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Emerging Combination of Saroglitazar and Vitamin E for the Treatment of NAFLD and NASH 治疗非酒精性脂肪肝和非酒精性脂肪性肝炎的新组合--沙格列扎和维生素 E
IF 3 Q2 Medicine Pub Date : 2024-05-14 DOI: 10.1016/j.jceh.2024.101449
Federica Tavaglione, Rohit Loomba
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引用次数: 0
First Report of Two-stage Living Donor Liver Transplantation to Avoid Futility and Ensure Double Equipoise in Acute Liver Failure Complicated by Toxic Liver Syndrome 首次报告两阶段活体肝移植,以避免急性肝功能衰竭并发中毒性肝脏综合征的无用性并确保双平衡
IF 3 Q2 Medicine Pub Date : 2024-05-09 DOI: 10.1016/j.jceh.2024.101443
Amarnath Kadimella , Chandan K. Kedarisetty , Ravi Raya , Rajgopal M. Acharya , Smith Kadakia , Ganesh Chowhan , Gottimukkala Jayalaxmi , Mettu S. Reddy

Acute hepatic failure may occasionally be complicated by toxic liver syndrome. Emergency hepatectomy for stabilization followed by delayed graft implantation is a recognized strategy in such cases in the setting of deceased donor liver transplantation. Living donor liver transplantation adds additional complexity to this scenario as the donor liver is a directed donation and failure to stabilize the patient after emergency hepatectomy can lead to a futile live donor hepatectomy, hepar-divisum, or an orphan graft. We report a case where the two-stage strategy was utilized to circumvent this situation. A patient with toxic liver syndrome underwent emergency hepatectomy and was closely monitored in the operating theater. A live donor hepatectomy was started after the recipient demonstrated cardiovascular and neurological stabilization. Graft implantation was completed after an anhepatic period of 9.45 h. To our knowledge, this is the first reported instance of using the two-stage strategy in living-donor-liver-transplantation for toxic liver syndrome to prevent futile donor surgery and achieve double equipoise.

急性肝功能衰竭偶尔会并发中毒性肝脏综合征。紧急肝切除以稳定病情,然后延迟移植肝的植入,是在已故供体肝移植情况下处理此类病例的公认策略。活体肝移植增加了这种情况的复杂性,因为捐献的肝脏是定向捐献的,紧急肝切除术后如果不能稳定患者病情,可能会导致无用的活体肝切除术、肝二分裂或无主移植物。我们报告了一个利用两阶段策略避免这种情况的病例。一名患有中毒性肝脏综合征的患者接受了紧急肝切除术,并在手术室接受了严密监测。在受体的心血管和神经功能稳定后,开始进行活体肝切除术。据我们所知,这是首次报道在中毒性肝综合征的活体肝移植中使用两阶段策略,以防止供体手术徒劳无功并实现双平衡。
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引用次数: 0
Experience of Performing Hepatic Interventional Radiological Procedures in a Tertiary Care Hospital in Odisha: A Case Series 在奥迪沙邦一家三级医院开展肝脏介入放射手术的经验,病例系列
IF 3 Q2 Medicine Pub Date : 2024-05-08 DOI: 10.1016/j.jceh.2024.101436
Dibya Lochan Praharaj , Swati Das , Vedavyas Mohapatra , Bipadabhanjan Mallick , Preetam Nath , Sarat Chandra Panigrahi , Suprabhat Giri , Saroj Kanta Sahu , Anil Chandra Anand , Subrat Kumar Acharya

Introduction

During last few decades, radiological interventions have played crucial role in the management of the patients with chronic liver diseases. Various procedures including transjugualar intrahepatic portosystemic shunt (TIPS), transjugular liver biopsy (TJLB), transarterial chemoembilization (TACE)/transarterial radioembolization (TARE), balloon retrograde transvenous obliteration (BRTO) and plug-assisted retrograde transvenous obliteration (PARTO) are being performed safely and have significantly improved clinical outcomes in these patients. The technical and clinical success depend on appropriate patient selection along with thorough knowledge and experience to perform these procedures. On the other hand, few adverse events may also be associated with these procedures. The intervention radiologist and hepatologists should identify and treat these complications at the earliest so as to improve outcome of the patient.

