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Mehta G, Riva A, Ballester MP, Uson E, Pujadas M, Carvalho-Gomes Â, Sahuco I, Bono A, D’Amico F, Viganò R, Diago E, Lanseros BT, Inglese E, Vazquez DM, Sharma R, Tsou HLP, Harris N, Broekhoven A, Kikkert M, Morales SPT, Myeni SK, Riveiro-Barciela M, Palom A, Zeni N, Brocca A, Cussigh A, Cmet S, Escudero-García D, Stocco M, Natola LA, Ieluzzi D, Paon V, Sangiovanni A, Farina E, di Benedetto C, Sánchez-Torrijos Y, Lucena-Varela A, Román E, Sánchez E, Sánchez-Aldehuelo R, López-Cardona J, Canas-Perez I, Eastgate C, Jeyanesan D, Morocho AE, Di Cola S, Lapenna L, Zaccherini G, Bongiovanni D, Zanaga P, Sayaf K, Hossain S, Crespo J, Robles-Díaz M, Madejón A, Degroote H, Fernández J, Korenjak M, Verhelst X, García-Samaniego J, Andrade RJ, Iruzubieta P, Wright G, Caraceni P, Merli M, Patel VC, Gander A, Albillos A, Soriano G, Donato MF, Sacerdoti D, Toniutto P, Buti M, Duvoux C, Grossi PA, Berg T, Polak WG, Puoti M, Bosch-Comas A, Belli L, Burra P, Russo FP, Coenraad M, Calleja JL, Perricone G, Berenguer M, Claria J, Moreau R, Arroyo V, Angeli P, Sánchez C, Ampuero J, Piano S, Chokshi S, Jalan R. Serological response and breakthrough infection after COVID-19 vaccination in patients with cirrhosis and post-liver transplant. Hepatol Commun 2023; 7:e0273. [PMID: 37870985 PMCID: PMC10586829 DOI: 10.1097/hc9.0000000000000273] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/21/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Vaccine hesitancy and lack of access remain major issues in disseminating COVID-19 vaccination to liver patients globally. Factors predicting poor response to vaccination and risk of breakthrough infection are important data to target booster vaccine programs. The primary aim of the current study was to measure humoral responses to 2 doses of COVID-19 vaccine. Secondary aims included the determination of factors predicting breakthrough infection. METHODS COVID-19 vaccination and Biomarkers in cirrhosis And post-Liver Transplantation is a prospective, multicenter, observational case-control study. Participants were recruited at 4-10 weeks following first and second vaccine doses in cirrhosis [n = 325; 94% messenger RNA (mRNA) and 6% viral vaccine], autoimmune liver disease (AILD) (n = 120; 77% mRNA and 23% viral vaccine), post-liver transplant (LT) (n = 146; 96% mRNA and 3% viral vaccine), and healthy controls (n = 51; 72% mRNA, 24% viral and 4% heterologous combination). Serological end points were measured, and data regarding breakthrough SARS-CoV-2 infection were collected. RESULTS After adjusting by age, sex, and time of sample collection, anti-Spike IgG levels were the lowest in post-LT patients compared to cirrhosis (p < 0.0001), AILD (p < 0.0001), and control (p = 0.002). Factors predicting reduced responses included older age, Child-Turcotte-Pugh B/C, and elevated IL-6 in cirrhosis; non-mRNA vaccine in AILD; and coronary artery disease, use of mycophenolate and dysregulated B-call activating factor, and lymphotoxin-α levels in LT. Incident infection occurred in 6.6%, 10.6%, 7.4%, and 15.6% of cirrhosis, AILD, post-LT, and control, respectively. The only independent factor predicting infection in cirrhosis was low albumin level. CONCLUSIONS LT patients present the lowest response to the SARS-CoV-2 vaccine. In cirrhosis, the reduced response is associated with older age, stage of liver disease and systemic inflammation, and breakthrough infection with low albumin level.
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Affiliation(s)
- Gautam Mehta
- Institute for Liver and Digestive Heath, University College London, London, UK
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Royal Free London NHS Foundation Trust, London, UK
| | - Antonio Riva
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Maria Pilar Ballester
- Department of Gastroenterology and Hepatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Eva Uson
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Montserrat Pujadas
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Ângela Carvalho-Gomes
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Ivan Sahuco
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Ariadna Bono
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Federico D’Amico
- ASST Grande Ospedale Metropolitano Niguarda, Infectious Diseases Unit, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy
| | - Raffaela Viganò
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
| | - Elena Diago
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain
- Central Unit of Clinical Research and Clinical Trials, Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBERehd, Madrid, Spain
| | - Beatriz Tormo Lanseros
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain
- CIBERehd, Madrid, Spain
| | - Elvira Inglese
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | - Rajni Sharma
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Hio Lam Phoebe Tsou
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Nicola Harris
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
| | - Annelotte Broekhoven
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Marjolein Kikkert
- Department of Medical Microbiology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Shessy P. Torres Morales
- Department of Medical Microbiology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - Sebenzile K. Myeni
- Department of Medical Microbiology, Leiden University Medical Center, RC Leiden, the Netherlands
| | | | - Adriana Palom
- Liver Unit, Hospital Universitario Valle de Hebron, Barcelona, Spain
| | - Nicola Zeni
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Alessandra Brocca
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Annarosa Cussigh
- Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, University of Udine, Udine, Italy
| | - Sara Cmet
- Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, University of Udine, Udine, Italy
| | | | - Matteo Stocco
- Department of Gastroenterology and Hepatology, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | | | - Veronica Paon
- Azienda Ospedaiera Universitaria Integrata Verona, Verona Italy
| | - Angelo Sangiovanni
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Elisa Farina
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Clara di Benedetto
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - Yolanda Sánchez-Torrijos
- Hospital Universitario Virgen del Rocio, Sevilla. Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Sevilla, Spain
| | - Ana Lucena-Varela
- Hospital Universitario Virgen del Rocio, Sevilla. Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Sevilla, Spain
| | - Eva Román
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- EUI-Sant Pau School of Nursing, Barcelona, Spain
| | - Elisabet Sánchez
- CIBERehd, Madrid, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Rubén Sánchez-Aldehuelo
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, Spain
- Universidad de Alcalá, Madrid, Spain
| | - Julia López-Cardona
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, Spain
| | | | | | - Dhaarica Jeyanesan
- Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK
| | | | - Simone Di Cola
- Department of Translational and Precision Medicine, University of Rome Sapienza, Roma, Italy
| | - Lucia Lapenna
- Department of Translational and Precision Medicine, University of Rome Sapienza, Roma, Italy
| | - Giacomo Zaccherini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Deborah Bongiovanni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Paola Zanaga
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Katia Sayaf
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Sabir Hossain
- Mid & South Essex NHS Foundation Trust, Basildon, UK
| | - Javier Crespo
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
- Clinical and Traslational Digestive Research Group, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Mercedes Robles-Díaz
- CIBERehd, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Antonio Madejón
- Liver Unit, Hospital Universitario La Paz, CIBERehd, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Helena Degroote
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Belgium
- Liver Research Center Ghent, Ghent University, Belgium
- European Reference Network (ERN)RARE-LIVER
| | - Javier Fernández
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
- Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS) and Centro de Investigación Biomèdica en Red (CIBEREHD), Barcelona, Spain
| | | | - Xavier Verhelst
- Department of Gastroenterology and Hepatology, Ghent University Hospital, Belgium
- Liver Research Center Ghent, Ghent University, Belgium
- European Reference Network (ERN)RARE-LIVER
| | - Javier García-Samaniego
- Liver Unit, Hospital Universitario La Paz, CIBERehd, IdiPAZ, Universidad Autónoma de Madrid, Madrid, Spain
| | - Raúl J. Andrade
- CIBERehd, Madrid, Spain
- Servicio de Aparato Digestivo, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Paula Iruzubieta
- Gastroenterology and Hepatology Department, Marqués de Valdecilla University Hospital, Santander, Spain
- Clinical and Traslational Digestive Research Group, Instituto de Investigación Sanitaria Valdecilla (IDIVAL), Santander, Spain
| | - Gavin Wright
- Mid & South Essex NHS Foundation Trust, Basildon, UK
| | - Paolo Caraceni
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
- Unit of Semeiotics, Liver and Alcohol-related Diseases, Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Manuela Merli
- Department of Translational and Precision Medicine, University of Rome Sapienza, Roma, Italy
| | - Vishal C Patel
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
- Institute of Liver Studies, King’s College Hospital NHS Foundation Trust, London, UK
| | - Amir Gander
- Royal Free London NHS Foundation Trust, London, UK
| | - Agustín Albillos
- Servicio de Gastroenterología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Salud Carlos III, Madrid, Spain
| | - Germán Soriano
- CIBERehd, Madrid, Spain
- Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Francesca Donato
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Division of Gastroenterology and Hepatology, Milan, Italy
| | - David Sacerdoti
- Azienda Ospedaiera Universitaria Integrata Verona, Verona Italy
| | - Pierluigi Toniutto
- Hepatology and Liver Transplantation Unit, Azienda Sanitaria Universitaria Integrata, University of Udine, Udine, Italy
| | - Maria Buti
- Liver Unit, Hospital Universitario Valle de Hebron, Barcelona, Spain
| | - Christophe Duvoux
- Department of Hepatogy-Liver Transplant Unit, Henri Mondor Hospital-APHP, Paris Est University, Paris, France
| | - Paolo Antonio Grossi
- Department of Medicine and Surgery, University of Insubria, Infectious and Tropical Diseases Unit, ASST Sette Laghim, Varese, Italy
| | - Thomas Berg
- European Association for the Study of the Liver (EASL)
| | - Wojciech G. Polak
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Massimo Puoti
- University of Milano Bicocca, Infectious Diseases Niguarda Great Metropolitan Hospital, Milan, Italy
| | - Anna Bosch-Comas
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Luca Belli
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
| | - Patrizia Burra
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Francesco Paolo Russo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Gastroenterology and Multivisceral Transplant Units, Azienda Ospedale Università’ di Padova, Padova, Italy
| | - Minneke Coenraad
- Department of Gastroenterology and Hepatology, Leiden University Medical Center, RC Leiden, the Netherlands
| | - José Luis Calleja
- Department of Gastroenterology and Hepatology, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHIM, Madrid, Spain
- CIBERehd, Madrid, Spain
| | - Giovanni Perricone
- ASST Grande Ospedale Metropolitano Niguarda, Hepatology and Gastroenterology Unit, Milan, Italy
| | - Marina Berenguer
- Hepatology, HBP Surgery and Transplantation, Hepatology & Liver Transplant Unit, La Fe University Hospital, Valencia, Spain
- Ciberehd, Universidad de Valencia, Valencia, Spain
| | - Joan Claria
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
- Hospital Clínic, Institut d’Investigacions Biomèdiques August Pi-Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red (CIBERehd) and Universitat de Barcelona, Barcelona, Spain
| | - Richard Moreau
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
- INSERM and Université Paris Cité, Centre de Recherche sur l’inflammation (CRI), Paris, France
- APHP, Service d’hépatologie, Hôpital Beaujon, Clichy, France
| | - Vicente Arroyo
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Paolo Angeli
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Cristina Sánchez
- European Foundation for the Study of Chronic Liver Failure (EF CLIF), EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain
| | - Javier Ampuero
- Hospital Universitario Virgen del Rocio, Sevilla. Instituto de Biomedicina de Sevilla, Universidad de Sevilla, Sevilla, Spain
| | - Salvatore Piano
- Department of Medicine - DIMED, Unit of Internal Medicine and Hepatology (UIMH), University of Padova, Padova, Italy
| | - Shilpa Chokshi
- The Roger Williams Institute of Hepatology, Foundation for Liver Research, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Rajiv Jalan
- Institute for Liver and Digestive Heath, University College London, London, UK
- Royal Free London NHS Foundation Trust, London, UK
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Riva S, Kabir Z, Biscoe N, O'Sullivan G, Soriano G, Penalvo J. Research ethics with real-world data (RWD) on COVID-19 infections: the unCoVer study. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac130.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Issue
The aim of the Horizon 2020 unCoVer project (Unravelling Data for Rapid Evidence-Based Response to COVID-19) is to coordinate research expertise in utilising Real World Data (RWD) to investigate the underlying risk factors for COVID-19 infection and severity, the effectiveness of treatments and the impact on health systems. RWD is particularly useful in a dynamic health context as it is relevant, timely, and more ecologically valid. Pooling clinical databases and integrating epidemiological principles and powerful biostatistical tools optimises resources and fully exploits routinely-collected data.
Description of the problem
RWD sharing poses new practical and ethical challenges to research. The unCoVer network has developed a federated data platform to access diverse databases for advanced analytics. This data access process entails GDPR, and regulatory and ethical nuances. The use of large-scale data from heterogeneous sources across multiple jurisdictions for research purposes presents a complex systems challenge.
Effects & Lessons
A dedicated team of unCoVer network members is responsible for addressing these challenges. Here, we describe the ethical and regulatory aspects of RWD sources, the role of the Data Protection Authorities and the Data Protection External Authority Board (DP-EAB) of the Uncover project, and the documentation involved, including a data processing agreement and a data transfer agreement. We provide an overview of the main principles for sharing RWD whilst maintaining integrity and security and how this translates into procedures to protect the rights, security, and well-being of human research participants. This represents a practical framework for researchers.
Key messages
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Affiliation(s)
- S Riva
- St. Mary's University, Twickenham , London, UK
| | - Z Kabir
- University College of Cork , Cork, Ireland
| | - N Biscoe
- St. Mary's University, Twickenham , London, UK
| | | | - G Soriano
- Institute of Tropical Medicine , Antwerp, Belgium
| | - J Penalvo
- Institute of Tropical Medicine , Antwerp, Belgium
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Jiménez C, Ventura-Cots M, Sala M, Calafat M, Garcia-Retortillo M, Cirera I, Cañete N, Soriano G, Poca M, Simón-Talero M, Altamirano J, Lucey M, Garcia-Tsao G, Brown RS, Schwabe RF, Verna EC, Schnabl B, Bosques-Padilla F, Mathurin P, Caballería J, Louvet A, Shawcross DL, Abraldes JG, Genescà J, Bataller R, Vargas V. Effect of rifaximin on infections, acute-on-chronic liver failure and mortality in alcoholic hepatitis: A pilot study (RIFA-AH). Liver Int 2022; 42:1109-1120. [PMID: 35220659 PMCID: PMC9311407 DOI: 10.1111/liv.15207] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/31/2022] [Accepted: 02/15/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND & AIMS Alcoholic hepatitis (AH) is associated with a high incidence of infection and mortality. Rifaximin reduces bacterial overgrowth and translocation. We aimed to study whether the administration of rifaximin as an adjuvant treatment to corticosteroids decreases the number of bacterial infections at 90 days in patients with severe AH compared to a control cohort. METHODS This was a multicentre, open, comparative pilot study of the addition of rifaximin (1200 mg/day/90 days) to the standard treatment for severe AH. The results were compared with a carefully matched historical cohort of patients treated with standard therapy and matching by age and model of end-stage liver disease (MELD). We evaluated bacterial infections, liver-related complications, mortality and liver function tests after 90 days. RESULTS Twenty-one and 42 patients were included in the rifaximin and control groups respectively. No significant baseline differences were found between groups. The mean number of infections per patient was 0.29 and 0.62 in the rifaximin and control groups, respectively (p = .049), with a lower incidence of acute-on-chronic liver failure (ACLF) linked to infections within the treatment group. Liver-related complications were lower within the rifaximin group (0.43 vs. 1.26 complications/patient respectively) (p = .01). Mortality was lower in the treated versus the control groups (14.2% vs. 30.9, p = .15) without significant differences. No serious adverse events were associated with rifaximin treatment. CONCLUSIONS Rifaximin is safe in severe AH with a significant reduction in clinical complications. A lower number of infections and a trend towards a lower ACLF and mortality favours its use in these patients.
