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Lin YC, Chang PF, Ni YH. Updated upper limits of normal serum alanine aminotrasferase levels for screening metabolic dysfunction-associated fatty liver disease in obese children. J Formos Med Assoc 2022; 121:2548-2555. [PMID: 35738972 DOI: 10.1016/j.jfma.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 05/23/2022] [Accepted: 06/06/2022] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND/PURPOSE Alanine aminotransferase (ALT) is a cost-effective screening test for asymptomatic liver diseases. The aims of this study are to redefine the ULNs of ALT using the 2010-2012 Nutrition and Health Survey in Taiwan (NAHSIT) database and to determine whether the updated ULNs can better screen for metabolic dysfunction-associated fatty liver disease (MAFLD) in obese children. METHODS Reference data were obtained from 2895 NAHSIT participants (1442 boys, 1453 girls) aged 6-18 years. Participants with any of MAFLD-related metabolic risk factors, including overweight/obesity, elevated triglyceride, low high-density lipoprotein cholesterol and high fasting glucose, were excluded. This study compared the sensitivities of different ULNs of ALT for detecting MAFLD in our previously established cohort of obese children. RESULTS The ULNs of ALT defined as the 95th percentile in metabolically healthy NAHSIT participants were 23 IU/L for boys and 18 IU/L for girls. When using the updated ULNs, the percentages of elevated ALT levels were 13.0% in boys and 7.8% in girls of all NAHSIT participants. When using the updated ULNs of ALT to detect MAFLD in obese children, the sensitivity was 84.0% in boys and 74.3% in girls. In contrast, when using the conventional ALT cutoff (>40 IU/L), the sensitivity decreased to 61.4% in boys and 36.4% in girls. CONCLUSION After taking into account MAFLD-related metabolic risk factors, the ULNs of ALT are 23 IU/L for boys and 18 IU/L for girls in Taiwan. The updated ULNs may be better cutoffs for screening MAFLD in obese children.
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Affiliation(s)
- Yu-Cheng Lin
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Healthcare Administration, Asia Eastern University of Science and Technology, New Taipei City, Taiwan.
| | - Pi-Feng Chang
- Department of Pediatrics, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Yen-Hsuan Ni
- Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
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102
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Lorenz G. [Diagnostic predictive value of liver biopsy for clinical aspects]. Z Arztl Fortbild (Jena) 2022; 72:793-6. [PMID: 362741 PMCID: PMC9736764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background The quest for improved diagnosis and treatment in home health care models has led to the development of wearable medical devices for remote vital signs monitoring. An accurate signal and a high diagnostic yield are critical for the cost-effectiveness of wearable health care monitoring systems and their widespread application in resource-constrained environments. Despite technological advances, the information acquired by these devices can be contaminated by motion artifacts (MA) leading to misdiagnosis or repeated procedures with increases in associated costs. This makes it necessary to develop methods to improve the quality of the signal acquired by these devices. Objective We aimed to present a novel method for electrocardiogram (ECG) signal denoising to reduce MA. We aimed to analyze the method’s performance and to compare its performance to that of existing approaches. Methods We present the novel Redundant denoising Independent Component Analysis method for ECG signal denoising based on the redundant and simultaneous acquisition of ECG signals and movement information, multichannel processing, and performance assessment considering the information contained in the signal waveform. The method is based on data including ECG signals from the patient’s chest and back, the acquisition of triaxial movement signals from inertial measurement units, a reference signal synthesized from an autoregressive model, and the separation of interest and noise sources through multichannel independent component analysis. Results The proposed method significantly reduced MA, showing better performance and introducing a smaller distortion in the interest signal compared with other methods. Finally, the performance of the proposed method was compared to that of wavelet shrinkage and wavelet independent component analysis through the assessment of signal-to-noise ratio, dynamic time warping, and a proposed index based on the signal waveform evaluation with an ensemble average ECG. Conclusions Our novel ECG denoising method is a contribution to converting wearable devices into medical monitoring tools that can be used to support the remote diagnosis and monitoring of cardiovascular diseases. A more accurate signal substantially improves the diagnostic yield of wearable devices. A better yield improves the devices’ cost-effectiveness and contributes to their widespread application.
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Gerussi A, Scaravaglio M, Cristoferi L, Verda D, Milani C, De Bernardi E, Ippolito D, Asselta R, Invernizzi P, Kather JN, Carbone M. Artificial intelligence for precision medicine in autoimmune liver disease. Front Immunol 2022; 13:966329. [PMID: 36439097 PMCID: PMC9691668 DOI: 10.3389/fimmu.2022.966329] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/13/2022] [Indexed: 09/10/2023] Open
Abstract
Autoimmune liver diseases (AiLDs) are rare autoimmune conditions of the liver and the biliary tree with unknown etiology and limited treatment options. AiLDs are inherently characterized by a high degree of complexity, which poses great challenges in understanding their etiopathogenesis, developing novel biomarkers and risk-stratification tools, and, eventually, generating new drugs. Artificial intelligence (AI) is considered one of the best candidates to support researchers and clinicians in making sense of biological complexity. In this review, we offer a primer on AI and machine learning for clinicians, and discuss recent available literature on its applications in medicine and more specifically how it can help to tackle major unmet needs in AiLDs.
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Affiliation(s)
- Alessio Gerussi
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Miki Scaravaglio
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Laura Cristoferi
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
- Bicocca Bioinformatics Biostatistics and Bioimaging Centre - B4, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Chiara Milani
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Elisabetta De Bernardi
- Department of Medicine and Surgery and Tecnomed Foundation, University of Milano - Bicocca, Monza, Italy
| | | | - Rosanna Asselta
- Humanitas Clinical and Research Center, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Pietro Invernizzi
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
| | - Jakob Nikolas Kather
- Department of Medicine III, University Hospital RWTH Aachen, Aachen, Germany
- Else Kroener Fresenius Center for Digital Health, Medical Faculty Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Marco Carbone
- Division of Gastroenterology, Center for Autoimmune Liver Diseases, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), San Gerardo Hospital, Monza, Italy
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Hansen L, Chang MF, Hiatt S, Dieckmann NF, Mitra A, Lyons KS, Lee CS. Symptom Classes in Decompensated Liver Disease. Clin Gastroenterol Hepatol 2022; 20:2551-2557.e1. [PMID: 34813941 PMCID: PMC9120261 DOI: 10.1016/j.cgh.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 09/26/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Patients with decompensated liver disease have been categorized by disease severity. This analysis sought to classify patients with end-stage liver disease based on symptoms rather than disease state and to identify distinct severity classes of physical and psychological symptoms. METHODS Patients with a model for end-stage liver disease-sodium score of 15 or higher were recruited from liver clinics in 2 health care organizations. They completed the Condensed Memorial Symptom Assessment Scale, Revised Ways of Coping Checklist, Patient Health Questionnaire, Life Orientation Test-Revised, and the Short-Form Health Survey. Cross-sectional data were analyzed using latent class mixture modeling. RESULTS The sample (N = 191; age, 56.6 ± 11.1 y; 33.5% ETOH; 28.3% nonalcoholic fatty liver disease; 13.1% autoimmune/primary biliary cholangitis/primary sclerosing cholangitis) was predominantly male (64.2%), Child-Turcotte-Pugh class C (49.5%), with an average model for end-stage liver disease-sodium score of 18.7 ± 4.9. Three distinct classes of symptoms were identified, as follows: mild (26.7%), moderate (41.4%), or severe (31.9%) symptoms. Symptom classes were independent of disease severity and demographic characteristics, except age. All Condensed Memorial Symptom Assessment Scale symptoms and Patient Health Questionnaire scores were significantly different across the 3 classes (P < .05). The symptom classes also differed significantly in physical and mental quality of life, optimism, and avoidance coping behaviors (all P < .001). CONCLUSIONS Patient-reported symptom severity occurred independent of disease severity, contrary to common assumptions. Focusing on the moderate and severe symptom classes as well as patient history of end-stage liver disease complications may enhance providers' ability to improve symptom management for this population.
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Affiliation(s)
- Lissi Hansen
- School of Nursing, Oregon Health and Science University, Portland, Oregon.
| | - Michael F Chang
- Gastroenterology and Hepatology, VA Portland Health Care System, Portland, Oregon
| | - Shirin Hiatt
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Nathan F Dieckmann
- School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Arnab Mitra
- Division of Gastroenterology and Hepatology, Oregon Health and Science University, Portland, Oregon
| | - Karen S Lyons
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts
| | - Christopher S Lee
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts
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105
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Capuano I, Buonanno P, Riccio E, Crocetto F, Pisani A. Parapelvic Cysts: An Imaging Marker of Kidney Disease Potentially Leading to the Diagnosis of Treatable Rare Genetic Disorders? A Narrative Review of the Literature. J Nephrol 2022; 35:2035-2046. [PMID: 35749008 DOI: 10.1007/s40620-022-01375-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 06/02/2022] [Indexed: 11/25/2022]
Abstract
Simple renal cysts are a common finding during abdominal imaging assessment. The incidence increases with age and it is higher in male gender. Parapelvic cysts are a subset of simple cysts that arise within the renal parenchyma, adjacent to the renal sinus, characterized by being generally single, larger, and incompletely surrounded by renal parenchyma. Noteworthy, parapelvic cysts are a rare and understudied condition which, although considered clinically insignificant due to the absence of influence on renal function, still have a controversial aetiopathogenesis. On the other hand, urological management and differential diagnosis have been thoroughly investigated. The aim of our review is to provide an overall vision on this rare condition, usually misdiagnosed and underestimated, on the basis of more recent data. An accurate differential diagnosis of parapelvic cysts can lead to the identification of treatable conditions such as Fabry disease, autosomal dominant polycystic kidney disease, polycystic liver disease and tuberous sclerosis complex disease.