Materials and methods

About 25 hepatic intervention radiology procedures were performed in our center from January 2022 to 2023 May. Among these we have selected five patients who underwent TACE/TIPS/DIPS in our institute. We have selected these cases as in each of these cases we encountered some interesting outcomes/complications which were managed successfully.

Results

The first case describes 33-year-old male with POEM syndrome and Budd Chiari Syndrome (BCS) who underwent TIPS and immediately had blockade of the stent. The second case is of a 43 years old male having BCS, refractory ascites with umbilical and inguinal hernia. The third case is of a 40 years old female with decompensated cirrhosis who underwent TIPS for portal hypertensive gastropathy. The fourth case is of a 51-years’ female with decompensated cirrhosis with sarcopenia. Finally, the fifth case describes 24-year-old female with BCS and hepatocellular carcinoma. In this article we discuss the procedure and clinical course of the patients following the procedure.

Conclusion

Hepatic radiological interventions though widely used can be associated with unusual albeit life threatening complications. Appropriate patient selection and thorough knowledge of procedure along with early diagnosis and management of these complications are key to obtain satisfying long term outcomes.

导言在过去几十年中,放射介入在慢性肝病患者的治疗中发挥了至关重要的作用。包括经颈静脉肝内门体分流术(TIPS)、经颈静脉肝活检术(TJLB)、经动脉化疗栓塞术(TACE)/经动脉放射栓塞术(TARE)、球囊逆行经静脉阻塞术(BRTO)和塞子辅助逆行经静脉阻塞术(PARTO)在内的各种手术正在安全进行,并显著改善了这些患者的临床疗效。技术和临床成功与否取决于对患者的适当选择以及实施这些手术的全面知识和经验。另一方面,这些手术也可能会出现一些不良事件。材料和方法2022 年 1 月至 2023 年 5 月,本中心共进行了约 25 例肝放射介入手术。其中,我们选择了五例在本院接受 TACE/TIPS/DIPS 的患者。第一例患者 33 岁,男性,患有 POEM 综合征和 Budd Chiari 综合征(BCS),接受 TIPS 后立即出现支架阻塞。第二个病例是一名 43 岁的男性,患有 BCS、难治性腹水和脐疝及腹股沟疝。第三例是一名 40 岁的女性,患有失代偿期肝硬化,因门脉高压性胃病接受了 TIPS 手术。第四个病例是一名 51 岁的女性失代偿期肝硬化患者,患有肌肉疏松症。最后,第五个病例是一名患有 BCS 和肝细胞癌的 24 岁女性。本文讨论了手术过程和术后患者的临床病程。 结论肝脏放射介入虽然应用广泛,但也可能会出现不寻常的并发症,尽管这些并发症可能危及生命。适当选择患者、全面了解手术方法以及早期诊断和处理这些并发症是获得令人满意的长期疗效的关键。
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引用次数: 0
Medically Tailored Meals for Patients With Cirrhosis and Hepatic Encephalopathy: The BRAINFOOD Proof-of-concept Trial 肝硬化和肝性脑病患者的药膳:BRAINFOOD 概念验证试验
IF 3 Q2 Medicine Pub Date : 2024-05-07 DOI: 10.1016/j.jceh.2024.101439
Elliot B. Tapper , Zachary M. Saleh , Sam Nikirk , Jasmohan Bajaj , Xi Chen , Anna S-F. Lok

Background and aims

Guidelines recommend that patients with hepatic encephalopathy (HE) receive a high-protein diet (roughly 1 g/kg actual body weight). Concommitant sodium restriction, low health literacy, and food insecurity limit patients’ ability to meet this goal. We aimed to determine the feasibility of home-delivered high-protein medically tailored meals (MTMs) for patients with a recent episode of overt HE.

