15,241 results match your criteria Portal-Systemic Encephalopathy


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

Plasma perfusion combined with plasma exchange in chronic hepatitis B-related acute-on-chronic liver failure patients.

Hepatol Int 2020 May 29. Epub 2020 May 29.

Department and Institute of Infectious Disease, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095, Jiefang Avenue, Wuhan, 430030, Hubei Province, China.

Background And Aims: Artificial liver support systems (ALSS) have been shown to significantly reduce mortality in patients with acute-on-chronic liver failure (ACLF). However, the characteristics of patients who would benefit most from ALSS treatment are poorly understood. This study aimed to delineate the indicators for ALSS and evaluate the effectiveness of plasma perfusion combined with plasma exchange (PP + PE) in patients with hepatitis B virus-related ACLF (HBV-ACLF). Read More

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http://dx.doi.org/10.1007/s12072-020-10053-xDOI Listing
May 2020
2.468 Impact Factor

Cost-Effectiveness of Rifaximin Treatment in Patients with Hepatic Encephalopathy.

J Manag Care Spec Pharm 2020 Jun;26(6):750-757

Xcenda, Palm Harbor, Florida.

Background: Hepatic encephalopathy (HE) is a complication of cirrhosis of the liver causing neuropsychiatric abnormalities. Clinical manifestations of overt HE result in increased health care resource utilization and effects on patient quality of life. While lactulose has historically been the mainstay of treatment for acute HE and maintenance of remission, there is an unmet need for additional therapeutic options with a favorable adverse event profile. Read More

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http://dx.doi.org/10.18553/jmcp.2020.26.6.750DOI Listing

High-mobility group protein B1: a predictive biomarker for hepatic encephalopathy after transjugular intrahepatic portosystemic shunt.

J Hepatobiliary Pancreat Sci 2020 May 28. Epub 2020 May 28.

Department of Interventional Therapy, Peking University Ninth School of Clinical Medicine, Beijing Shijitan Hospital, No.10 Tieyi Road, Yangfangdian street, Haidian District, Beijing, 100038, China.

Purpose: To investigate whether portal level of High-mobility group protein B1 (HMGB1) is associated with hepatic encephalopathy (HE) after transjugular intrahepatic portosystemic shunt (TIPS).

Methods: We enrolled 127 consecutive patients who underwent TIPS and collected portal and peripheral blood samples in our department from December 2017 to May 2019. HMGB1 levels were determined using enzyme-linked immunosorbent assay kits. Read More

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http://dx.doi.org/10.1002/jhbp.770DOI Listing

Hemodynamic Instability in Hypoxic Ischemic Encephalopathy: More Than Just Brain Injury-Understanding Physiology, Assessment, and Management.

Neonatal Netw 2020 May;39(3):129-136

Hypoxic-ischemic encephalopathy (HIE) can have both transient and long-lasting effects on the neonate, including neurologic, renal, cardiac, hepatic, and hematologic. Both the disease process and the treatment option of therapeutic hypothermia can result in hemodynamic instability. Understanding the effects of HIE on the neonatal myocardium, pulmonary vascular bed, and the cardiac dysfunction that can occur is key to managing infants with HIE. Read More

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http://dx.doi.org/10.1891/0730-0832.39.3.129DOI Listing

Clinical Usefulness of the Inhibitory Control Test (ICT) in the Diagnosis of Minimal Hepatic Encephalopathy.

Int J Environ Res Public Health 2020 May 22;17(10). Epub 2020 May 22.

Department of Infectious Diseases and Hepatology, Medical University of Bialystok, 15-540 Bialystok, Poland.

: Minimal hepatic encephalopathy (MHE) refers to a number of neuropsychiatric and neurophysiological disorders in patients with cirrhosis who do not show abnormalities on physical examination or in clinical tests. The aim of this study was to determine the prevalence, risk factors, and predictive value of minimal hepatic encephalopathy and the usefulness of the inhibitory control test (ICT) in the diagnosis. : Seventy patients (mean age 53 years, range 24-77) with liver cirrhosis were enrolled in the study. Read More

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http://dx.doi.org/10.3390/ijerph17103645DOI Listing

Randomised clinical trial: Standard of care versus early-transjugular intrahepatic porto-systemic shunt (TIPSS) in patients with cirrhosis and oesophageal variceal bleeding.