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Affiliation(s)
- Ivana Capuano
- Department of Public Health, Chair of Nephrology "Federico II", University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Pasquale Buonanno
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Eleonora Riccio
- Institute for Biomedical Research and Innovation, National Research Council of Italy, Palermo, Italy
| | - Felice Crocetto
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, Italy
| | - Antonio Pisani
- Department of Public Health, Chair of Nephrology "Federico II", University of Naples, Via Sergio Pansini, 5, 80131, Naples, Italy
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Grant RK, Brindle WM, Donnelly MC, McConville PM, Stroud TG, Bandieri L, Plevris JN. Gastrointestinal and liver disease in patients with schizophrenia: A narrative review. World J Gastroenterol 2022; 28:5515-5529. [PMID: 36304087 PMCID: PMC9594005 DOI: 10.3748/wjg.v28.i38.5515] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/29/2022] [Accepted: 09/21/2022] [Indexed: 02/06/2023] Open
Abstract
Schizophrenia is a severe mental illness which can have a devastating impact on an individual’s quality of life. Comorbidities are high amongst patients and life expectancy is approximately 15 years less than the general population. Despite the well-known increased mortality, little is known about the impact of gastrointestinal and liver disease on patients with schizophrenia. We aimed to review the literature and to make recommendations regarding future care. Literature searches were performed on PubMed to identify studies related to gastrointestinal and liver disease in patients with schizophrenia. High rates of chronic liver disease were reported, with Non-Alcoholic Fatty Liver Disease being of particular concern; antipsychotics and metabolic syndrome were contributing factors. Rates of acute liver failure were low but have been associated with antipsychotic use and paracetamol overdose. Coeliac disease has historically been linked to schizophrenia; however, recent research suggests that a causal link is yet to be proven. Evidence is emerging regarding the relationships between schizophrenia and peptic ulcer disease, inflammatory bowel disease and irritable bowel syndrome; clinical vigilance regarding these conditions should be high. Patients with schizophrenia poorly engage with bowel cancer screening programmes, leading to late diagnosis and increased mortality. Clozapine induced constipation is a significant issue for many patients and requires close monitoring. There is a significant burden of gastrointestinal and liver disease amongst patients with schizophrenia. Better levels of support from all members of the medical team are essential to ensure that appropriate, timely care is provided.
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Affiliation(s)
- Rebecca K Grant
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - William M Brindle
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Mhairi C Donnelly
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
| | - Pauline M McConville
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, United Kingdom
| | - Thomas G Stroud
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, United Kingdom
| | - Lorenzo Bandieri
- General Adult Psychiatry, Royal Edinburgh Hospital, Edinburgh, EH10 5HF, United Kingdom
| | - John N Plevris
- The Centre for Liver and Digestive Disorders, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, United Kingdom
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Kushner T, Park C, Masand D, Rosenbluth E, Carroll C, Grace M, Rodriguez-Rivas C, De La Cruz H, Overbey J, Sperling R. Prevalence of elevated alanine aminotransferase (ALT) in pregnancy: A cross-sectional labor and delivery-based assessment. Medicine (Baltimore) 2022; 101:e30408. [PMID: 36221350 PMCID: PMC9542988 DOI: 10.1097/md.0000000000030408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Since liver tests are not routinely checked in pregnancy, the prevalence of abnormal liver tests and liver-related abnormalities in pregnancy in a US-based population is not known. We sought to determine the prevalence of abnormal alanine aminotransferase (ALT) among pregnant Individuals who present to labor and delivery for evaluation and to evaluate prevalence of underlying diagnosed liver conditions. Prospective study evaluating liver tests in consecutive samples obtained on the labor and delivery unit. Patient characteristics were compared between those with and without abnormal ALT and those with and without abnormal ALT without a liver-related diagnosis made in clinical practice, using t tests for continuous measures and χ2 or Fisher's exact tests as appropriate for categorical measures. Logistic regression was utilized to identify factors associated with abnormal ALT in this subcohort to determine predictors of abnormal ALT in those without a known liver-related diagnosis. We collected 1024 laboratory specimens from 996 patients. Of these patients, 131 of 996 (13.2%) had elevated ALT ≥25 IU/L; 20 (2%) had ALT ≥50, 6 (0.6%) had ALT ≥125 and 3 (0.3%) had ALT ≥250. 61/131 (46.6%) of patients with ALT ≥25 IU/L had not had LTs checked during routine pregnancy care. 20 (15%) of individuals with abnormal LT had preeclampsia; 5 (4%) had cholestasis of pregnancy; 1 (0.8%) had hepatitis C; there were no other chronic liver diseases diagnosed. There were no significant demographic or clinical differences between those with and without ALT ≥25, whether liver disease diagnosis was made or not. We identified an over 10% prevalence of abnormal LTs in consecutive pregnant individuals who presented to L&D, most of whom did not have a liver-related condition diagnosed in clinical practice. Among those with liver-related diagnoses, PE and ICP were the most common among individuals with ALT≥25 IU/mL, with chronic liver disease rarely diagnosed. Further evaluation of the role of ALT testing as part of routine prenatal care is needed, particularly in establishing a baseline prevalence of liver test abnormalities in pregnancy and independent association with pregnancy outcomes.
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Affiliation(s)
- Tatyana Kushner
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
- * Correspondence: Tatyana Kushner, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1123, New York, NY 10029 (e-mail: )
| | - Claire Park
- Department of Obstetrics, Gynecology and Reproductive Science and the Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dana Masand
- Department of Obstetrics, Gynecology and Reproductive Science and the Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Emma Rosenbluth
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Carin Carroll
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marie Grace
- Department of Pathology and Laboratory Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Clara Rodriguez-Rivas
- Department of Medicine, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hernis De La Cruz
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jessica Overbey
- Department of Population Health Science and Policy, Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rhoda Sperling
- Department of Obstetrics, Gynecology and Reproductive Science and the Department of Medicine, Division of Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY
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Ueno H, Douhara A, Osaki Y, Koizumi A, Yorioka N, Ueda S, Tsutsumi M, Yoshiji H. Liver Biopsy-confirmed Primary Hepatic Amyloidosis with Only Jaundice As the Initial Symptom: An Autopsy Case Report. Intern Med 2022; 61:2877-2881. [PMID: 35228432 PMCID: PMC9593147 DOI: 10.2169/internalmedicine.9189-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Amyloidosis causes various symptoms in many organs of the body, but amyloidosis that presents with liver damage alone has never been reported. We treated an 83-year-old man with amyloidosis who presented with liver damage alone. The liver damage in this patient was histologically proven to be liver amyloidosis. The administration of bortezomib and dexamethasone was not effective, so he rapidly died of liver failure. An aggressive liver biopsy should be considered when unexplained jaundice is observed.
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Affiliation(s)
- Hirotsugu Ueno
- Department of Gastroenterology, Saiseikai Chuwa Hospital, Japan
| | | | - Yui Osaki
- Department of Gastroenterology, Saiseikai Chuwa Hospital, Japan
| | | | | | - Shigehiko Ueda
- Department of Gastroenterology, Saiseikai Chuwa Hospital, Japan
| | | | - Hitoshi Yoshiji
- Department of Gastroenterology, Nara Medical University, Japan
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Drenth J, Barten T, Hartog H, Nevens F, Taubert R, Torra Balcells R, Vilgrain V, Böttler T. EASL Clinical Practice Guidelines on the management of cystic liver diseases. J Hepatol 2022; 77:1083-1108. [PMID: 35728731 DOI: 10.1016/j.jhep.2022.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 02/07/2023]
Abstract
The advent of enhanced radiological imaging techniques has facilitated the diagnosis of cystic liver lesions. Concomitantly, the evidence base supporting the management of these diseases has matured over the last decades. As a result, comprehensive clinical guidance on the subject matter is warranted. These Clinical Practice Guidelines cover the diagnosis and management of hepatic cysts, mucinous cystic neoplasms of the liver, biliary hamartomas, polycystic liver disease, Caroli disease, Caroli syndrome, biliary hamartomas and peribiliary cysts. On the basis of in-depth review of the relevant literature we provide recommendations to navigate clinical dilemmas followed by supporting text. The recommendations are graded according to the Oxford Centre for Evidence-Based Medicine system and categorised as 'weak' or 'strong'. We aim to provide the best available evidence to aid the clinical decision-making process in the management of patients with cystic liver disease.
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110
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Liang C, Zheng SJ, Duan ZP. [Introduction to the recommendations from the European Association for the Study of the Liver clinical practice guidelines on the management of cystic liver disease]. Zhonghua Gan Zang Bing Za Zhi 2022; 30:931-933. [PMID: 36299185 DOI: 10.3760/cma.j.cn501113-20220719-00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The diagnosis of cystic liver disease has made great progress with the advent of enhanced imaging techniques. At the same time, its management has gradually improved over the past few decades, providing the basis for the development of appropriate diagnostic and treatment guidelines. To this end, the European Association for the Study of the Liver has developed clinical guidelines for the diagnosis and treatment of non-infectious cystic liver disease. This guideline put forward recommendations based on an in-depth review of the relevant literature for addressing clinical issues, including the diagnosis and treament of hepatic cysts, hepatic mucocystic tumors, biliary hamartomas, polycystic liver disease, Caroli disease or Caroli syndrome, biliary hamartomas, and peribiliary cyst.