Methods

We enrolled patients with prior overt HE on active HE therapy in a 6-month trial of MTM. All received 21 home-delivered meals/week with protein snacks (mid-day and bedtime) for 12 weeks. Patients completed follow-up at week 24. The primary outcome was feasibility. Additional outcomes included change in protein and micronutrient intake (measured using 24 h dietary recalls performed by dieticians), cognitive function (Animal Naming Test [ANT]; EncephalApp Stroop), physical function (Liver Frailty Index [LFI]), and quality of life (Short Form-8 Health Survey [SF-8]). Healthcare utilization was also assessed.

Results

Ten patients competed the study with >90% of MTM consumed. Protein intake rose from 74.6 ± 25.1 g at baseline to 93.8 ± 24.3 g on MTM (P = 0.04). Branched-chain amino acids also increased—valine 3.73 ± 1.26 g to 5.17 ± 1.28 g, isoleucine 3.32 ± 1.18 to 4.69 ± 1.55, leucine 5.83 ± 2.00 to 7.49 ± 2.07, all P < 0.001. The LFI score improved from 4.42 ± 0.32 to 3.96 ± 0.82 by the end of the MTM phase (P = 0.03). SF-8 quality-of-life scores improved from 55.5 ± 15.5 at baseline to 64.7 ± 18.3 after the MTM phase, to 64.4 ± 19.1 at the end of the study (P = 0.1). EncephalApp Stroop time improved from 227 ± 94 to 194 ± 58s by the end of the MTM phase (P = 0.08). ANT scores were similarly non-significantly improved.

Conclusion

Home-delivered MTMs are feasible, increase protein consumption, and may improve patient wellbeing. A randomized trial is needed.

背景和目的指南建议肝性脑病(HE)患者接受高蛋白饮食(大约每公斤实际体重 1 克)。同时存在的钠限制、健康知识水平低和食物不安全限制了患者实现这一目标的能力。我们的目的是确定为近期发作过明显高血压的患者提供高蛋白家庭定制餐(MTM)的可行性。方法我们招募了接受过明显高血压积极治疗的患者参加为期 6 个月的 MTM 试验。在为期 12 周的试验中,所有患者每周接受 21 次送餐上门服务,并提供蛋白质点心(中午和睡前)。患者在第 24 周完成随访。主要结果是可行性。其他结果包括蛋白质和微量营养素摄入量的变化(通过营养师进行的 24 小时饮食回顾测量)、认知功能(动物命名测试 [ANT];EncephalApp Stroop)、身体功能(肝脏虚弱指数 [LFI])和生活质量(简表-8 健康调查 [SF-8])。此外,还对医疗保健的使用情况进行了评估。蛋白质摄入量从基线时的 74.6 ± 25.1 克增加到 MTM 后的 93.8 ± 24.3 克(P = 0.04)。支链氨基酸也有所增加--缬氨酸从 3.73 ± 1.26 g 增加到 5.17 ± 1.28 g,异亮氨酸从 3.32 ± 1.18 增加到 4.69 ± 1.55,亮氨酸从 5.83 ± 2.00 增加到 7.49 ± 2.07,所有 P 均为 0.001。在 MTM 阶段结束时,LFI 分数从 4.42 ± 0.32 降至 3.96 ± 0.82(P = 0.03)。SF-8 生活质量评分从基线时的 55.5 ± 15.5 分提高到 MTM 阶段后的 64.7 ± 18.3 分,再提高到研究结束时的 64.4 ± 19.1 分(P = 0.1)。到 MTM 阶段结束时,脑应用 Stroop 时间从 227±94 秒缩短至 194±58 秒(P = 0.08)。结论居家 MTM 是可行的,它能增加蛋白质的摄入量,并能改善患者的健康状况。需要进行随机试验。
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引用次数: 0
Successful Surgical Management of Giant Mucinous Cystic Neoplasm of Liver (MCN-L) Presenting With Peritoneal Rupture and Biliary Prolapse: Case Report and Review of Literature 成功手术治疗伴有腹膜破裂和胆道脱垂的肝脏巨大粘液囊性肿瘤(MCN-L):病例报告和文献综述。
IF 3 Q2 Medicine Pub Date : 2024-05-07 DOI: 10.1016/j.jceh.2024.101441
Ruchi Rastogi , Subhash Gupta , Sanjiv Saigal , Mukesh Kumar , Rohan Luthra , Riti Agarwal , Bharat Aggarwal