Aliment Pharmacol Ther 2020 May 26. Epub 2020 May 26.

Liver Unit, Royal Infirmary of Edinburgh and University of Edinburgh, Edinburgh, UK.

Background: Early-transjugular intrahepatic porto-systemic shunt (TIPSS) has been recommended in international guidelines for high-risk patients with oesophageal variceal bleeding.

Aims: To validate the results of a previous randomised control trial which supports use of early-TIPSS.

Methods: In a two-centre open-label parallel-group randomised control trial, patients with cirrhosis and acute variceal bleeding were recruited following haemostasis with vaso-active drugs and endoscopic band ligation. Read More

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http://dx.doi.org/10.1111/apt.15797DOI Listing

Cognitive and neurophysiological assessment of patients with minimal hepatic encephalopathy in Brazil.

Sci Rep 2020 May 25;10(1):8610. Epub 2020 May 25.

Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, RJ, Brazil.

Minimal hepatic encephalopathy is a syndrome caused by cirrhosis, with a broad spectrum of clinical manifestations. Its diagnosis is based on abnormal results of cognitive and neurophysiological tests, but there are no universally available criteria, especially in Brazil, where local testing standards are required. The objective of the present study was to compare the performance of the mini-mental state examination (MMSE), Rey's auditory-verbal learning test (RAVLT), psychometric score of hepatic encephalopathy (PHES), topographic mapping of brain electrical activity (TMBEA) and long-latency auditory evoked potential (P300) in the detection of minimal hepatic encephalopathy in Brazil. Read More

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http://dx.doi.org/10.1038/s41598-020-65307-3DOI Listing

Adult-onset portosystemic encephalopathy caused by patent ductus venosus successfully treated with endovascular coil embolization: a rare case report.

CVIR Endovasc 2020 May 25;3(1):28. Epub 2020 May 25.

Department of Cardiovascular Intervention Radiology Center, Taijukai General Hospital Kaisei Hospital, 3-5-28 Muromachi, Sakaide-City, Kagawa, 762-0007, Japan.

Background: Patent ductus venosus (PDV) is a congenital shunt between the portal vein (PV) and inferior vena cava (IVC). However, there are few reports on symptomatic adult-onset PDV, and the appropriate management of this condition remains unknown. In particular, there are few reports on the use of endovascular therapy for the treatment of patients with symptomatic adult-onset PDV. Read More

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http://dx.doi.org/10.1186/s42155-020-00118-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7246263PMC

Ventricular Fibrillation Caused by Primary Carnitine Deficiency.

J Emerg Med 2020 May 21. Epub 2020 May 21.

Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.

Background: Primary carnitine deficiency (PCD) is a rare but potentially life-threatening genetic disorder if left untreated. Although some patients remain asymptomatic lifelong, a few patients present with hepatic encephalopathy, hypoglycemia, cardiomyopathy, dysrhythmia, and even sudden death.

Case Report: A 25-year-old woman with PCD collapsed suddenly while eating lunch. Read More

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http://dx.doi.org/10.1016/j.jemermed.2020.04.024DOI Listing

Successful Surgical Intervention for Recurring Severe Hepatic Encephalopathy Caused by Portosystemic Collaterals After Living-Donor Liver Transplantation: A Case Report.

Transplant Proc 2020 May 21. Epub 2020 May 21.

Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

Introduction: Portosystemic collaterals (PsC) are a common finding in patients with cirrhosis who need liver transplantation (LT), and PsCs may cause several problems before and after LT. We report a case of successful surgical treatment of severe hepatic encephalopathy (HE) caused by PsC after living-donor LT (LDLT).

Case: A 71-year-old woman with hepatocellular carcinoma underwent LDLT for chronic hepatitis C virus infection at 64 years of age. Read More

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http://dx.doi.org/10.1016/j.transproceed.2020.01.156DOI Listing

Predictors of Occurrence and Risk of Hepatic Encephalopathy After TIPS Creation: A 15-Year Experience.

Cardiovasc Intervent Radiol 2020 May 20. Epub 2020 May 20.

Cleveland Clinic, Cleveland, OH, USA.

