15,140 results match your criteria Encephalopathy Hepatic


Associations Between Mean Arterial Pressure and Poor ICU Outcomes in Critically Ill Patients With Cirrhosis: Is 65 The Sweet Spot?

Crit Care Med 2020 Jun 22. Epub 2020 Jun 22.

Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, IN.

Objectives: Mean arterial pressure is critically important in patients with cirrhosis in the ICU, however, there is limited data to guide therapies and targets.

Design: Retrospective observational study.

Setting: Tertiary care ICU. Read More

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http://dx.doi.org/10.1097/CCM.0000000000004442DOI Listing

Important Unresolved Questions in the Management of Hepatic Encephalopathy: An ISHEN Consensus.

Am J Gastroenterol 2020 Jul;115(7):989-1002

Department of Medicine, University of Padova, Padova, Italy.

Management of hepatic encephalopathy (HE) remains challenging from a medical and psychosocial perspective. Members of the International Society for Hepatic Encephalopathy and Nitrogen Metabolism recognized 5 key unresolved questions in HE management focused on (i) driving, (ii) ammonia levels in clinical practice, (iii) testing strategies for covert or minimal HE, (iv) therapeutic options, and (v) nutrition and patient-reported outcomes. The consensus document addresses these topical issues with a succinct review of the literature and statements that critically evaluate the current science and practice, laying the groundwork for future investigations. Read More

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http://dx.doi.org/10.14309/ajg.0000000000000603DOI Listing

Continuing Medical Education Questions: July 2020.

Am J Gastroenterol 2020 Jul;115(7):979

Article Title: Important Unresolved Questions in the Management of Hepatic Encephalopathy: An ISHEN Consensus. Read More

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http://dx.doi.org/10.14309/ajg.0000000000000742DOI Listing

Potentially Reversible and Recognizable Acute Encephalopathic Syndromes: Disease Categorization and MRI Appearances.

AJNR Am J Neuroradiol 2020 Jul 2. Epub 2020 Jul 2.

Department of Radiology (A.M.M.), University of Miami School of Medicine, Miami, Florida.

"Encephalopathy" is a vague term that encompasses varying definitions, often with a nonspecific clinical presentation and numerous possible pathophysiologic causes. Hence, MR imaging plays a crucial role in the early diagnosis and treatment by identifying imaging patterns when there is limited clinical history in such patients with acute encephalopathy. The aim of this review was to aid in remembrance of etiologies of potentially reversible acute encephalopathic syndromes on MR imaging. Read More

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http://dx.doi.org/10.3174/ajnr.A6634DOI Listing

Capsule, a Traditional Chinese Medicinal Formulation, Enhances the Survival of Patients with Hepatocellular Carcinoma and Vp3-4 Portal Vein Tumor Thrombosis Undergoing Supportive Treatment.

J Altern Complement Med 2020 Jul 2. Epub 2020 Jul 2.

Center of Integrative Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing, China.

(FFBM) capsule, a type of Chinese medicinal formulation, has decades of history in treating hepatocellular carcinoma (HCC). This retrospective study aimed to observe the effect of FFBM capsules on the 6-month survival of patients with advanced HCC and Vp3-4 portal vein tumor thrombosis (PVTT) who received supportive therapy alone. In total, 320 HCC/Vp3-4 PVTT patients underwent treatment with supportive therapy, of whom 95 took FFBM capsules and were treated with supportive therapy (FFBM group) and 225 received supportive therapy alone (control group). Read More

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http://dx.doi.org/10.1089/acm.2019.0334DOI Listing

Lactate-free AARC ACLF Score (LaFAS) - A Simple Userfriendly Score is the Best Prognostic Marker for Patients with Alcohol Induced ACLF in Western Indian Population in a Nontransplant Resource-limited Setting.

J Assoc Physicians India 2020 May;68(5):34-38

Professor and Head, Department of Gastroenterology, Lokmanya Tilak Municipal General Hospital and Medical College, Mumbai, Maharashtra.

Introduction: Acute-on-Chronic liver failure (ACLF) is a disease with a distinct spectrum of liver injury, with a rapid downhill course Here we describe three new scores - Albumin Bilirubin Index (ALBI), platelet albumin bilirubin index (PALBI) and Lactate-free AARC ACLF score(LaFAS), in predicting short-term mortality in patients with alcohol induced ACLF when compared to standard validated scores.

Methods: Consecutive patients diagnosed as alcohol induced ACLF as per the APASL 2014 definition were included in the study. Standard scores - MELD, MELD-Na, Maddreys' discriminant function, CLIF-OF and CLIF-C ACLF scores, APACHE II, ALBI, PALBI and LaFAS were calculated. Read More

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Usefulness of Carnitine Supplementation for the Complications of Liver Cirrhosis.

Nutrients 2020 Jun 29;12(7). Epub 2020 Jun 29.

Department of Gastroenterology/Internal Medicine, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu 501-1194, Japan.

