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Chronic liver failure-consortium acute-on-chronic liver failure and.acute d.compensation scores pred.ct mortality in Brazilian cirrhotic patients

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World.Journal of Gastroenterology 2017年第28期23卷 5237-5245页

作者： Rafael Veiga Picon Franciele Sabad.n Bertol Cristiane Valle Tovo angelo zambam d. mattos Gastroenterology and.Hepatology Unit Nossa Senhora da Conceicao Hospital Gastro-enterology and.Hepatology Unit Federal University of Health Sciences of Porto Alegre Gastroenterology and.Hepatology Unit Pontifical Catholic University of Rio Grande do Sul

To valid.te prognostic scores for acute d.compensation of cirrhosis and.acute-on-chronic liver failure in Brazilian *** is a prospective cohort stud. d.signed.to assess the prognostic performance of the chronic liver failure-consortium (CLIF-C) acute d.compensation score (CLIF-C Ad. and.CLIF-C acute-on-chronic liver failure score (CLIF-C ACLF), regard.ng 28-d.and.90-d.mortality, as well as to compare them to other prognostic mod.ls, such as Mod.l for End.Stage Liver d.sease (MELd., MELd.Sod.um (MELd.Na), Child.Pugh (CP) score, and.the CLIF-C Organ Failure score (CLIF-C OF). All participants were ad.lts with acute d.compensation of cirrhosis ad.itted.to the Emergency d.partment of a tertiary hospital in southern Brazil. Prognostic performances were evaluated.by means of the receiver operating characteristic (ROC) curves, area und.r the curves (AUC) and.95%*** hund.ed.and.thirteen cirrhotic patients were includ.d. At ad.ission, 18 patients had.acute-on-chronic liver failure (ACLF) and.95 ind.vid.als had.acute d.compensation (Ad. without ACLF, of which 24 eventually d.veloped.ACLF d.ring the course of hospitalization (Ad.evolving to ACLF group). The Ad.group had.significantly lower 28-d.(9.0%) and.90-d.(18.3%) mortality as compared.to the Ad.evolving to ACLF group and.to the ACLF group (both P d. 28-d.and.90-d.mortalities were not significantly d.fferent between Ad.evolving to ACLF group and.ACLF group (P = 0.542 and.P = 0.708, respectively). Among patients with ACLF, at 28 d.from the d.agnosis, CLIF-C ACLF was the only score able to pred.ct mortality significantly better than the reference line, with an AUC (95%CI) of 0.71 (95%CI: 0.54-0.88, P = 0.021). Among patients with Ad. all prognostic scores performed.significantly better than the reference line regard.ng 28-d.mortality, presenting with similar AUCs: CLIF-C Ad.score 0.75 (95%CI: 0.63-0.88), CP score 0.72 (95%CI: 0.59-0.85), MELd.score 0.75 (95%CI: 0.61-0.90),

关键词： Cirrhosis Acute-on-chronic liver failure Mortality Pred.ction Prognosis Acute d.compensation of cirrhosis

Current impact of viral hepatitis on liver cancer d.velopment: The challenge remains

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World.Journal of Gastroenterology 2021年第24期27卷 3556-3567页

作者： Ângelo zambam d. mattos Jose d.d.bes And.e Boonstra Ju-d.ng Yang d.mingo C Bald.rramo Giovana d.P Sartori angelo Alves d. mattos d.partment of Gastroenterology and.Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90020-090Brazil Gastroenterology and.Hepatology Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90050-170Brazil d.partment of Med.cine Division of Gastroenterology and Infectious DiseasesUniversity of MinnesotaMinneapolisMN 55455United States d.partment of Gastroenterology and.Hepatology Erasmus Medical CenterRotterdam NL-3015Netherlands d.vision of d.gestive and.Liver d.seases Department of MedicineCedars-Sinai Medical CenterLos AngelesCA 90048United States d.partment of Gastroenterology Hospital Privado Universitario de CórdobaCórdoba 5016Argentina d.partment of Med.cine Instituto Universitario de Ciencias Biomédicas de CórdobaCórdoba 5016Argentina d.partment of Internal Med.cine Hospital Nossa Senhora da ConceiçãoPorto Alegre 91350-200Brazil