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Affiliation(s)
- César Jiménez
- Vall d'Hebron Hospital Universitari, Liver Unit; Vall d'Hebron Institut de Recerca, Liver Unit, Universitat Autonoma de Barcelona, Department of Medicine, Barcelona, Spain
| | - Meritxell Ventura-Cots
- Vall d'Hebron Hospital Universitari, Liver Unit; Vall d'Hebron Institut de Recerca, Liver Unit, Universitat Autonoma de Barcelona, Department of Medicine, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Margarita Sala
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Margalida Calafat
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Gastroenterology Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain
| | - Montserrat Garcia-Retortillo
- Liver Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Isabel Cirera
- Liver Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nuria Cañete
- Liver Section, Gastroenterology Department, Hospital del Mar, IMIM (Hospital del Mar Medical Research Institute), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Germán Soriano
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Barcelona Spain, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Gastroenterology, Barcelona, Catalunya, ES, Universitat Autonoma de Barcelona, Medicine, Barcelona, Catalunya, Spain
| | - María Poca
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Barcelona Spain, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Gastroenterology, Barcelona, Catalunya, ES, Universitat Autonoma de Barcelona, Medicine, Barcelona, Catalunya, Spain
| | - Macarena Simón-Talero
- Vall d'Hebron Hospital Universitari, Liver Unit; Vall d'Hebron Institut de Recerca, Liver Unit, Universitat Autonoma de Barcelona, Department of Medicine, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - José Altamirano
- Department of Internal Medicine, Hospital Quironsalud, Barcelona, Spain
| | - Michael Lucey
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Guadalupe Garcia-Tsao
- Section of Digestive Diseases, Yale University, New Haven, Connecticut Section of Digestive Diseases, Department of Veterans Affairs Connecticut Healthcare, West Haven, Connecticut, USA
| | - Robert S Brown
- Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York City, New York, USA
| | - Robert F Schwabe
- Department of Medicine, Columbia University, New York City, New York, USA
| | - Elizabeth C Verna
- Center for Liver Disease and Transplantation, Columbia University Irving Medical Center, New York City, New York, USA
| | - Bernd Schnabl
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | | | - Philippe Mathurin
- Service des Maladies de L'appareil Digestif et Unité INSERM U995, Lille, France
| | - Juan Caballería
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain.,Liver Unit, Hospital Clinic, Barcelona, Spain
| | - Alexandre Louvet
- Service des Maladies de L'appareil Digestif et Unité INSERM U995, Lille, France
| | - Debbie L Shawcross
- Department of Inflammation Biology, School of Immunology and Microbial Sciences, Institute of Liver Sciences, King's College London, London, UK
| | - Juan G Abraldes
- Division of Gastroenterology, Liver Unit, University of Alberta, Edmonton, Canada
| | - Joan Genescà
- Vall d'Hebron Hospital Universitari, Liver Unit; Vall d'Hebron Institut de Recerca, Liver Unit, Universitat Autonoma de Barcelona, Department of Medicine, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Ramon Bataller
- Center for Liver Diseases, Pittsburgh Liver Research Center, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Víctor Vargas
- Vall d'Hebron Hospital Universitari, Liver Unit; Vall d'Hebron Institut de Recerca, Liver Unit, Universitat Autonoma de Barcelona, Department of Medicine, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
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Gallego-Durán R, Albillos A, Ampuero J, Arechederra M, Bañares R, Blas-García A, Berná G, Caparrós E, Delgado TC, Falcón-Pérez JM, Francés R, Fernández-Barrena MG, Graupera I, Iruzubieta P, Nevzorova YA, Nogueiras R, Macías RIR, Marín F, Sabio G, Soriano G, Vaquero J, Cubero FJ, Gracia-Sancho J. Metabolic-associated fatty liver disease: from simple steatosis towards liver cirrhosis and potential complications. Proceedings of the Third Translational Hepatology Meeting, endorsed by the Spanish Association for the Study of the Liver (AEEH). Gastroenterología y Hepatología 2022; 45:724-734. [DOI: 10.1016/j.gastrohep.2022.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
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5
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Ampuero J, Aller R, Gallego-Durán R, Crespo J, Abad J, González-Rodríguez Á, Gómez-Camarero J, Caballería J, Lo Iacono O, Ibañez L, García-Samaniego J, Martín-Mateos R, Francés R, Fernández-Rodríguez C, Diago M, Soriano G, Andrade RJ, Latorre R, Jorquera F, Morillas RM, Escudero D, Estévez P, Hernández-Guerra M, Augustín S, Pareja-Megia MJ, Banales JM, Aspichueta P, Benlloch S, Rosales JM, Salmerón J, Turnes J, Romero-Gómez M. Definite and indeterminate nonalcoholic steatohepatitis share similar clinical features and prognosis: A longitudinal study of 1893 biopsy-proven nonalcoholic fatty liver disease subjects. Liver Int 2021; 41:2076-2086. [PMID: 33896100 DOI: 10.1111/liv.14898] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/01/2021] [Accepted: 04/06/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIM Histological score systems may not fully capture the essential nonalcoholic steatohepatitis (NASH) features, which is one of the leading causes of screening failure in clinical trials. We assessed the NASH distribution and its components across the fibrosis stages and their impact on the prognosis and their relationship with the concept of metabolic-associated fatty liver disease (MAFLD). METHODS Spanish multicenter study including 1893 biopsy-proven nonalcoholic fatty liver disease (NAFLD) patients from HEPAmet registry. NASH was diagnosed by NAS score ≥4 (including steatosis, ballooning and lobular inflammation) and fibrosis by Kleiner score. The presence of MAFLD was determined. Progression to cirrhosis, first episode of decompensated cirrhosis and death were collected during the follow-up (4.7 ± 3.8 years). RESULTS Fibrosis was F0 34.3% (649/1893), F1 27% (511/1893), F2 16.5% (312/1893), F3 15% (284/1893) and F4 7.2% (137/1893). NASH diagnosis 51.9% (982/1893), and its individual components (severe steatosis, ballooning and lobular inflammation), increased from F0 (33.6%) to F2 (68.6%), and decreased significantly in F4 patients (51.8%) (P = .0001). More than 70% of non-NASH patients showed some inflammatory activity (ballooning or lobular inflammation), showing a similar MAFLD rate than NASH (96.2% [945/982] vs. 95.2% [535/562]) and significantly higher than nonalcoholic fatty liver (NAFL) subjects (89.1% [311/349]) (P < .0001). Progression to cirrhosis was similar between NASH (9.5% [51/539]) and indeterminate NASH (7.9% [25/316]), and higher than steatosis (5% [14/263]) (logRank 8.417; P = .015). Death and decompensated cirrhosis were similar between these. CONCLUSIONS The prevalence of steatohepatitis decreased in advanced liver disease. However, most of these patients showed some inflammatory activity histologically and had metabolic disturbances. These findings should be considered in clinical trials whose main aim is to prevent cirrhosis progression and complications, liver transplant and death.
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Affiliation(s)
- Javier Ampuero
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain.,SeLiver Group, Instituto de Biomedicina de Sevilla, Seville, Spain.,CIBERehd, Madrid, Spain
| | - Rocío Aller
- Centro de Investigación de Endocrinología y Nutrición, Hospital Clínico Universitario de Valladolid, Universidad de Valladolid, Valladolid, Spain
| | - Rocío Gallego-Durán
- SeLiver Group, Instituto de Biomedicina de Sevilla, Seville, Spain.,CIBERehd, Madrid, Spain
| | - Javier Crespo
- Digestive Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - Javier Abad
- Digestive Department, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Águeda González-Rodríguez
- Liver Research Unit, Hospital Universitario Santa Cristina Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | - Joan Caballería
- CIBERehd, Madrid, Spain.,Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBPAS), Barcelona, Spain
| | - Oreste Lo Iacono
- Digestive Department, Hospital Universitario Tajo, Aranjuez, Spain
| | - Luis Ibañez
- CIBERehd, Madrid, Spain.,Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | - Rosa Martín-Mateos
- CIBERehd, Madrid, Spain.,Digestive Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rubén Francés
- CIBERehd, Madrid, Spain.,Hospital General Universitario de Alicante, Universidad Miguel Hernández, Elche, Spain
| | | | - Moisés Diago
- Digestive Department, Hospital General Universitario de Valencia, Valencia, Spain
| | - Germán Soriano
- CIBERehd, Madrid, Spain.,Digestive Department, Hospital de la Santa Creu i San Pau, Barcelona, Spain
| | - Raúl J Andrade
- CIBERehd, Madrid, Spain.,Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | - Raquel Latorre
- Digestive Department, Hospital Universitari Son Llátzer, Mallorca, Spain
| | - Francisco Jorquera
- CIBERehd, Madrid, Spain.,Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED, León, Spain
| | - Rosa M Morillas
- CIBERehd, Madrid, Spain.,Digestive Department, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Desam Escudero
- Hospital Clínico Universitario de Valencia, Universitat de València, Valencia, Spain
| | - Pamela Estévez
- Digestive Department, Complejo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | | | - Jesús M Banales
- CIBERehd, Madrid, Spain.,Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute-Donostia University Hospital, University of the Basque Country (UPV/EHU), Ikerbasque, San Sebastian, Spain
| | - Patricia Aspichueta
- CIBERehd, Madrid, Spain.,Department of Physiology, Faculty of Medicine and Nursing, Biocruces Research Institute, University of Basque Country UPV/EHU, Leioa, Spain
| | - Salvador Benlloch
- CIBERehd, Madrid, Spain.,Digestive Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Javier Salmerón
- Digestive Department, Hospital Universitario San Cecilio, Granada, Spain
| | - Juan Turnes
- Digestive Department, Complejo Hospitalario de Pontevedra, Pontevedra, Spain
| | - Manuel Romero-Gómez
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Seville, Spain.,SeLiver Group, Instituto de Biomedicina de Sevilla, Seville, Spain.,CIBERehd, Madrid, Spain
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6
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Fajardo J, Núñez E, Szafranska J, Poca M, Lobo D, Martín B, Hernández D, Roig C, Huerta A, Corominas H, Sánchez‐Cabús S, Soriano G. We report a patient who presented intrahepatic cholangitis and cholecystitis after SARS-CoV-2 infection. J Gastroenterol Hepatol 2021; 36:2037. [PMID: 34105805 PMCID: PMC8242606 DOI: 10.1111/jgh.15537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 12/09/2022]
Affiliation(s)
- J Fajardo
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - E Núñez
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - J Szafranska
- Department of PathologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - M Poca
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - D Lobo
- Department of RheumatologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - B Martín
- Department of SurgeryHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - D Hernández
- Department of RadiologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - C Roig
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - A Huerta
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - H Corominas
- Department of RheumatologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - S Sánchez‐Cabús
- Department of SurgeryHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain
| | - G Soriano
- Department of GastroenterologyHospital de la Santa Creu i Sant Pau, Autonomous University of BarcelonaBarcelonaSpain,CIBERehd, Instituto de Salud Carlos IIIMadridSpain
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7
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Trebicka J, Fernandez J, Papp M, Caraceni P, Laleman W, Gambino C, Giovo I, Uschner FE, Jansen C, Jimenez C, Mookerjee R, Gustot T, Albillos A, Bañares R, Jarcuska P, Steib C, Reiberger T, Acevedo J, Gatti P, Shawcross DL, Zeuzem S, Zipprich A, Piano S, Berg T, Bruns T, Danielsen KV, Coenraad M, Merli M, Stauber R, Zoller H, Ramos JP, Solé C, Soriano G, de Gottardi A, Gronbaek H, Saliba F, Trautwein C, Kani HT, Francque S, Ryder S, Nahon P, Romero-Gomez M, Van Vlierberghe H, Francoz C, Manns M, Garcia-Lopez E, Tufoni M, Amoros A, Pavesi M, Sanchez C, Praktiknjo M, Curto A, Pitarch C, Putignano A, Moreno E, Bernal W, Aguilar F, Clària J, Ponzo P, Vitalis Z, Zaccherini G, Balogh B, Gerbes A, Vargas V, Alessandria C, Bernardi M, Ginès P, Moreau R, Angeli P, Jalan R, Arroyo V, Semela D, Elkrief L, Elsharkawy A, Tornai T, Tornai I, Altorjay I, Antognoli A, Baldassarre M, Gagliardi M, Bertoli E, Mareso S, Brocca A, Campion D, Saracco GM, Rizzo M, Lehmann J, Pohlmann A, Brol MJ, Chang J, Schierwagen R, Solà E, Amari N, Rodriguez M, Nevens F, Clemente A, Janicko M, Markwardt D, Mandorfer M, Welsch C, Welzel TM, Ciraci E, Patel V, Ripoll C, Herber A, Horn P, Bendtsen F, Gluud LL, Schaapman J, Riggio O, Rainer F, Moritz JT, Mesquita M, Alvarado-Tapias E, Akpata O, Aamann L, Samuel D, Tresson S, Strnad P, Amathieu R, Simón-Talero M, Smits F, van den Ende N, Martinez J, Garcia R, Rupprechter H, Engelmann C, Özdogan OC. PREDICT identifies precipitating events associated with the clinical course of acutely decompensated cirrhosis. J Hepatol 2021; 74:1097-1108. [PMID: 33227350 DOI: 10.1016/j.jhep.2020.11.019] [Citation(s) in RCA: 125] [Impact Index Per Article: 41.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Acute decompensation (AD) of cirrhosis may present without acute-on-chronic liver failure (ACLF) (AD-No ACLF), or with ACLF (AD-ACLF), defined by organ failure(s). Herein, we aimed to analyze and characterize the precipitants leading to both of these AD phenotypes. METHODS The multicenter, prospective, observational PREDICT study (NCT03056612) included 1,273 non-electively hospitalized patients with AD (No ACLF = 1,071; ACLF = 202). Medical history, clinical data and laboratory data were collected at enrolment and during 90-day follow-up, with particular attention given to the following characteristics of precipitants: induction of organ dysfunction or failure, systemic inflammation, chronology, intensity, and relationship to outcome. RESULTS Among various clinical events, 4 distinct events were precipitants consistently related to AD: proven bacterial infections, severe alcoholic hepatitis, gastrointestinal bleeding with shock and toxic encephalopathy. Among patients with precipitants in the AD-No ACLF cohort and the AD-ACLF cohort (38% and 71%, respectively), almost all (96% and 97%, respectively) showed proven bacterial infection and severe alcoholic hepatitis, either alone or in combination with other events. Survival was similar in patients with proven bacterial infections or severe alcoholic hepatitis in both AD phenotypes. The number of precipitants was associated with significantly increased 90-day mortality and was paralleled by increasing levels of surrogates for systemic inflammation. Importantly, adequate first-line antibiotic treatment of proven bacterial infections was associated with a lower ACLF development rate and lower 90-day mortality. CONCLUSIONS This study identified precipitants that are significantly associated with a distinct clinical course and prognosis in patients with AD. Specific preventive and therapeutic strategies targeting these events may improve outcomes in patients with decompensated cirrhosis. LAY SUMMARY Acute decompensation (AD) of cirrhosis is characterized by a rapid deterioration in patient health. Herein, we aimed to analyze the precipitating events that cause AD in patients with cirrhosis. Proven bacterial infections and severe alcoholic hepatitis, either alone or in combination, accounted for almost all (96-97%) cases of AD and acute-on-chronic liver failure. Whilst the type of precipitant was not associated with mortality, the number of precipitant(s) was. This study identified precipitants that are significantly associated with a distinct clinical course and prognosis of patients with AD. Specific preventive and therapeutic strategies targeting these events may improve patient outcomes.