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Affiliation(s)
- C Liang
- The Department of Liver Center, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
| | - S J Zheng
- The Department of Liver Center, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
| | - Z P Duan
- The Department of Liver Center, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing YouAn Hospital, Capital Medical University, Beijing 100069, China
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111
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Bischoff SC, Barazzoni R, Busetto L, Campmans‐Kuijpers M, Cardinale V, Chermesh I, Eshraghian A, Kani HT, Khannoussi W, Lacaze L, Léon‐Sanz M, Mendive JM, Müller MW, Ockenga J, Tacke F, Thorell A, Vranesic Bender D, Weimann A, Cuerda C. European guideline on obesity care in patients with gastrointestinal and liver diseases - Joint European Society for Clinical Nutrition and Metabolism / United European Gastroenterology guideline. United European Gastroenterol J 2022; 10:663-720. [PMID: 35959597 PMCID: PMC9486502 DOI: 10.1002/ueg2.12280] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with chronic gastrointestinal (GI) disease such as inflammatory bowel disease (IBD), irritable bowel syndrome (IBS), celiac disease, gastroesophageal reflux disease (GERD), pancreatitis, and chronic liver disease (CLD) often suffer from obesity because of coincidence (IBD, IBS, celiac disease) or related pathophysiology (GERD, pancreatitis and CLD). It is unclear if such patients need a particular diagnostic and treatment that differs from the needs of lean GI patients. The present guideline addresses this question according to current knowledge and evidence. OBJECTIVE The objective of the guideline is to give advice to all professionals working in the field of gastroenterology care including physicians, surgeons, dietitians and others how to handle patients with GI disease and obesity. METHODS The present guideline was developed according to the standard operating procedure for European Society for Clinical Nutrition and Metabolism guidelines, following the Scottish Intercollegiate Guidelines Network grading system (A, B, 0, and good practice point [GPP]). The procedure included an online voting (Delphi) and a final consensus conference. RESULTS In 100 recommendations (3x A, 33x B, 24x 0, 40x GPP, all with a consensus grade of 90% or more) care of GI patients with obesity - including sarcopenic obesity - is addressed in a multidisciplinary way. A particular emphasis is on CLD, especially fatty liver disease, since such diseases are closely related to obesity, whereas liver cirrhosis is rather associated with sarcopenic obesity. A special chapter is dedicated to obesity care in patients undergoing bariatric surgery. The guideline focuses on adults, not on children, for whom data are scarce. Whether some of the recommendations apply to children must be left to the judgment of the experienced pediatrician. CONCLUSION The present guideline offers for the first time evidence-based advice how to care for patients with chronic GI diseases and concomitant obesity, an increasingly frequent constellation in clinical practice.
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Affiliation(s)
| | - Rocco Barazzoni
- Department of Medical, Technological and Translational SciencesUniversity of TriesteTriesteItaly
| | - Luca Busetto
- Department of MedicineUniversity of PadovaPadovaItaly
| | - Marjo Campmans‐Kuijpers
- Department of Gastroenterology and HepatologyUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Vincenzo Cardinale
- Department of Medico‐Surgical Sciences and BiotechnologiesSapienza University of RomeRomeItaly
| | - Irit Chermesh
- Department of GastroenterologyRambam Health Care CampusAffiliated with Technion‐Israel Institute of TechnologyHaifaIsrael
| | - Ahad Eshraghian
- Department of Gastroenterology and HepatologyAvicenna HospitalShirazIran
| | - Haluk Tarik Kani
- Department of GastroenterologyMarmara UniversitySchool of MedicineIstanbulTurkey
| | - Wafaa Khannoussi
- Hepato‐Gastroenterology DepartmentMohammed VI University HospitalOujdaMorocco
- Laboratoire de Recherche des Maladies Digestives (LARMAD)Mohammed the First UniversityOujdaMorocco
| | - Laurence Lacaze
- Department of NutritionRennes HospitalRennesFrance
- Department of general surgeryMantes‐la‐Jolie HospitalFrance
- Department of clinical nutritionPaul Brousse‐Hospital, VillejuifFrance
| | - Miguel Léon‐Sanz
- Department of Endocrinology and NutritionUniversity Hospital Doce de OctubreMedical SchoolUniversity ComplutenseMadridSpain
| | - Juan M. Mendive
- La Mina Primary Care Academic Health Centre. Catalan Institute of Health (ICS)University of BarcelonaBarcelonaSpain
| | - Michael W. Müller
- Department of General and Visceral SurgeryRegionale Kliniken HoldingKliniken Ludwigsburg‐Bietigheim gGmbHBietigheim‐BissingenGermany
| | - Johann Ockenga
- Medizinische Klinik IIKlinikum Bremen‐MitteBremenGermany
| | - Frank Tacke
- Department of Hepatology & GastroenterologyCharité Universitätsmedizin BerlinCampus Virchow‐Klinikum and Campus Charité MitteBerlinGermany
| | - Anders Thorell
- Department of Clinical ScienceDanderyds HospitalKarolinska InstitutetStockholmSweden
- Department of SurgeryErsta HospitalStockholmSweden
| | - Darija Vranesic Bender
- Department of Internal MedicineUnit of Clinical NutritionUniversity Hospital Centre ZagrebZagrebCroatia
| | - Arved Weimann
- Department of General, Visceral and Oncological SurgerySt. George HospitalLeipzigGermany
| | - Cristina Cuerda
- Departamento de MedicinaUniversidad Complutense de MadridNutrition UnitHospital General Universitario Gregorio MarañónMadridSpain
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Ongaro M, Bronstein FN, Goossens N, Spahr L, Bresson Hadni S. [Polycystic liver disease]. Rev Med Suisse 2022; 18:1599-1605. [PMID: 36047551 DOI: 10.53738/revmed.2022.18.793.1599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Polycystic liver disease (PLD) includes three entities in adults : biliary hamartomas which develop as a result of ductal plate malformation, autosomal dominant polycystic liver disease (ADPLD) and autosomal dominant polycystic kidney disease (ADPKD) which occur in the setting of genetic disorders. Hamartomas are asymptomatic and benign. PLD are marked by a steady growth of cysts over time, clinically silent in the majority of cases. Symptomatic forms mainly affect women due to the influence of estrogens on the growth of cysts therefore estrogen treatments are contraindicated in this setting. Diagnosis is based on imaging. Complications are rare but must be identified early in order to offer appropriate care in an expert center.
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Affiliation(s)
- Marie Ongaro
- Service de gastroentérologie et hépatologie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | | | - Nicolas Goossens
- Service de gastroentérologie et hépatologie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Laurent Spahr
- Service de gastroentérologie et hépatologie, Hôpitaux universitaires de Genève, 1211 Genève 14
| | - Solange Bresson Hadni
- Service de gastroentérologie et hépatologie, Hôpitaux universitaires de Genève, 1211 Genève 14
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Ishinuki T, Ota S, Harada K, Kawamoto M, Meguro M, Kutomi G, Tatsumi H, Harada K, Miyanishi K, Kato T, Ohyanagi T, Hui TT, Mizuguchi T. Current standard values of health utility scores for evaluating cost-effectiveness in liver disease: A meta-analysis. World J Gastroenterol 2022; 28:4442-4455. [PMID: 36159009 PMCID: PMC9453766 DOI: 10.3748/wjg.v28.i31.4442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/26/2022] [Accepted: 07/25/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Health utility assessments have been developed for various conditions, including chronic liver disease. Health utility scores are required for socio-economic evaluations, which can aid the distribution of national budgets. However, the standard health utility assessment scores for specific health conditions are largely unknown.
AIM To summarize the health utility scores, including the EuroQOL 5-dimensions 5-levels (EQ-5D-5L), EuroQol-visual analogue scale, short from-36 (SF-36), RAND-36, and Health Utilities Index (HUI)-Mark2/Mark3 scores, for the normal population and chronic liver disease patients.
METHODS A systematic literature search of PubMed and MEDLINE, including the Cochrane Library, was performed. Meta-analysis was performed using the RevMan software. Multiple means and standard deviations were combined using the StatsToDo online web program.
RESULTS The EQ-5D-5L and SF-36 can be used for health utility evaluations during antiviral therapy for hepatitis C. HUI-Mark2/Mark3 indicated that the health utility scores of hepatitis B patients are roughly 30% better than those of hepatitis C patients.
CONCLUSION The EQ-5D-5L is the most popular questionnaire for health utility assessments. Health assessments that allow free registration would be useful for evaluating health utility in patients with liver disease.