Mucinous cystic neoplasms of liver (MCN-L) are generally considered benign indolent cystic liver lesions, not associated with significant clinical symptoms in majority of patients. However, rarely these benign-appearing lesions may have a complicated clinical course, presenting with jaundice, acute abdomen, or malignant transformation. We report one such rare clinical presentation of MCN-L presenting with obstructive jaundice and abdominal pain due to prolapse of cystic component in biliary system and peritoneal rupture occurring simultaneously. Despite the complex nature of presentation, it was successfully managed surgically with normal follow-up imaging.

肝脏黏液囊性瘤(MCN-L)通常被认为是良性、惰性的肝脏囊性病变,大多数患者不会出现明显的临床症状。然而,在极少数情况下,这些看似良性的病变可能会出现复杂的临床过程,表现为黄疸、急腹症或恶性转化。我们报告的 MCN-L 就是这种罕见的临床表现之一,由于胆道系统囊性成分脱垂和腹膜破裂同时发生,患者出现梗阻性黄疸和腹痛。尽管病情复杂,但手术治疗成功,随访造影正常。
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引用次数: 0
Systemic Therapies for Hepatocellular Carcinoma in India 印度肝细胞癌的系统疗法
IF 3 Q2 Medicine Pub Date : 2024-05-06 DOI: 10.1016/j.jceh.2024.101440
Vinay Jahagirdar , Kaanthi Rama , Mohammed F. Habeeb , Mithun Sharma , Padaki N. Rao , Duvvur N. Reddy , Amit G. Singal , Anand V. Kulkarni

Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality in India. This review explores the epidemiological trends and the landscape of systemic therapy for HCC in the Indian context, acknowledging the recent shift in etiology from viral hepatitis to lifestyle-associated factors.

A comprehensive review of the literature was conducted, including data from the Global Cancer Observatory and the Indian Council of Medical Research, along with a critical analysis of various clinical trials. The article investigates systemic therapies in-depth, discussing their mechanisms, efficacy, and adaptation to Indian healthcare framework.

Progression-free survival with a hazard ratio of ≤0.6 compared to sorafenib, overall survival of ∼16–19 months, and objective response rate of 20–30% are the defining thresholds for systemic therapy clinical trials. Systemic therapy for advanced HCC in India primarily involves the use of tyrosine kinase inhibitors such as sorafenib, lenvatinib, regorafenib, and cabozantinib, with sorafenib being the most commonly used drug for a long time. Monoclonal antibodies such as ramucirumab and bevacizumab and immune-checkpoint inhibitors, such as atezolizumab, nivolumab, and pembrolizumab, are expanding treatment horizons. Lenvatinib has emerged as a cost-effective alternative, and the combination of atezolizumab and bevacizumab has demonstrated superior outcomes in terms of overall survival and progression-free survival. Despite these advances, late-stage diagnosis and limited healthcare accessibility pose significant challenges, often relegating patients to palliative care.

