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Decompensated cirrhosis

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https://www.readbyqxmd.com/read/28550272/non-alcoholic-fatty-liver-disease-a-chronic-disease-of-the-21-st-century
#1
Metrakos Peter, Nilsson Tommy
Non-alcoholic fatty liver disease (NAFLD) comprises a spectrum of metabolic states ranging from simple steatosis to inflammation with associated fibrosis to cirrhosis. Though accumulation of hepatic fat is not associated with a significant increase in mortality rates, hepatic inflammation is, as this augments the risk of terminal liver disease, i.e., cirrhosis, hepatic decompensation (liver failure) and/or hepatocellular carcinoma. Disease progression is usually slow, over a decade or more and, for the most part, remains asymptomatic...
May 26, 2017: Journal of Biomedical Research
https://www.readbyqxmd.com/read/28550020/translation-adaptation-and-validation-of-two-versions-of-the-chronic-liver-disease-questionnaire-in-malaysian-patients-for-speakers-of-both-english-and-malay-languages-a-cross-sectional-study
#2
Shasha Khairullah, Sanjiv Mahadeva
OBJECTIVE: We aimed to adapt, translate and validate the Chronic Liver Disease Questionnaire (CLDQ) in Malaysian patients with chronic liver diseases of various aetiologies. SETTING: Tertiary level teaching institution in Malaysia. PARTICIPANTS: The validation process involved 211 adult patients (English language n=101, Malay language n=110) with chronic liver disease. Characteristics of the study subjects were as follows: mean (SD) age was 56 (12...
May 25, 2017: BMJ Open
https://www.readbyqxmd.com/read/28546792/hepatitis-c-virus-and-liver-transplantation
#3
Kalyan Ram Bhamidimarri, Sanjaya K Satapathy, Paul Martin
Hepatitis C virus (HCV) is a major cause of death from infectious disease and is still the leading indication for liver transplantation in the United States and other Western countries. All-oral, direct-acting antiviral (DAA) therapies have revolutionized the field, with HCV cure rates of more than 90% among treated patients. The safety and tolerability of these DAA agents have expanded the feasibility of HCV treatment even in the challenging pre- and post-liver transplant settings. However, the unique properties of DAA agents and the host profiles in these settings can limit the generalizability of HCV regimens, and prolongation of treatment duration or addition of ribavirin may be required in certain scenarios to optimize treatment outcomes...
April 2017: Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28545169/plasma-cystatin-c-is-a-predictor-of-renal-dysfunction-aclf-and-mortality-in-patients-with-acutely-decompensated-liver-cirrhosis
#4
Daniel Markwardt, Lesca Holdt, Christian Steib, Andreas Benesic, Flemming Bendtsen, Mauro Bernardi, Richard Moreau, Daniel Teupser, Julia Wendon, Frederik Nevens, Jonel Trebicka, Elisabet Garcia, Marco Pavesi, Vicente Arroyo, Alexander L Gerbes
BACKGROUND: The development of acute-on-chronic liver failure (ACLF) in patients with liver cirrhosis is associated with high mortality rates. Renal failure is the most significant organ dysfunction that occurs in ACLF. So far there are no biomarkers predicting ACLF. AIM: To investigate whether Cystatin C (CysC) and neutrophil gelatinase-associated lipocalin (NGAL) can predict development of renal dysfunction (RD), hepatorenal syndrome (HRS), ACLF and mortality, respectively...
May 25, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28544696/increased-incidence-of-liver-cancer-after-successful-daa-treatment-of-chronic-hepatitis-c-fact-or-fiction
#5
Alfredo Alberti, Sara Piovesan
Therapy of hepatitis C has been revolutionized by Direct Antiviral Agents. These drugs are safe and efficacious in all infected patients, including those with advanced, or decompensated cirrhosis, and are currently largely used in such cases in clinical practice worldwide. It was therefore cause of great concern the publication of two reports suggesting that treatment with DAAs could increase the risk of hepatocellular carcinoma in cirrhotic patients, particularly in those receiving antiviral therapy after having been cured for an HCC...
June 2017: Liver International: Official Journal of the International Association for the Study of the Liver
https://www.readbyqxmd.com/read/28535652/-analysis-of-clinical-prognosis-and-the-correlation-between-bile-duct-injury-after-transcatheter-arterial-chemoembolization-and-the-level-of-hepatic-arterial-embolization-in-patients-with-hepatocellular-carcinoma
#6
H Y Xu, X P Yu, R Feng, H J Hu, W W Xiao
Objective: To evaluate the correlation between bile duct injury after transcatheter arterial chemoembolization and the level of hepatic arterial embolization, and to analyze the clinical prognosis of hepatocellular carcinoma patients. Methods: From January18, 2012 to December18, 2014, 21 patients underwent TACE for HCC were retrospectively reviewed, including patients' clinical and pathological data. The clinical outcome and relevant factors for bile duct injury were analyzed. Results: A total of 21 patients were identified with bile duct injury at our single institution...