Purpose: To identify clinical variables, including use of newer Viatorr TIPS endoprosthesis with controlled expansion (VCX) that may affect the occurrence and risk of hepatic encephalopathy after transjugular intrahepatic portosystemic shunt (TIPS) creation.

Methods: A total of 376 patients who underwent TIPS creation at our institution between 2003 and 2018 were retrospectively identified. Of these patients, 71 received a Viatorr controlled expansion endoprosthesis and 305 received a Viatorr TIPS endoprosthesis (older version without controlled expansion). Read More

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http://dx.doi.org/10.1007/s00270-020-02512-7DOI Listing

Cognitive Function in Liver Transplantation.

Curr Transplant Rep 2020 26;7(2):31-37. Epub 2020 Mar 26.

2Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, Virginia Commonwealth University and McGuire VA Medical Center, 1201 Broad Rock Boulevard, Richmond, VA USA.

Purpose Of Review: Liver transplantation (LT) remains the only way to cure patients with severe liver diseases. Important questions about neurological sequelae and quality of life after LT have emerged. In this review, we discuss the neurocognitive changes associated with LT and we conclude with recommendations in this regard for patients, caregivers, and physicians. Read More

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http://dx.doi.org/10.1007/s40472-020-00274-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223312PMC

Reversible Fulminant Hepatitis Secondary to Cocaine in the Setting of β-Blocker Use.

J Investig Med High Impact Case Rep 2020 Jan-Dec;8:2324709620924203

University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.

. Fulminant hepatitis is acute hepatic injury with severe decline in hepatic function manifested by encephalopathy, hypercoagulable state, jaundice, renal failure, hypoglycemia, or a constellation of these symptoms in patients without preexisting liver disease. Etiologies include viral infections, hepatotoxic drugs, autoimmune diseases, vaso-occlusive diseases, sepsis, and malignant infiltration. Read More

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http://dx.doi.org/10.1177/2324709620924203DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7243380PMC

Propofol alone prevents worsening hepatic encephalopathy rather than midazolam alone or combined sedation after esophagogastroduodenoscopy in compensated or decompensated cirrhotic patients.

Eur J Gastroenterol Hepatol 2020 Jun 1. Epub 2020 Jun 1.

Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.

Background: This study was conducted to determine which type and dose of sedative drugs should be given to cirrhotic patients with compensation or decompensation during esophagogastroduodenoscopy (EGD) to prevent hepatic encephalopathy (HE) after sedation.

Methods: We reviewed the medical records of cirrhotic patients consecutively admitted to the hospital and conducted a number connection test (NCT) before and 2 h after EGD with moderate sedation. Sedation was performed using either propofol alone, midazolam alone, or combined propofol + midazolam. Read More

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http://dx.doi.org/10.1097/MEG.0000000000001755DOI Listing

Effects of Branched-Chain Amino Acid (BCAA) Supplementation on the Progression of Advanced Liver Disease: A Korean Nationwide, Multicenter, Prospective, Observational, Cohort Study.

Nutrients 2020 May 15;12(5). Epub 2020 May 15.

Medical Research Collabration Center in KNUH and School of Medicine, Kyungpook National University, Daegu 41944, Korea.

Background And Aims: Clinical evidence for the benefits of branched-chain amino acids (BCAAs) is lacking in advanced liver disease. We evaluated the potential benefits of long-term oral BCAA supplementation in patients with advanced liver disease.

Methods: Liver cirrhosis patients with Child-Pugh (CP) scores from 8 to 10 were prospectively recruited from 13 medical centers. Read More

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http://dx.doi.org/10.3390/nu12051429DOI Listing

L-Aspartate, L-Ornithine and L-Ornithine-L-Aspartate (LOLA) and Their Impact on Brain Energy Metabolism.

Neurochem Res 2020 Jun 18;45(6):1438-1450. Epub 2020 May 18.

Neuroscience Research Australia, Barker St, Randwick, NSW, 2031, Australia.