Addressing HCC in India demands an integrative approach that not only encompasses advancements in systemic therapy but also targets early detection and comprehensive care models. Future strategies should focus on enhancing awareness, screening for high-risk populations, and overcoming infrastructural disparities. Ensuring the judicious use of systemic therapies within the constraints of the Indian healthcare economy is crucial. Ultimately, a nuanced understanding of systemic therapeutic options and their optimal utilization will be pivotal in elevating the standard of HCC care in India.

肝细胞癌(HCC)是印度癌症相关死亡的主要原因。这篇综述探讨了印度的流行病学趋势和 HCC 的系统治疗情况,同时承认最近病因从病毒性肝炎转向生活方式相关因素。文章对文献进行了全面综述,包括来自全球癌症观察站和印度医学研究理事会的数据,以及对各种临床试验的批判性分析。与索拉非尼相比,无进展生存期的危险比≤0.6,总生存期为16-19个月,客观反应率为20-30%,这些都是系统疗法临床试验的界定标准。在印度,晚期 HCC 的全身治疗主要包括使用酪氨酸激酶抑制剂,如索拉非尼、伦伐替尼、瑞戈非尼和卡博赞替尼,其中索拉非尼是长期以来最常用的药物。ramucirumab和贝伐珠单抗等单克隆抗体以及atezolizumab、nivolumab和pembrolizumab等免疫检查点抑制剂正在扩大治疗范围。伦伐替尼已成为一种具有成本效益的替代疗法,atezolizumab和贝伐珠单抗的联合用药在总生存期和无进展生存期方面都取得了卓越的疗效。尽管取得了这些进展,但晚期诊断和有限的医疗可及性带来了巨大挑战,往往使患者只能接受姑息治疗。在印度治疗 HCC 需要采取综合方法,不仅包括系统治疗方面的进展,还要针对早期检测和综合护理模式。未来的战略应侧重于提高认识、筛查高危人群以及克服基础设施方面的差距。确保在印度医疗经济的限制下合理使用系统疗法至关重要。最终,对全身治疗方案及其最佳利用的细致了解将对提高印度的 HCC 治疗水平起到关键作用。
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引用次数: 0
Effect of Ruzu Herbal Bitters on the Liver Function and Lipid Profile Parameters of Alloxan-Induced Diabetic Rats 儒足苦药对四氧嘧啶诱导的糖尿病大鼠肝功能及血脂指标的影响
IF 3 Q2 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.jceh.2021.09.012
David C. Obasi , Victor N. Ogugua

Background

Ruzu herbal bitters (RHB) is a polyherbal mixture produced in Nigeria indicated for diabetes and other ailments. The consumers of the product testify of its efficacy, but there are not much scientific information on RHB. The study determined the effect of RHB on the liver function and lipid profile parameters of alloxan-induced diabetic rats.

Method

Fifty-four adult albino rats were divided into nine groups of six rats each. Group 1 was the normal control, while groups 2–6 were diabetic. Group 2 was not treated, while groups 3–6 were respectively treated with 5 mg/kg b.w of glibenclamide, 0.14, 0.29, and 0.57 ml/kg b.w of RHB. Groups 7–9 were not diabetic but treated as groups 4–6. Diabetes was induced by intraperitoneal injection of freshly prepared alloxan into adult male albino Wister rats with a single dose of 120 mg/kg body weight. The blood sugar level, weight, liver function, and lipid profile of the rats were tested using standard methods.

Result

The results showed a significant (P < 0.05) increase in the blood glucose level and decrease in weight in the diabetic-untreated group compared to the normal group. The liver function and lipid profile tests showed significant (P<0.05) increases in the activities of gamma-glutamyltransferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST); increases in the levels of total bilirubin, total cholesterol (T.CHOL), triglycerides (TG), very low-density lipoprotein (VLDL) and lowdensity lipoprotein (LDL); decreases in the levels of total protein, albumin and high-density lipoproteins (HDL), in the diabetic-untreated group compared to the normal group. However, treatment of the diabetic rats with different doses of RHB caused the reversal of these effects to near-normal levels in a dose-dependent manner.