May 23, 2017: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
https://www.readbyqxmd.com/read/28533909/recent-advances-in-the-management-of-variceal-bleeding
#7
Ihteshamul Haq, Dhiraj Tripathi
Acute haemorrhage from ruptured gastroesophageal varices is perhaps the most serious consequence of uncontrolled portal hypertension in cirrhotic patients. It represents a medical emergency and is associated with a high morbidity and mortality. In those who survive the initial bleeding event, the risks of further bleeding and other decompensated events remain high. The past 30 years have seen a slow evolution of management strategies that have greatly improved the chances of surviving a variceal haemorrhage...
May 2017: Gastroenterology Report
https://www.readbyqxmd.com/read/28533907/novel-treatment-options-for-portal-hypertension
#8
Philipp Schwabl, Wim Laleman
Portal hypertension is most frequently associated with cirrhosis and is a major driver for associated complications, such as variceal bleeding, ascites or hepatic encephalopathy. As such, clinically significant portal hypertension forms the prelude to decompensation and impacts significantly on the prognosis of patients with liver cirrhosis. At present, non-selective β-blockers, vasopressin analogues and somatostatin analogues are the mainstay of treatment but these strategies are far from satisfactory and only target splanchnic hyperemia...
May 2017: Gastroenterology Report
https://www.readbyqxmd.com/read/28533906/diagnosis-of-cirrhosis-and-portal-hypertension-imaging-non-invasive-markers-of-fibrosis-and-liver-biopsy
#9
REVIEW
Bogdan Procopet, Annalisa Berzigotti
The concept of 'cirrhosis' is evolving and it is now clear that compensated and decompensated cirrhosis are completely different in terms of prognosis. Furthermore, the term 'advanced chronic liver disease (ACLD)' better reflects the continuum of histological changes occurring in the liver, which continue to progress even after cirrhosis has developed, and might regress after removing the etiological factor causing the liver disease. In compensated ACLD, portal hypertension marks the progression to a stage with higher risk of clinical complication and requires an appropriate evaluation and treatment...
May 2017: Gastroenterology Report
https://www.readbyqxmd.com/read/28527664/a-new-hdv-mouse-model-identifies-mitochondrial-antiviral-signaling-protein-mavs-as-a-key-player-in-ifn-%C3%AE-induction
#10
Lester Suárez-Amarán, Carla Usai, Marianna Di Scala, Cristina Godoy, Yi Ni, Mirja Hommel, Laura Palomo, Víctor Segura, Cristina Olagüe, Africa Vales, Alicia Ruiz-Ripa, Maria Buti, Eduardo Salido, Jesús Prieto, Stephan Urban, Francisco Rodríguez-Frias, Rafael Aldabe, Gloria González-Aseguinolaza
BACKGROUND & AIMS: Studying hepatitis delta virus (HDV) and developing new treatments is hampered by the limited availability of small animal models. Here a description of a robust mouse model of HDV infection that mimics several important characteristics of the human disease is presented. METHODS: HDV- and HBV-replication competent genomes were delivered to the mouse liver using adeno-associated viruses (AAV) (AAV-HDV and AAV-HBV). Viral load, antigen expression and genomes were quantified at different time points after AAV injection...
May 17, 2017: Journal of Hepatology
https://www.readbyqxmd.com/read/28520728/cost-effectiveness-of-hepatitis-c-treatment-using-generic-direct-acting-antivirals-available-in-india
#11
Rakesh Aggarwal, Qiushi Chen, Amit Goel, Nicole Seguy, Razia Pendse, Turgay Ayer, Jagpreet Chhatwal
BACKGROUND & AIMS: Availability of directly-acting antivirals (DAAs) has changed the treatment landscape of hepatitis C virus (HCV) infection. The high price of DAAs has restricted their use in several countries. However, in some countries such as India, generic DAAs are available at much cheaper price. This study examined whether generic DAAs could be cost-saving and how long it would take for the treatment to become cost-saving/effective. METHODS: A previously-validated, mathematical model was adapted to the HCV-infected population in India to compare the outcomes of no treatment versus treatment with DAAs...