Carnitine is a vitamin-like substance that regulates lipid metabolism and energy production. Carnitine homeostasis is mainly regulated by dietary intake and biosynthesis in the organs, including the skeletal muscle and the liver. Therefore, liver cirrhotic patients with reduced food intake, malnutrition, biosynthetic disorder, and poor storage capacity of carnitine in the skeletal muscle and liver are more likely to experience carnitine deficiency. Read More

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http://dx.doi.org/10.3390/nu12071915DOI Listing

Significant improvement in portal-systemic liver failure symptoms and successful management of portal-splenic venous hemodynamics by the combination of interventional radiology and pharmacotherapy.

Hepatol Res 2020 Jul 1. Epub 2020 Jul 1.

Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minami-Kogushi, Ube-Yamaguchi, 7558505, Japan.

Aim: To describe a case of hepatitis C virus-related decompensated cirrhosis with portal-systemic liver failure and refractory encephalopathy that was successfully managed with a combination of interventional radiology and pharmacotherapy to improve hepatic function including hyperammonemia and to control portal-splenic venous hemodynamics with hepatic venous pressure gradient (HVPG) monitoring.

Case Presentation: A man in his late 50s presented with a Child-Pugh score of 13, Model for End-Stage Liver Disease-sodium (MELD-Na) score of 19, and blood ammonia level of 185 μg/dL. He underwent balloon-occluded retrograde transvenous obliteration (BRTO) followed by partial splenic embolization (PSE) and non-selective beta-blocker (NSBB) administration. Read More

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http://dx.doi.org/10.1111/hepr.13545DOI Listing

Evaluation of Preoperative and Postoperative S100β and NSE Levels in Liver Transplantation and Right Lobe Living-Donor Hepatectomy: A Prospective Cohort Study.

Transplant Proc 2020 Jun 27. Epub 2020 Jun 27.

Akdeniz University Medical Faculty, Department of General Surgery, Antalya, Turkey.

Background And Aims: This study aimed to evaluate plasma neuron-specific enolase (NSE) and S100β levels in orthotopic liver transplantation.

Materials And Methods: A total of 56 patients who underwent orthotopic liver transplantation were divided into 3 groups. Healthy donors (group D), end-stage liver failure (ESLF) patients (recipient, group R), and ESLF patients diagnosed with hepatic encephalopathy (HE, group HE). Read More

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http://dx.doi.org/10.1016/j.transproceed.2020.04.1818DOI Listing

[Unsolved issues of pregnancy in liver cirrhosis].

Ter Arkh 2019 Apr 15;91(4):114-117. Epub 2019 Apr 15.

Obstetric Clinic, University Hospital "Dr. Georgi Stranski", Department of obstetrics and gynecology, Medical University.

Pregnancy in patients with liver cirrhosis and portal hypertension occurs very rare, because of their significantly derailed reproductive functions. Тhe risks for the mother and the fetus are connected with worsening of the portal hypertension, progression of decompensated liver cirrhosis and development of its complications: liver failure, ascites, hepatorenal syndrome, hepatic encephalopathy and variceal hemorrhage, and with increased incidence of spontaneous abortions and abnormal uterine bleeding. The decision for continuation of the pregnancy in cirrhotic patients must be based on individual approach and a multidisciplinary team consisting of obstetricians, hepatologists, anesthesiologists, surgeons and hematologists must participate in the therapy. Read More

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http://dx.doi.org/10.26442/00403660.2019.04.000145DOI Listing

Application of the Molecular Adsorbent Recirculating System in Type 1 Hepatorenal Syndrome in the Course of Alcohol-Related Acute on Chronic Liver Failure.

Med Sci Monit 2020 Jun 30;26:e923805. Epub 2020 Jun 30.

Department of Gastroenterology, Endocrinology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.

BACKGROUND This study aimed to evaluate the Molecular Adsorbent Recirculating System (MARS) effectiveness in patients with alcohol-related acute-on-chronic liver failure (AoCLF) complicated with type 1 hepatorenal syndrome (HRS). So far, MARS efficacy and safety has been demonstrated in various acute liver failure scenarios. MATERIAL AND METHODS Data from 41 MARS procedures (10 patients with type 1 HRS, in the course of alcohol-related AoCLF were considered for this study. Read More

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http://dx.doi.org/10.12659/MSM.923805DOI Listing

Association between diabetes mellitus and hepatic encephalopathy in patients with liver cirrhosis.

Aliment Pharmacol Ther 2020 Jun 29. Epub 2020 Jun 29.

Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.

Background: Diabetes mellitus may lead to increased serum ammonia and systemic inflammation thereby promoting hepatic encephalopathy (HE).

Aims: We investigated the potential association between diabetes mellitus/glycaemic control and the presence of covert HE as well as the development of overt HE in a prospective setting.