L-Ornithine-L-aspartate (LOLA), a crystalline salt, is used primarily in the management of hepatic encephalopathy. The degree to which it might penetrate the brain, and the effects it might have on metabolism in brain are poorly understood. Here, to investigate the effects of LOLA on brain energy metabolism we incubated brain cortical tissue slices from guinea pig (Cavea porcellus) with the constituent amino acids of LOLA, L-ornithine or L-aspartate, as well as LOLA, in the presence of [1-C]D-glucose and [1,2-C]acetate; these labelled substrates are useful indicators of brain metabolic activity. Read More

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http://dx.doi.org/10.1007/s11064-020-03044-9DOI Listing

Inducing Acute Liver Injury in Rats via Carbon Tetrachloride (CCl4) Exposure Through an Orogastric Tube.

J Vis Exp 2020 Apr 28(158). Epub 2020 Apr 28.

Department of Anesthesiology and Critical Care, Soroka Medical Center, Ben-Gurion University of the Negev;

Acute liver injury (ALI) plays a crucial role in the development of hepatic failure, which is characterized by severe liver dysfunction including complications such as hepatic encephalopathy and impaired protein synthesis. Appropriate animal models are vital to test the mechanism and pathophysiology of ALI and investigate different hepatoprotective strategies. Due to its ability to perform chemical transformations, carbon tetrachloride (CCl4) is widely used in the liver to induce ALI through the formation of reactive oxygen species. Read More

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http://dx.doi.org/10.3791/60695DOI Listing

A Latin American survey on demographic aspects of hospitalized, decompensated cirrhotic patients and the resources for their management.

Ann Hepatol 2020 Apr 23. Epub 2020 Apr 23.

Gastroenterology Department, Hospital de la Samaritana, Bogotá, Colombia.

Introduction & Objectives: Liver cirrhosis is a major cause of mortality worldwide. Adequate diagnosis and treatment of decompensating events requires of both medical skills and updated technical resources. The objectives of this study were to search the demographic profile of hospitalized cirrhotic patients in a group of Latin American hospitals and the availability of expertise/facilities for the diagnosis and therapy of decompensation episodes. Read More

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http://dx.doi.org/10.1016/j.aohep.2020.03.007DOI Listing

Minimal hepatic encephalopathy and sleep disorders in patients with cirrhosis: Which comes first?

Saudi J Gastroenterol 2020 May-Jun;26(3):111-112

Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome, Italy.

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http://dx.doi.org/10.4103/sjg.SJG_169_20DOI Listing

Prognostic value of the albumin-bilirubin grade in patients with hepatocellular carcinoma and other liver diseases.

Ann Transl Med 2020 Apr;8(8):553

Department of Gastroenterology, Tangdu Hospital, Fourth Military Medical University, Xi'an 710038, China.

One of the most commonly used systems for grading liver function in hepatocellular carcinoma (HCC) patients is the Child-Pugh (CP) score. However, the CP scoring system is not without its shortcomings: for example, the cut-off values for the parameters are calculated arbitrarily and the assessment of ascites and hepatic encephalopathy is subjective. More recently, an alternative to traditional CP grade has emerged in the form of albumin-bilirubin (ALBI) grade. Read More

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http://dx.doi.org/10.21037/atm.2020.02.116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7214886PMC

The Pull-Through Technique for Recanalization of Transjugular Intrahepatic Portosystemic Shunt Dysfunction.

Gastroenterol Res Pract 2020 27;2020:9150173. Epub 2020 Apr 27.

Division of Vascular and Interventional Radiology, Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515 Guangdong, China.

Purpose: To evaluate the technical efficacy and safety of the pull-through technique in recanalization of transjugular intrahepatic portosystemic shunt (TIPS) when standard transjugular approach is inaccessible.

Materials And Methods: A retrospective review of patients underwent TIPS revision via the pull-through technique was performed. Transhepatic directly punctured stent was conducted if the portal vein could not be accessed via standard transjugular approach. Read More

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http://dx.doi.org/10.1155/2020/9150173DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7201481PMC

Acetyl-L-Carnitine in Dementia and Other Cognitive Disorders: A Critical Update.

Nutrients 2020 May 12;12(5). Epub 2020 May 12.

Department of Biomedical and Biotechnological Science, University of Catania, Via Santa Sofia 89, 95123 Catania, Italy.