2017: PloS One
https://www.readbyqxmd.com/read/28512923/the-braden-scale-a-standard-tool-for-assessing-pressure-ulcer-risk-predicts-early-outcomes-after-liver-transplantation
#12
Vinay Sundaram, Jane Lim, Danielle M Tholey, Sentia Iriana, Irene Kim, Vignan Manne, Nicholas N Nissen, Andrew S Klein, Tram T Tran, Walid S Ayoub, Barry Schlansky
The Braden Scale is a standardized tool to assess pressure ulcer risk, that is reported for all hospitalized patients in the United States (US) per requirements of the Center for Medicare and Medicaid Services. Previous data has shown the Braden Scale can predict both frailty and mortality risk in patients with decompensated cirrhosis. Our aim was to evaluate the association of Braden Scale score with short-term outcomes after liver transplantation (LT). We performed a retrospective cohort study of deceased-donor LT recipients at two centers, and categorized them according to the Braden Scale at hospital admission as low (>18), moderate (16-18), or high risk (<16) for pressure ulcer...
May 17, 2017: Liver Transplantation
https://www.readbyqxmd.com/read/28507927/immune-dysfunction-in-cirrhosis
#13
REVIEW
Mohd Talha Noor, Piyush Manoria
Cirrhosis due to any etiology disrupts the homeostatic role of liver in the body. Cirrhosis-associated immune dysfunction leads to alterations in both innate and acquired immunity, due to defects in the local immunity of liver as well as in systemic immunity. Cirrhosis-associated immune dysfunction is a dynamic phenomenon, comprised of both increased systemic inflammation and immunodeficiency, and is responsible for 30% mortality. It also plays an important role in acute as well as chronic decompensation. Immune paralysis can accompany it, which is characterized by increase in anti-inflammatory cytokines and suppression of proinflammatory cytokines...
March 28, 2017: Journal of Clinical and Translational Hepatology
https://www.readbyqxmd.com/read/28504842/safety-and-efficacy-of-current-daa-regimens-in-kidney-and-liver-transplant-recipients-with-hepatitis-c-results-from-the-hcv-target-study
#14
Varun Saxena, Vandana Khungar, Elizabeth C Verna, Josh Levitsky, Robert S Brown, Mohamed A Hassan, Mark S Sulkowski, Jacqueline G O'Leary, Farrukh Koraishy, Joseph S Galati, Alexander A Kuo, Monika Vainorius, Lucy Akushevich, David R Nelson, Michael W Fried, Norah Terrault, K Rajender Reddy
BACKGROUND: Data outside of clinical trials with direct acting antiviral (DAA) regimens with or without ribavirin as treatment of chronic HCV in solid organ transplant recipients is limited. METHODS: Liver transplant (LT), kidney transplant (KT) and dual liver kidney (DLK) transplant recipients from the HCV-TARGET database, a multicenter, longitudinal clinical care treatment cohort, treated with DAA regimens between January 1 2014 and February 15, 2016 were included to assess safety and efficacy...
May 15, 2017: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/28501004/adipose-derived-mesenchymal-stem-cells-slow-disease-progression-of-acute-on-chronic-liver-failure
#15
Carlos Gilsanz, Maria-Angeles Aller, Sherezade Fuentes-Julian, Isabel Prieto, Alejandro Blázquez-Martinez, Salvador Argudo, Jorge Fernández-Delgado, Jose Beleña, Jaime Arias, María P De Miguel
A serious complication of chronic hepatic insufficiency is acute-on-chronic liver failure, a recognized syndrome characterized by acute decompensation of cirrhosis and organ/system failure. We investigated the use of adipose-derived mesenchymal stem cells (AD-MSCs) in an experimental model of acute-on-chronic liver failure, developed by microsurgical extrahepatic cholestasis in rats. Rats undergoing microsurgical extrahepatic cholestasis were treated by intraparenchymal liver injection of human or rat AD-MSCs, undifferentiated or previously differentiated in vitro toward the hepatocyte lineage...
May 10, 2017: Biomedicine & Pharmacotherapy, Biomédecine & Pharmacothérapie
https://www.readbyqxmd.com/read/28500294/adipocyte-fatty-acid-binding-protein-is-overexpressed-in-cirrhosis-and-correlates-with-clinical-outcomes
#16
Isabel Graupera, Mar Coll, Elisa Pose, Chiara Elia, Salvatore Piano, Elsa Solà, Delia Blaya, Patricia Huelin, Cristina Solé, Rebeca Moreira, Gloria de Prada, Núria Fabrellas, Adrià Juanola, Manuel Morales-Ruiz, Pau Sancho-Bru, Càndid Villanueva, Pere Ginès
Fatty-acid-binding proteins (FABPs) are small intracellular proteins that coordinate lipid-mediated processes by targeting metabolic and immune response pathways. The aim of the study was to investigate plasma FABPs levels and their relationship with clinical outcomes in cirrhosis. Plasma levels of L-FABP1(liver and kidney), I-FABP2(intestine), and A-FABP4(adipocyte and macrophages) were measured in 274 patients with decompensated cirrhosis. Hepatic gene expression of FABPs was assessed in liver biopsies from patients with decompensated cirrhosis and in liver cell types from mice with cirrhosis...