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Affiliation(s)
- Tomohiro Ishinuki
- Department of Nursing, Surgical Sciences, Sapporo Medical University, Sapporo 0608556, Japan
| | - Shigenori Ota
- Departments of Surgery, Surgical Science and Oncology, Sapporo Medical University, Sapporo 0608543, Japan
| | - Kohei Harada
- Department of Radiology, Sapporo Medical University, Sapporo 0608543, Japan
| | - Masaki Kawamoto
- Departments of Surgery, Nemuro City Hospital, Nemuro 0870008, Japan
| | - Makoto Meguro
- Departments of Surgery, Sapporo Satozuka Hospital, Sapporo 0040811, Japan
| | - Goro Kutomi
- Departments of Surgery, Surgical Science and Oncology, Sapporo Medical University, Sapporo 0608543, Japan
| | - Hiroomi Tatsumi
- Department of Intensive Care Medicine, Sapporo Medical University, Sapporo 0608543, Japan
| | - Keisuke Harada
- Department of Emergency Medicine, Sapporo Medical University, Sapporo 0608543, Japan
| | - Koji Miyanishi
- Department of Medical Oncology, Sapporo Medical University, Sapporo 0608543, Japan
| | - Toru Kato
- Departments of Surgery, Surgical Science and Oncology, Sapporo Medical University, Sapporo 0608543, Japan
| | - Toshio Ohyanagi
- Department of Liberal Arts and Sciences, Center for Medical Education, Sapporo Medical University, Sapporo 0608556, Japan
| | - Thomas T Hui
- Departments of Surgery, Stanford University School of Medicine, Stanford, 94598, United States
| | - Toru Mizuguchi
- Department of Nursing, Surgical Sciences, Sapporo Medical University, Sapporo 0608556, Japan
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114
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Ishikawa T, Kodama E, Kobayashi T, Azumi M, Nozawa Y, Iwanaga A, Sano T, Honma T. Clinical efficacy of Mac-2-binding protein glycosylation isomer as a biomarker for albumin-bilirubin grade and the Controlling Nutritional Status score in chronic liver disease: investigation of cut-off values by the type of chronic liver disease. Ann Palliat Med 2022; 11:2658-2667. [PMID: 35815452 DOI: 10.21037/apm-22-270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/01/2022] [Indexed: 09/28/2023]
Abstract
BACKGROUND Mac-2-binding protein glycosylation isomer (M2BPGi), a novel noninvasive biomarker for fibrosis, is a prognostic factor for liver disease; however, its relationship with hepatic function reserve and nutritional status remains unclear. Furthermore, the cut-off value of this marker varies with the underlying liver disease. This study aims to clarify that M2BPGi can be clinically used as a hepatic function reserve marker and nutritional index without pushing the search for alternative markers to the forefront in clinical practice as an important biomarker. METHODS Seven hundred and forty-three outpatients with chronic liver disease (CLD) were enrolled. We evaluated the relationship among M2BPGi, albumin-bilirubin (ALBI) grade, and Controlling Nutritional Status (CONUT) score as nutritional status markers. Diagnostic performance of M2BPGi values in distinguishing different modified ALBI (mALBI) grade and CONUT score were compared using receiver operating characteristic (ROC) curve analysis. RESULTS The M2BPGi level increased with ALBI and mALBI grades. The correlation coefficient (r2) between M2BPGi and ALBI grade was 0.40 (r=0.63), indicating a positive correlation between M2BPGi and ALBI grade. The cut-off for M2BPGi to predict mALBI G1 vs. G2-G3 was 1.07, G1-2a vs. G2b-3 was 1.73, and mALBI G1-2 vs. G3 was 5.83 under the ROC curves. The cut-off for M2BPGi to predict CONUT score normal vs. light-severe was 1.60, normal-light vs. moderate-severe was 1.74, and normal-moderate vs. severe was 5.83 under the ROC curves. M2BPGi correlates with ALBI grade and is useful for diagnosing ROC analysis results, especially G2 and above. M2BPGi also correlates with the CONUT score and is useful for diagnosing ROC analysis results, especially moderate or higher. These results showed similar diagnostic performance regardless of the etiology of the background liver disease. CONCLUSIONS Although the predictive cut-off value varied with the type of liver disease, M2BPGi was found to be a single predict biomarker of ALBI and CONUT, and thus, is an effective indicator of CLD status. Further investigation is warranted to determine the clinical utility of this marker.
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Affiliation(s)
- Toru Ishikawa
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Erina Kodama
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Takamasa Kobayashi
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Motoi Azumi
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Yujiro Nozawa
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Akito Iwanaga
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Tomoe Sano
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
| | - Terasu Honma
- Department of Gastroenterology, Saiseikai Niigata Hospital, Niigata, Japan
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115
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Giannini EG, Lisman T. The international normalized ratio - Great for prediction of bleeding in patients taking vitamin K antagonists, useless for prediction of bleeding in patients with chronic liver disease. J Thromb Haemost 2022; 20:1565-1567. [PMID: 35754010 DOI: 10.1111/jth.15756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Edoardo G Giannini
- Gastroenterology Unit, Department of Internal Medicine, University of Genoa, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Ton Lisman
- Surgical Research Laboratory and Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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116
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Afzal A, Gage BF, Suhong L, Schoen MW, Korenblat K, Sanfilippo KM. Different risks of hemorrhage in patients with elevated international normalized ratio from chronic liver disease versus warfarin therapy, a population-based retrospective cohort study. J Thromb Haemost 2022; 20:1610-1617. [PMID: 35491428 PMCID: PMC9247029 DOI: 10.1111/jth.15743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Patients with chronic liver disease (CLD) often present with an elevated international normalized ratio (INR). Although elevated INR reflects a higher risk of hemorrhage among warfarin users, its clinical significance in CLD patients is less clear. OBJECTIVES We used Veterans Health Administration data to quantify the association between INR and (non-variceal) hemorrhage in patients with CLD compared to warfarin users. METHODS We performed a multivariate competing risk analysis to study the association between INR and hemorrhage in the two cohorts. We used an interaction term between INR and cohort (CLD/warfarin users) to test if INR had different effects on hemorrhage in the two cohorts. RESULTS Data from 80 134 patients (14, 412 with CLD and 65, 722 taking warfarin) were analyzed. The effect of INR on the risk of hemorrhage differed between CLD patients and warfarin users (interaction P < .001). As INR increased above 1.5, the adjusted hazard ratio (aHR) for hemorrhage in CLD patients increased to 2.25 but remained fairly constant with further elevation of INR values. In contrast, the risk of hemorrhage in patients taking warfarin remained low with INR in the subtherapeutic (INR <2.0) and therapeutic ranges (INR 2.0-3.0), and increased exponentially with INR in the supratherapeutic range (aHR 1.64 with INR >3.0-3.5, and 4.70 with INR >3.5). CONCLUSIONS The relationship between INR and risk of hemorrhage in CLD patients is different from that in warfarin users. Caution should be exercised extrapolating data from warfarin users to make clinical decisions in CLD patients.
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Affiliation(s)
- Amber Afzal
- Department of Medicine, Division of Hematology, Washington University in St Louis, MO
| | - Brian F Gage
- Department of Medicine, Division of General Medical Sciences, Washington University in St Louis, MO
| | - Luo Suhong
- Research Service, St. Louis Veterans Affairs Medical Center, St Louis, MO
| | - Martin W Schoen
- Department of Medicine, St. Louis Veterans Affairs Medical Center, St Louis, MO
| | - Kevin Korenblat
- Department of Medicine, Division of Gastroenterology, Washington University in St Louis, MO, USA
| | - Kristen M Sanfilippo
- Department of Medicine, Division of Hematology, Washington University in St Louis, MO
- Department of Medicine, St. Louis Veterans Affairs Medical Center, St Louis, MO
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Abstract
Systemic rheumatic diseases (SRDs) are chronic, inflammatory, autoimmune disorders with the presence of autoantibodies that may affect any organ or system. Liver dysfunction in SRDs can be associated with prescribed drugs, viral hepatitis, alternative hepatic comorbidities and coexisting autoimmune liver diseases (AILDs), requiring an exclusion of secondary conditions before considering liver involvement. The patterns of overlap diseases depend predominantly on genetic determinants with common susceptible loci widely distributing in both disorders. In AILDs, it is important to identify the overlapping SRDs at an early stage since such a coexistence may influence the disease course and prognosis. Commonly co-occurring SRDs in AILDs are Sjögren syndrome (SS), rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) in autoimmune hepatitis (AIH), and SS, RA or systemic sclerosis in primary biliary cholangitis. Owing to different disease complications and therapies, it is imperative to differentiate between SLE liver involvement and SLE-AIH overlap disease. Therapeutic options can be personalized to control coexisting conditions of liver autoimmunity and rheumatic manifestations in AILD-SRD overlap diseases. The collaboration between hepatologists and rheumatologists can lead to significant advances in managing such a complex scenario. In this review, we provide a comprehensive overview on coexisting AILDs in different SRDs and the therapeutic approach in managing these overlap diseases.
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Affiliation(s)
- Chrong-Reen Wang
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan 70403, Taiwan
| | - Hung-Wen Tsai
- Department of Pathology, National Cheng Kung University Hospital, Tainan 70403, Taiwan
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118
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Testino G. Letter to the editor: Chronic liver disease among adolescents and young adults: Alcohol use disorder identification. Hepatology 2022; 75:1662-1663. [PMID: 35076964 DOI: 10.1002/hep.32360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 12/08/2022]
Affiliation(s)
- Gianni Testino
- Unit of Addiction and HepatologyAlcohological Regional CentreASL3 c/o Polyclinic San Martino HospitalGenovaItaly
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119
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Téllez L, Guerrero A. Management of Liver Decompensation in Advanced Liver Disease (Renal Impairment, Liver Failure, Adrenal Insufficiency, Cardiopulmonary Complications). Clin Drug Investig 2022; 42:15-23. [PMID: 35522396 PMCID: PMC9205830 DOI: 10.1007/s40261-022-01149-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 12/17/2022]
Abstract
Systemic complications often occur in patients with advanced liver disease. In particular, the development of renal complications (acute kidney injury, hepatorenal syndrome), acute-on-chronic liver failure, cardiopulmonary diseases, or relative adrenal insufficiency can be serious in patients with advanced liver disease and may determine the patient’s quality of life and prognosis. Therefore, the early diagnosis of possible complications is the key to the prompt initiation of specific treatments that can improve quality of life and survival. For this purpose, networking with reference centers where multidisciplinary units are available is essential so that every patient is evaluated in clinical discussions involving specialists from different fields.