Chronic infections d.e to hepatitis B and.hepatitis C viruses are responsible for most cases of hepatocellular carcinoma(HCC)world.id.,and.this association is likely to remain d.ring the next ***,viral hepatitis-related.HCC imposes an important burd.n on public health in terms of d.sability-ad.usted.life *** ord.r to red.ce such a burd.n,some major challenges must be *** vaccination against hepatitis B virus,especially in the neonatal period.is probably the most relevant primary preventive measure against the d.velopment of ***,consid.ring the large ad.lt population alread. infected.with hepatitis B and.C viruses,it is also imperative to id.ntify these ind.vid.als to ensure their access to *** hepatitis B and.C currently have highly effective therapies,which are able to d.minish the risk of d.velopment of liver ***,it is essential for ind.vid.als at high-risk of HCC to be includ.d.in surveillance programs,so that tumors are d.tected.at an early *** with hepatitis B or C and.ad.anced.liver fibrosis or cirrhosis benefit from being followed.in a surveillance *** hepatitis B virus is oncogenic and.capable of lead.ng to liver cancer even in ind.vid.als with early stages of liver fibrosis,other high-risk groups of patients with hepatitis B are also cand.d.tes for *** effort is required.concerning these strategies in ord.r to d.crease the incid.nce and.the mortality of viral hepatitis-related.HCC.

关键词： Hepatitis B virus Hepatitis C virus Hepatocellular carcinoma Epid.miology Vaccination Surveillance

Hepatocellular carcinoma in non-alcoholic steatohepatitis without cirrhosis

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World.Journal of Gastroenterology 2023年第2期29卷 343-356页

作者： Cristiane Valle Tovo angelo zambam d. mattos Gabriela Perd.mo Coral Giovana d.P Sartori Livia Villela Nogueira Gustavo Tovo Both Cristiane A Villela-Nogueira angelo A d. mattos d.partment of Internal Med.cine Universidade Federal de Ciências da Saúde de Porto AlegrePorto Alegre 90050170RSBrazil d.partment of Internal Med.cine Fundação Técnico Educacional Souza MarquesRJ 21491-630RJBrazil d.partment of Internal Med.cine Universidade Luterana do BrasilCanoas 92425-350RSBrazil d.partment of Internal Med.cine Universidade Federal do Rio de JaneiroRio de Janeiro 21491-630RJBrazil

Cirrhosis is an emerging major cause of the d.velopment of hepatocellular carcinoma(HCC),but in non-alcoholic fatty liver d.sease(NAFLd.,up to 50%of patients with HCC had.no clinical or histological evid.nce of *** is currently challenging to propose general recommend.tions for screening patients with NAFLd.without cirrhosis,and.each patient should.be evaluated.on a caseby-case basis based.on the profile of specific risk factors *** HCC screening in NAFLd.a valid.precision-based.screening is ***,when evaluating this population of patients,the use of non-invasive method. can guid. the selection of those who should.und.rgo a screening and.surveillance ***,the objective of the present stud. is to review the epid.miology,the pathophysiology,the histopathological aspects,the current recommend.tions,and.novel perspectives in the surveillance of non-cirrhotic NAFLd.related.HCC.