Several studies explored the effects of acetyl-L-carnitine (ALC) in dementia, suggesting a role in slowing down cognitive decline. Nevertheless, in 2003 a systematic review concluded there was insufficient evidence to recommend a clinical use, although a meta-analysis in the same year showed a significant advantage for ALC for clinical scales and psychometric tests. Since then, other studies have been published; however, a critical review is still lacking. Read More

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http://dx.doi.org/10.3390/nu12051389DOI Listing
May 2020
3.148 Impact Factor

Management options for rectal variceal bleeding in the setting of hepatic encephalopathy.

ANZ J Surg 2020 May 14. Epub 2020 May 14.

Colorectal Surgery Unit, Monash Health, Dandenong Hospital, Melbourne, Victoria, Australia.

Bleeding related to rectal varices associated with portal hypertension is rare but life-threatening, and requires prompt treatment. We reviewed the literature for patients with this complex presentation and current recommendations, and commented on a case at our institution of a 68-year-old man with Child-Pugh B alcoholic liver cirrhosis and hepatic encephalopathy who presented with profuse life-threatening rectal variceal bleeding. Treatment options for rectal varices in patients with hepatic encephalopathy were reviewed and a management algorithm was devised from current knowledge in the literature. Read More

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http://dx.doi.org/10.1111/ans.15982DOI Listing

[A new perspective on acute-on-chronic liver failure based on clinical outcome of dynamic classification criteria].

Zhonghua Gan Zang Bing Za Zhi 2020 Apr;28(4):319-325

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 analyze the clinical characteristics among types of acute-on-chronic liver failure (ACLF) and explore the new classification criteria for judging the prognosis of acute-on-chronic liver failure, so as to provide a basis for the formulation of more precise therapeutic schedule. 388 cases with ACLF diagnosed in two tertiary level hospitals were included. Patients demographic characteristics, clinical examination information, diagnostic and treatment process information were collected. Read More

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http://dx.doi.org/10.3760/cma.j.cn501113-0309-00099DOI Listing

[Progress in Clinical Research of Amide Proton Transfer Imaging].

Zhongguo Yi Liao Qi Xie Za Zhi 2020 Feb;44(2):185-188

Department of Radiology, Children's Hospital Affiliated to Zhejiang University School of Medicine, Hangzhou, 310052.

As a new type of magnetic resonance imaging method, amide proton transfer (APT) imaging can detect the chemical exchange characteristics of free proprotein, peptide amide proton and water proton by water signal changes, reflecting the changes of protein and pH in tissues. In recent years, clinical research on brain tumors, multiple sclerosis, hepatic encephalopathy and cervical cancer have been carried out. It is a radiation-free and non-invasive new magnetic resonance molecular imaging technology. Read More

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http://dx.doi.org/10.3969/j.issn.1671-7104.2020.02.018DOI Listing
February 2020

An Interesting Case of Congenital Intrahepatic Porto-hepatic Shunt as a Cause of Unexplained Encephalopathy.

Cureus 2020 Apr 11;12(4):e7639. Epub 2020 Apr 11.

Internal Medicine, St. Vincent's Medical Center, Bridgeport, USA.

Congenital portosystemic shunts can be divided into two types: intrahepatic shunts in which there is an abnormal connection between the branches of the portal vein and either the inferior vena cava or the hepatic veins and less commonly the extrahepatic type in which the portal system is connected to one of the branches of the mesenteric veins. Here we describe a 73-year-old woman who was admitted to the hospital with clinical evidence of encephalopathy and was found to have hyperammonemia. Abdominal computed tomography angiography was performed and revealed a dilated portal vein measuring up to 1. Read More

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http://dx.doi.org/10.7759/cureus.7639DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216313PMC

Recent advances in understanding and managing hepatic encephalopathy in chronic liver disease.

F1000Res 2020 29;9. Epub 2020 Apr 29.

Institute for Liver and Digestive Health, University College London, Royal Free Campus, Rowland Hill Street, London, NW3 2PF, UK.