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Affiliation(s)
- Jonel Trebicka
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany.
| | - Javier Fernandez
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Maria Papp
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | | | - Wim Laleman
- Department of Gastroenterology and Hepatology, Section of Liver and Biliopancreatic disorders, University of Leuven, Leuven, Belgium
| | | | - Ilaria Giovo
- A.O.U. Città della Salute e della Scienza Torino, Torino, Italy
| | - Frank Erhard Uschner
- Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany
| | - Christian Jansen
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Cesar Jimenez
- Liver Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | | | | | - Agustin Albillos
- Department of Gastroenterology, Hospital Universitario Ramón y Cajal, IRYCIS, University of Alcalá, CIBEREHD, Madrid, Spain
| | - Rafael Bañares
- Hospital General Universitario Gregorio Marañón. Facultad de Medicina (Universidad Complutense of Madrid), CIBERehd, Madrid, Spain
| | - Peter Jarcuska
- Pavol Jozef Safarik University in Kosice, Kosice, Slovakia
| | - Christian Steib
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU, Munich, Germany
| | | | - Juan Acevedo
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Pietro Gatti
- Internal Medicine PO Ostuni, ASL Brindisi, Italy
| | | | - Stefan Zeuzem
- Department of Internal Medicine I, Goethe University Frankfurt, Frankfurt, Germany
| | | | | | - Thomas Berg
- Division of Hepatology, Department of Medicine II, Leipzig University, Medical Center, Leipzig, Germany
| | - Tony Bruns
- Jena University Hospital, Jena, Germany; Aachen University Hospital, Aachen, Germany
| | - Karen Vagner Danielsen
- Gastrounit, Medical Section, Hvidovre Hospital and Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | - Heinz Zoller
- Medical University of Innsbruck, Innsbruck, Austria
| | | | - Cristina Solé
- Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Germán Soriano
- Hospital de la Santa Creu i Sant Pau and CIBERehd, Barcelona, Spain
| | - Andrea de Gottardi
- University Clinic of Visceral Surgery and Medicine-Inselspital, Bern and Ente Ospedaliero Cantonale, Universita della Svizzera Italiana, Lugano, Switzerland
| | | | - Faouzi Saliba
- AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Universite Paris Saclay, INSERM Unit 1193, Villejuif, France
| | | | | | | | - Stephen Ryder
- NIHR Biomedical Research Centre at Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | - Pierre Nahon
- AP-HP, Hôpital Jean Verdier, Service d'Hépatologie, Bondy, France; Université Paris 13, Sorbonne Paris Cité, "Equipe labellisée Ligue Contre le Cancer", Saint-Denis, France; Inserm, UMR-1162, "Génomique fonctionnelle des tumeurs solides", Paris, France
| | | | | | - Claire Francoz
- APHP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France; Inserm, Université de Paris, Centre de Recherche sur L´Inflammation, Paris, France
| | | | | | | | - Alex Amoros
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Marco Pavesi
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Cristina Sanchez
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Michael Praktiknjo
- Department of Internal Medicine I, University Hospital Bonn, Bonn, Germany
| | - Anna Curto
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Carla Pitarch
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | | | - Esau Moreno
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | | | - Ferran Aguilar
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
| | - Joan Clària
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Paola Ponzo
- A.O.U. Città della Salute e della Scienza Torino, Torino, Italy
| | - Zsuzsanna Vitalis
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | | | - Boglarka Balogh
- University of Debrecen, Faculty of Medicine, Institute of Medicine, Department of Gastroenterology, Debrecen, Hungary
| | - Alexander Gerbes
- Department of Medicine II, Liver Centre Munich, University Hospital, LMU, Munich, Germany
| | - Victor Vargas
- Liver Unit, Hospital Vall d'Hebron, Universitat Autònoma de Barcelona, CIBEREHD, Barcelona, Spain
| | | | | | - Pere Ginès
- Hospital Clinic of Barcelona, University of Barcelona, CIBEReHD, IDIBAPS, Barcelona, Spain
| | - Richard Moreau
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; APHP, Hôpital Beaujon, Service d'Hépatologie, Clichy, France; Inserm, Université de Paris, Centre de Recherche sur L´Inflammation, Paris, France
| | - Paolo Angeli
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; University of Padova, Padova, Italy
| | - Rajiv Jalan
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain; UCL Medical School,Royal Free Hospital, London, UK
| | - Vicente Arroyo
- European Foundation for Study of Chronic Liver Failure, EF-Clif, Barcelona, Spain
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Sourdet S, Soriano G, Delrieu J, Steinmeyer Z, Guyonnet S, Saint-Aubert L, Payoux P, Ousset PJ, Ghisolfi A, Chicoulaa B, Dardenne S, Gemar T, Baziard M, Guerville F, Andrieu S, Vellas B. Cognitive Function and Amyloid Marker in Frail Older Adults: The COGFRAIL Cohort Study. J Frailty Aging 2021; 10:160-167. [PMID: 33575706 DOI: 10.14283/jfa.2020.57] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Frailty and cognitive impairment are common manifestations of the ageing process and are closely related. But the mechanisms linking aging, physical frailty, and cognitive disorders, are complex and remain unclear. OBJECTIVES We aim to explore the role of cerebral amyloid pathology, but also a range of nutritional, physical, biological or brain-aging marker in the development of cognitive frailty. METHOD COGFRAIL study is a monocentric prospective study of frail older patients with an objective cognitive impairment (Clinical Dementia Rating Scale global score at 0.5 or 1). Three-hundred-and-twenty-one patients are followed up every 6 months, for 2 years. Clinical assessment at baseline and during follow-up included frailty, physical, mood, sensory, nutritional, and cognitive assessment (with a set of neuropsychological tests). Cerebral amyloid pathology is measured by amyloid Positron Emission Tomography (PET) or amyloid-β-1-42 level in cerebrospinal fluid. Brain magnetic resonance imaging, measurement of body composition using Dual X Ray Absorptiometry and blood sampling are performed. The main outcome of the study is to assess the prevalence of positive cerebral amyloid status according to amyloid PET or amyloid-β-1-42 level CSF. Secondary outcomes included biological, nutritional, MRI imaging, cognitive, clinical, physical and body composition markers to better understand the mechanisms of cognitive frailty. PERSPECTIVE COGFRAIL study will give the opportunity to better understand the link between Gerosciences, frailty, cognitive impairment, and Alzheimer's disease, and to better characterize the physical and cognitive trajectories of frail older adults according to their amyloid status. Understanding the relationship between physical frailty and cognitive impairment is a prerequisite for the development of new interventions that could prevent and treat both conditions.
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Affiliation(s)
- S Sourdet
- Sandrine Sourdet, MD - Hôpital de jour d'évaluation des fragilités, Service de Médecine Interne et Gérontologie Clinique, La Cité de la Santé, Hôpital La Grave, Place Lange, TSA 60033, 31059 Toulouse cedex 9, France, Phone: (33) 5 61 77 79 29, Fax: (33) 5 61 77 79 27, E-mail:
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9
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Jyväkorpi SK, Ramel A, Strandberg TE, Piotrowicz K, Błaszczyk-Bębenek E, Urtamo A, Rempe HM, Geirsdóttir Ó, Vágnerová T, Billot M, Larreur A, Savera G, Soriano G, Picauron C, Tagliaferri S, Sanchez-Puelles C, Cadenas VS, Perl A, Tirrel L, Öhman H, Weling-Scheepers C, Ambrosi S, Costantini A, Pavelková K, Klimkova M, Freiberger E, Jonsson PV, Marzetti E, Pitkälä KH, Landi F, Calvani R. The sarcopenia and physical frailty in older people: multi-component treatment strategies (SPRINTT) project: description and feasibility of a nutrition intervention in community-dwelling older Europeans. Eur Geriatr Med 2021; 12:303-312. [PMID: 33583000 PMCID: PMC7990826 DOI: 10.1007/s41999-020-00438-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/09/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The "Sarcopenia and Physical Frailty in Older People: Multicomponent Treatment Strategies" (SPRINTT) project sponsored a multi-center randomized controlled trial (RCT) with the objective to determine the effect of physical activity and nutrition intervention for prevention of mobility disability in community-dwelling frail older Europeans. We describe here the design and feasibility of the SPRINTT nutrition intervention, including techniques used by nutrition interventionists to identify those at risk of malnutrition and to carry out the nutrition intervention. METHODS SPRINTT RCT recruited older adults (≥ 70 years) from 11 European countries. Eligible participants (n = 1517) had functional limitations measured with Short Physical Performance Battery (SPPB score 3-9) and low muscle mass as determined by DXA scans, but were able to walk 400 m without assistance within 15 min. Participants were followed up for up to 3 years. The nutrition intervention was carried out mainly by individual nutrition counseling. Nutrition goals included achieving a daily protein intake of 1.0-1.2 g/kg body weight, energy intake of 25-30 kcal/kg of body weight/day, and serum vitamin D concentration ≥ 75 mmol/L. Survey on the method strategies and feasibility of the nutrition intervention was sent to all nutrition interventionists of the 16 SPRINTT study sites. RESULTS Nutrition interventionists from all study sites responded to the survey. All responders found that the SPRINTT nutrition intervention was feasible for the target population, and it was well received by the majority. The identification of participants at nutritional risk was accomplished by combining information from interviews, questionnaires, clinical and laboratory data. Although the nutrition intervention was mainly carried out using individual nutritional counselling, other assisting methods were used as appropriate. CONCLUSION The SPRINTT nutrition intervention was feasible and able to adapt flexibly to varying needs of this heterogeneous population. The procedures adopted to identify older adults at risk of malnutrition and to design the appropriate intervention may serve as a model to deliver nutrition intervention for community-dwelling older people with mobility limitations.
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Affiliation(s)
- S K Jyväkorpi
- Clinicum, Department of General Practice, Helsinki University Central Hospital, University of Helsinki, Tukholmankatu 8 B, 00014, Helsinki, Finland.
| | - A Ramel
- The Icelandic Gerontological Research Center, The National University Hospital of Iceland, Reykjavik, Iceland
| | - T E Strandberg
- Clinicum, Department of General Practice, Helsinki University Central Hospital, University of Helsinki, Tukholmankatu 8 B, 00014, Helsinki, Finland.,University of Oulu, Center for Life Course Health Research, Oulu, Finland
| | - K Piotrowicz
- Faculty of Medicine, Department of Internal Medicine and Gerontology, Jagiellonian University Medical College, Krakow, Poland
| | - E Błaszczyk-Bębenek
- Department of Nutrition and Drug Research, Institute of Public Health, Faculty of Health Science, Jagiellonian University Medical College, Krakow, Poland
| | - A Urtamo
- Clinicum, Department of General Practice, Helsinki University Central Hospital, University of Helsinki, Tukholmankatu 8 B, 00014, Helsinki, Finland
| | - H M Rempe
- Institute for Biomedicine of Aging, Friedrich-Alexander-University of Erlangen-Nürnberg, Erlangen, Germany
| | - Ó Geirsdóttir
- The Icelandic Gerontological Research Center, The National University Hospital of Iceland, Reykjavik, Iceland
| | - T Vágnerová
- 1St Faculty of Medicine, Department of Gerontology & Geriatrics, Charles University in Prague, General University Hospital Prague, Nové Město, Czech Republic
| | - M Billot
- PRISMATICS Lab (Predictive Research In Spine/Neuromodulation Management And Thoracic Innovation/Cardiac Surgery), Poitiers University Hospital, Poitiers, France
| | - A Larreur
- Department of Geriatrics, University Hospital of Limoges, Limoges, France
| | - G Savera
- Università Cattolica del Sacro Cuore, Rome, Italy
| | - G Soriano
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - C Picauron
- Gérontopôle, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - S Tagliaferri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | | | - A Perl
- Medical University of Graz, Graz, Austria
| | - L Tirrel
- Diabetes Frail, Medici Medical Practice, Luton, UK
| | - H Öhman
- Clinicum, Department of General Practice, Helsinki University Central Hospital, University of Helsinki, Tukholmankatu 8 B, 00014, Helsinki, Finland
| | | | | | | | | | - M Klimkova
- Silesian Hospital, Opava, Czech Republic
| | - E Freiberger
- 1St Faculty of Medicine, Department of Gerontology & Geriatrics, Charles University in Prague, General University Hospital Prague, Nové Město, Czech Republic
| | - P V Jonsson
- The Icelandic Gerontological Research Center, The National University Hospital of Iceland, Reykjavik, Iceland
| | - E Marzetti
- Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - K H Pitkälä
- Clinicum, Department of General Practice, Helsinki University Central Hospital, University of Helsinki, Tukholmankatu 8 B, 00014, Helsinki, Finland
| | - F Landi
- Università Cattolica del Sacro Cuore, Rome, Italy.,Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - R Calvani
- Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
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de Souto Barreto P, Pothier K, Soriano G, Lussier M, Bherer L, Guyonnet S, Piau A, Ousset PJ, Vellas B. A Web-Based Multidomain Lifestyle Intervention for Older Adults: The eMIND Randomized Controlled Trial. J Prev Alzheimers Dis 2021; 8:142-150. [PMID: 33569560 PMCID: PMC7754697 DOI: 10.14283/jpad.2020.70] [Citation(s) in RCA: 6] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022]
Abstract
Importance/Objective: To describe the feasibility and acceptability of a 6-month web-based multidomain lifestyle training intervention for community-dwelling older people and to test the effects of the intervention on both function- and lifestyle-related outcomes. DESIGN 6-month, parallel-group, randomized controlled trial (RCT). SETTING Toulouse area, South-West, France. PARTICIPANTS Community-dwelling men and women, ≥ 65 years-old, presenting subjective memory complaint, without dementia. INTERVENTION The web-based multidomain intervention group (MIG) received a tablet to access the multidomain platform and a wrist-worn accelerometer measuring step counts; the control group (CG) received only the wrist-worn accelerometer. The multidomain platform was composed of nutritional advices, personalized exercise training, and cognitive training. Main outcomes and measures: Feasibility, defined as the proportion of people connecting to ≥75% of the prescribed sessions, and acceptability, investigated through content analysis from recorded semi-structured interviews. Secondary outcomes included clinical (eg, cognitive function, mobility, health-related quality of life (HRQOL)) and lifestyle (eg, step count, food intake) measurements. RESULTS Among the 120 subjects (74.2 ±5.6 years-old; 57.5% women), 109 completed the study (n=54, MIG; n=55, CG). 58 MIG subjects connected to the multidomain platform at least once; among them, adherers of ≥75% of sessions varied across multidomain components: 37 people (63.8% of 58 participants) for cognitive training, 35 (60.3%) for nutrition, and three (5.2%) for exercise; these three persons adhered to all multidomain components. Participants considered study procedures and multidomain content in a positive way; the most cited weaknesses were related to exercise: too easy, repetitive, and slow progression. Compared to controls, the intervention had a positive effect on HRQOL; no significant effects were observed across the other clinical and lifestyle outcomes. CONCLUSIONS AND RELEVANCE Providing multidomain lifestyle training through a web-platform is feasible and well-accepted, but the training should be challenging enough and adequately progress according to participants' capabilities to increase adherence. Recommendations for a larger on-line multidomain lifestyle training RCT are provided.