Conclusions

Our study reveals that RHB has antidiabetic, hepatoprotective, and antihyperlipidemic effects.

背景Ruzu 草药苦味剂(RHB)是尼日利亚生产的一种多草药混合物,用于治疗糖尿病和其他疾病。该产品的消费者证明了它的功效,但有关 RHB 的科学信息并不多。本研究确定了 RHB 对阿脲诱导的糖尿病大鼠肝功能和血脂谱参数的影响。第 1 组为正常对照组,第 2-6 组为糖尿病组。第 2 组不进行治疗,第 3-6 组分别使用格列本脲 5 毫克/千克体重、RHB 0.14、0.29 和 0.57 毫升/千克体重进行治疗。第 7-9 组没有糖尿病,但接受了与第 4-6 组相同的治疗。成年雄性白化威斯特大鼠腹腔注射新鲜制备的阿脲,单次剂量为 120 毫克/千克体重,诱发糖尿病。结果表明,与正常组相比,糖尿病未治疗组的血糖水平显著升高(P <0.05),体重下降。肝功能和血脂检测结果显示,γ-谷氨酰转移酶(GGT)、碱性磷酸酶(ALP)、丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)的活性明显增加(P<0.05);总胆红素、总胆固醇(T.CHOL)、甘油三酯(TG)、极低密度脂蛋白(VLDL)和低密度脂蛋白(LDL)水平升高;与正常组相比,糖尿病未治疗组的总蛋白、白蛋白和高密度脂蛋白(HDL)水平降低。然而,用不同剂量的 RHB 治疗糖尿病大鼠可使这些影响逆转至接近正常水平,且呈剂量依赖性。
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引用次数: 0
Use of Bacterial DNA Concentration in Ascites as a Marker for Spontaneous Bacterial Peritonitis 利用腹水中的细菌 DNA 浓度作为自发性细菌性腹膜炎的标志物
IF 3 Q2 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.jceh.2024.101434
Niklas F. Aehling , Arno Hagenunger , Sandra Krohn , Katharina Zeller , Kathrin Jäger , Adam Herber , Cornelius Engelmann , Thomas Berg

Background and aims

Spontaneous bacterial peritonitis (SBP) is a common and serious complication in patients with decompensated cirrhosis. Precise quantification of bacterial DNA (bactDNA) and the related inflammatory response might add further information on the course of disease. The aim of the study was to evaluate the association between bactDNA, cytokine levels and clinical outcome.

Methods

Ascites and serum samples of 98 patients with decompensated liver cirrhosis (42 with SBP and 56 without SBP) as well as serum samples of 21 healthy controls were collected. BactDNA in ascites and serum was detected and quantified by 16S rRNA PCR. Concentrations of IL-1β, TNF-α, IL-6, IL-8 and IL-10 were measured by a LEGENDplexTM multi-analyte flow assay. Clinical data were collected and analyzed retrospectively.

Results

BactDNA was detected more frequently in ascites of patients with SBP (n = 24/42; 57.1%) than in ascites of patients without SBP (n = 5/56; 8.9%; P < 0.001). Additionally, IL-6 levels in both ascites and serum were significantly higher in patients with SBP (ascites P < 0.001, serum P = 0.036). The quantity of bactDNA in ascites was strongly correlated with polymorphonuclear neutrophil count in ascites (r = 0.755; P < 0.001) as well as ascites IL-6 levels (r = 0.399; P < 0.001). Receiver operating characteristic (ROC) curve analysis to diagnose SBP provided an AUC of 0.764 (95% CI: 0.661–0.867) for serum IL-6 levels, an AUC of 0.810 (95% CI: 0.714–0.905) for ascites IL-6 levels, and an AUC of 0.755 (95% CI: 0.651–0.858) for bactDNA levels in ascites.

Conclusions

The correlation between the amount of bactDNA and IL-6 confirms the pathophysiological relevance of bactDNA and IL-6 as potential biomarkers for the diagnosis of SBP.