Methods: A total of 240 patients with liver cirrhosis were included into this prospective cohort study and followed for a median of 17 months. Read More

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http://dx.doi.org/10.1111/apt.15915DOI Listing

Transjugular intrahepatic portosystemic shunt and alfapump® system for refractory ascites in liver cirrhosis: Outcomes and complications.

United European Gastroenterol J 2020 Jun 26:2050640620938525. Epub 2020 Jun 26.

Hepatology, University Clinic for Visceral Surgery and Medicine, Bern, Switzerland.

Background: Treatment of refractory ascites in liver cirrhosis is challenging. Transjugular intrahepatic portosystemic shunt and alfapump® have been proposed for the management, but few data comparing both exist.

Aims: The aim of this study was to evaluate the characteristics and outcomes of patients treated with transjugular intrahepatic portosystemic shunt and alfapump® for refractory ascites at our centre. Read More

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http://dx.doi.org/10.1177/2050640620938525DOI Listing

Liver-related effects of chronic hepatitis C antiviral treatment.

World J Gastroenterol 2020 Jun;26(22):2931-2947

Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus N DK-8200, Denmark.

More than five years ago, the treatment of hepatitis C virus infection was revolutionized with the introduction of all-oral direct-acting antiviral (DAA) drugs. They proved highly efficient in curing patients with chronic hepatitis C (CHC), including patients with cirrhosis. The new DAA treatments were alleged to induce significant improvements in clinical outcome and prognosis, but the exact cause of the expected benefit was unclear. Read More

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http://dx.doi.org/10.3748/wjg.v26.i22.2931DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7304101PMC

Change in Patient MELD-Na and Albumin Level From the Time of Celiac Disease Diagnosis to Six Months Later After Gluten-Free Diet.

Cureus 2020 May 22;12(5):e8237. Epub 2020 May 22.

Biostatistics, Geisinger Medical Center, Danville, USA.

Background & aims Celiac disease (CD) is a multisystem disorder triggered by dietary gluten in genetically predisposed individuals that may affect any organ system, including the liver. We evaluated a change in patient model for end-stage liver disease (MELD)-Na and albumin level from the time of celiac disease diagnosis to six months later, after implementing a gluten-free diet. Methods A retrospective study was conducted from January 1, 2006, to June 30, 2018. Read More

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http://dx.doi.org/10.7759/cureus.8237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7306642PMC

The Genus : Gut Bacteria With Emerging Implications to Inflammation, Cancer, and Mental Health.

Front Immunol 2020 9;11:906. Epub 2020 Jun 9.

Division of Gastroenterology and Liver Disease, Case Western Reserve University School of Medicine, Cleveland, OH, United States.

is a relatively new genus of bacteria isolated primarily from medical clinical samples, although at a low rate compared to other genus members of the phylum, which are highly relevant in dysbiosis and disease. According to the taxonomy database at The National Center for Biotechnology Information, the genus consists of 13 species: , and and , and the subspecies subspecies vulgaris (vs. subsp. Read More

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http://dx.doi.org/10.3389/fimmu.2020.00906DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7296073PMC

Early-TIPS Versus Current Standard Therapy for Acute Variceal Bleeding in Cirrhosis Patients: A Systemic Review With Meta-analysis.

Front Pharmacol 2020 20;11:603. Epub 2020 May 20.

Department of Obstetrical, Jining No.1 People's Hospital, Jining, China.

Background: The survival of early placement (within 72h after admission) of transjugular intrahepatic portosystemic shunts (early-TIPS) in patients with cirrhosis and acute variceal bleeding (AVB) is controversial.

Objectives: We performed a systemic review and meta-analysis to assess whether early-TIPS could improve survival in patients with cirrhosis and acute variceal bleeding.

Methods: A systematic search of the literature was conducted in PubMed, EMBASE, and Cochrane Library published before 25 June 2019 for eligible studies that compared early-TIPS with a combination of endoscopic variceal ligation (EVL) and pharmacotherapy in the therapeutic effect in AVB patients. Read More

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http://dx.doi.org/10.3389/fphar.2020.00603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7282546PMC

Minimal Hepatic Encephalopathy: Effect of H. pylori infection and small intestinal bacterial overgrowth treatment on clinical outcomes.

Sci Rep 2020 Jun 22;10(1):10079. Epub 2020 Jun 22.

Section of Gastroenterology, Department of Medicine, Aga Khan University, Karachi, Pakistan.

The effect Helicobacter pylori (Hp) infection and small intestinal bacterial over growth (SIBO) in minimal hepatic encephalopathy (MHE) is not well understood. The aim of the study was to determine the effect of eradication of Hp infection and SIBO treatment on MHE in patients with cirrhosis. Patients with cirrhosis were enrolled and MHE was determined by psychometric tests and critical flicker frequency analysis. Read More

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http://dx.doi.org/10.1038/s41598-020-67171-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7308324PMC

A novel method: can stapedial acoustic reflex have a role in the diagnosis of minimal hepatic encephalopathy?