Hepatic encephalopathy (HE) is a common, severe complication of advanced chronic liver disease (CLD) and has a devastating impact on the patient's quality of life and prognosis. The neurotoxin ammonia and the presence of systemic and neurological inflammation are considered the key drivers of this neuropsychiatric syndrome. Treatment options available in routine clinical practice are limited, and the development of novel therapies is hampered owing to the complexity and heterogeneity of HE. Read More

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http://dx.doi.org/10.12688/f1000research.22183.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7194462PMC

Transjugular intrahepatic portosystemic shunt versus endoscopic therapy for prevention of variceal rebleeding in patients with hepatocellular carcinoma meeting the Milan criteria.

Eur J Gastroenterol Hepatol 2020 May 8. Epub 2020 May 8.

Objective: Transjugular intrahepatic portosystemic shunt (TIPS) and endoscopic therapy (ET) have been recommended to prevent variceal rebleeding due to cirrhotic portal hypertension. However, which one is better for patients with hepatocellular carcinoma (HCC) remains controversial. Hence, we aimed to compare the clinical outcomes of these two treatments for these subpopulation. Read More

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http://dx.doi.org/10.1097/MEG.0000000000001750DOI Listing

Type 2 Diabetes and Metformin Use Associate With Outcomes of Patients With Non-alcoholic Steatohepatitis-related, Child-Pugh A Cirrhosis.

Clin Gastroenterol Hepatol 2020 May 7. Epub 2020 May 7.

Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, Australia; Department of Hepatology, Sir Charles Gairdner Hospital, Nedlands Australia.

Background & Aims: Factors that affect outcomes of patients with non-alcoholic steatohepatitis (NASH) related cirrhosis are unclear. We studied associations of type 2 diabetes, levels of hemoglobin A1c (HbA1c), and use antidiabetic medications with survival and liver-related events in patients with NASH and compensated cirrhosis.

Methods: We collected data from 299 patients with biopsy-proven NASH with Child-Pugh A cirrhosis from tertiary hospitals in Spain, Australia, Hong Kong, and Cuba, from April 1995 through December 2016. Read More

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http://dx.doi.org/10.1016/j.cgh.2020.04.083DOI Listing

Insurance Status but Not Race/Ethnicity are Associated with Outcomes in a Large Hospitalized Cohort of Patients with Cirrhosis.

Clin Gastroenterol Hepatol 2020 May 7. Epub 2020 May 7.

University of Pennsylvania, USA.

Background & Aims: Insurance, race, and ethnicity can affect outcomes of patients with cirrhosis, but findings from prospective studies are unclear. We investigated the role of insurance status and race and ethnicity (race/ethnicity) on inpatient and 90-day post-discharge outcomes in a large inpatient cohort of patients with cirrhosis.

Methods: We used data from the North American Consortium for the Study of End-Stage Liver Disease (NACSELD) database, from 13 tertiary-care centers. Read More

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http://dx.doi.org/10.1016/j.cgh.2020.04.081DOI Listing
May 2020
7.896 Impact Factor

Real-world effectiveness and safety of tolvaptan in liver cirrhosis patients with hepatic edema: results from a post-marketing surveillance study (START study).

J Gastroenterol 2020 May 9. Epub 2020 May 9.

Department of Pharmacovigilance, Otsuka Pharmaceutical Co., Ltd., Tokyo, Japan.

Background: This large-scale post-marketing surveillance study (START study) evaluated the effectiveness and safety of tolvaptan in Japanese liver cirrhosis patients with hepatic edema in real-world clinical settings. Here, we present the final analysis outcomes.

Methods: A prospective, multicenter, non-interventional study involving patients who received tolvaptan for the treatment of liver cirrhosis with hepatic edema with an insufficient response to conventional diuretics. Read More

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http://dx.doi.org/10.1007/s00535-020-01691-xDOI Listing

Causes and Rates of 30-Day Readmissions After Transjugular Intrahepatic Portosystemic Shunts.

AJR Am J Roentgenol 2020 May 6:1-7. Epub 2020 May 6.

Department of Radiology, Division of Vascular and Interventional Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, 1 Deaconess Rd, WCC 308, Boston, MA 02215.

The purpose of this study was to investigate the causes and rates of 30-day readmission after transjugular intrahepatic portosystemic shunt (TIPS) at a single liver transplant center. We reviewed 165 TIPS procedures performed between 2003 and 2013. After excluding patients who died during the index admission ( = 16), any readmission within 30 days of discharge was identified, and cause of readmission was determined. Read More

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http://dx.doi.org/10.2214/AJR.19.21732DOI Listing

Xiaochaihutang Improves the Cortical Astrocyte Edema in Thioacetamide-Induced Rat Acute Hepatic Encephalopathy by Activating NRF2 Pathway.

