergoing-abdominal-surgery
#17
REVIEW
Deepanshu Jain, Ejaz Mahmood, Maria V-Bandres, Eyob Feyssa
Despite improvements in the surgical techniques, anesthesia and intensive care, abdominal surgery in patients with cirrhosis remains a challenge. Transjugular intrahepatic portosystemic shunt (TIPS) has been used to manage complications of portal hypertension. Preoperative TIPS (prophylactic) can theoretically improve outcomes in this population. Seven original studies were identified with 24 patients who underwent prophylactic TIPS before abdominal surgery. No perioperative mortality or major abdominal bleeding attributable to portal hypertension was reported for this cohort...
May 2018: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/29720857/portal-vein-thrombosis-in-cirrhosis-diagnosis-natural-history-and-therapeutic-challenges
#18
REVIEW
Aikaterini Mantaka, Aikaterini Augoustaki, Elias A Kouroumalis, Dimitrios N Samonakis
Portal vein thrombosis (PVT) is a frequent complication in cirrhosis and its prevalence increases with disease severity. Several factors are involved in the development and progression of PVT. The challenge for the management of PVT is the precise evaluation of the bleeding risk as opposed to life-threatening extension of thrombosis. Nevertheless, the impact on the progression and outcome of liver disease is unclear. A critical evaluation of the available data discloses that treating PVT in cirrhotics is safe and effective...
May 2018: Annals of Gastroenterology: Quarterly Publication of the Hellenic Society of Gastroenterology
https://www.readbyqxmd.com/read/29718863/endoscopic-retrograde-cholangiopancreatography-in-adult-patients-with-biliary-atresia-process-compliant-case-series
#19
Jong Jin Hyun, Shayan S Irani, Richard A Kozarek
INTRODUCTION: Biliary atresia is a progressive inflammatory disease of the bile duct that eventually results in biliary cirrhosis. It is a rare neonatal disease that mandates treatment within the first 2 years of life in order for the infant to survive. Patients usually undergo palliative Kasai portoenterostomy. Even when Kasai portoenterostomy has been performed in a timely manner, progression is still inevitable. In fact, the majority of patients require curative liver transplantation at a later stage before reaching adulthood...
May 2018: Medicine (Baltimore)
https://www.readbyqxmd.com/read/29717414/primary-central-sleep-apnea-and-anesthesia-a-retrospective-case-series
#20
Alexandru Alexa, Meghna P Mansukhani, Bhargavi Gali, Atousa Deljou, Juraj Sprung, Toby N Weingarten
PURPOSE: Primary (idiopathic) central sleep apnea (PCSA) is a rare central sleep-related breathing disorder characterized by increased chemoreceptor sensitivity to partial pressure of carbon dioxide, which manifests as hyperventilation followed by apnea during non-rapid eye movement sleep. The purpose of this retrospective study was to describe the postoperative course of patients who had PCSA and underwent procedures requiring anesthetic management. METHODS: Patients who received a diagnosis of PCSA at our institution and required procedural anesthesia between 1 January 2010 and 1 June 2016 underwent a comprehensive review of their health records with a focus on identifying respiratory complications...
May 1, 2018: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
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