Eur J Gastroenterol Hepatol 2020 Jun 19. Epub 2020 Jun 19.

Gastroenterology, University of Gaziantep Medical Faculty, Department, Gaziantep, Turkey.

Objective: Stapedial acoustic reflex is an easily accessible and applicable test which is also valuable for the clinical conditions which affect the various locations of the central nervous system. Searching the diagnostic value of stapedial acoustic reflex at minimal hepatic encephalopathy is the aim of this research.

Methods: Diagnosis of minimal hepatic encephalopathy was conducted by mini-mental state and critical flickered frequency tests. Read More

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http://dx.doi.org/10.1097/MEG.0000000000001781DOI Listing

Outcome Prediction of Covert Hepatic Encephalopathy in Liver Cirrhosis: Comparison of Four Testing Strategies.

Clin Transl Gastroenterol 2020 Jun;11(6):e00172

Department of Internal Medicine I, University Medical Center of the Johannes Gutenberg-University, Mainz, Germany.

Introduction: Despite the negative impact of covert hepatic encephalopathy on the outcome of patients with liver cirrhosis, data regarding the ability of different testing strategies to predict overt hepatic encephalopathy (OHE) development and mortality are limited. This study aimed to compare the ability of Psychometric Hepatic Encephalopathy Score (PHES), critical flicker frequency (CFF), simplified animal naming test (S-ANT1), and clinical covert hepatic encephalopathy (CCHE) score to predict OHE development and mortality.

Methods: A total of 224 patients with liver cirrhosis were tested with different testing strategies and prospectively followed up regarding clinically relevant outcomes (OHE or death/liver transplantation). Read More

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http://dx.doi.org/10.14309/ctg.0000000000000172DOI Listing

Endothelin-1 level as a predictor of hepatopulmonary syndrome in liver cirrhosis.

Med Glas (Zenica) 2020 Aug 1;17(2). Epub 2020 Aug 1.

Department of Child Health, Faculty of Medicine, Universitas Prima, Medan, Indonesia.

Aim To determine the role of endothelin (ET)-1 in predicting hepatopulmonary syndrome (HPS) in patients with liver cirrhosis. Methods A cross sectional study involving 80 liver cirrhosis patients aged 18 years or older was conducted in Adam Malik General Hospital Medan, Indonesia between July 2017 and June 2018. HPS diagnosis was confirmed from the presence of liver cirrhosis, abnormal oxygenation, and intrapulmonary vascular dilatations (IPVD). Read More

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http://dx.doi.org/10.17392/1177-20DOI Listing

Low health literacy is associated with frailty and reduced likelihood of liver transplant listing: a prospective cohort study.

Liver Transpl 2020 Jun 21. Epub 2020 Jun 21.

Division of Gastroenterology and Hepatology, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA.

The effect of low health literacy (HL) on outcomes in end-stage liver disease (ESLD) is largely unknown. The association of low HL on clinical outcomes was investigated in a prospective cohort of outpatients with ESLD undergoing liver transplant (LT) evaluation. From 2014-2017, 276 patients underwent LT evaluation with assessments of liver disease severity, medical and psychosocial comorbidities, physical frailty, and malnutrition. Read More

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http://dx.doi.org/10.1002/lt.25830DOI Listing

Combination of monoammonium glycyrrhizinate and cysteine hydrochloride ameliorated lipopolysaccharide/galactosamine-induced acute liver injury through Nrf2/ARE pathway.

Eur J Pharmacol 2020 Jun 13;882:173258. Epub 2020 Jun 13.

Beijing Aohe Pharmaceutical Research Institute Co., Ltd., Beijing, 101113, China. Electronic address:

Combination of monoammonium glycyrrhizinate and cysteine hydrochloride (MG-CH) has been used for treatment of chronic liver damage in clinic for several years, however, the effect of MG-CH on acute liver injury (ALI) is still obscure. In this study, we aimed to investigate the effect of MG-CH on ALI induced by co-injection of lipopolysaccharide (LPS) and d-galactosamine (GalN). Our results found that MG-CH produced the optimal therapeutic effect at the ratio of 2:1, as manifested by the increased survival percentage, decreased ALT and AST level and improved hepatic pathology. Read More

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http://dx.doi.org/10.1016/j.ejphar.2020.173258DOI Listing

Ammonia-Induced Glial-Inflammaging.

Mol Neurobiol 2020 Jun 15. Epub 2020 Jun 15.

Programa de Pós-Graduação em Ciências Biológicas: Bioquímica, Instituto de Ciências Básicas da Saúde, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos, 2600 - Anexo, Bairro Santa Cecília, Porto Alegre, RS, 90035-003, Brazil.