Front Pharmacol 2020 16;11:382. Epub 2020 Apr 16.

Key Laboratory of Infectious Disease and Biosafety, and Provincial Department of Education, Zunyi Medical University, Zunyi, China.

Oxidative stress induced by high ammonia, which leads to astrocyte edema, is the key to acute hepatic encephalopathy (AHE). Nuclear factor erythroid 2-related factor 2 (NRF2) has been implicated in oxidative stress, but the mechanism of NRF2 against ammonia-induced astrocytes edema has not been fully studied. We confirmed that the NRF2 pathway is related to brain edema caused by AHE and found that Xiaochaihutang (XCHT) could effectively activate the NRF2 pathway to treat AHE. Read More

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http://dx.doi.org/10.3389/fphar.2020.00382DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7179068PMC

A novel, bedside, etiology specific prognostic model (Peds-HAV) in hepatitis A induced pediatric acute liver failure.

Hepatol Int 2020 May 5. Epub 2020 May 5.

Department of Pediatric Hepatology, Institute of Liver and Biliary Sciences, New Delhi, 110070, India.

Background: Hepatitis A virus (HAV) is the commonest cause of pediatric acute liver failure (PALF) in developing countries. Our objective was to develop and validate a HAV-etiology specific prognostic model in PALF.

Methods: All children with HAV induced PALF (IgM HAV reactive) were included. Read More

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http://dx.doi.org/10.1007/s12072-020-10050-0DOI Listing
May 2020
2.468 Impact Factor

Longitudinal osmotic and neurometabolic changes in young rats with chronic cholestatic liver disease.

Sci Rep 2020 May 5;10(1):7536. Epub 2020 May 5.

Swiss Pediatric Liver Center, University Hospitals Geneva, and Department of Pediatrics, Obstetrics and Gynecology, Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Type C hepatic encephalopathy (type C HE) is increasingly suspected in children with chronic liver disease (CLD), and believed to underlie long-term neurocognitive difficulties. The molecular underpinnings of type C HE in both adults and children are incompletely understood. In the present study we combined the experimental advantages of in vivo high field H magnetic resonance spectroscopy with immunohistochemistry to follow longitudinally over 8 weeks the neurometabolic changes in the hippocampus of animals having undergone bile duct ligation as pups. Read More

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http://dx.doi.org/10.1038/s41598-020-64416-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7200786PMC

Biomarkers in newborns with hypoxic-ischemic encephalopathy treated with therapeutic hypothermia.

Childs Nerv Syst 2020 May 4. Epub 2020 May 4.

Department of Neonatology, Poznan University of Medical Sciences, Poznan, Poland.

Purpose: The aim of the presented study was to evaluate the differences between selected biochemical markers in infants with moderate or severe hypoxic-ischemic encephalopathy (HIE) and their impact on patient prognosis.

Methods: A total of 57 cooled newborns were divided into groups according to Sarnat staging of HIE (A, moderate vs. B, severe). Read More

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http://dx.doi.org/10.1007/s00381-020-04645-zDOI Listing

Outcomes after hepatic encephalopathy in population-based cohorts of patients with cirrhosis.

Aliment Pharmacol Ther 2020 Jun 3;51(12):1397-1405. Epub 2020 May 3.

Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, MI, USA.

Background: Hepatic encephalopathy is a devastating complication of cirrhosis.

Aim: To describe the outcomes after developing hepatic encephalopathy among contemporary, aging patients.

Methods: We examined data for a 20% random sample of United States Medicare enrolees with cirrhosis and Part D prescription coverage from 2008 to 2014. Read More

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http://dx.doi.org/10.1111/apt.15749DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266029PMC

Molecular Mechanism for Protection Against Liver Failure in Human Yellow Fever Infection.

Hepatol Commun 2020 May 16;4(5):657-669. Epub 2020 Mar 16.

Department of Physiology and Biophysics Universidade Federal de Minas Gerais Belo Horizonte Brazil.