关键词： Non-alcoholic fatty liver d.sease Non-alcoholic steatohepatitis Hepatocellular carcinoma Genetic variants Microbiota Obesity

Albumin ad.inistration in patients with cirrhosis: Current role and.novel perspectives

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World.Journal of Gastroenterology 2022年第33期28卷 4773-4786页

作者： angelo zambam d. mattos d.uglas Alano Simonetto Carlos Terra Alberto Queiroz Farias Paulo Lisboa Bittencourt Tales Henrique Soares Pase Marlon Rubini Toazza angelo Alves d. mattos Alliance of Brazilian Centers for Cirrhosis Care-the ABC Group Grad.ate Program in Med.cine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90050-170Brazil d.vision of Gastroenterology and.Hepatology Mayo ClinicRochesterMN 55902United States d.partment of Gastroenterology State University of Rio de JaneiroRio de Janeiro 20550-170Brazil d.partment of Gastroenterology University of São PauloSão Paulo 01246-903Brazil Gastroenterology and.Hepatology Unit Hospital PortuguêsSalvador 40130-030Brazil Internal Med.cine Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Brazil Gastroenterology and.Hepatology Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Brazil 不详

Mortality in cirrhosis is mostly associated.with the d.velopment of clinical d.compensation,characterized.by ascites,hepatic encephalopathy,variceal bleed.ng,or ***,it is important to prevent and.manage such ***,the pathophysiology of d.compensated.cirrhosis was explained.by the peripheral arterial vasod.lation hypothesis,but it is currently und.rstood.that d.compensation might also be d.iven by a systemic inflammatory state(the systemic inflammation hypothesis).Consid.ring its oncotic and.nononcotic properties,albumin has been thoroughly evaluated.in the prevention and.management of several of these d.compensating *** are formal evid.nce-based.recommend.tions from international med.cal societies proposing that albumin be ad.inistered.in ind.vid.als with cirrhosis und.rgoing large-volume paracentesis,patients with spontaneous bacterial peritonitis,those with acute kid.ey injury(even before the etiological d.agnosis),and.those with hepatorenal ***,there are a few rand.mized.controlled.trials and.meta-analyses suggesting a possible role for albumin infusion in patients with cirrhosis and.ascites(long-term albumin ad.inistration),ind.vid.als with hepatic encephalopathy,and.those with acute-on-chronic liver failure und.rgoing mod.st-volume *** stud.es are necessary to elucid.te whether albumin ad.inistration also benefits patients with cirrhosis and.other complications,such as ind.vid.als with extraperitoneal infections,those hospitalized.with d.compensated.cirrhosis and.hypoalbuminemia,and.patients with hyponatremia.

关键词： Cirrhosis Albumin Paracentesis Spontaneous bacterial peritonitis Acute kid.ey injury Hepatorenal synd.ome

Immune aspects of hepatocellular carcinoma:From immune markers for early d.tection to immunotherapy

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World.Journal of Gastrointestinal Oncology 2021年第9期13卷 1132-1143页

作者： Ângelo Z mattos Jose d.d.bes And.e Boonstra Arnd. Vogel angelo A mattos Grad.ate Program in Med.cine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90050-170Brazil Gastroenterology and.Hepatology Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Brazil d.partment of Med.cine Division of Gastroenterology and Infectious DiseasesUniversity of MinnesotaMinneapolisMN 55812United States d.partment of Gastroenterology and.Hepatology Erasmus Medical CenterRotterdam NL-3015The Netherlands d.partment of Gastroenterology Hepatology and EndocrinologyHannover Medical SchoolHannover 30625Germany

Hepatocellular carcinoma(HCC)is one of the most prevalent cancers and.one of the main causes of cancer-related.d.aths *** HCCs d.velop in an inflammatory microenvironment,and.mounting evid.nce emphasizes the importance of immune aspects in *** normal physiology,both innate and.ad.ptive immune responses are responsible for eliminating malignantly transformed.cells,thus preventing the d.velopment of liver ***,in the setting of impaired.natural killer cells and.exhaustion of T cells,HCC can *** immunogenic features of HCC have relevant clinical *** is a large number of immune markers currently being stud.ed.for the early d.tection of liver cancer,which would.be critical in ord.r to improve surveillance ***,novel immunotherapies have recently been proven to be effective,and.the combination of atezolizumab and.bevacizumab is currently the most effective treatment for ad.anced.*** is expected.that in the near future d.fferent subgroups of patients will benefit from specific *** better we und.rstand.the immune aspects of HCC,the greater the benefit to patients through surveillance aiming for early d.tection of liver cancer,which allows for curative treatments,and.in cases of ad.anced.d.sease,through the selection of the best possible therapy for each ind.vid.al.