Astrocytes are functionally diverse glial cells that maintain blood-brain barrier (BBB) integrity, provide metabolic and trophic support, and react to pathogens or harmful stimuli through inflammatory response. Impairment of astrocyte functions has been implicated in hepatic encephalopathy (HE), a neurological complication associated with hyperammonemia. Although hyperammonemia is more common in adults, ammonia gliotoxicity has been mainly studied in cultured astrocytes derived from neonate animals. Read More

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http://dx.doi.org/10.1007/s12035-020-01985-4DOI Listing

Efficacy of albumin-bilirubin score to predict hepatic encephalopathy in patients underwent transjugular intrahepatic portosystemic shunt.

Eur J Gastroenterol Hepatol 2020 Jun 11. Epub 2020 Jun 11.

Department of Gastroenterology and Hepatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China.

Background And Aims: The occurrence of hepatic encephalopathy is one of the main factors limiting the development and application of transjugular intrahepatic portosystemic shunt (TIPS). Our study aimed to verify the efficacy of the albumin-bilirubin score, an objective and simple scoring system, to predict post-TIPS hepatic encephalopathy.

Methods: From February 2014 to July 2019, a total of 224 patients who underwent TIPS procedure were entered into the study. Read More

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http://dx.doi.org/10.1097/MEG.0000000000001801DOI Listing

Weekend admissions with ascites are associated with delayed paracentesis: A nationwide analysis of the 'weekend effect'.

Ann Hepatol 2020 Jun 4. Epub 2020 Jun 4.

Department of Gastroenterology, UMMS-Baystate Medical Center, Springfield, MA, USA.

Introduction And Objectives: Weekend admissions has previously been associated with worse outcomes in conditions requiring specialists. Our study aimed to determine in-hospital outcomes in patients with ascites admitted over the weekends versus weekdays. Time to paracentesis from admission was studied as current guidelines recommend paracentesis within 24h for all patients admitted with worsening ascites or signs and symptoms of sepsis/hepatic encephalopathy (HE). Read More

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http://dx.doi.org/10.1016/j.aohep.2020.05.005DOI Listing

Calprotectin as Diagnostic Marker for Hepatic Encephalopathy and Spontaneous Bacterial Peritonitis in Cirrhosis.

Clin Lab 2020 Jun;66(6)

Background: Calprotectin is a well-established marker for intestinal inflammation, mainly in inflammatory bowel disease, and represents one of the most studied biomarkers in stool samples.

Methods: Apart from its important diagnostic role in inflammatory bowel disease, there are few studies showing that calprotectin can also be used as a diagnostic tool in patients suffering from hepatic encephalopathy (HE) and spontaneous bacterial peritonitis (SBP) in cirrhosis.

Results: Since calprotectin concentration in the human stool or in ascites is elevated at an early stage of inflammation, it might serve as an early screening tool for patients suffering from cirrhosis who are at risk to develop these conditions. Read More

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http://dx.doi.org/10.7754/Clin.Lab.2019.190934DOI Listing

Molecular hydrogen improves type 2 diabetes through inhibiting oxidative stress.

Exp Ther Med 2020 Jul 30;20(1):359-366. Epub 2020 Apr 30.

Department of Endocrinology, Weifang People's Hospital, Weifang, Shandong 261041, P.R. China.

The aim of the present study was to investigate the potential therapeutic effects of molecular hydrogen on type 2 diabetes mellitus (T2DM) in rats. Following maintenance on a high-fat diet for 4 weeks, a T2DM model was established using an injection of 30 mg/kg streptozotocin via the caudal vein into Sprague-Dawley rats. On day 0 and Day 80, the blood samples were obtained from each rat for the measurement of biochemical indicators including blood lipids, fasting blood glucose, hepatic glycogen, fasting serum insulin, insulin sensitivity index, insulin resistance index, serum superoxide dismutase (SOD) and serum malondialdehyde (MDA) using an automatic biochemical analyzer. Read More

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http://dx.doi.org/10.3892/etm.2020.8708DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7291681PMC

[Comparison of clinical features between patients with acute-on-chronic liver failure and decompensated liver cirrhosis combined with acute kidney injury].

Zhonghua Gan Zang Bing Za Zhi 2020 May;28(5):391-396

Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing You'an Hospital Affiliated to Capital Medical University, Beijing 100069, China; Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing 100069, China.

To compare the clinical features between patients with acute-on-chronic liver failure (ACLF) and decompensated liver cirrhosis (DC) combined with acute kidney injury (AKI). Demographic data, clinical examination results, diagnosis and treatment information of ACLF and DC patients were collected retrospectively. Clinical characteristics of ACLF combined with AKI and DC combined with AKI and their impact on the 90-day mortality risk were compared. Read More

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http://dx.doi.org/10.3760/cma.j.cn501113-20200417-00192DOI Listing

Bodybuilding supplements leading to copper toxicity, encephalopathy, fulminant hepatic failure and rhabdomyolysis.

Am J Emerg Med 2020 Jun 2. Epub 2020 Jun 2.