May 12, 2017: Scientific Reports
https://www.readbyqxmd.com/read/28500122/navigating-the-benefits-and-burdens-of-life-saving-treatment-in-severely-decompensated-cirrhosis-an-illustrative-multisourced-narrative
#17
Philip Berry, Kuldeep Cheent, Heather Lewis, Marcus Peck
Severely decompensated cirrhosis presents major challenges in terms of balancing the benefits and burdens of life-extending treatment. Using accounts and interviews with a patient, her mother, consultant hepatologists and a consultant intensivist, this article explores the decision making around a 43-year-old woman with alcoholic liver disease who died after 100 days in a hospital. Particular focus is given to decisions on escalation, recognition of futility, distress associated with therapy and how messages given during end-of-life discussions are processed...
May 12, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/28497758/ombitasvir-paritaprevir-and-ritonavir-with-or-without-dasabuvir-plus-ribavirin-for-patients-with-hepatitis-c-virus-genotype-1-or-4-infection-with-cirrhosis-abacus-a-prospective-observational-study
#18
Salvatore Petta, Marco Marzioni, Pierluigi Russo, Alessio Aghemo, Alfredo Alberti, Antonio Ascione, Andrea Antinori, Raffaele Bruno, Savino Bruno, Antonio Chirianni, Giovanni Battista Gaeta, Edoardo G Giannini, Manuela Merli, Vincenzo Messina, Simona Montilla, Carlo Federico Perno, Massimo Puoti, Giovanni Raimondo, Maria Rendina, Francesca Ceccherini Silberstein, Erica Villa, Anna Linda Zignego, Luca Pani, Antonio Craxì
BACKGROUND: We ran a compassionate use nationwide programme (ABACUS) to provide access to ombitasvir, paritaprevir, and ritonavir, with dasabuvir, plus ribavirin for hepatitis C virus (HCV) genotype 1 infection and ombitasvir, paritaprevir, and ritonavir, plus ribavirin for HCV genotype 4 infection in patients with cirrhosis at high risk of decompensation while approval of these regimens was pending in Italy. METHODS: In this prospective observational study, we collected data from a compassionate use nationwide programme from March 17, 2014, to May 28, 2015...
June 2017: Lancet. Gastroenterology & Hepatology
https://www.readbyqxmd.com/read/28494539/-current-status-and-perspectives-of-diagnosis-and-treatment-of-complications-related-to-liver-cirrhosis
#19
Y M Nan
Liver cirrhosis is the severe period of chronic liver diseases, especially decompensated liver cirrhosis and its complications, such as ascites, esophagogastric variceal bleeding, hepatic encephalopathy, acute kidney injury, and hepatocellular carcinoma, which greatly affect patients' quality of life and even threaten their lives. Early prevention and treatment of the causes of development and progression and pathogenic mechanism may slow down or reverse liver cirrhosis and its severe complications. Once the disease progresses to portal hypertension and related complications, it is very important to select preventive measures for acute exacerbation of different complications, as well as the methods and timing for treatment in acute stage, which may help to save patients' lives and improve their prognosis...
April 20, 2017: Zhonghua Gan Zang Bing za Zhi, Zhonghua Ganzangbing Zazhi, Chinese Journal of Hepatology
https://www.readbyqxmd.com/read/28487083/hcv-clearance-after-direct-acting-antivirals-in-patients-with-cirrhosis-by-stages-of-liver-impairment-the-ital-c-network-study
#20
Antonio Massimo Ippolito, Michele Milella, Vincenzo Messina, Fabio Conti, Raffaele Cozzolongo, Filomena Morisco, Giuseppina Brancaccio, Michele Barone, Teresa Santantonio, Chiara Masetti, Paolo Tundo, Antonina Smedile, Vito Carretta, Pietro Gatti, Antonio Patrizio Termite, Maria Rosa Valvano, Giuseppe Bruno, Claudia Fabrizio, Pietro Andreone, Marianna Zappimbulso, Giovanni Battista Gaeta, Nicola Napoli, Luca Fontanella, Gianfranco Lauletta, Giuseppe Cuccorese, Antonio Metrangolo, Ruggiero Francavilla, Emanuela Ciracì, Salvatore Rizzo, Angelo Andriulli
BACKGROUND: Sustained virological response (SVR12) rates at 12 weeks after treatment for HCV-infected patients with decompensated cirrhosis are used when referring to those with moderate functional impairment, while few data are available for those with more severe impairment. The use of the cirrhosis staging system proposed by D'Amico might provide new insights on timing for antiviral therapy. METHODS: We investigated efficacy (SVR12), safety, and post-treatment variations in clinical and laboratory parameters in 2612 patients with advanced fibrosis (n=575) or cirrhosis (n=2037)...
April 8, 2017: Digestive and Liver Disease
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