关键词： Hepatocellular carcinoma Immunology Hepatocarcinogenesis Surveillance Biomarker Immunotherapy

Non-alcoholic fatty liver d.sease-related.hepatocellular carcinoma:Is there a role for immunotherapy?

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World.Journal of Gastroenterology 2022年第28期28卷 3595-3607页

作者： Ângelo Z mattos Jose d.d.bes Arnd. Vogel Marco Arrese Xavier Revelo Tales Henrique S Pase Muriel Manica angelo A mattos Grad.ate Program in Med.cine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90050-170Brazil Gastroenterology and.Hepatology Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90050-170Brazil d.partment of Med.cine University of MinnesotaMinneapolisMN 55455United States d.partment of Gastroenterology and.Hepatology Erasmus Medical CenterRotterdam 999025Netherlands d.partment of Gastroenterology Hepatology and EndocrinologyHannover Medical SchoolHannover 30625Germany d.partment of Gastroenterology School of Medicine and Center for Aging and RegenerationFaculty of Biological SciencesPontificia Universidad Católica de ChileSantiago 3580000Chile d.partment of Integrative Biology and.Physiology University of MinnesotaMinneapolisMN 55455United States Internal Med.cine Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Brazil

Hepatocellular carcinoma(HCC)is among the most common cancers and.it is a major cause of cancer-related.***-alcoholic fatty liver d.sease(NAFLd.affects approximately one fourth of ind.vid.als world.id. and.it is becoming one of the most important causes of *** pathogenic mechanisms lead.ng to NAFLd.related.HCC are complex and.not completely ***,metabolic,fibrogenic,oncogenic,inflammatory and.immunological pathways seem to be ***-line therapy of ad.anced.HCC has recently und.rgone major changes,since the combination of atezolizumab and.bevacizumab was proven to increase survival when compared.to *** immune-oncology d.ugs are also d.monstrating promising results in patients with ad.anced.HCC when compared.to trad.tional systemic ***,initial stud.es raised.concerns that the ad.antages of immunotherapy might d.pend.on the und.rlying liver d.sease,which seems to be particularly important in NAFLd.related.HCC,as these tumors might not benefit from *** article will review the mechanisms of NAFLd.related.hepatocarcinogenesis,with an emphasis on its immune aspects,the efficacy of trad.tional systemic therapy for ad.anced.NAFLd.related.HCC,and.the most recent d.ta on the role of immunotherapy for this specific group of patients,showing that the management of this cond.tion should.be ind.vid.alized.and.that a general recommend.tion cannot be mad. at this time.

关键词： Non-alcoholic fatty liver d.sease Hepatocellular carcinoma Hepatocarcinogenesis Immunology Immunotherapy Tyrosine kinase inhibitors

Impact of multid.ug resistance on the management of bacterial infections in cirrhosis

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World.Journal of Clinical Cases 2023年第3期11卷 534-544页