Department of Emergency Medicine, United States of America; Division of Toxicology, University of California Davis Medical Center, Sacramento, CA, United States of America.

Millions of people worldwide use nutritional and dietary supplements, such as vitamins and minerals. These and other performance-enhancing substances are also used by high school, college, and professional athletes, bodybuilders, and amateur sports enthusiasts. The constituents of these supplements and their metabolites may be harmful and not listed on the product label. Read More

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http://dx.doi.org/10.1016/j.ajem.2020.05.096DOI Listing

A nomogram to predict the risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt in Cirrhotic Patients.

Sci Rep 2020 Jun 10;10(1):9381. Epub 2020 Jun 10.

Department of Gastroenterology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, Jiangsu, China.

Background And Aim: Hepatic encephalopathy (HE) is a serious complication of decompensated liver cirrhosis, affecting the prognosis of patients underwent transjugular intrahepatic portosystemic shunts (TIPS). We aim to create a nomogram to predict hepatic encephalopathy- free survivals (HEFS) after TIPS in cirrhotic patients and select appropriate candidates for TIPS.

Methods: Cirrhotic patients underwent TIPS from 2015 to 2018 in our department were included. Read More

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http://dx.doi.org/10.1038/s41598-020-65227-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7287049PMC
June 2020
5.078 Impact Factor

Pediatric Wilson Disease Presenting as Acute Liver Failure: An Individual Patient Data Meta-Analysis.

J Pediatr Gastroenterol Nutr 2020 Jun 9. Epub 2020 Jun 9.

Division of Gastroenterology, Hepatology, and Nutrition, Hospital for Sick Children, University of Toronto, Toronto Canada.

Objectives: Wilson disease (WD) presenting as acute liver failure (ALF) is rare and typically fatal without liver transplantation (LT). Its rarity has hindered comprehensive studies. We undertook an individual patient data (IPD) meta-analysis to characterize a cohort of pediatric patients presenting with ALF whose final diagnosis was WD to examine outcomes and identify predictors of poor outcomes. Read More

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http://dx.doi.org/10.1097/MPG.0000000000002777DOI Listing

Transjugular intrahepatic portosystemic shunt and splenectomy are more effective than endoscopic therapy for recurrent variceal bleeding in patients with idiopathic noncirrhotic portal hypertension.

World J Clin Cases 2020 May;8(10):1871-1877

Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China.

Background: Transjugular intrahepatic portosystemic shunt (TIPS), splenectomy plus esophagogastric devascularization (SED) and endoscopic therapy + non-selective β-blockers (ET + NSBB) are widely applied in secondary prevention of recurrent gastroesophageal variceal bleeding in patients with liver cirrhosis. These different treatments, however, have not been compared in patients with idiopathic non-cirrhotic portal hypertension (INCPH).

Aim: To compare the outcomes of TIPS, SED and ET + NSBB in the control of variceal rebleeding in patients with INCPH. Read More

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http://dx.doi.org/10.12998/wjcc.v8.i10.1871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7262696PMC

Spastic paraparesis associated with advanced liver cirrhosis: a condition obscure in terms of treatment and prognosis.

BMJ Case Rep 2020 Jun 7;13(6). Epub 2020 Jun 7.

General Medicine, Government Medical College and Hospital, Chandigarh, India.

Hepatic myelopathy or spastic paraparesis of liver disease is an insidious onset condition with pure motor spastic paraparesis without sensory, bladder or bowel involvement in patients with chronic liver disease, in which the neurological dysfunction cannot be explained by other causes. It is a rare, relentlessly progressive and mostly irreversible neurological complication resulting from portosystemic shunts occurring spontaneously, created surgically or due to 'functional shunting'. In some cases, no evidence of shunting is elicitable due to difficulty in locating the hidden collaterals. Read More

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http://dx.doi.org/10.1136/bcr-2020-235090DOI Listing

A Rare Cause of Acute Liver Failure: Diffuse Liver Metastization of Merkel Cell Carcinoma.

GE Port J Gastroenterol 2020 Apr 9;27(3):203-206. Epub 2019 Oct 9.

Gastroenterology Department, Centro Hospitalar de São João, Porto, Portugal.

The authors describe a case of a 76-year-old male with a medical history of Merkel cell carcinoma (MCC) of the right lower eyelid. He was admitted to the emergency department due to abdominal pain in the right hypochondrium, nauseas, asthenia, and choluria with 3 days of evolution. Biochemical liver workup revealed a cytocholestase pattern as well as a prolonged prothrombin time. Read More

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http://dx.doi.org/10.1159/000503150DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7250333PMC

Acute Liver Injury and Decompensated Cirrhosis.

Med Clin North Am 2020 Jul;104(4):647-662

Division of Liver Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1109, New York, NY 10029, USA.