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Affiliation(s)
- P de Souto Barreto
- Professor Philipe de Souto Barreto, Gérontopôle de Toulouse, Institut du Vieillissement, 37 Allées Jules Guesde, F-31000 Toulouse, France, Phone: (+33) 561 145 668, Fax: (+33) 561 145 640, e-mail:
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11
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Ampuero J, Aller R, Gallego-Durán R, Crespo J, Calleja JL, García-Monzón C, Gómez-Camarero J, Caballería J, Lo Iacono O, Ibañez L, García-Samaniego J, Albillos A, Francés R, Fernández-Rodríguez C, Diago M, Soriano G, Andrade RJ, Latorre R, Jorquera F, Morillas RM, Escudero D, Estévez P, Hernandez-Guerra M, Augustín S, Bañales J, Aspichueta P, Benlloch S, Rosales JM, Salmerón J, Turnes J, Romero-Gómez M. Erratum to: "Significant fibrosis predicts new-onset diabetes mellitus and arterial hypertension in patients with NASH (J Hepatol 2020; 73: 17-25). J Hepatol 2020; 73:740-741. [PMID: 32654856 DOI: 10.1016/j.jhep.2020.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Javier Ampuero
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; SeLiver group, Instituto de Biomedicina de Sevilla, Spain; CIBERehd, Spain.
| | - Rocío Aller
- Hospital Clínico Universitario de Valladolid. Centro de Investigación de Endocrinología y Nutrición. Universidad de Valladolid, Spain
| | | | - Javier Crespo
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Carmelo García-Monzón
- Liver Research Unit, Hospital Universitario Santa Cristina Instituto de Investigación Sanitaria Princesa Madrid, Spain
| | | | - Joan Caballería
- CIBERehd, Spain; Liver Unit. Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBPAS). Barcelona, Spain
| | | | - Luis Ibañez
- CIBERehd, Spain; Hospital Gregorio Marañón, Madrid, Spain
| | | | - Agustín Albillos
- CIBERehd, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rubén Francés
- CIBERehd, Spain; Hospital General Universitario de Alicante, Universidad Miguel Hernández, Spain
| | | | - Moisés Diago
- Hospital General Universitario de Valencia, Spain
| | | | - Raúl J Andrade
- CIBERehd, Spain; Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | | | - Francisco Jorquera
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED y CIBERehd, León, España
| | | | | | | | | | | | - Jesús Bañales
- CIBERehd, Spain; Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute - Donostia University Hospital, University of the Basque Country (UPV/EHU), Ikerbasque, San Sebastian, Spain
| | - Patricia Aspichueta
- Biocruces Research Institute, Barakaldo. Department of Physiology, Faculty of Medicine and Nursing, University of Basque Country UPV/EHU, Leioa, Spain
| | | | | | | | | | - Manuel Romero-Gómez
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; SeLiver group, Instituto de Biomedicina de Sevilla, Spain; CIBERehd, Spain.
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12
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Ampuero J, Aller R, Gallego-Durán R, Crespo J, Calleja JL, García-Monzón C, Gómez-Camarero J, Caballería J, Lo Iacono O, Ibañez L, García-Samaniego J, Albillos A, Francés R, Fernández-Rodríguez C, Diago M, Soriano G, Andrade RJ, Latorre R, Jorquera F, Morillas RM, Escudero D, Estévez P, Guerra MH, Augustín S, Banales JM, Aspichueta P, Benlloch S, Rosales JM, Salmerón J, Turnes J, Romero Gómez M. Significant fibrosis predicts new-onset diabetes mellitus and arterial hypertension in patients with NASH. J Hepatol 2020; 73:17-25. [PMID: 32147361 DOI: 10.1016/j.jhep.2020.02.028] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS Non-alcoholic fatty liver disease (NAFLD) could play a catalytic role in the development of metabolic comorbidities, although the magnitude of this effect in metabolically healthy patients with NAFLD remains unclear. We assessed the role of biopsy-proven NAFLD on the risk of developing type 2 diabetes mellitus (T2DM) and other metabolic comorbidities (arterial hypertension [AHT], and dyslipidemia) in metabolically healthy patients. METHODS We included 178 metabolically healthy-defined by the absence of baseline T2DM, AHT, dyslipidemia-patients with biopsy-proven NAFLD from the HEPAmet Registry (N = 1,030). Hepamet fibrosis score (HFS), NAFLD fibrosis score, and Fibrosis-4 were calculated. Follow-up was computed from biopsy to the diagnosis of T2DM, AHT, or dyslipidemia. RESULTS During a follow-up of 5.6 ± 4.4 years, T2DM occurred in 9% (16/178), AHT in 8.4% (15/178), low HDL in 9.6% (17/178), and hypertriglyceridemia in 23.6% (42/178) of patients. In multivariate analysis, significant fibrosis predicted T2DM and AHT. Independent variables related to T2DM appearance were significant fibrosis (HR 2.95; 95% CI 1.19-7.31; p = 0.019), glucose levels (p = 0.008), age (p = 0.007) and BMI (p = 0.039). AHT was independently linked to significant fibrosis (HR 2.39; 95% CI 1.14-5.10; p = 0.028), age (p = 0.0001), BMI (p = 0.006), glucose (p = 0.021) and platelets (p = 0.050). The annual incidence rate of T2DM was higher in patients with significant fibrosis (4.4 vs. 1.2 cases per 100 person-years), and increased in the presence of obesity, similar to AHT (4.6 vs. 1.1 cases per 100 person-years). HFS >0.12 predicted the risk of T2DM (25% [4/16] vs. HFS <0.12 4.5% [4/88]; logRank 6.658, p = 0.010). CONCLUSION Metabolically healthy patients with NAFLD-related significant fibrosis were at greater risk of developing T2DM and AHT. HFS >0.12, but not NAFLD fibrosis score or Fibrosis-4, predicted the occurrence of T2DM. LAY SUMMARY Patients with biopsy-proven non-alcoholic fatty liver disease and significant fibrosis were at risk of developing type 2 diabetes mellitus and arterial hypertension. The risk of metabolic outcomes in patients with significant fibrosis was increased in the presence of obesity. In addition to liver biopsy, patients at intermediate-to-high risk of significant fibrosis by Hepamet fibrosis score were at risk of type 2 diabetes mellitus.
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Affiliation(s)
- Javier Ampuero
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; SeLiver group, Instituto de Biomedicina de Sevilla, Spain; CIBERehd, Spain.
| | - Rocío Aller
- Hospital Clínico Universitario de Valladolid, Centro de Investigación de Endocrinología y Nutrición, Universidad de Valladolid, Spain
| | | | - Javier Crespo
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | | | - Carmelo García-Monzón
- Liver Research Unit, Hospital Universitario Santa Cristina Instituto de Investigación Sanitaria Princesa Madrid, Spain
| | | | - Joan Caballería
- CIBERehd, Spain; Liver Unit. Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBPAS), Barcelona, Spain
| | | | - Luis Ibañez
- CIBERehd, Spain; Hospital Gregorio Marañón, Madrid, Spain
| | | | - Agustín Albillos
- CIBERehd, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Rubén Francés
- CIBERehd, Spain; Hospital General Universitario de Alicante, Universidad Miguel Hernández, Spain
| | | | - Moisés Diago
- Hospital General Universitario de Valencia, Spain
| | | | - Raúl J Andrade
- CIBERehd, Spain; Unidad de Gestión Clínica de Enfermedades Digestivas, Instituto de Investigación Biomédica de Málaga-IBIMA, Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Málaga, Spain
| | | | - Francisco Jorquera
- Servicio de Aparato Digestivo, Complejo Asistencial Universitario de León, IBIOMED y CIBERehd, León, España
| | | | | | | | | | | | - Jesús M Banales
- CIBERehd, Spain; Department of Liver and Gastrointestinal Diseases, Biodonostia Research Institute - Donostia University Hospital, University of the Basque Country (UPV/EHU), Ikerbasque, San Sebastian, Spain
| | - Patricia Aspichueta
- Biocruces Research Institute, Barakaldo, Department of Physiology, Faculty of Medicine and Nursing, University of Basque Country UPV/EHU, Leioa, Spain
| | | | | | | | | | - Manuel Romero Gómez
- Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain; SeLiver group, Instituto de Biomedicina de Sevilla, Spain; CIBERehd, Spain.
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Soriano G, Zerrad M, Amra C. Black paints covered with multidielectrics: light absorbers. Opt Express 2020; 28:16857-16868. [PMID: 32549499 DOI: 10.1364/oe.393903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
Black paints are commonly used to provide broadband light absorbers in high-precision optics. We show how multidielectric coatings improve the performances of these absorbers. The coated rough paints still exhibit a quasi-lambertian diffuse reflection, but this scattering pattern can be reduced by several orders of magnitude, which strongly enhances absorption. Predictions are based on an exact electromagnetic theory of light scattering from arbitrary rough multilayers. Results are also compared to useful approximate theories.
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Soriano G, Zerrad M, Amra C. Anti-scattering effect analyzed with an exact theory of light scattering from rough multilayers. Opt Lett 2019; 44:4455-4458. [PMID: 31517905 DOI: 10.1364/ol.44.004455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 08/14/2019] [Indexed: 06/10/2023]
Abstract
First-order theories of light scattering previously revealed the existence of anti-scattering effects in optical multilayers. Here we present an exact electromagnetic theory that is able to complete the scattering analysis when first-order scattering is cancelled. The theory is valid for arbitrary rough multilayers.
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Román E, Nieto JC, Gely C, Vidal S, Pozuelo M, Poca M, Juárez C, Guarner C, Manichanh C, Soriano G. Effect of a Multistrain Probiotic on Cognitive Function and Risk of Falls in Patients With Cirrhosis: A Randomized Trial. Hepatol Commun 2019; 3:632-645. [PMID: 31061952 PMCID: PMC6492476 DOI: 10.1002/hep4.1325] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 01/30/2019] [Indexed: 12/11/2022] Open
Abstract
Probiotics can modulate gut microbiota, intestinal permeability, and immune response and could therefore improve cognitive dysfunction and help avoid potential consequences, such as falls, in patients with cirrhosis. The aim of this study was to evaluate the effect of a multistrain probiotic on cognitive function, risk of falls, and inflammatory response in patients with cirrhosis. Consecutive outpatients with cirrhosis and cognitive dysfunction (defined by a Psychometric Hepatic Encephalopathy Score [PHES] < -4) and/or falls in the previous year were randomized to receive either a sachet of a high-concentration multistrain probiotic containing 450 billion bacteria twice daily for 12 weeks or placebo. We evaluated the changes in cognitive function (PHES); risk of falls (Timed Up and Go [TUG] test, gait speed, and incidence of falls); systemic inflammatory response; neutrophil oxidative burst; intestinal barrier integrity (serum fatty acid-binding protein 6 [FABP-6] and 2 [FABP-2] and zonulin and urinary claudin-3); bacterial translocation (lipopolysaccharide-binding protein [LBP]); and fecal microbiota. Thirty-six patients were included. Patients treated with the probiotic (n = 18) showed an improvement in the PHES (P = 0.006), TUG time (P = 0.015) and gait speed (P = 0.02), and a trend toward a lower incidence of falls during follow-up (0% compared with 22.2% in the placebo group [n = 18]; P = 0.10). In the probiotic group, we observed a decrease in C-reactive protein (P = 0.01), tumor necrosis factor alpha (P = 0.01), FABP-6 (P = 0.009), and claudin-3 (P = 0.002), and an increase in poststimulation neutrophil oxidative burst (P = 0.002). Conclusion: The multistrain probiotic improved cognitive function, risk of falls, and inflammatory response in patients with cirrhosis and cognitive dysfunction and/or previous falls.
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Affiliation(s)
- Eva Román
- Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Barcelona Spain.,Escola Universitària d'Infermeria EUI-Sant Pau Barcelona Spain.,Institut de Recerca IIB-Sant Pau Barcelona Spain.,CIBERehd Instituto de Salud Carlos III Madrid Spain
| | | | | | - Sílvia Vidal
- Institut de Recerca IIB-Sant Pau Barcelona Spain.,Department of Immunology Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona Barcelona Spain
| | - Marta Pozuelo
- Fundació Hospital Universitari Vall d'Hebron-Institut de Recerca Barcelona Spain
| | - Maria Poca
- Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Barcelona Spain.,CIBERehd Instituto de Salud Carlos III Madrid Spain
| | - Cándido Juárez
- Institut de Recerca IIB-Sant Pau Barcelona Spain.,Department of Immunology Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona Barcelona Spain
| | - Carlos Guarner
- Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Barcelona Spain.,CIBERehd Instituto de Salud Carlos III Madrid Spain
| | - Chaysavanh Manichanh
- Fundació Hospital Universitari Vall d'Hebron-Institut de Recerca Barcelona Spain.,CIBERehd Instituto de Salud Carlos III Madrid Spain
| | - Germán Soriano
- Department of Gastroenterology Hospital de la Santa Creu i Sant Pau Barcelona Spain.,CIBERehd Instituto de Salud Carlos III Madrid Spain
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Román E, Gely C, Flavià M, Poca M, Alvarado E, Vargas V, Guarner C, Soriano G. Patients with Compensated Cirrhosis Are Also at Risk of Falling. Hepatology 2019; 69:455-457. [PMID: 30014491 DOI: 10.1002/hep.30180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/13/2018] [Indexed: 12/07/2022]
Affiliation(s)
- Eva Román
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Escola Universitària d'Infermeria EUI-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Institut de Recerca- IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Gely
- Institut de Recerca- IIB Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Montse Flavià
- Liver Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain
| | - Maria Poca
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Edilmar Alvarado
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Víctor Vargas
- Liver Unit, Department of Internal Medicine, Hospital Vall d'Hebron, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Guarner
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Germán Soriano
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
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Giudici KV, de Souto Barreto P, Soriano G, Rolland Y, Vellas B. Defining Vitality: Associations of Three Operational Definitions of Vitality with Disability in Instrumental Activities of Daily Living and Frailty among Elderly Over a 3-Year Follow-Up (MAPT Study). J Nutr Health Aging 2019; 23:386-392. [PMID: 30932139 DOI: 10.1007/s12603-019-1175-0] [Citation(s) in RCA: 5] [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] [Indexed: 01/09/2023]
Abstract
OBJECTIVES This study aimed to examine the associations of three operational definitions of vitality with variation in instrumental activities of daily living (IADL) and frailty over a 3-year follow-up among non-demented, community-dwelling elderly. DESIGN Observational study. SETTING AND PARTICIPANTS 1,679 elderly >70y (64.7% female) participants of the Multidomain Alzheimer Preventive Trial (MAPT). MEASUREMENTS Vitality was defined as a psychological concept using three items from the Geriatric Depression Scale; as a physical construct using the highest quartile for hand grip strength; and as global physiological reservoir using a combination of good physical and cognitive functions. Variables were assessed at baseline, 6, 12, 24 and 36 months of follow-up. RESULTS Prevalence of high vitality at baseline was 57.1%, 28.5% and 21.6% for psychological, physical, and physiological reservoir, respectively. People with high vitality presented higher IADL scores compared to people with low vitality for all definitions. Analysis from the mixed-effect model found no differences between vitality groups for IADL performance across all definitions. IADL scores improved among subjects with high vitality over time, independent on the definition; while no significant variation was observed among those with low vitality. Participants with low vitality presented 2.0 to 6.1 higher odds of having more frailty components over time (p<0.0001). CONCLUSION High vitality defined as a concept related to psychological, physical, or physiological reservoir constructs were positively associated with better IADL performance and with reduced likelihood of frailty worsening over time.