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Affiliation(s)
- Luis Téllez
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Insituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red (CIBERehd), Universidad de Alcalá, Ctra. Colmenar Viejo, km 9,100, 28034, Madrid, Spain.
| | - Antonio Guerrero
- Department of Gastroenterology and Hepatology, Hospital Universitario Ramón y Cajal, Insituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red (CIBERehd), Universidad de Alcalá, Ctra. Colmenar Viejo, km 9,100, 28034, Madrid, Spain
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120
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Zhang B, Zhou J, Xie W, Tao K, Lu S, Yuan X, Liu L, Wang W, Mao Y, Bie P, Liu J, Bi X, Zhang Z, Liang C, Cai J, Jian Z, Lv Y, Zhu P, Zhang W, Yang H, Zhou W, Zhang B, Chen X. Expert consensus on organizing the multidisciplinary team (MDT) diagnosis and treatment of hepato-pancreato-biliary diseases in China. Sci China Life Sci 2022; 65:1036-1039. [PMID: 35314917 DOI: 10.1007/s11427-021-2079-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Affiliation(s)
- Binhao Zhang
- Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jian Zhou
- Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Weifen Xie
- Shanghai Changzheng Hospital, Shanghai, 200003, China
| | - Kaishan Tao
- Xijing Hospital of Air Force Medical University, Xi'an, 710032, China
| | - Shichun Lu
- Chinese PLA General Hospital, Beijing, 100048, China
| | - Xianglin Yuan
- Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Lianxin Liu
- The First Affiliated Hospital of University of Science and Technology of China, Hefei, 230001, China
| | - Weilin Wang
- The Second Affiliated Hospital of Medical College of Zhejiang University, Hangzhou, 310009, China
| | - Yilei Mao
- Peking Union Medical College Hospital, Beijing, 100140, China
| | - Ping Bie
- The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Jingfeng Liu
- Fujian Medical University Cancer Hospital, Fuzhou, 350005, China
| | - Xinyu Bi
- Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - Zhiwei Zhang
- Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Changhong Liang
- Guangdong Provincial People's Hospital, Guangzhou, 510080, China
| | - Jianqiang Cai
- Cancer Hospital Chinese Academy of Medical Sciences, Beijing, 100021, China
| | - Zhixiang Jian
- Guangdong Provincial People's Hospital, Guangzhou, 510080, China
| | - Yi Lv
- The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, China
| | - Peng Zhu
- Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Wei Zhang
- Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongqiang Yang
- The First Affiliated Hospital of Chengdu Medical College, Chengdu, 610599, China
| | - Weiping Zhou
- The Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, 201805, China
| | - Bixiang Zhang
- Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Xiaoping Chen
- Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, China.
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121
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Wang MK, Yu XL, Zhou LY, Si HM, Hui JF, Hou DY, Li WP, Yang JS. COVID-19 and liver dysfunction: What nutritionists need to know. World J Gastroenterol 2022; 28:1526-1535. [PMID: 35582132 PMCID: PMC9048466 DOI: 10.3748/wjg.v28.i15.1526] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/24/2021] [Accepted: 03/27/2022] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus-2 has brought serious challenges for the medical field. Patients with COVID-19 usually have respiratory symptoms. However, liver dysfunction is not an uncommon presentation. Additionally, the degree of liver dysfunction is associated with the severity and prognosis of COVID-19. Prevention, diagnosis, and treatment of malnutrition should be routinely recommended in the management of patients with COVID-19, especially in those with liver dysfunction. Recently, a large number of studies have reported that nutrition therapy measures, including natural dietary supplements, vitamins, minerals and trace elements, and probiotics, might have potential hepatoprotective effects against COVID-19-related liver dysfunction via their antioxidant, antiviral, anti-inflammatory, and positive immunomodulatory effects. This review mainly focuses on the possible relationship between COVID-19 and liver dysfunction, nutritional and metabolic characteristics, nutritional status assessment, and nutrition therapy to provide a reference for the nutritionists while making evidence-based nutritional decisions during the COVID-19 pandemic.
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Affiliation(s)
- Ming-Ke Wang
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Xue-Lu Yu
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Li-Yun Zhou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Hong-Mei Si
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ju-Fen Hui
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Deng-Yong Hou
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Wei-Peng Li
- Department of Disease Control and Prevention, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
| | - Ji-Shun Yang
- Medical Care Center, Naval Medical Center of PLA, Naval Medical University, Shanghai 200052, China
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Pugliese N, Arcari I, Aghemo A, Lania AG, Lleo A, Mazziotti G. Osteosarcopenia in autoimmune cholestatic liver diseases: Causes, management, and challenges. World J Gastroenterol 2022; 28:1430-1443. [PMID: 35582674 PMCID: PMC9048470 DOI: 10.3748/wjg.v28.i14.1430] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 12/05/2021] [Accepted: 03/06/2022] [Indexed: 02/06/2023] Open
Abstract
Primary biliary cholangitis and primary sclerosing cholangitis (PSC) are the most common cholestatic liver diseases (CLD) in adults and are both characterized by an immune pathogenesis. While primary biliary cholangitis is a model autoimmune disease, with over 90% of patients presenting very specific autoantibodies against mitochondrial antigens, PSC is considered an immune mediated disease. Osteoporosis is the most common bone disease in CLD, resulting in frequent fractures and leading to significant morbidity. Further, sarcopenia is emerging as a frequent complication of chronic liver diseases with a significant prognostic impact and severe implications on the quality of life of patients. The mechanisms underlying osteoporosis and sarcopenia in CLD are still largely unknown and the association between these clinical conditions remains to be dissected. Although timely diagnosis, prevention, and management of osteosarcopenia are crucial to limit the consequences, there are no specific guidelines for management of osteoporosis and sarcopenia in patients with CLD. International guidelines recommend screening for bone disease at the time of diagnosis of CLD. However, the optimal monitoring strategies and treatments have not been defined yet and vary among centers. We herein aim to comprehensively outline the pathogenic mechanisms and clinical implications of osteosarcopenia in CLD, and to summarize expert recommendations for appropriate diagnostic and therapeutic approaches.
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Affiliation(s)
- Nicola Pugliese
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, MI, Italy
| | - Ivan Arcari
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, MI, Italy
| | - Alessio Aghemo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, MI, Italy
| | - Andrea G Lania
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milan, Italy
- Department of Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano 20089, MI, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, Rozzano 20089, MI, Italy
| | - Gherardo Mazziotti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele 20090, Milan, Italy
- Department of Endocrinology, Diabetology and Medical Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano 20089, MI, Italy
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123
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Newman LA, Muller K, Rowland A. Circulating cell-specific extracellular vesicles as biomarkers for the diagnosis and monitoring of chronic liver diseases. Cell Mol Life Sci 2022; 79:232. [PMID: 35397694 PMCID: PMC8995281 DOI: 10.1007/s00018-022-04256-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/02/2022] [Accepted: 03/17/2022] [Indexed: 11/30/2022]
Abstract
AbstractChronic liver diseases represent a burgeoning health problem affecting billions of people worldwide. The insufficient performance of current minimally invasive tools is recognised as a significant barrier to the clinical management of these conditions. Extracellular vesicles (EVs) have emerged as a rich source of circulating biomarkers closely linked to pathological processes in originating tissues. Here, we summarise the contribution of EVs to normal liver function and to chronic liver pathologies; and explore the use of circulating EV biomarkers, with a particular focus on techniques to isolate and analyse cell- or tissue-specific EVs. Such approaches present a novel strategy to inform disease status and monitor changes in response to treatment in a minimally invasive manner. Emerging technologies that support the selective isolation and analysis of circulating EVs derived only from hepatic cells, have driven recent advancements in EV-based biomarker platforms for chronic liver diseases and show promise to bring these techniques to clinical settings.
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Affiliation(s)
- Lauren A Newman
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Kate Muller
- Department of Gastroenterology and Hepatology, College of Medicine and Public Health, Flinders Medical Centre, Adelaide, SA, Australia
| | - Andrew Rowland
- Department of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
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Galante GJ. Defining and Treating Cystic Fibrosis Liver Disease: Some Things Old and Some Things New. J Cyst Fibros 2022; 21:199-201. [PMID: 35337600 DOI: 10.1016/j.jcf.2022.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Gary J Galante
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada.
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125
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Oh H. A non-invasive test that enables longitudinal monitoring of chronic liver disease: VCTE versus 2D-SWE. Korean J Intern Med 2022; 37:281-282. [PMID: 35272441 PMCID: PMC8925961 DOI: 10.3904/kjim.2022.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 02/20/2022] [Indexed: 11/27/2022] Open
Affiliation(s)
- Hyunwoo Oh
- Division of Gastroenterology, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University, Uijeongbu, Korea
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126
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127
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Seeking editor for Clinical Liver Disease. Hepatol Commun 2022; 6:i. [PMID: 35202512 DOI: 10.1002/hep4.1917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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128
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Zhao-Fleming HH, Davidson TM, Eaton JE. 55-Year-Old Woman With Abnormal Liver Test Results. Mayo Clin Proc 2022; 97:614-619. [PMID: 35135693 DOI: 10.1016/j.mayocp.2021.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 07/13/2021] [Accepted: 07/16/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Hannah H Zhao-Fleming
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - Tara M Davidson
- Resident in Internal Medicine, Mayo Clinic School of Graduate Medical Education, Rochester, MN
| | - John E Eaton
- Advisor to residents and Consultant in Gastroenterology and Hepatology, Rochester, MN.