背景和目的自发性细菌性腹膜炎(SBP)是失代偿期肝硬化患者常见的严重并发症。对细菌 DNA(bactDNA)和相关炎症反应的精确定量可进一步了解病程。研究旨在评估 bactDNA、细胞因子水平和临床预后之间的关联。方法收集了 98 例失代偿期肝硬化患者(42 例伴有 SBP,56 例无 SBP)的腹水和血清样本,以及 21 例健康对照者的血清样本。通过 16S rRNA PCR 检测腹水和血清中的 BactDNA 并进行定量。IL-1β、TNF-α、IL-6、IL-8 和 IL-10 的浓度通过 LEGENDplexTM 多分析流式分析仪进行测定。结果在 SBP 患者腹水中检测到的 BactDNA(n = 24/42;57.1%)多于在非 SBP 患者腹水中检测到的 BactDNA(n = 5/56;8.9%;P <;0.001)。此外,SBP 患者腹水和血清中的 IL-6 水平均显著升高(腹水 P < 0.001,血清 P = 0.036)。腹水中的 bactDNA 数量与腹水中的多形核中性粒细胞计数(r = 0.755; P <0.001)和腹水 IL-6 水平(r = 0.399; P <0.001)密切相关。诊断 SBP 的接收者操作特征(ROC)曲线分析显示,血清 IL-6 水平的 AUC 为 0.764(95% CI:0.661-0.867),腹水 IL-6 水平的 AUC 为 0.810(95% CI:0.714-0.905),腹水 IL-6 水平的 AUC 为 0.结论 bactDNA 和 IL-6 的含量之间的相关性证实了 bactDNA 和 IL-6 作为诊断 SBP 的潜在生物标记物的病理生理学相关性。
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引用次数: 0
Issue Highlights 发行亮点
IF 3 Q2 Medicine Pub Date : 2024-05-01 DOI: 10.1016/S0973-6883(24)00099-9
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引用次数: 0
Health-related Quality of Life in Patients With Liver Cirrhosis: A Randomized Study 肝硬化患者的健康相关生活质量:随机研究
IF 3 Q2 Medicine Pub Date : 2024-04-30 DOI: 10.1016/j.jceh.2024.101433
Siddheesh Rajpurohit, Balaji Musunuri, Pooja B. Mohan, Ganesh Bhat, Shiran Shetty

Background/Aims

Health-related quality of life (HRQoL) relates to how people perceive illness and treatment affects their physical health, emotional health, functional status, and social position. Along with clinical goals, HRQoL is significant. Therefore, the present study evaluates the effect of patient counseling and education on HRQoL of cirrhotic patients.

Methods

This prospective study was conducted in a tertiary care center of coastal Karnataka, Kasturba Medical College, Manipal, Karnataka from October 2022 with a three-month follow-up. Patients with a confirmed diagnosis of liver cirrhosis visiting the outpatient department of age ≥18 were enrolled in the study and divided on the basis of compensated and decompensated cirrhosis. Patients were randomized into two groups i.e., case and control in compensated and decompensated group through the envelop method of randomization. The case group received patient education and counseling along with standard medical therapy. CLDQ was used to evaluate HRQoL scores on baseline and after the third month.

Results

A total of 104 patients were enrolled with a mean age of 53.49 ± 11.25, with most being male (80.7%). Out of 104, 60 and 44 had compensated and decompensated cirrhosis. Case and control groups did not differ significantly on baseline. However, on follow-up, the compensated group showed significant improvement in abdominal symptoms, fatigue, and emotional functions. Meanwhile, the decompensated group showed significant improvement in activity, emotional function, and worry domain of CLDQ. Higher MELD scores were the significant factor associated with lower HRQoL scores.

Conclusion

Patient education and counseling positively impacted the fatigue, emotional, and worry domain of the CLDQ. Hence, the present study recommends making an effort to promote patient counseling and education via leaflets or videos.