Yellow fever (YF) is a viral hemorrhagic fever that typically involves the liver. Brazil recently experienced its largest recorded YF outbreak, and the disease was fatal in more than a third of affected individuals, mostly because of acute liver failure. Affected individuals are generally treated only supportively, but during the recent Brazilian outbreak, selected patients were treated with liver transplant. Read More

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http://dx.doi.org/10.1002/hep4.1504DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7193135PMC

Psychological Burden of Hepatic Encephalopathy on Patients and Caregivers.

Clin Transl Gastroenterol 2020 Apr;11(4):e00159

Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA.

Objectives: Hepatic encephalopathy (HE) is common in advanced cirrhosis and is characterized by marked neuropsychiatric abnormalities. However, despite its severity and effects on brain function, the impact of HE on psychological status of patients has not been adequately assessed. The aim of this study was to evaluate the effect of HE on psychological status of patients and their informal caregivers. Read More

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http://dx.doi.org/10.14309/ctg.0000000000000159DOI Listing

Spontaneous porto-systemic shunts in liver cirrhosis: Clinical and therapeutical aspects.

World J Gastroenterol 2020 Apr 14;26(15):1726-1732. Epub 2020 Apr 14.

Department of Translational and Precision Medicine, "Sapienza" University of Rome, Rome 00185, Italy.

Spontaneous porto-systemic shunts (SPSS) are frequent in liver cirrhosis and their prevalence increases as liver function deteriorates, probably as a consequence of worsening portal hypertension, but without achieving an effective protection against cirrhosis' complications. Several types of SPSS have been described in the literature, each one associated with different clinical manifestations. In particular, recurrent or persistent hepatic encephalopathy is more frequent in patients with splenorenal shunt, while the presence of gastric varices and consequently the incidence of variceal bleeding is more common in gastrorenal shunt. Read More

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http://dx.doi.org/10.3748/wjg.v26.i15.1726DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7183860PMC

Effects of erythropoietin on bile duct ligation-induced neuro-inflammation in male rats.

AIMS Neurosci 2019 29;6(2):43-53. Epub 2019 Apr 29.

Neuroscience Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran.

Hepatic encephalopathy (HE) is a brain disorder as a result of liver failure. Previous studies have indicated that erythropoietin (EPO) has neuroprotective effects in different neurological diseases. This study addressed the therapeutic effect of a four-week treatment with EPO on neuronal damages in bile duct-ligated rats. Read More

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http://dx.doi.org/10.3934/Neuroscience.2019.2.43DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7179341PMC

Systemic Oxidative Stress Markers in Cirrhotic Patients with Hepatic Encephalopathy: Possible Connections with Systemic Ammoniemia.

Medicina (Kaunas) 2020 Apr 23;56(4). Epub 2020 Apr 23.

Romanian Academy, Iasi Branch, Nr. 8, Carol I Avenue, no. 8, 700505 Iasi, Romania.

Oxidative stress shows evidence of dysregulation in cirrhotic patients with hepatic encephalopathy (HE), although there are still controversies regarding the connections between oxidative stress and ammonia in these patients. The aim of this study was to evaluate the oxidative stress implication in overt HE pathogenesis of cirrhotic patients. We performed a prospective case-control study, which included 40 patients divided into two groups: group A consisted of 20 cirrhotic patients with HE and increased systemic ammoniemia, and group B consisted of 20 cirrhotic patients with HE and normal systemic ammoniemia. Read More

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http://dx.doi.org/10.3390/medicina56040196DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231105PMC

Hepatitis E Infection With Acute Liver Failure.

ACG Case Rep J 2020 Mar 18;7(3):e00361. Epub 2020 Mar 18.

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

A 21-year-old man from India presented with acute hepatitis associated with a 1-week history of abdominal pain, pruritus, and dark urine. Over a 7-day admission, the patient's acute hepatitis evolved into acute liver failure with low-grade encephalopathy, markedly elevated transaminases, bilirubin, and impaired hepatic synthetic function. He was eventually diagnosed with acute hepatitis E virus (HEV) and was transitioned to supportive management. Read More

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http://dx.doi.org/10.14309/crj.0000000000000361DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7162134PMC