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129
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García-Compeán D, Orsi E, Kumar R, Gundling F, Nishida T, Villarreal-Pérez JZ, Del Cueto-Aguilera ÁN, González-González JA, Pugliese G. Clinical implications of diabetes in chronic liver disease: Diagnosis, outcomes and management, current and future perspectives. World J Gastroenterol 2022; 28:775-793. [PMID: 35317103 PMCID: PMC8900578 DOI: 10.3748/wjg.v28.i8.775] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 11/19/2021] [Accepted: 01/25/2022] [Indexed: 02/06/2023] Open
Abstract
Diabetes mellitus (DM) is common in liver cirrhosis (LC). The pathophysiological association is bidirectional. DM is a risk factor of LC and LC is a diabetogenic condition. In the recent years, research on different aspects of the association DM and LC has been intensified. Nevertheless, it has been insufficient and still exist many gaps. The aims of this review are: (1) To discuss the latest understandings of the association of DM and LC in order to identify the strategies of early diagnosis; (2) To evaluate the impact of DM on outcomes of LC patients; and (3) To select the most adequate management benefiting the two conditions. Literature searches were conducted using PubMed, Ovid and Scopus engines for DM and LC, diagnosis, outcomes and management. The authors also provided insight from their own published experience. Based on the published studies, two types of DM associated with LC have emerged: Type 2 DM (T2DM) and hepatogenous diabetes (HD). High-quality evidences have determined that T2DM or HD significantly increase complications and death pre and post-liver transplantation. HD has been poorly studied and has not been recognized as a complication of LC. The management of DM in LC patients continues to be difficult and should be based on drug pharmacokinetics and the degree of liver failure. In conclusion, the clinical impact of DM in outcomes of LC patients has been the most studied item recently. Nevertheless many gaps still exist particularly in the management. These most important gaps were highlighted in order to propose future lines for research.
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Affiliation(s)
- Diego García-Compeán
- Gastroenterology Service and Department of Internal Medicine, Faculty of Medicine, University Hospital “Dr. José E. González”, Universidad Autónoma de Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - Emanuela Orsi
- Diabetes Service, Endocrinology and Metabolic Diseases Unit, Fdn IRCCS Ca Granda, Endocrine Unit, Padigl Granelli, Milan 20121, Italy
| | - Ramesh Kumar
- Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
| | - Felix Gundling
- Department of Gastroenterology, Gastrointestinal Oncology, Hepatology, Diabetics, Metabolism and Infectious Diseases, Sozialstiftung Bamberg, Bamberg 96049, Germany
| | - Tsutomu Nishida
- Department of Gastroenterology, Toyonaka Municipal Hospital, Osaka 560-8565, Japan
| | | | - Ángel N Del Cueto-Aguilera
- Department of Gastroenterology and Internal Medicine, Faculty of Medicine, University Hospital, Autonomous University of Nuevo León, Monterrey 64700, Nuevo León, Mexico
| | - José A González-González
- Gastroenterology Service and Department of Internal Medicine, University Hospital Dr. José E González and Medical School, Monterrey 64460, Nuevo León, Mexico
| | - Giuseppe Pugliese
- Department of Clinical and Molecular Medicine, La Sapienza University, Roma 00161, Italy
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Calabrese GV, Waku M, Mazzarulli F, Di Nuzzo D, Ciarelli F, Bennato A, Mucilli F. Laparoscopic deroofing in large hepatic cyst with alcohol sclerotherapy. Analysis of three cases. Ann Ital Chir 2022; 93:224-228. [PMID: 35478187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Hepatic cysts have become increasingly frequent findings thanks to the improvement in diagnostic investigations. Distinction has to be made between congenital hepatic cysts (like liver cyst, PLCD) and acquired forms (such as a parasitic cyst and a cyst occurring as part of a neoplastic process) (1). When a simple hepatic cyst becomes symptomatic, when its size is > 4 cm or when there is some radiological suspicion of malignancy (thick wall, peripheral enhancement on CT/MRI) surgical management is indicated and relies on a variety of techniques (2). Presently the two most common techniques are percutaneous aspiration with sclerotherapy and laparoscopic fenestration. The use of laparoscopic approach has achieved, in the last years, some great results, for it shortens hospital stay, involves minimal invasiveness and offers low recurrence rate. We report three cases of symptomatic hepatic cysts successfully treated by using laparoscopic procedure. KEY WORDS: Laparoscopic deroofing, Sclerotherapy, Simple hepatic cysts.
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Abstract
Anti-mitochondrial antibodies (AMA) are directed against the E2 subunits of the 2-oxo acid dehydrogenase complexes (PDC-E2) and are the typical biomarkers of primary biliary cholangitis (PBC), being present in 90-95% of patients, with increasing sensitivity at increasing titers. Albeit being highly specific for PBC diagnosis, AMA can be detected in less than 1% of healthy subjects, and thus the management subjects with no sign or symptom of liver disease is still a challenge and data concerning clinical risk of developing PBC in this subgroup of patients are controversial. Moreover, AMA can also be detected in patients affected by overlap syndrome, as well as hepatic diseases (i.e., NASH and viral hepatitis), while the association with autoimmune diseases, in particular Sjögren's syndrome, systemic sclerosis, and systemic lupus erythematosus, is well established. Furthermore, new associations are being identified with inflammatory myositis and heart disease. AMA are directed towards the pyruvate dehydrogenase multi enzyme complex (PDC-E2) subunit, which represents an epithelial specific autoantigen for PBC. This review focuses on the main characteristics of AMA, their association with autoimmune diseases and liver diseases.
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Affiliation(s)
- Francesca Colapietro
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
| | - Ana Lleo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.
| | - Elena Generali
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Division of Internal Medicine and Hepatology, Department of Gastroenterology, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy
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Squires JE, McKiernan PJ, Squires RH. Acute Liver Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference. Pediatrics 2022; 149:S59-S65. [PMID: 34970684 DOI: 10.1542/peds.2021-052888i] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/30/2022] Open
Abstract
CONTEXT Develop evidence-based criteria for individual organ dysfunction. OBJECTIVES Evaluate current evidence and develop contemporary consensus criteria for acute liver dysfunction with associated outcomes in critically ill children. DATA SOURCES Electronic searches of PubMed and Embase conducted from January 1992 to January 2020, used medical subject heading terms and text words to characterize acute liver dysfunction and outcomes. STUDY SELECTION Studies evaluating critically ill children with acute liver dysfunction, assessed screening tools, and outcomes were included. Studies evaluating adults, infants ≤36 weeks gestational age, or animals or were reviews/commentaries, case series with sample size ≤10, or non-English language studies were excluded. DATA EXTRACTION Data were abstracted from each eligible study into a data extraction form along with risk of bias assessment by a task force member. RESULTS The systematic review supports criteria for acute liver dysfunction, in the absence of known chronic liver disease, as having onset of symptoms <8 weeks, combined with biochemical evidence of acute liver injury, and liver-based coagulopathy, with hepatic encephalopathy required for an international normalized ratio between 1.5 and 2.0. LIMITATIONS Unable to assess acute-on-chronic liver dysfunction, subjective nature of hepatic encephalopathy, relevant articles missed by reviewers. CONCLUSIONS Proposed criteria identify an infant, child, or adolescent who has reached a clinical threshold where any of the 3 outcomes (alive with native liver, death, or liver transplant) are possible and should prompt an urgent liaison with a recognized pediatric liver transplant center if liver failure is the principal driver of multiple organ dysfunction.
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Nishida N. [Development and application of artificial intelligence (AI) models for liver diseases]. Nihon Shokakibyo Gakkai Zasshi 2022; 119:626-641. [PMID: 35811120 DOI: 10.11405/nisshoshi.119.626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Affiliation(s)
- Naoshi Nishida
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine
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135
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Šmíd V. Liver tests. Cas Lek Cesk 2022; 161:52-56. [PMID: 35728957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Liver function tests are among the most determined biochemical parameters, and it is essential that their interpretation is always performed correctly. The presence of liver disease is indicated not only by the well-known basic panel of liver function tests (bilirubin, ALT, AST, GGT and ALP), but also by other biochemical parameters, especially albumin, INR and platelet count. The latter analytes are often overlooked, as is the fact that normal values in the baseline liver test panel do not yet rule out advanced chronic liver disease - liver fibrosis or cirrhosis. In contrast, high levels of liver function tests do not automatically indicate liver failure. Considering the increasing incidence of liver disease as well as the rising mortality from liver causes in many European countries, it is desirable to update the diagnostic algorithm when pathological liver function tests are detected.
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136
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Schupack DA, Mars RAT, Voelker DH, Abeykoon JP, Kashyap PC. The promise of the gut microbiome as part of individualized treatment strategies. Nat Rev Gastroenterol Hepatol 2022; 19:7-25. [PMID: 34453142 PMCID: PMC8712374 DOI: 10.1038/s41575-021-00499-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2021] [Indexed: 02/07/2023]
Abstract
Variability in disease presentation, progression and treatment response has been a central challenge in medicine. Although variability in host factors and genetics are important, it has become evident that the gut microbiome, with its vast genetic and metabolic diversity, must be considered in moving towards individualized treatment. In this Review, we discuss six broad disease groups: infectious disease, cancer, metabolic disease, cardiovascular disease, autoimmune or inflammatory disease, and allergic and atopic diseases. We highlight current knowledge on the gut microbiome in disease pathogenesis and prognosis, efficacy, and treatment-related adverse events and its promise for stratifying existing treatments and as a source of novel therapies. The Review is not meant to be comprehensive for each disease state but rather highlights the potential implications of the microbiome as a tool to individualize treatment strategies in clinical practice. Although early, the outlook is optimistic but challenges need to be overcome before clinical implementation, including improved understanding of underlying mechanisms, longitudinal studies with multiple data layers reflecting gut microbiome and host response, standardized approaches to testing and reporting, and validation in larger cohorts. Given progress in the microbiome field with concurrent basic and clinical studies, the microbiome will likely become an integral part of clinical care within the next decade.