Hospitalists often care for patients with liver disease, including those with acute liver injury and failure and patients with complications of decompensated cirrhosis. Acute liver failure is a true emergency, requiring intensive care and oftentimes transfer of the patient to a liver transplant center. Patients with decompensated cirrhosis have complications of portal hypertension, including variceal hemorrhage, ascites, spontaneous bacterial peritonitis, and hepatic encephalopathy. Read More

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http://dx.doi.org/10.1016/j.mcna.2020.02.010DOI Listing

Metabolomic signature as a predictor of liver disease events in patients with HIV/HCV co-infection.

J Infect Dis 2020 Jun 5. Epub 2020 Jun 5.

Duke Clinical Research Institute, Durham, NC, United States.

Background: Advanced liver disease due to HCV is a leading cause of HIV-related morbidity and mortality. There remains a need to develop noninvasive predictors of clinical outcomes in persons living with HIV/HCV co-infection.

Methods: We conducted a nested case-control study in 126 patients with HIV/HCV and utilized multiple quantitative metabolomic assays to identify a prognostic profile that predicts ESLD events including ascites, hepatic encephalopathy, hepatocellular carcinoma, esophageal variceal bleed, and spontaneous bacterial peritonitis. Read More

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http://dx.doi.org/10.1093/infdis/jiaa316DOI Listing

Altered faecal microbiota on the expression of Th cells responses in the exacerbation of patients with hepatitis E infection.

J Viral Hepat 2020 Jun 5. Epub 2020 Jun 5.

State Key Laboratory for the Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.

Fulminant hepatitis E may lead to acute liver failure (ALF). Perturbations of intestinal microbiota are related to severe liver disease. To study the correlations between faecal microbiota and the occurrence and exacerbation of hepatitis E virus (HEV) infection, we characterized 24 faecal samples from 12 patients with acute hepatitis E (AHE) and 12 patients with HEV-ALF using high-throughput sequencing. Read More

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http://dx.doi.org/10.1111/jvh.13344DOI Listing
June 2020
3.909 Impact Factor

Extracorporeal renal and liver support in pediatric acute liver failure.

Pediatr Nephrol 2020 Jun 5. Epub 2020 Jun 5.

Pediatric Intensive Care Unit, King's College Hospital, 3rd Floor Cheyne Wing, London, SE5 9RS, UK.

The liver is the only organ which can regenerate and, thus, potentially negate the need for transplantation in acute liver failure (ALF). Cerebral edema and sepsis are leading causes of mortality in ALF. Both water-soluble and protein-bound toxins have been implicated in pathogenesis of various ALF complications. Read More

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http://dx.doi.org/10.1007/s00467-020-04613-4DOI Listing

Management of Multi Organ Dysfunction in Neonatal Encephalopathy.

Front Pediatr 2020 15;8:239. Epub 2020 May 15.

Discipline of Paediatrics, Trinity College, The University of Dublin, Dublin, Ireland.

Neonatal Encephalopathy (NE) describes neonates with disturbed neurological function in the first post-natal days of life. NE is an overall term that does not specify the etiology of the encephalopathy although it often involves hypoxia-ischaemia. In NE, although neurological dysfunction is part of the injury and is most predictive of long-term outcome, these infants may also have multiorgan injury and compromise, which further contribute to neurological impairment and long-term morbidities. Read More

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http://dx.doi.org/10.3389/fped.2020.00239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243796PMC

Hepatic encephalopathy due to a congenital portosystemic shunt: a disease with a changeable presentation.

Rev Esp Enferm Dig 2020 Jun;112(6):508-509

Patología Digestiva, Consorcio Hospital General Universitario de Valencia.

The presence of congenital portosystemic shunts in adult patients is an uncommon entity that can manifests itself with hepatic encephalopathy symptoms. However, its clinical presentation can be very diverse and varied, hence it is essential to bear it in mind to be able to diagnose it. In this manuscript we exemplify this variability by presenting a patient with complex long-standing neurological syndrome of uncertain origin, that was finally diagnosed of portosystemic shunt. Read More

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http://dx.doi.org/10.17235/reed.2020.6665/2019DOI Listing

Cognition-tracking-based strategies for diagnosis and treatment of minimal hepatic encephalopathy.

Metab Brain Dis 2020 Jun 3. Epub 2020 Jun 3.

Difficult & Complicated Liver Diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, 100069, China.

Minimal hepatic encephalopathy (MHE), which shows mild cognitive impairment, is a subtle complication of cirrhosis that has been shown to affect daily functioning and quality of life. However, until 2014, relevant guidelines do not give much attention to the diagnosis and treatment of MHE, resulting in patients being ignored and denied the benefits of treatment. In this review, we summarize recent cognition-based research about (1) alteration of nerve cells, including astrocytes, microglial cells and neurons, in mild cognitive impairment in MHE; (2) comparison of methods in detecting cognitive impairment in MHE; and (3) comparison of methods for therapy of cognitive impairment in MHE. Read More

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http://dx.doi.org/10.1007/s11011-020-00539-wDOI Listing

Liver Cirrhosis Complications Management At The Emergency Department.