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Affiliation(s)
- K V Giudici
- Kelly Virecoulon Giudici, Gérontopôle de Toulouse, Institut du Vieillissement, 37 Allées Jules Guesdes, 31000 Toulouse, France, E-mail:
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Chhetri J, de Souto Barreto P, Soriano G, Gennero I, Cantet C, Vellas B. Vitamin D, homocysteine and n−3PUFA status according to physical and cognitive functions in older adults with subjective memory complaint: Results from cross-sectional study of the MAPT trial. Exp Gerontol 2018; 111:71-77. [DOI: 10.1016/j.exger.2018.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/25/2018] [Accepted: 07/07/2018] [Indexed: 01/01/2023]
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Pothier K, Soriano G, Lussier M, Naudin A, Costa N, Guyonnet S, Piau A, Ousset PJ, Nourhashemi F, Vellas B, de Souto Barreto P. A web-based multidomain lifestyle intervention with connected devices for older adults: research protocol of the eMIND pilot randomized controlled trial. Aging Clin Exp Res 2018; 30:1127-1135. [PMID: 29368298 DOI: 10.1007/s40520-018-0897-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 12/13/2017] [Accepted: 01/16/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND Multidomain interventions composed of nutritional counseling, exercise and cognitive trainings have shown encouraging results as effective preventive strategies delaying age-related declines. However, these interventions are time- and resource-consuming. The use of Information and Communication Technologies (ICT) might facilitate the translation from research into real-world practice and reach a massive number of people. AIM This article describes the protocol of the eMIND study, a randomized controlled trial (RCT) using a web-based multidomain intervention for older adults. METHODS One hundred and twenty older adults (≥ 65 years), with a spontaneous memory complaint, will be randomly assigned to a six-month web-based multidomain (nutritional counseling, physical and cognitive trainings) intervention group with a connected accelerometer (number of steps, energy expenditure), or to a control group with access to general information on healthy aging plus the accelerometer, but no access to the multidomain intervention. The main outcome is the feasibility/acceptability of the web-based intervention. Secondary clinical outcomes include: cognitive functions, physical performance, nutritional status and cost-effectiveness. RESULTS We expect a high amount of adherers (ie, > 75% compliance to the protocol) to reflect the feasibility. Acceptability, assessed through interviews, should allow us to understand motivators and barriers to this ICT intervention. We also expect to provide data on its effects on various clinical outcomes and efficiency. CONCLUSION AND DISCUSSION The eMIND study will provide crucial information to help developing a future and larger web-based multidomain lifestyle RCT, which should facilitate the translation of this ICT intervention from the research world into real-life clinical practice for the healthcare of older adults.
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Affiliation(s)
- Kristell Pothier
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France.
| | - G Soriano
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
| | - M Lussier
- School of Rehabilitation Sciences, Faculty of Medicine, Université de Montréal, Montréal, H3C 3J7, Canada
- Centre de Recherche de l'Institut Universitaire de Gériatrie de Montréal, Montréal, H3W 1W5, Canada
| | - A Naudin
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
| | - N Costa
- Medical Information Department, University Hospital of Toulouse, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - S Guyonnet
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - A Piau
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
| | - P J Ousset
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
| | - F Nourhashemi
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - B Vellas
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
| | - P de Souto Barreto
- Institut du Vieillissement, Gérontopôle de Toulouse, Centre Hospitalo-Universitaire de Toulouse (CHU Toulouse), 37 allée Jules Guesde, 31000, Toulouse, France
- UMR INSERM 1027, University of Toulouse III, Toulouse, France
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20
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Nieto JC, Perea L, Soriano G, Zamora C, Cantó E, Medina A, Poca M, Sanchez E, Roman E, Julià G, Navarro F, Gely C, Alvarado EA, Guarner C, Juarez C, Vidal S. Ascitic fluid regulates the local innate immune response of patients with cirrhosis. J Leukoc Biol 2018; 104:833-841. [PMID: 29851144 DOI: 10.1002/jlb.3a0218-072r] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/23/2018] [Accepted: 05/09/2018] [Indexed: 12/22/2022] Open
Abstract
Ascitic neutrophils from cirrhotic patients with spontaneous bacterial peritonitis (SBP) exhibit an impaired oxidative burst that could facilitate bacterial infection. However, the influence of the cell-free ascitic fluid of these patients on neutrophil function has not been investigated. To analyze this influence, we determined the ascitic levels of cytokines, resistin, and lactoferrin and their association with neutrophil function, disease severity score, and SBP resolution. We analyzed NETosis induction by microscopy and oxidative burst by the flow cytometry of healthy neutrophils cultured in ascitic fluid from cirrhotic patients with sterile ascites (SA) and with SBP before and after antibiotic treatment. Resistin, IL-6, IL-1 receptor antagonist, IL-1β, and lactoferrin levels were measured in ascitic fluids and supernatants of cultured neutrophils and PBMCs by ELISA. Upon stimulation, healthy neutrophils cultured in SBP ascitic fluid produced lower NETosis and oxidative burst than those cultured in SA. Ascitic resistin levels were negatively correlated with NETosis, oxidative burst, and ascitic glucose levels; and positively correlated with the model for end-stage liver disease score. After an E. coli or TNF-α stimulus, neutrophils were the major resistin producers. Resistin indirectly reduced the oxidative burst of neutrophils and directly reduced the inflammatory phenotype of monocytes and TNF-α production. Bacterial-induced resistin production can down-regulate the inflammatory response of macrophages and neutrophil function in ascitic fluid. Consequently, this down-regulation may jeopardize the elimination of bacteria that translocate to ascitic fluid in patients with cirrhosis.
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Affiliation(s)
- Juan C Nieto
- Department of Immunology, Institut de Recerca and Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Lídia Perea
- Department of Immunology, Institut de Recerca and Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Germán Soriano
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Zamora
- Department of Immunology, Institut de Recerca and Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Elisabet Cantó
- Department of Immunology, Institut de Recerca and Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Aina Medina
- Department of Immunology, Institut de Recerca and Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Maria Poca
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Elisabet Sanchez
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain
| | - Eva Roman
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain.,Escola Universitària d'Infermeria EUI-Sant Pau, Barcelona, Spain
| | - Germà Julià
- Department of Immunology, Institut de Recerca and Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Ferran Navarro
- Department of Microbiology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Cristina Gely
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Edilmar A Alvarado
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | - Carlos Guarner
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Madrid, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cándido Juarez
- Department of Immunology, Institut de Recerca and Hospital Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Sílvia Vidal
- Department of Immunology, Institut de Recerca and Hospital Santa Creu i Sant Pau, Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
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21
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Alvarado-Tapias E, Guarner-Argente C, Oblitas E, Sánchez E, Vidal S, Román E, Concepción M, Poca M, Gely C, Pavel O, Nieto JC, Juárez C, Guarner C, Soriano G. Toll-like receptor 4 polymorphisms and bacterial infections in patients with cirrhosis and ascites. World J Hepatol 2018; 10:124-133. [PMID: 29399286 PMCID: PMC5787676 DOI: 10.4254/wjh.v10.i1.124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 12/13/2017] [Accepted: 12/29/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the relationship between the presence of toll-like receptor 4 (TLR4) polymorphisms and bacterial infections in cirrhotic patients with ascites.
METHODS We prospectively included consecutive patients with cirrhosis and ascites hospitalized during a 6-year period. Patients with human immunodeficiency virus (HIV) infection or any other immunodeficiency, patients with advanced hepatocellular carcinoma (beyond Milan’s criteria) or any other condition determining poor short-term prognosis, and patients with a permanent urinary catheter were excluded. The presence of D299G and/or T399I TLR4 polymorphisms was determined by sequencing and related to the incidence and probability of bacterial infections, other complications of cirrhosis, hepatocellular carcinoma, and mortality during follow-up. A multivariate analysis to identify predictive variables of mortality in the whole series was performed.
RESULTS We included 258 patients: 28 (10.8%) were carriers of D299G and/or T399I TLR4 polymorphisms (polymorphism group) and 230 patients were not (wild-type group). The probability of developing any bacterial infection at one-year follow-up was 78% in the polymorphism group and 69% in the wild-type group (P = 0.54). The one-year probability of presenting infections caused by gram-negative bacilli (51% vs 44%, P = 0.68), infections caused by gram-positive cocci (49% vs 40%, P = 0.53), and spontaneous bacterial peritonitis (29% vs 34%, respectively, P = 0.99) did not differ between the two groups. The one-year probability of transplant-free survival was 55% in the polymorphism group and 66% in the wild-type group (P = 0.15). Multivariate analysis confirmed that age, Child-Pugh score, active alcohol intake, previous hepatic encephalopathy, hepatocellular carcinoma and serum creatinine were associated with a higher risk of death during follow-up.
CONCLUSION Genetic polymorphisms D299G and/or T399I of TLR4 do not seem to play a relevant role in the predisposition of cirrhotic patients with ascites to bacterial infections.
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Affiliation(s)
- Edilmar Alvarado-Tapias
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
- Instituto de Salud Carlos III, Institut de Recerca IIB-Sant Pau, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès) 08193, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Carlos Guarner-Argente
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
| | - Elida Oblitas
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
| | - Elisabet Sánchez
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
- Instituto de Salud Carlos III, Institut de Recerca IIB-Sant Pau, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès) 08193, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Silvia Vidal
- Instituto de Salud Carlos III, Institut de Recerca IIB-Sant Pau, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès) 08193, Spain
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
| | - Eva Román
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid 28029, Spain
- Escola Universitària d’Infermeria EUI-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
| | - Mar Concepción
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
| | - Maria Poca
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Cristina Gely
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
- Instituto de Salud Carlos III, Institut de Recerca IIB-Sant Pau, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès) 08193, Spain
| | - Oana Pavel
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
| | - Juan Camilo Nieto
- Instituto de Salud Carlos III, Institut de Recerca IIB-Sant Pau, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès) 08193, Spain
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
| | - Cándido Juárez
- Department of Immunology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
| | - Carlos Guarner
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
- Instituto de Salud Carlos III, Institut de Recerca IIB-Sant Pau, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès) 08193, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid 28029, Spain
| | - Germán Soriano
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona 08025, Spain
- Instituto de Salud Carlos III, Institut de Recerca IIB-Sant Pau, Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès) 08193, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid 28029, Spain
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22
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Ayuso T, Marzo-Sola ME, Castillo-Trivino T, Soriano G, Otano MA, Lopez MA, Croitoru IM, Olascoaga J. [Fingolimod: effectiveness and safety in routine clinical practice. An observational, retrospective, multi-centre study in Navarra, Gipuzkoa and La Rioja]. Rev Neurol 2016; 63:S5-S11. [PMID: 27658434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
AIM To evaluate the effectiveness and safety of fingolimod in clinical practice in Navarra, Gipuzkoa and La Rioja regions. PATIENTS AND METHODS We conducted a retrospective multi-centre study with recurrent multiple sclerosis patients treated with fingolimod, following the product data sheet. The following data were evaluated: annualised relapse rate (ARR), percentage of patients free from relapses, disability using the Expanded Disability Status Scale (EDSS) and the percentage of patients without gadolinium-enhancing lesions. RESULTS A total of 113 patients were treated with fingolimod: 6% were naive, and 58% and 35% were patients previously treated with an immunomodulator and natalizumab, respectively. Fingolimod lowered the ARR after the first (67%; 1 to 0.3; p < 0.0001) and second (89%; 1 to 0.1; p < 0.0001) years of treatment, and thus the number of patients free from relapses during the treatment increased. The baseline EDSS was 3 and after treatment with fingolimod was 2.5 in both years. The percentage of patients without gadolinium-enhancing lesions after the first year of treatment was 77%. Similar results were observed in naive patients and in those previously treated with an immunomodulator. In patients previously treated with natalizumab no changes were observed following the treatment. CONCLUSIONS The use of fingolimod in clinical practice showed an effectiveness similar to that observed in clinical trials. There were no changes in the ARR after changing from natalizumab, and only one patient presented a 'relapse' after withdrawal of natalizumab. Fingolimod acts like a safe drug, with scarce side effects and a low percentage of drop-outs.