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Affiliation(s)
- Daniel A Schupack
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Ruben A T Mars
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Dayne H Voelker
- Division of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jithma P Abeykoon
- Division of Hematology and Oncology, Mayo Clinic, Rochester, MN, USA
| | - Purna C Kashyap
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA.
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137
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Deftereos S, Kalbazidou M. Supradiaphragmatic ectopic liver. Pan Afr Med J 2022; 41:152. [PMID: 35573433 PMCID: PMC9058991 DOI: 10.11604/pamj.2022.41.152.33696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/15/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Savas Deftereos
- Radiology Department, Democritus University of Thrace, Alexandroupolis, Greece
- Corresponding author: Savas Deftereos, Radiology Department, Democritus University of Thrace, Alexandroupolis, Greece.
| | - Maria Kalbazidou
- Radiology Department, Democritus University of Thrace, Alexandroupolis, Greece
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Haloui A, Kariche N, Aissaoui A, Najjioui Y, Tiabi EM, Seghrouchni N, Bennani A. Biliary hamartoma: a report of two cases. Pan Afr Med J 2022; 42:57. [PMID: 35949474 PMCID: PMC9307921 DOI: 10.11604/pamj.2022.42.57.29748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 05/02/2022] [Indexed: 11/28/2022] Open
Abstract
Biliary hamartoma, also known as biliary micro hamartoma or Von Meyenburg complex, is a rare benign liver lesion, thought to be a ductal plate malformation rather than a true neoplasm. It is often seen incidentally on imagery or surgery as multiple small subcapsular nodules, scattered throughout the liver, making it likely to be mistaken for metastatic nodules. The histological presentation can also be deceptive, leading to the misdiagnosis of an adenocarcinoma of hepato-biliary differentiation or a metastasis. We hereby present two cases of biliary hamartoma, found incidentally on imagery and surgery, the first one in a 94-year-old woman, and the second in a 48-year-old man, which was initially misdiagnosed as an adenocarcinoma, along with a discussion of key clinical and pathological findings to help avoid this diagnostic pitfall.
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Affiliation(s)
- Anass Haloui
- Laboratory of Pathological Anatomy, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
- Corresponding author: Anass Haloui, Laboratory of Pathological Anatomy, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco.
| | - Nassira Kariche
- Laboratory of Pathological Anatomy, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Asmae Aissaoui
- Laboratory of Pathological Anatomy, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Youness Najjioui
- Laboratory of Pathological Anatomy, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - El Mehdi Tiabi
- Laboratory of Pathological Anatomy, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Noura Seghrouchni
- Laboratory of Pathological Anatomy, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
| | - Amal Bennani
- Laboratory of Pathological Anatomy, Faculty of Medicine and Pharmacy of Oujda, Mohammed First University, Oujda, Morocco
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139
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Hu J, Chen M, Cai X. Severe Polycystic Liver Disease With Hepatic Cyst Infection. Clin Gastroenterol Hepatol 2022; 20:e3. [PMID: 32712395 DOI: 10.1016/j.cgh.2020.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/21/2020] [Indexed: 02/07/2023]
Affiliation(s)
- Jiahao Hu
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Mingyu Chen
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China
| | - Xiujun Cai
- Department of General Surgery, Sir Run-Run Shaw Hospital, Zhejiang University, Hangzhou, China; Engineering Research Center of Cognitive Healthcare of Zhejiang Province, Hangzhou, China
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140
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Phisalprapa P, Tanwandee T, Neo BL, Singh S. Knowledge, attitude, and behaviors toward liver health and viral hepatitis-related liver diseases in Thailand. Medicine (Baltimore) 2021; 100:e28308. [PMID: 34941122 PMCID: PMC8702093 DOI: 10.1097/md.0000000000028308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 11/26/2021] [Indexed: 01/05/2023] Open
Abstract
This study aimed to quantify and evaluate the knowledge and awareness toward liver health and diseases as well as explore the attitudes and knowledge toward screening, diagnosis, and treatment of liver disease among the Thai population.This is a cross-sectional, self-reported and web-based questionnaire study. Awareness, perceptions and attitudes toward liver-related health and diseases as well as screening, diagnosis and treatment of liver diseases were assessed among 500 Thai adults.Respondents were mostly ≥35 years (62.0%) and females (52.0%). While there was an overall awareness regarding viral hepatitis as the main etiology of liver failure/cancer, respondents expressed misperceptions that hint at social stigmatization or discrimination toward infected individuals. A significant proportion lacked knowledge of liver screening tests and relevant diagnostic tests for viral hepatitis-related liver diseases. Screening or treatment costs and perception of being healthy were among reasons for not seeking medical consultation when exposed to risk factors or diagnosed. Treatment practices of hepatitis included prescription medication (59.1%), functional foods (51.8%) and traditional treatment (28.2%). Multivariate analysis identified income, recent health screening status and being diagnosed with liver disease(s) as significant predictors of the knowledge, attitude, and behaviors of the Thai population toward liver diseases.This study highlighted a degree of misperception and lack of in-depth understanding toward hepatitis-related liver diseases including poor attitudes and knowledge toward screening, diagnosis, and treatment of liver diseases. Factors identified suggest an unmet need to encourage proactive health-seeking behaviors to reduce transmission risks of hepatitis-related liver diseases within the community.
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Affiliation(s)
- Pochamana Phisalprapa
- Division of Ambulatory Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
| | - Tawesak Tanwandee
- Division of Gastroenterology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Thailand
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141
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Thomas H. The Liver Meeting Digital Experience 2021. Lancet Gastroenterol Hepatol 2021; 7:15. [PMID: 34895506 DOI: 10.1016/s2468-1253(21)00439-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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142
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Verma HK, Bhaskar LVKS. SARS-CoV-2 infection in people with pre-existing liver disease: Further research is warranted. World J Gastroenterol 2021; 27:7855-7858. [PMID: 34963747 PMCID: PMC8661380 DOI: 10.3748/wjg.v27.i45.7855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/13/2021] [Accepted: 09/08/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with severe liver disease who have been infected with severe acute respiratory syndrome coronavirus-2 (coronavirus disease 2019) frequently develop acute respiratory distress syndrome and multiple organ failure, with a high mortality rate, as a result of the hyper-proinflammatory state known as the cytokine storm. Clinicians must recognize cytokine storms earlier to avoid intensive care admission and multi-organ damage, a critical life-threatening condition with prognostic and therapeutic implications
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Affiliation(s)
- Henu Kumar Verma
- Department of Immunopathology, Institute of lungs Biology and Disease, Comprehensive Pneumology Center, Neuherberg 85764, Munich, Germany
| | - LVKS Bhaskar
- Zoology, Guru Ghasidas Vishwavidyalaya, Bilaspur 495001, Chhattisgarh, India
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143
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Padmakala S, Subasini CA, Karuppiah SP, Sheeba A. ESVM-SWRF: Ensemble SVM-based sample weighted random forests for liver disease classification. Int J Numer Method Biomed Eng 2021; 37:e3525. [PMID: 34431606 DOI: 10.1002/cnm.3525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
Recently, a significant way to diagnose the disease is using the model of medical data mining. The most challenging task in the healthcare field is to face a large amount of data during disease analyzes and prediction. Once the data are transformed into valuable data by means of data mining models then the actual prediction and decision making is easier. The existing studies met few shortcomings because of higher execution time, more computational complexities, less scalability, slow convergence, and lack of providing the solution. In this article, we have proposed an ensemble SVM-based sample weighted random forests (eSVM-swRF) with novel improved colliding body optimization (NICBO) algorithm to predict liver diseases. The extraction, loading, transformation, and analysis (ELTA) are used to pre-process the patient data. The significant feature with a suitable model is generated depending upon the filter-based method. Based on eSVM-swRF, the parameter values such as penalty parameter (P), threshold (T), and mTry are optimized via a novel improved colliding boding optimization (NICBO) algorithm. The UCI dataset provides liver disease data for this study. The implementation platform of RapidMiner Studio version 7.6 with different evaluation measures is used to validate the performance of eSVM-swRF with the NICBO method. Anyway, the proposed method yields outstanding performance than other existing methods such as Particle Swarm Optimization-based Support Vector Machine (PSO-SVM), fuzzy adaptive, and neighbor weighted k-NN (FuzzyANWKNN), Naïve Bayes-based Support Vector Machine (NB-SVM), and Neural network.
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Affiliation(s)
- S Padmakala
- Department of CSE, St. Joseph's Institute of Technology, Chennai, Tamil Nadu, India
| | - C A Subasini
- Department of CSE, St. Joseph's Institute of Technology, Chennai, Tamil Nadu, India
| | - S P Karuppiah
- Departmentof MBA, St. Joseph's College of Engineering, Chennai, India
| | - Adlin Sheeba
- Department of CSE, St. Joseph's Institute of Technology, Chennai, Tamil Nadu, India
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144
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Smith A, Baumgartner K, Cooper J, St Louis J. Liver Disease: Evaluation of Patients With Abnormal Liver Test Results. FP Essent 2021; 511:11-22. [PMID: 34855337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The prevalence of abnormal liver test results in the general population is estimated to be between 10% and 20%. The terms liver tests or liver chemistries are recommended to describe more accurately the tests used to assess liver health, instead of the term liver function tests. Defining normal ranges for liver transaminase levels can be challenging. Levels are affected by factors such as body mass index and sex. Elevated transaminase levels are associated with increased risks of liver-related and all-cause mortality. Patient with signs or symptoms of liver disease or abnormal liver test results should be evaluated to determine the etiology. For patients with abnormal liver test results, the initial evaluation should include a review of previous laboratory test results, medical and family histories, substance use, and drugs, including over-the-counter drugs and herbal supplements. Physical examination results often are normal but findings may be consistent with acute disease. Tests should include a complete blood cell count; alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, and albumin levels; prothrombin time; hepatitis B surface antigen; hepatitis B core antibody; hepatitis C antibody; ferritin and iron levels and transferrin saturation; and right upper quadrant abdominal ultrasonography. Additional tests and imaging should be based on patient-specific risk factors and the pattern of abnormal liver test results.