Rev Recent Clin Trials 2020 Jun 3. Epub 2020 Jun 3.

Department of Health Sciences, University "Magna Græcia", Catanzaro. Italy.

Background And Aims: liver cirrhosis (LC) of any origin has always been a source of several emergencies for physicians working at the Emergency Department (ER). LC patients can present with several complications that are sometimes difficult to recognize and treat. Thus, we reviewed the literature evidences for the diagnosis and management of several LC related emergencies. Read More

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http://dx.doi.org/10.2174/1574887115666200603160816DOI Listing

The autophagic marker p62 highlights Alzheimer type II astrocytes in metabolic/hepatic encephalopathy.

Neuropathology 2020 Jun 2. Epub 2020 Jun 2.

Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria.

Metabolic/hepatic encephalopathy is neuropathologically characterized by the presence of Alzheimer type II astrocytes (AA II) with large and clear nuclear morphology. To date, there is no good immunohistochemical marker to better identify these cells. Here, we assessed cases of hepatic encephalopathy of different etiologies by immunohistochemistry using an anti-p62 antibody. Read More

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http://dx.doi.org/10.1111/neup.12660DOI Listing

Perspective of placenta derived mesenchymal stem cells in acute liver failure.

Cell Biosci 2020 24;10:71. Epub 2020 May 24.

1Department of Tissue Engineering and Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Acute Liver failure (ALF) is a life-threatening disease and is determined by coagulopathy (with INR ≥ 1.5) and hepatic encephalopathy as a result of severe liver injury in patients without preexisting liver disease. Since there are problems with liver transplantation including lack of donors, use of immunosuppressive drugs, and high costs of this process, new therapeutic approaches alongside current treatments are needed. Read More

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http://dx.doi.org/10.1186/s13578-020-00433-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7245988PMC

Fibroblast Growth Factor-21 ameliorates hepatic encephalopathy by activating the STAT3-SOCS3 pathway to inhibit activated hepatic stellate cells.

EXCLI J 2020 4;19:567-581. Epub 2020 May 4.

Bio-pharmaceutical Laboratory, College of Life Sciences, Northeast Agricultural University, Harbin 150030, China.

Neurological dysfunction, one of the consequences of acute liver failure (ALF), and also referred to as hepatic encephalopathy (HE), contributes to mortality posing challenges for clinical management. FGF21 has been implicated in the inhibition of cognitive decline and fibrogenesis. However, the effects of FGF21 on the clinical and molecular presentations of HE has not been elucidated. Read More

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http://dx.doi.org/10.17179/excli2020-1287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7257252PMC
May 2020
0.857 Impact Factor

A Physiology-Based Pharmacokinetic Framework to Support Drug Development and Dose Precision During Therapeutic Hypothermia in Neonates.

Front Pharmacol 2020 13;11:587. Epub 2020 May 13.

Department of Development and Regeneration, KU Leuven, Leuven, Belgium.

Therapeutic hypothermia (TH) is standard treatment for neonates (≥36 weeks) with perinatal asphyxia (PA) and hypoxic-ischemic encephalopathy. TH reduces mortality and neurodevelopmental disability due to reduced metabolic rate and decreased neuronal apoptosis. Since both hypothermia and PA influence physiology, they are expected to alter pharmacokinetics (PK). Read More

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http://dx.doi.org/10.3389/fphar.2020.00587DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7237643PMC

Prognostic significance of hepatic encephalopathy in patients with cirrhosis treated with current standards of care.

World J Gastroenterol 2020 May;26(18):2221-2231

Department of Gastroenterology, Monash Health, Clayton 3168, Victoria, Australia.

Background: Hepatic encephalopathy (HE) is a reversible neuropsychiatric complication of liver cirrhosis and occurs in up to 50% of cirrhotic patients. Studies examining the prognostic significance of HE are limited despite the high prevalence in cirrhosis.

Aim: To define the clinical outcomes of patients after an episode of HE treated with current standards-of-care. Read More

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http://dx.doi.org/10.3748/wjg.v26.i18.2221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7235207PMC

Astrocyte lesions in cerebral cortex and cerebellum of dogs with congenital ortosystemic shunting.

J Vet Sci 2020 May;21(3):e44

Royal (Dick) School of Veterinary Studies and The Roslin Institute, The University of Edinburgh, Edinburgh, EH25 9RG, United Kingdom.

Background: Congenital portosystemic shunt (cPSS) is one of the most common congenital disorders diagnosed in dogs. Hepatic encephalopathy (HE) is a frequent complication in dogs with a cPSS and is a major cause of morbidity and mortality. Despite HE been a major cause of morbidity in dogs with a cPSS, little is known about the cellular changes that occur in the central nervous system of dogs with a cPSS. Read More

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http://dx.doi.org/10.4142/jvs.2020.21.e44DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7263922PMC