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Affiliation(s)
- T Ayuso
- Complejo Hospitalario de Navarra , Pamplona, Espana
| | - M E Marzo-Sola
- Complejo Hospitalario San Millan-San Pedro, 26004 Logrono, Espana
| | | | - G Soriano
- Complejo Hospitalario de Navarra , Pamplona, Espana
| | - M A Otano
- Complejo Hospitalario de Navarra , Pamplona, Espana
| | - M A Lopez
- Complejo Hospitalario San Millan-San Pedro, 26004 Logrono, Espana
| | | | - J Olascoaga
- Hospital Donostia, 20014 San Sebastian, Espana
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23
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Soriano G, Guyonnet S, Goisser S, Sourdet S, Lamy S, Ghisolfi A, Vellas B. MON-LB257: Assessment of Energy Intake in Older People: Comparison of a Diet History Interview with a 3-Day Dietary Intake Record. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30891-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Poca M, Alvarado-Tapias E, Concepción M, Pérez-Cameo C, Cañete N, Gich I, Romero C, Casas M, Román E, Castells L, Vargas V, Carrión JA, Guarner C, Soriano G. Predictive model of mortality in patients with spontaneous bacterial peritonitis. Aliment Pharmacol Ther 2016; 44:629-37. [PMID: 27464682 DOI: 10.1111/apt.13745] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/27/2016] [Accepted: 07/07/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hospital mortality in patients with spontaneous bacterial peritonitis (SBP) is high despite albumin treatment, particularly in those with worse liver and/or renal function. AIM To determine the independent predictive factors of in-hospital mortality and to create and validate a predictive model of mortality in patients with SBP. METHODS We analysed all cirrhotic patients with high-risk SBP (serum urea ≥11 mmol/L and/or serum bilirubin ≥68 μmol/L) between 2001 and 2011. We developed a predictive model of in-hospital mortality and validated this in a different cohort. RESULTS We included 118 high-risk SBP episodes treated with antibiotics and albumin. In-hospital mortality was 33/118 (28%). The independent predictive factors of in-hospital mortality at SBP diagnosis were serum urea, blood leucocyte count, Child-Pugh score and mean arterial pressure. A predictive model including these four variables showed a discrimination accuracy (AUC) of 0.850, 95% CI 0.777-0.922. A cut-off point of 0.245 showed a sensitivity of 0.85 and specificity of 0.75. The in-hospital mortality was 28/49 (57.1%) in patients with a model value ≥0.245, and 5/69 (7.2%) in patients with a model value <0.245 (P < 0.001). The validation series included 161 patients with an in-hospital mortality of 40/161 (24.8%), 30/77 (39.0%) in patients with a model value ≥0.245, and 10/84 (11.9%) in those with a model value <0.245 (P < 0.001). CONCLUSIONS We developed and validated a predictive model of mortality that includes serum urea, blood leucocyte count, Child-Pugh score and mean arterial pressure in high-risk patients with spontaneous bacterial peritonitis. These findings may help to identify patients who would benefit from additional therapeutic strategies.
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Affiliation(s)
- M Poca
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - E Alvarado-Tapias
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Concepción
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - C Pérez-Cameo
- Department of Internal Medicine-Liver Unit, Hospital Vall d'Hebron, Barcelona, Spain
| | - N Cañete
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - I Gich
- Department of Clinical Epidemiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,CIBERsam, Barcelona, Spain
| | - C Romero
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Casas
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - E Román
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain.,Escola Universitària d'Infermeria EUI-Sant Pau, Barcelona, Spain
| | - L Castells
- Department of Internal Medicine-Liver Unit, Hospital Vall d'Hebron, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - V Vargas
- Department of Internal Medicine-Liver Unit, Hospital Vall d'Hebron, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - J A Carrión
- Liver Section, Gastroenterology Department, Hospital del Mar, Universitat Autònoma de Barcelona, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - C Guarner
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
| | - G Soriano
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain.,CIBERehd, Instituto de Salud Carlos III, Barcelona, Spain
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25
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Esteve M, Temiño R, Carrasco A, Batista L, Del Val A, Blé M, Santaolaria S, Molina-Infante J, Soriano G, Agudo S, Zabana Y, Andújar X, Aceituno M, Ribes J, Madridejos R, Fernández-Bañares F. Potential coeliac disease markers and autoimmunity in olmesartan induced enteropathy: A population-based study. Dig Liver Dis 2016; 48:154-61. [PMID: 26699826 DOI: 10.1016/j.dld.2015.09.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 09/12/2015] [Accepted: 09/21/2015] [Indexed: 12/11/2022]
Abstract
AIMS (1) Assess the population-based incidence of severe olmesartan-associated enteropathy. (2) To describe patients of the Spanish registry. (3) Evaluate markers of potential coeliac disease and associated autoimmunity. METHODS Crude incidence rates in the area of Terrassa (Catalonia) were calculated. Clinical characteristics of patients in the Spanish registry were collected. Duodenal lymphocyte subpopulations and anti-TG2 IgA deposits were assessed in a subset of patients. RESULTS Annual incidence rates (2011-2014) ranged from 0 to 22 cases per 10(4) treated patients. Twenty patients were included in the Spanish registry. Nineteen (95%) exhibited villous atrophy and 16 (80%) had severe enteropathy. Lupus-like disease occurred during olmesartan treatment in 3 patients. HLA-DQ2/DQ8 was positive in 64%. Markers of potential coeliac disease were present in 4 out of 8 patients (positive anti-TG2 deposits and/or increased CD3+gammadelta+ intraepithelial lymphocytes and reduced CD3-). Histopathological changes and clinical manifestations including autoimmune disorders improved after olmesartan discontinuation but not after gluten-free diet, irrespective of the presence or absence of coeliac markers. CONCLUSIONS Incidence of severe olmesartan-associated enteropathy was low. Autoimmune phenomena were present in a subset of cases and reversed after olmesartan removal. A genetic coeliac disease background and the presence of potential coeliac markers might uncover predisposing factors.
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Affiliation(s)
- Maria Esteve
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain.
| | - Rocío Temiño
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain
| | - Anna Carrasco
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
| | - Lissette Batista
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain
| | - Adolfo Del Val
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Michel Blé
- Department of Gastroenterology, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | | | - Germán Soriano
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
| | - Sandra Agudo
- Department of Gastroenterology, Fundación Hospital Alcorcón, Madrid, Spain
| | - Yamile Zabana
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
| | - Xavier Andújar
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
| | - Montserrat Aceituno
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
| | - Josepa Ribes
- Cancer Plan of the Catalan Government, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Department of Clinical Sciences, School of Medicine, Universitat de Barcelona, Barcelona, Catalonia, Spain; Cancer Epidemiology, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Rosa Madridejos
- Department of Pharmacy, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Barcelona, Catalonia, Spain
| | - Fernando Fernández-Bañares
- Department of Gastroenterology, Hospital Universitari Mutua Terrassa, Universitat de Barcelona, Catalonia, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Catalonia, Spain
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Fernández J, Aracil C, Solà E, Soriano G, Cinta Cardona M, Coll S, Genescà J, Hombrados M, Morillas R, Martín-Llahí M, Pardo A, Sánchez J, Vargas V, Xiol X, Ginès P. [Evaluation and treatment of the critically ill cirrhotic patient]. Gastroenterol Hepatol 2016; 39:607-626. [PMID: 26778768 DOI: 10.1016/j.gastrohep.2015.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/15/2015] [Accepted: 09/18/2015] [Indexed: 12/12/2022]
Abstract
Cirrhotic patients often develop severe complications requiring ICU admission. Grade III-IV hepatic encephalopathy, septic shock, acute-on-chronic liver failure and variceal bleeding are clinical decompensations that need a specific therapeutic approach in cirrhosis. The increased effectiveness of the treatments currently used in this setting and the spread of liver transplantation programs have substantially improved the prognosis of critically ill cirrhotic patients, which has facilitated their admission to critical care units. However, gastroenterologists and intensivists have limited knowledge of the pathogenesis, diagnosis and treatment of these complications and of the prognostic evaluation of critically ill cirrhotic patients. Cirrhotic patients present alterations in systemic and splanchnic hemodynamics, coagulation and immune dysfunction what further increase the complexity of the treatment, the risk of developing new complications and mortality in comparison with the general population. These differential characteristics have important diagnostic and therapeutic implications that must be known by general intensivists. In this context, the Catalan Society of Gastroenterology and Hepatology requested a group of experts to draft a position paper on the assessment and treatment of critically ill cirrhotic patients. This article describes the recommendations agreed upon at the consensus meetings and their main conclusions.
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Affiliation(s)
- Javier Fernández
- Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERehd, Barcelona, España
| | - Carles Aracil
- Servei de Digestiu, Hospital Universitari Arnau de Villanova, Lleida, España
| | - Elsa Solà
- Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERehd, Barcelona, España
| | - Germán Soriano
- Servicio de Patología Digestiva, Hospital de la Santa Creu i Sant Pau. CIBERehd, Instituto de Salud Carlos III, Barcelona, España
| | - Maria Cinta Cardona
- Servicio de Digestivo, Hospital de Tortosa Verge de la Cinta, Tortosa, Tarragona, España
| | - Susanna Coll
- Servicio de Digestivo, Hospital del Mar, Barcelona, España
| | - Joan Genescà
- Servicio de Medicina Interna-Hepatología, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron (VHIR), Universidad Autónoma de Barcelona CIBERehd, Barcelona, España
| | - Manoli Hombrados
- Servicio de Aparato Digestivo, Hospital Dr. Josep Trueta, Facultat de Medicina, Universitat de Girona, Girona, España
| | - Rosa Morillas
- Servicio de Hepatología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España
| | - Marta Martín-Llahí
- Servei de Digestiu, Hospital de Sant Joan Despí Moisès Broggi, Sant Joan Despí, Barcelona, España
| | - Albert Pardo
- Servicio de Aparato Digestivo, Hospital Universitari de Tarragona Joan XXIII, Tarragona, España
| | - Jordi Sánchez
- Corporació Sanitària Parc Taulí, Sabadell. CIBERehd, Instituto de Salud Carlos III, Sabadell, Barcelona, España
| | - Victor Vargas
- Servicio de Medicina Interna-Hepatología, Hospital Universitari Vall d'Hebron, Institut de Recerca Vall d'Hebron (VHIR), Universidad Autónoma de Barcelona CIBERehd, Barcelona, España
| | - Xavier Xiol
- Servicio de Aparato Digestivo, Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Barcelona, España
| | - Pere Ginès
- Liver Unit, Hospital Clínic, Universitat de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, CIBERehd, Barcelona, España.
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Amra C, Petiteau D, Zerrad M, Guenneau S, Soriano G, Gralak B, Bellieud M, Veynante D, Rolland N. Analogies between optical propagation and heat diffusion: applications to microcavities, gratings and cloaks. Proc Math Phys Eng Sci 2015; 471:20150143. [PMID: 26730214 PMCID: PMC4685876 DOI: 10.1098/rspa.2015.0143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
A new analogy between optical propagation and heat diffusion in heterogeneous anisotropic media has been proposed recently by three of the present authors. A detailed derivation of this unconventional correspondence is presented and developed. In time harmonic regime, all thermal parameters are related to optical ones in artificial metallic media, thus making possible to use numerical codes developed for optics. Then, the optical admittance formalism is extended to heat conduction in multilayered structures. The concepts of planar microcavities, diffraction gratings and planar transformation optics for heat conduction are addressed. Results and limitations of the analogy are emphasized.
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Affiliation(s)
- C Amra
- Aix Marseille Université, Institut Fresnel, CNRS, Ecole Centrale Marseille, Faculté des Sciences et Techniques de St Jérôme , 13397 Marseille Cedex 20, France
| | - D Petiteau
- Aix Marseille Université, Institut Fresnel, CNRS, Ecole Centrale Marseille, Faculté des Sciences et Techniques de St Jérôme , 13397 Marseille Cedex 20, France
| | - M Zerrad
- Aix Marseille Université, Institut Fresnel, CNRS, Ecole Centrale Marseille, Faculté des Sciences et Techniques de St Jérôme , 13397 Marseille Cedex 20, France
| | - S Guenneau
- Aix Marseille Université, Institut Fresnel, CNRS, Ecole Centrale Marseille, Faculté des Sciences et Techniques de St Jérôme , 13397 Marseille Cedex 20, France
| | - G Soriano
- Aix Marseille Université, Institut Fresnel, CNRS, Ecole Centrale Marseille, Faculté des Sciences et Techniques de St Jérôme , 13397 Marseille Cedex 20, France
| | - B Gralak
- Aix Marseille Université, Institut Fresnel, CNRS, Ecole Centrale Marseille, Faculté des Sciences et Techniques de St Jérôme , 13397 Marseille Cedex 20, France
| | - M Bellieud
- Université Montpellier 2, CNRS, LMGC , Montpellier, France
| | - D Veynante
- Ecole Centrale Paris , CNRS, EM2C, Paris, France
| | - N Rolland
- Université de Lille 1 , CNRS, IEMN, Lille, France
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Soriano G, Zerrad M, Amra C. Speckle intensity statistics for chromatic scattering media under partially polarized illumination. Opt Express 2015; 23:20796-20803. [PMID: 26367932 DOI: 10.1364/oe.23.020796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intensity contrast in a fully developed speckle pattern resulting from the elastic scattering of a partially polarized light from a strongly scattering medium is theoretically and numerically studied. Simple expressions are derived when the illumination bandwidth is much smaller or larger than the chromatic length of the scattering medium.
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Nieto JC, Sánchez E, Romero C, Román E, Poca M, Guarner C, Juárez C, Soriano G, Vidal S. Impaired innate immune response of leukocytes from ascitic fluid of patients with spontaneous bacterial peritonitis. J Leukoc Biol 2015; 98:819-25. [PMID: 26254307 DOI: 10.1189/jlb.3ab0315-106r] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 06/23/2015] [Indexed: 12/24/2022] Open
Abstract
An ascitic microenvironment can condition the immune response of cells from cirrhotic patients with spontaneous bacterial peritonitis. To characterize this response, we determined the cytokine concentrations in ascitic fluid and analyzed the phenotype and function of ascitic leukocytes at diagnosis and after antibiotic-induced resolution in sterile ascites and ascitic fluid of 2 spontaneous bacterial peritonitis variants: positive and negative bacteriological culture. At diagnosis, a high concentration was found of IL-6 and IL-10 in the ascitic fluid from negative and positive bacteriological culture. The IL-6 concentration correlated with the percentage of neutrophils (R = 0.686, P < 0.001). In this context, positive and negative culture neutrophils had an impaired oxidative burst, and, after the antibiotic, the negative culture spontaneous bacterial peritonitis burst was fully recovered. Higher concentrations of IL-6 and IL-10 correlated with the presence of low granular CD 14(low) macrophages (R = -0.436, P = 0.005 and R = 0.414, P = 0.007, respectively). Positive culture spontaneous bacterial peritonitis macrophages expressed the lowest levels of CD16, CD86, CD11b and CD206, and HLA-DR, suggesting an impaired global function. Treatment increased all markers on the positive culture macrophages and CD11b and CD86 on negative culture macrophages. In negative culture spontaneous bacterial peritonitis, this increase was accompanied by phagocytic function recovery. The antibiotics then reverted the marker levels on positive and negative culture macrophages to the levels on sterile ascitis macrophages and restored ascitic negative culture cell function.