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Affiliation(s)
- Andrew Smith
- Department of Family Medicine - Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111
| | - Katrina Baumgartner
- Department of Family Medicine - Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111
| | - Julia Cooper
- Harlem Residency in Family Medicine - The Institute for Family Health, 1824 Madison Ave, New York, NY 10035
| | - Joshua St Louis
- Department of Family Medicine - Tufts University School of Medicine, 136 Harrison Ave, Boston, MA 02111
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145
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Chinese Society of Hepatology, Chinese Medical Association. [Guidelines on the management of cholestasis liver diseases (2021)]. Zhonghua Nei Ke Za Zhi 2021; 60:1075-87. [PMID: 34856682 DOI: 10.3760/cma.j.cn112138-20211112-00795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
In 2015, the Chinese Society of Hepatology and Chinese Society of Gastroenterology issued the consensus on the diagnosis and management of cholestatic liver diseases. In the past years, more data have emerged from clinical practice. Herein, the Autoimmune Liver Disease Group of the Chinese Society of Hepatology organized an expert group to review the evidence and updated the recommendations to formulate the guidelines. There are 22 recommendations on clinical practice of cholestatic liver diseases. The guidelines aim to provide a working reference for the management of cholestatic liver diseases.
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146
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Nguyen G, Lejeune M, Crichi B, Frere C. Hemostasis testing in patients with liver dysfunction: Advantages and caveats. World J Gastroenterol 2021; 27:7285-7298. [PMID: 34876789 PMCID: PMC8611202 DOI: 10.3748/wjg.v27.i42.7285] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/08/2021] [Accepted: 10/20/2021] [Indexed: 02/06/2023] Open
Abstract
Due to concomitant changes in pro- and anti-coagulant mechanisms, patients with liver dysfunction have a “rebalanced hemostasis”, which can easily be tipped toward either a hypo- or a hypercoagulable phenotype. Clinicians are often faced with the question whether patients with chronic liver disease undergoing invasive procedures or surgery and those having active bleeding require correction of the hemostasis abnormalities. Conventional coagulation screening tests, such as the prothrombin time/international normalized ratio and the activated partial thromboplastin time have been demonstrated to have numerous limitations in these patients and do not predict the risk of bleeding prior to high-risk procedures. The introduction of global coagulation assays, such as viscoelastic testing (VET), has been an important step forward in the assessment of the overall hemostasis profile. A growing body of evidence now suggests that the use of VET might be of significant clinical utility to prevent unnecessary infusion of blood products and to improve outcomes in numerous settings. The present review discusses the advantages and caveats of both conventional and global coagulation assays to assess the risk of bleeding in patients with chronic liver disease as well as the current role of transfusion and hemostatic agents to prevent or manage bleeding.
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Affiliation(s)
- Guillaume Nguyen
- Department of Hematology, Trousseau Hospital, Assistance Publique Hôpitaux de Paris, Paris 75012, France
| | - Manon Lejeune
- Department of Hematology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris 75013, France
| | - Benjamin Crichi
- Department of Internal Medicine, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris, Paris 75010, France
| | - Corinne Frere
- Department of Hematology, Pitié-Salpêtrière Hospital, Assistance Publique Hôpitaux de Paris, Paris 75013, France
- Inserm UMRS_1166, Institute of Cardiometabolism and Nutrition, Sorbonne Université, Paris 75013, France
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147
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Bernstein D, Roth N, Kim A, Epstein M, Hirschwerk D, Kvasnovsky CL, Satapathy SK. Presentation, patterns and predictive value of baseline liver tests on outcomes in COVID-19 patients without chronic liver disease. World J Gastroenterol 2021; 27:7350-7361. [PMID: 34876794 PMCID: PMC8611205 DOI: 10.3748/wjg.v27.i42.7350] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 07/12/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) infection is known to cause abnormal hepatic enzymes. The long term consequences of such elevations are uncertain.
AIM To assessed the prevalence and prognostic value of initial liver enzymes in a large cohort of COVID-19 patients.
METHODS We reviewed electronic medical records of 10614 COVID-19 patients without known chronic liver disease who were admitted to our health system from March 1, 2020, to April 30, 2020. We analyzed baseline demographics and liver chemistries. The primary outcome was in-hospital mortality, and the secondary outcome was a composite of in-hospital mortality or need for mechanical ventilation.
RESULTS Subjects with abnormal liver tests had increased risks of mortality and composite outcome when compared to patients with normal measurements on unadjusted analysis and after adjustment for demographic factors.
CONCLUSION In our diverse patient population, liver enzyme abnormalities are associated with increased mortality and the need for mechanical ventilation in subjects without chronic liver disease. Cholestasis patients are at the greatest risk for poor outcomes.
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Affiliation(s)
- David Bernstein
- Department of Medicine/Hepatology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
| | - Nitzan Roth
- Department of Medicine/Hepatology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
| | - Angela Kim
- Division of Infectious Diseases, Department of Medicine Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
| | - Marcia Epstein
- Division of Infectious Diseases, Department of Medicine Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
| | - David Hirschwerk
- Division of Infectious Diseases, Department of Medicine Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
| | - Charlotte L Kvasnovsky
- Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY 11042, United States
| | - Sanjaya K Satapathy
- Department of Medicine/Hepatology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, United States
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148
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Holmes BB, Russ JB, Wu YW, Gallagher RC, Gano D. Clinical Reasoning: A 2-Day-Old Boy With Sudden Cardiac Arrest and Encephalopathy. Neurology 2021; 97:e1743-e1746. [PMID: 34158382 PMCID: PMC10513875 DOI: 10.1212/wnl.0000000000012408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Brandon B Holmes
- From the Neurology Residency Program (B.B.H.) and Child Neurology Residency Program (J.B.R.), Department of Neurology, University of California San Francisco; and the Departments of Neurology (Y.W.W., D.G.), and Pediatrics (R.C.G., D.G.), University of California San Francisco.
| | - Jeffrey B Russ
- From the Neurology Residency Program (B.B.H.) and Child Neurology Residency Program (J.B.R.), Department of Neurology, University of California San Francisco; and the Departments of Neurology (Y.W.W., D.G.), and Pediatrics (R.C.G., D.G.), University of California San Francisco
| | - Yvonne W Wu
- From the Neurology Residency Program (B.B.H.) and Child Neurology Residency Program (J.B.R.), Department of Neurology, University of California San Francisco; and the Departments of Neurology (Y.W.W., D.G.), and Pediatrics (R.C.G., D.G.), University of California San Francisco
| | - Renata C Gallagher
- From the Neurology Residency Program (B.B.H.) and Child Neurology Residency Program (J.B.R.), Department of Neurology, University of California San Francisco; and the Departments of Neurology (Y.W.W., D.G.), and Pediatrics (R.C.G., D.G.), University of California San Francisco
| | - Dawn Gano
- From the Neurology Residency Program (B.B.H.) and Child Neurology Residency Program (J.B.R.), Department of Neurology, University of California San Francisco; and the Departments of Neurology (Y.W.W., D.G.), and Pediatrics (R.C.G., D.G.), University of California San Francisco
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149
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Tang S, Duan ZP, Zheng SJ. [A brief talk on the diagnostic principle for inherited metabolic liver disease in adult]. Zhonghua Gan Zang Bing Za Zhi 2021; 29:919-922. [PMID: 34814384 DOI: 10.3760/cma.j.cn501113-20210827-00435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
There are many types of inherited metabolic liver diseases, with diverse and non-specific clinical manifestations. Therefore, the problem of misdiagnosis and missed diagnosis is more prominent in clinical practice, and it is a problematic issue encountered by clinicians. The dependency of diagnosis is on comprehensive analysis of clinical manifestations, laboratory, imaging, liver biopsy, and genetic examinations. This article reviews the diagnostic principle for inherited metabolic liver disease in adult.
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Affiliation(s)
- S Tang
- The First Department of Liver Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
| | - Z P Duan
- The Fourth Department of Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing 100069, China
| | - S J Zheng
- The First Department of Liver Center, Beijing You'an Hospital, Capital Medical University, Beijing 100069, China
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150
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Ding Y, Sheng QJ, Dou XG. [Early-stage clinical features, diagnosis and treatment progress of pregnancy-related liver disease]. Zhonghua Gan Zang Bing Za Zhi 2021; 29:923-926. [PMID: 34814385 DOI: 10.3760/cma.j.cn501113-20210829-00436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pregnancy-related liver disease is a group of severe diseases that usually resulting in worsening clinical outcome in pregnant women and fetuses. Therefore, diagnosis and treatment at early-stage are essential. This paper reviews the early-stage clinical features, pathogenesis, diagnosis and treatment key points of common pregnancy-related liver diseases such as hyperemesis gravidarum, intrahepatic cholestasis of pregnancy, hemolysis, elevated liver enzymes and low platelet syndrome, and acute fatty liver of pregnancy, in order to help clinicians, improve their understanding of pregnancy-related liver disease.
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Affiliation(s)
- Y Ding
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, China
| | - Q J Sheng
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, China
| | - X G Dou
- Department of Infectious Diseases, Shengjing Hospital of China Medical University, Shenyang 110022, China
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