背景/目的健康相关生活质量(HRQoL)与人们如何看待疾病和治疗对其身体健康、情绪健康、功能状态和社会地位的影响有关。随着临床目标的实现,HRQoL 具有重要意义。因此,本研究评估了患者咨询和教育对肝硬化患者 HRQoL 的影响。方法这项前瞻性研究于 2022 年 10 月在卡纳塔克邦马尼帕尔的卡斯特尔巴医学院沿海卡纳塔克邦的一家三级医疗中心进行,随访三个月。在门诊部就诊的肝硬化确诊患者中,年龄≥18 岁的患者被纳入研究,并按肝硬化代偿期和失代偿期进行划分。通过包络随机法将患者随机分为两组,即代偿组和失代偿组中的病例组和对照组。病例组在接受标准药物治疗的同时,还接受患者教育和咨询。结果 共有 104 名患者入组,平均年龄为(53.49±11.25)岁,大部分为男性(80.7%)。104 名患者中,60 人患有代偿期肝硬化,44 人患有失代偿期肝硬化。病例组和对照组在基线上没有明显差异。但在随访中,代偿组的腹部症状、疲劳和情绪功能有明显改善。与此同时,失代偿组在活动、情绪功能和CLDQ的担忧领域有明显改善。较高的 MELD 评分是与较低的 HRQoL 评分相关的重要因素。因此,本研究建议通过传单或视频努力促进患者咨询和教育。
{"title":"Health-related Quality of Life in Patients With Liver Cirrhosis: A Randomized Study","authors":"Siddheesh Rajpurohit,&nbsp;Balaji Musunuri,&nbsp;Pooja B. Mohan,&nbsp;Ganesh Bhat,&nbsp;Shiran Shetty","doi":"10.1016/j.jceh.2024.101433","DOIUrl":"https://doi.org/10.1016/j.jceh.2024.101433","url":null,"abstract":"<div><h3>Background/Aims</h3><p>Health-related quality of life (HRQoL) relates to how people perceive illness and treatment affects their physical health, emotional health, functional status, and social position. Along with clinical goals, HRQoL is significant. Therefore, the present study evaluates the effect of patient counseling and education on HRQoL of cirrhotic patients.</p></div><div><h3>Methods</h3><p>This prospective study was conducted in a tertiary care center of coastal Karnataka, Kasturba Medical College, Manipal, Karnataka from October 2022 with a three-month follow-up. Patients with a confirmed diagnosis of liver cirrhosis visiting the outpatient department of age ≥18 were enrolled in the study and divided on the basis of compensated and decompensated cirrhosis. Patients were randomized into two groups i.e., case and control in compensated and decompensated group through the envelop method of randomization. The case group received patient education and counseling along with standard medical therapy. CLDQ was used to evaluate HRQoL scores on baseline and after the third month.</p></div><div><h3>Results</h3><p>A total of 104 patients were enrolled with a mean age of 53.49 ± 11.25, with most being male (80.7%). Out of 104, 60 and 44 had compensated and decompensated cirrhosis. Case and control groups did not differ significantly on baseline. However, on follow-up, the compensated group showed significant improvement in abdominal symptoms, fatigue, and emotional functions. Meanwhile, the decompensated group showed significant improvement in activity, emotional function, and worry domain of CLDQ. Higher MELD scores were the significant factor associated with lower HRQoL scores.</p></div><div><h3>Conclusion</h3><p>Patient education and counseling positively impacted the fatigue, emotional, and worry domain of the CLDQ. Hence, the present study recommends making an effort to promote patient counseling and education via leaflets or videos.</p></div>","PeriodicalId":15479,"journal":{"name":"Journal of Clinical and Experimental Hepatology","volume":null,"pages":null},"PeriodicalIF":3.0,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141241797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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Journal of Clinical and Experimental Hepatology
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