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Affiliation(s)
- Juan Camilo Nieto
- *Department of Immunology and Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; and Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisabet Sánchez
- *Department of Immunology and Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; and Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Cristina Romero
- *Department of Immunology and Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; and Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Eva Román
- *Department of Immunology and Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; and Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Poca
- *Department of Immunology and Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; and Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Carlos Guarner
- *Department of Immunology and Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; and Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Cándido Juárez
- *Department of Immunology and Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; and Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Germán Soriano
- *Department of Immunology and Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; and Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Silvia Vidal
- *Department of Immunology and Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut de Recerca IIB-Sant Pau, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; and Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Stephens C, Ortega-Alonso A, Medina-Cáliz I, Robles-Díaz M, Castiella A, Otazua P, Zapata E, Gomez-Moreno E, López-Nevot M, Ruiz-Cabello F, Soriano G, Roman E, Hallal H, Andrade R, Lucena M. Autoantibody presentation in Drug-Induced Liver Injury (DILI) and idiopathic Autoimmune Hepatitis (AIH): The influence of HLA alleles. Clin Ther 2015. [DOI: 10.1016/j.clinthera.2015.05.342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gustot T, Fernandez J, Garcia E, Morando F, Caraceni P, Alessandria C, Laleman W, Trebicka J, Elkrief L, Hopf C, Solís-Munoz P, Saliba F, Zeuzem S, Albillos A, Benten D, Montero-Alvarez JL, Chivas MT, Concepción M, Córdoba J, McCormick A, Stauber R, Vogel W, de Gottardi A, Welzel TM, Domenicali M, Risso A, Wendon J, Deulofeu C, Angeli P, Durand F, Pavesi M, Gerbes A, Jalan R, Moreau R, Ginés P, Bernardi M, Arroyo V, Bañares R, Bocci M, Catalina MV, Chin JL, Coenraad MJ, Coilly A, Dorn L, Gatta A, Gerber L, Grøenbæk H, Graupera I, Guevara M, Hausen A, Karlsen S, Lohse AW, Maggioli C, Markwardt D, Martinez J, Marzano A, de la Mata García M, Mesonero F, Mookerjee RP, Moreno C, Morrell B, Mortensen C, Nevens F, Peck‐Radosavljevic M, Rizzetto M, Romano A, Samuel D, Sauerbruch T, Simon‐Talero M, Solà E, Soriano G, Sperl J, Spindelboeck W, Steib C, Valla D, Verbeke L, Van Vlierberghe H, Wege H, Willars C, Baenas MY, Zaccherini G. Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology 2015; 62:243-52. [PMID: 25877702 DOI: 10.1002/hep.27849] [Citation(s) in RCA: 407] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 04/07/2015] [Indexed: 12/20/2022]
Abstract
UNLABELLED Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation (AD) of cirrhosis, organ failure(s), and high 28-day mortality. We investigated whether assessments of patients at specific time points predicted their need for liver transplantation (LT) or the potential futility of their care. We assessed clinical courses of 388 patients who had ACLF at enrollment, from February through September 2011, or during early (28-day) follow-up of the prospective multicenter European Chronic Liver Failure (CLIF) ACLF in Cirrhosis study. We assessed ACLF grades at different time points to define disease resolution, improvement, worsening, or steady or fluctuating course. ACLF resolved or improved in 49.2%, had a steady or fluctuating course in 30.4%, and worsened in 20.4%. The 28-day transplant-free mortality was low-to-moderate (6%-18%) in patients with nonsevere early course (final no ACLF or ACLF-1) and high-to-very high (42%-92%) in those with severe early course (final ACLF-2 or -3) independently of initial grades. Independent predictors of course severity were CLIF Consortium ACLF score (CLIF-C ACLFs) and presence of liver failure (total bilirubin ≥12 mg/dL) at ACLF diagnosis. Eighty-one percent had their final ACLF grade at 1 week, resulting in accurate prediction of short- (28-day) and mid-term (90-day) mortality by ACLF grade at 3-7 days. Among patients that underwent early LT, 75% survived for at least 1 year. Among patients with ≥4 organ failures, or CLIF-C ACLFs >64 at days 3-7 days, and did not undergo LT, mortality was 100% by 28 days. CONCLUSIONS Assessment of ACLF patients at 3-7 days of the syndrome provides a tool to define the emergency of LT and a rational basis for intensive care discontinuation owing to futility.
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Affiliation(s)
- Thierry Gustot
- Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Elisabet Garcia
- Data Management Center of the EASL-CLIF Consortium, CIBEReHD, Barcelona, Spain
| | | | | | | | - Wim Laleman
- University Hospital Gasthuisberg, Leuven, Belgium
| | | | | | - Corinna Hopf
- University of Munich, Klinikum der LMU, Munich, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Carme Deulofeu
- Data Management Center of the EASL-CLIF Consortium, CIBEReHD, Barcelona, Spain
| | | | | | - Marco Pavesi
- Data Management Center of the EASL-CLIF Consortium, CIBEReHD, Barcelona, Spain
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Gómez-Ansón B, Román E, Fernández de Bobadilla R, Pires-Encuentra P, Díaz-Manera J, Núñez F, Martinez-Horta S, Vives-Gilabert Y, Pagonabarraga J, Kulisevsky J, Cordoba J, Guarner C, Soriano G. Alterations in cerebral white matter and neuropsychology in patients with cirrhosis and falls. PLoS One 2015; 10:e0118930. [PMID: 25793766 PMCID: PMC4368732 DOI: 10.1371/journal.pone.0118930] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [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: 07/23/2014] [Accepted: 01/07/2015] [Indexed: 12/15/2022] Open
Abstract
Background & Aim Falls are frequent in patients with cirrhosis but underlying mechanisms are unknown. The aim was to determine the neuropsychological, neurological and brain alterations using magnetic resonance-diffusion tensor imaging (MR-DTI) in cirrhotic patients with falls. Patients and methods Twelve patients with cirrhosis and falls in the previous year were compared to 9 cirrhotic patients without falls. A comprehensive neuropsychological and neurological evaluation of variables that may predispose to falls included: the Mini-Mental State Examination, Psychometric Hepatic Encephalopathy Score (PHES), Parkinson’s Disease-Cognitive Rating Scale, specific tests to explore various cognitive domains, Unified Parkinson’s Disease Rating Scale to evaluate parkinsonism, scales for ataxia and muscular strength, and electroneurography. High-field MR (3T) including DTI and structural sequences was performed in all patients. Results The main neuropsychological findings were impairment in PHES (p = 0.03), Parkinson’s Disease-Cognitive Rating Scale (p = 0.04) and in executive (p<0.05) and visuospatial-visuoconstructive functions (p<0.05) in patients with falls compared to those without. There were no statistical differences between the two groups in the neurological evaluation or in the visual assessment of MRI. MR-DTI showed alterations in white matter integrity in patients with falls compared to those without falls (p<0.05), with local maxima in the superior longitudinal fasciculus and corticospinal tract. These alterations were independent of PHES as a covariate and correlated with executive dysfunction (p<0.05). Conclusions With the limitation of the small sample size, our results suggest that patients with cirrhosis and falls present alterations in brain white matter tracts related to executive dysfunction. These alterations are independent of PHES impairment.
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Affiliation(s)
- Beatriz Gómez-Ansón
- Neuroradiology Unit, Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Eva Román
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Escola Universitària d’Infermeria EUI-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Ramón Fernández de Bobadilla
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Jordi Díaz-Manera
- Neuromuscular Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Valencia, Spain
| | - Fidel Núñez
- Neuroradiology Unit, Department of Radiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Saül Martinez-Horta
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Yolanda Vives-Gilabert
- Port d’Informació Científica (PIC), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Institut de Física d’Altes Energies (IFAE), Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Javier Pagonabarraga
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Jaume Kulisevsky
- Movement Disorders Unit, Department of Neurology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Centro de Investigación Biomédica en Red Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain
| | - Juan Cordoba
- Department of Internal Medicine, Hospital Vall d’Hebron, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Carlos Guarner
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
| | - Germán Soriano
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut de Recerca IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Barcelona, Spain
- * E-mail:
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Sánchez E, Nieto JC, Boullosa A, Vidal S, Sancho FJ, Rossi G, Sancho-Bru P, Oms R, Mirelis B, Juárez C, Guarner C, Soriano G. VSL#3 probiotic treatment decreases bacterial translocation in rats with carbon tetrachloride-induced cirrhosis. Liver Int 2015; 35:735-45. [PMID: 24750552 DOI: 10.1111/liv.12566] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 04/17/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Probiotics can prevent pathological bacterial translocation in cirrhosis by modulating intestinal microbiota and improving gut barrier and immune disturbances. To evaluate the effect of probiotic VSL#3 on bacterial translocation, intestinal microbiota, gut barrier and inflammatory response in rats with experimental cirrhosis. METHODS Forty-six Sprague-Dawley rats with CCl4 -induced cirrhosis were randomized into two groups: VSL#3 group (n = 22) that received VSL#3 in drinking water, and water group (n = 24) that received water only. Treatment began at week 6 of cirrhosis induction and continued until laparotomy, performed 1 week after development of ascites or at week 20. A control group included 11 healthy rats. At this study end, we evaluated bacterial translocation, intestinal flora, intestinal barrier (ileal claudin-2 and 4, β-defensin-1, occludin and malondialdehyde as index of oxidative damage) and serum cytokines. RESULTS Mortality during this study was similar in the VSL#3 group (10/22, 45%) and the water group (10/24, 42%) (P = 1). The incidence of bacterial translocation was 1/12 (8%) in the VSL#3 group, 7/14 (50%) in the water group (P = 0.03 vs. VSL#3 group) and 0/11 in the control group (P = 0.008 vs. water group). The concentration of ileal and caecal enterobacteria and enterococci was similar in the two groups of cirrhotic rats. The ileal occludin concentration was higher and ileal malondialdehyde and serum levels of TNF-α were lower in the VSL#3 group than in the water group (P < 0.05). CONCLUSIONS VSL#3 decreases bacterial translocation, the pro-inflammatory state and ileal oxidative damage and increases ileal occludin expression in rats with experimental cirrhosis.
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Affiliation(s)
- Elisabet Sánchez
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Institut d'Investigacions Biomèdiques (IIB) Sant Pau, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
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Lens S, Mensa L, Gambato M, González P, Torras X, Soriano G, Costa J, Capón A, Londoño MC, Mariño Z, Navasa M, Pérez-del-Pulgar S, Forns X. HEV infection in two referral centers in Spain; epidemiology and clinical outcomes. J Clin Virol 2015; 63:76-80. [DOI: 10.1016/j.jcv.2014.12.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/19/2014] [Accepted: 12/24/2014] [Indexed: 01/30/2023]
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Dupont J, Orlik X, Ghabbach A, Zerrad M, Soriano G, Amra C. Polarization analysis of speckle field below its transverse correlation width : application to surface and bulk scattering. Opt Express 2014; 22:24133-24141. [PMID: 25321988 DOI: 10.1364/oe.22.024133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
An experimental method for accurate polarimetric characterization of speckle field below its transverse correlation width is proposed. Using a polarimetric analyzer, the speckle field under investigation is probed by a set of polarimetric projections describing the full Poincaré sphere surface. Spatial polarimetric variations of the speckle field are thus observed with an accuracy of 1% for each Stokes parameter. Moreover, all the experimental data can be guaranteed by a validity criterion. Using white paper sheet and rough metal samples, the method exhibits strong potential to analyze and differentiate speckle fields generated by bulk and surface scattering.
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Román E, Torrades MT, Nadal MJ, Cárdenas G, Nieto JC, Vidal S, Bascuñana H, Juárez C, Guarner C, Córdoba J, Soriano G. Randomized pilot study: effects of an exercise programme and leucine supplementation in patients with cirrhosis. Dig Dis Sci 2014; 59:1966-75. [PMID: 24599772 DOI: 10.1007/s10620-014-3086-6] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 02/18/2014] [Indexed: 12/25/2022]
Abstract
BACKGROUND Physical exercise could improve functional limitations, muscle mass, and health-related quality of life (HRQoL) in patients with cirrhosis. AIM The purpose of this study was to evaluate the efficacy and safety of an exercise programme and leucine supplementation to increase exercise capacity, muscle mass, and HRQoL in patients with cirrhosis. PATIENTS AND METHODS Seventeen outpatients with cirrhosis were randomized to an exercise group (n = 8) or a control group (n = 9) in a pilot study. The programme of moderate exercise was performed for 12 weeks under supervision of a physiotherapist. All patients received oral leucine (10 g/day) during the study. At baseline and at the end of the study, we determined exercise capacity (6-min walk and 2-min step tests), anthropometric measurements, and HRQoL by Short Form-36 (SF-36) questionnaire. We also analyzed safety regarding complications of cirrhosis, liver and renal function, inflammatory response and oxidative stress. RESULTS In the exercise group, exercise capacity improved, as shown by the increase in the 6-min walk test from 365 (160-420) to 445 m (250-500) (p = 0.01), and in the 2-min step test (p = 0.02). Lower thigh circumference also increased, from 41 (34-53) to 46 cm (36-56) (p = 0.02), and the domains of SF-36 general health (p = 0.03), vitality (p = 0.01) and social function (p = 0.04) improved significantly. In the control group, no statistically significant changes were observed in any of the parameters. We did not observe complications of cirrhosis in either group during the study. CONCLUSIONS A programme of moderate physical exercise together with leucine supplements in patients with cirrhosis is safe and improves exercise capacity, leg muscle mass and HRQoL.
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Affiliation(s)
- Eva Román
- Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Mas Casanovas 90, 08041, Barcelona, Spain
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Abstract
Alterations in intestinal microbiota and inflammatory response play a key role in disease progression and development of complications in liver diseases, mainly in cirrhosis and non-alcoholic steatohepatitis. Probiotics can be useful to delay disease progression and to prevent development of complications due to their ability to modulate intestinal flora, intestinal permeability and inflammatory response. Several studies have shown the efficacy of probiotics in the treatment of minimal hepatic encephalopathy and the prevention of episodes of overt hepatic encephalopathy. Probiotics have also been observed to prevent postoperative bacterial infections and to improve liver damage in non-alcoholic steatohepatitis. However, more studies are needed in order to confirm the efficacy and safety of probiotics in patients with liver diseases, and to better understanding of the mechanisms implicated in their effects.
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Affiliation(s)
- Germán Soriano
- Servicio de Patología Digestiva, Institud de Recerca IIB-Sant Pau, Hospital de Santa Creu i Sant Pau, Barcelona, España.
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Ghabbach A, Zerrad M, Soriano G, Amra C. Accurate metrology of polarization curves measured at the speckle size of visible light scattering. Opt Express 2014; 22:14594-14609. [PMID: 24977555 DOI: 10.1364/oe.22.014594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
An optical procedure is presented to measure at the speckle size and with high accuracy, the polarization degree of patterns scattered by disordered media. Whole mappings of polarization ratio, polarimetric phase and polarization degree are pointed out. Scattered clouds are emphasized on the Poincaré sphere, and are completed by probability density functions of the polarization degree. A special care is attributed to the accuracy of data. The set-up provides additional signatures of scattering media.
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Soriano G, Zerrad M, Amra C. Enpolarization and depolarization of light scattered from chromatic complex media. Opt Express 2014; 22:12603-12613. [PMID: 24921377 DOI: 10.1364/oe.22.012603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Influence of the variations of the scattering properties of a disordered medium with respect to frequency on the polarization of scattered light is investigated. We focus on the strongly scattering regime with the sum of random phasors scattering model that is extended to chromatic media and made frequency-sensitive. It is numerically shown how the scattered polarization depends on the incident polarization and the incident light bandwidth to scattering coefficients chromatic length ratio. Under the presented approach, both phenomena of depolarization and enpolarization of light appear unified.
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Ampuero J, Bañales JM, Soriano G, Crespo J, Olcoz JL, Diago M, Calleja JL, Romero-Gómez M. Polycystic liver in the adult (PLA) in Spain: analysis of a structured survey analyzing the experience and attitude of gastroenterologists in Spain. Rev Esp Enferm Dig 2014; 106:263-275. [PMID: 25075657] [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: 06/03/2023]
Abstract
BACKGROUND Polycystic liver in the adult (PLA) is a rare disease characterized by chronic liver enlargement. OBJECTIVE To analyse gastroenterologists´ involvement in, experience with, and attitude toward diagnosing, monitoring, andtreating patients with PLA in Spain. METHODS Each of seven study coordinators contacted 15 specialists in their geographic area about participating in the study via an online structured survey. RESULTS Of the 105 clinics contacted, 88 completed the questionnaire, with a mean of 3 patients being followed per practice, although 6 clinics were following more than 20 patients with PLA. Patients were being followed mainly by the Department of Hepatology (81 %) and/or the Department of Gastroenterology (33 %). The majority of patients were diagnosed (98 %) and monitored (97 %) using liver ultrasound. When diagnosed, 76 % of patients were under 50 years of age, females predominating.The primary treatment objective for the patients was symptomatic management. Pharmacotherapy was prescribed by 28 % of physicians: Somatostatin analogues, primarily, followed by mTOR inhibitors. One-third of the clinics indicated that they had patients who had undergone liver transplant and/or surgery. CONCLUSIONS Ultrasound is the diagnosing and monitoring method of choice. Among the clinics using pharmacotherapy for symptomatic management, somatostatin analogues were the drugs of choice. These clinics´ infrequent use of invasive procedures suggests that they perceive the various invasive techniques as not very effective.
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Simón-Talero M, García-Martínez R, Torrens M, Augustin S, Gómez S, Pereira G, Guevara M, Ginés P, Soriano G, Román E, Sánchez-Delgado J, Ferrer R, Nieto JC, Sunyé P, Fuentes I, Esteban R, Córdoba J. Effects of intravenous albumin in patients with cirrhosis and episodic hepatic encephalopathy: a randomized double-blind study. J Hepatol 2013; 59:1184-92. [PMID: 23872605 DOI: 10.1016/j.jhep.2013.07.020] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Revised: 07/04/2013] [Accepted: 07/07/2013] [Indexed: 12/16/2022]
Abstract
BACKGROUND & AIMS Episodic hepatic encephalopathy is frequently precipitated by factors that induce circulatory dysfunction, cause oxidative stress-mediated damage or enhance astrocyte swelling. The administration of albumin could modify these factors and improve the outcome of hepatic encephalopathy. The aim of this study is to assess the efficacy of albumin in a multicenter, prospective, double-blind, controlled trial (ClinicalTrials.gov number, NCT00886925). METHODS Cirrhotic patients with an acute episode of hepatic encephalopathy (grade II-IV) were randomized to receive albumin (1.5g/kg on day 1 and 1.0g/kg on day 3) or isotonic saline, in addition to the usual treatment (laxatives, rifaximin 1200mg per day). The primary end point was the proportion of patients in which encephalopathy was resolved on day 4. The secondary end points included survival, length of hospital stay, and biochemical parameters. RESULTS Fifty-six patients were randomly assigned to albumin (n=26) or saline (n=30) stratified by the severity of HE. Both groups were comparable regarding to demographic data, liver function, and precipitating factors. The percentage of patients without hepatic encephalopathy at day 4 did not differ between both groups (albumin: 57.7% vs. saline: 53.3%; p>0.05). However, significant differences in survival were found at day 90 (albumin: 69.2% vs. saline: 40.0%; p=0.02). CONCLUSIONS Albumin does not improve the resolution of hepatic encephalopathy during hospitalization. However, differences in survival after hospitalization suggest that the development of encephalopathy may identify a subgroup of patients with advanced cirrhosis that may benefit from the administration of albumin.
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Affiliation(s)
- Macarena Simón-Talero
- Liver Unit, Department of Internal Medicine, Hospital Universitari Vall d'Hebron, Institut de Recerca (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain
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Soriano G, Zerrad M, Amra C. Mapping the coherence time of far-field speckle scattered by disordered media. Opt Express 2013; 21:24191-24200. [PMID: 24104329 DOI: 10.1364/oe.21.024191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The polarization and temporal coherence properties of light are altered by scattering events. In this paper, we follow a far-field approach, modelizing the scattering from disordered media with the scattering matrix formalism. The degree of polarization and coherence time of the scattered light are expressed with respect to the characteristics of the incident field.
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Arhab S, Soriano G, Ruan Y, Maire G, Talneau A, Sentenac D, Chaumet PC, Belkebir K, Giovannini H. Nanometric resolution with far-field optical profilometry. Phys Rev Lett 2013; 111:053902. [PMID: 23952401 DOI: 10.1103/physrevlett.111.053902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Indexed: 06/02/2023]
Abstract
We show experimentally that a resolution far beyond that of conventional far-field optical profilometers can be reached with optical diffraction tomography. This result is obtained in the presence of multiple scattering when using an adapted inverse scattering algorithm for profile reconstruction. This new profilometry technique, whose resolution can be compared to that of atomic microscopes, also gives access to the permittivity of the surface.
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Affiliation(s)
- S Arhab
- Aix-Marseille Université, CNRS, Centrale Marseille, Institut Fresnel, UMR 7249, 13013 Marseille, France
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Martínez-Lapiscina EH, Ayuso T, Lacruz F, Gurtubay IG, Soriano G, Otano M, Bujanda M, Bacaicoa MC. Cortico-juxtacortical involvement increases risk of epileptic seizures in multiple sclerosis. Acta Neurol Scand 2013; 128:24-31. [PMID: 23289848 DOI: 10.1111/ane.12064] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Previous studies have reported an increased risk for epileptic seizures in multiple sclerosis (MS) patients. However, data on the pathogenesis of seizures remain inconclusive. The aim of our study is to evaluate prevalence, clinical and paraclinical features of epileptic attacks in our MS cohort and to search MS-specific risk factors for epileptic seizures. MATERIALS AND METHODS In this cohort of 428 MS patients, 13 patients were identified with epileptic seizures occurring at any point during the course of MS including at MS onset. As a control group, we selected 26 MS patients without seizures and matched for gender, age and date of MS onset. We compared demographic features and clinic-radiological findings between the both groups. RESULTS Thirteen patients (3%) were identified as having epileptic attacks. Ten patients (77%) experienced focal seizures, half of whom had confirmed secondary generalization. We did not find an association between seizures and disease course. Most patients had a single or few (2-5) seizures. MS patients with seizures had a significantly higher number of cortical and juxtacortical lesions on T2-weighted/fluid attenuation inversion recovery magnetic resonance imaging than control group [OR = 2.6 CI95% (1.0-6.5); P = 0.047]. CONCLUSIONS Our findings support a credible role of cortical and juxtacortical involvement in the development of epileptic seizures in MS.
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Affiliation(s)
| | - T. Ayuso
- Neurology; Complejo Hospitalario de Navarra; Pamplona; Spain
| | - F. Lacruz
- Neurology; Complejo Hospitalario de Navarra; Pamplona; Spain
| | - I. G. Gurtubay
- Neurophysiology; Complejo Hospitalario de Navarra; Pamplona; Spain
| | - G. Soriano
- Neurology; Complejo Hospitalario de Navarra; Pamplona; Spain
| | - M. Otano
- Neurology; Complejo Hospitalario de Navarra; Pamplona; Spain
| | - M. Bujanda
- Neurology; Complejo Hospitalario de Navarra; Pamplona; Spain
| | - M. C. Bacaicoa
- Neuroradiology; Complejo Hospitalario de Navarra; Pamplona; Spain
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Sánchez E, Francés R, Soriano G, Mirelis B, Sancho FJ, González-Navajas JM, Muñoz C, Song XY, Pérez-Mateo M, Such J, Guarner C. Modulation of inflammatory response in a cirrhotic rat model with induced bacterial peritonitis. PLoS One 2013; 8:e59692. [PMID: 23527251 PMCID: PMC3603865 DOI: 10.1371/journal.pone.0059692] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 09/14/2012] [Accepted: 02/17/2013] [Indexed: 12/21/2022] Open
Abstract
Bacterial peritonitis is a severe complication in patients with cirrhosis and ascites and despite antibiotic treatment, the inflammatory response to infection may induce renal dysfunction leading to death. This investigation evaluated the effect of TNF-α blockade on the inflammatory response and mortality in cirrhotic rats with induced bacterial peritonitis treated or not with antibiotics. Sprague-Dawley rats with carbon-tetrachloride-induced cirrhosis were treated with an intraperitoneal injection of 109 CFU of Escherichia coli diluted in 20 mL of sterile water to induce bacterial peritonitis and randomized to receive subcutaneously-administered placebo, ceftriaxone, anti-TNF-α mAb and ceftriaxone, or anti-TNF-α mAb alone. No differences were observed between groups at baseline in respect to renal function, liver hepatic tests, serum levels of nitrite/nitrate and TNF-α. Treatment with ceftriaxone reduced mortality (73.3%) but differences did not reach statistical significance as compared to placebo. Mortality in rats treated with ceftriaxone and anti-TNF-α mAb was significantly lower than in animals receiving placebo (53% vs. 100%, p<0.01). Serum TNF-α decreased significantly in surviving rats treated with ceftriaxone plus anti-TNF-α mAb but not in treated with antibiotics alone. Additional studies including more animals are required to assess if the association of antibiotic therapy and TNF-α blockade might be a possible approach to reduce mortality in cirrhotic patients with bacterial peritonitis.
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Affiliation(s)
- Elisabet Sánchez
- Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Institut dInvestigacions Biomédiques de Sant Pau (IIB), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Rubén Francés
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Unidad Hepática, Hospital General Universitario, Universidad Miguel Hernández, Alicante, Spain
| | - Germán Soriano
- Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Institut dInvestigacions Biomédiques de Sant Pau (IIB), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
| | - Beatriz Mirelis
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- Department of Microbiology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Francesc J. Sancho
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Manuel González-Navajas
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Unidad Hepática, Hospital General Universitario, Universidad Miguel Hernández, Alicante, Spain
| | - Carlos Muñoz
- Department of Microbiology, Hospital General Universitario, Universidad Miguel Hernández, Alicante, Spain
| | - Xiao-yu Song
- Research and Development Centocor, Malvern, Pennsylvania, United States of America
| | - Miguel Pérez-Mateo
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - José Such
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Unidad Hepática, Hospital General Universitario, Universidad Miguel Hernández, Alicante, Spain
| | - Carlos Guarner
- Liver Section, Department of Gastroenterology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red en el Área temática de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Institut dInvestigacions Biomédiques de Sant Pau (IIB), Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain
- * E-mail:
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Zerrad M, Soriano G, Ghabbach A, Amra C. Light enpolarization by disordered media under partial polarized illumination: the role of cross-scattering coefficients. Opt Express 2013; 21:2787-2794. [PMID: 23481735 DOI: 10.1364/oe.21.002787] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We show how disordered media allow to increase the local degree of polarization (DOP) of an arbitrary (partial) polarized incident beam. The role of cross-scattering coefficients is emphasized, together with the probability density functions (PDF) of the scattering DOP. The average DOP of scattering is calculated versus the incident illumination DOP.
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Affiliation(s)
- M Zerrad
- Institut Fresnel, UMR CNRS 7249, Aix-Marseille Université, Ecole Centrale, Marseille, France.
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Soriano G, Sánchez E, Guarner C, Schiffrin EJ. Lactobacillus johnsonii La1 without antioxidants does not decrease bacterial translocation in rats with carbon tetrachloride-induced cirrhosis. J Hepatol 2012; 57:1395-6. [PMID: 22824820 DOI: 10.1016/j.jhep.2012.07.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Revised: 07/12/2012] [Accepted: 07/12/2012] [Indexed: 02/07/2023]
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Missaka H, Leão F, Cantarelli LH, Dallava PV, Almeida JEE, Figueiredo PC, Nogueira F, Divan-Filho S, Lannes RS, Vila-Da-Mota FM, Usiglio DS, Soriano G, Jabour LF, Oliveira LC. Ultrassonography at Bedside in Emergency ICU: a powerful diagnostic tool. Crit Ultrasound J 2012. [PMCID: PMC3524484 DOI: 10.1186/2036-7902-4-s1-a5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Prim N, Escamilla P, Solé R, Llovet T, Soriano G, Muñoz C. Risk of underdiagnosing amebic dysentery due to false-negative Entamoeba histolytica antigen detection. Diagn Microbiol Infect Dis 2012; 73:372-3. [PMID: 22683092 DOI: 10.1016/j.diagmicrobio.2012.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/25/2012] [Accepted: 04/30/2012] [Indexed: 11/26/2022]
Abstract
Entamoeba histolytica antigen assays on stool are widely used to diagnose amebiasis. We report a case of confirmed amebic colitis with a false-negative antigen detection that became positive after treatment. Our results indicate that these assays may underdiagnose acute amebic infection when used alone and should be used cautiously.
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Affiliation(s)
- Núria Prim
- Servei de Microbiologia, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
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Soriano G, Román E, Córdoba J, Torrens M, Poca M, Torras X, Villanueva C, Gich IJ, Vargas V, Guarner C. Cognitive dysfunction in cirrhosis is associated with falls: a prospective study. Hepatology 2012; 55:1922-30. [PMID: 22213000 DOI: 10.1002/hep.25554] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 11/30/2011] [Indexed: 12/22/2022]
Abstract
UNLABELLED Falls are frequent among patients with debilitating disorders and can have a serious effect on health status. Mild cognitive disturbances associated with cirrhosis may increase the risk for falls. Identifying subjects at risk may allow the implementation of preventive measures. Our aim was to assess the predictive value of the Psychometric Hepatic Encephalopathy Score (PHES) in identifying patients likely to sustain falls. One hundred and twenty-two outpatients with cirrhosis were assessed using the PHES and were followed at specified intervals. One third of them exhibited cognitive dysfunction (CD) according to the PHES (<-4). Seventeen of the forty-two patients (40.4%) with CD had at least one fall during follow-up. In comparison, only 5 of 80 (6.2%) without CD had falls (P < 0.001). Fractures occurred in 4 patients (9.5%) with CD, but in no patients without CD (P = 0.01). Patients with CD needed more healthcare (23.8% versus 2.5%; P < 0.001), more emergency room care (14.2% versus 2.5%; P = 0.02), and more hospitalization (9.5% versus 0%; P = 0.01) as a result of falls than patients without CD. Patients taking psychoactive treatment (n = 21) had a higher frequency of falls, and this was related to an abnormal PHES. In patients without psychoactive treatment (n = 101), the incidence of falls was 32.4% in patients with CD versus 7.5% in those without CD (P = 0.003). In the multivariate analysis, CD was the only independent predictive factor of falls (odds ratio, 10.2; 95% confidence interval, 3.4-30.4; P < 0.001). The 1-year probability of falling was 52.3% in patients with CD and 6.5% in those without (P < 0.001). CONCLUSION An abnormal PHES identifies patients with cirrhosis who are at risk for falls. This psychometric test may be useful to promote awareness of falls and identify patients who may benefit from preventive strategies.
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Affiliation(s)
- Germán Soriano
- Department of Gastroenterology, Institut d'Investigació Biomèdica Sant Pau, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
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