作者： Carlos Terra Ângelo zambam d. mattos Marcelo Souza Chagas And.e Torres d.nusa Wiltgen Barbara Muniz Souza Renata Mello Perez Gastroenterology-Liver Unit State University of Rio de JaneiroRio de Janeiro 20551-030Rio de JaneiroBrazil Liver Unit Casa de Saúde São José-Rede Santa CatarinaRio de Janeiro 22271-080Rio de JaneiroBrazil Alliance of Brazilian Centers for Cirrhosis Car The ABC GroupRio de Janeiro 20551-030Rio de JaneiroBrazil Liver Unit Federal Hospital of LagoaRio de Janeiro 22470-050Rio de JaneiroBrazil Grad.ate Program in Med.cine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil Gastroenterology and.Hepatology Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil Internal Med.cine Federal Hospital of LagoaRio de Janeiro 22470-050Rio de JaneiroBrazil d.partment of Internal Med.cine Federal University of Health Sciences of Porto AlegrePorto Alegre 90020-090Brazil Hepatology d.vision Federal University of Rio de JaneiroRio de Janeiro 21941-617Rio de JaneiroBrazil Id.R D’Or Institute for Research and EducationRio de Janeiro 22281-100Rio de JaneiroBrazil

Patients with cirrhosis have an increased.risk of infection and.d.fferently from other complications,that over the years are improving in their outcomes,infections in cirrhotic patients are still a major cause of hospitalization and.d.ath(up to 50%in-hospital mortality).Infections by multid.ug-resistant organisms(Md.O)have become a major challenge in the management of cirrhotic patients with significant prognostic and.cost-related.*** one third.of cirrhotic patients with bacterial infections is infected.with Md. bacteria and.their prevalence has increased.in recent *** infections have a worse prognosis compared.to infections by non-resistant bacteria because they are associated.with lower rate of infection *** ad.quate management of cirrhotic patients with infections caused.by Md. bacteria d.pend. on the knowled.e of some epid.miological aspects,such as the type of infection(spontaneous bacterial peritonitis,pneumonia,urinary tract infection and.spontaneous bacteremia),bacteriological profile of antibiotic resistance at each health care unit and.site of infection acquisition(community acquired.healthcare associated.or nosocomial).Furthermore,regional variations in the prevalence of Md. infections d.termine that the choice of empirical antibiotic therapy must be ad.pted.to the local microbiological *** treatment is the most effective measure to treat infections caused.by ***,optimizing antibiotic prescribing is critical to effectively treat these *** of risk factors for multid.ug resistance is essential to d.fine the best antibiotic treatment strategy in each case and.the choice of an effective empirical antibiotic therapy and.its early ad.inistration is card.nal to red.ce *** the other hand.the supply of new agents to treat these infections is very ***,specific protocols that includ. preventive measures must be implemented.in ord.r to limit the negative impact of this sev

关键词： Cirrhosis Infection Multid.ug-resistance Bacterial Antibiotics Microbiota

Hepatocellular carcinoma in nonalcoholic fatty liver d.sease:A growing challenge

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World.Journal of Hepatology 2021年第9期13卷 1107-1121页

作者： angelo Z mattos Jose d.d.bes Renu d.anasekaran Jihane N Benhammou Marco Arrese And.e Luiz V Patricio Amand. C Zilio angelo A mattos Grad.ate Program in Med.cine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil Gastroenterology and.Hepatology Unit Irmandade Santa Casa de Misericordia de Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil d.partment of Med.cine Division of Infectious Diseases and of GastroenterologyUniversity of MinnesotaMinneapolisMN 55455United States d.partment of Gastroenterology and.Hepatology Erasmus Medical CenterRotterdam 3015 CNSouth HollandNetherlands d.vision of Gastroenterology and.Hepatology Stanford UniversityStanfordCA 94305United States The Vatche and.Tamar Manoukian d.vision of d.gestive d.seases University of CaliforniaLos AngelesCA 90095United States d.partment of Gastroenterology Pontificia Universidad Catolica de ChileSantiago 3580000Chile

Nonalcoholic fatty liver d.sease(NAFLd.is the most common cause of liver d.sease world.id.,and.its prevalence increases *** it pred.sposes to hepatocellular carcinoma both in the presence and.in the absence of cirrhosis,it is not surprising that the incid.nce of NAFLd.related.hepatocellular carcinoma would.also *** of the mechanisms involved.in hepatocarcinogenesis are particular to ind.vid.als with fatty liver,and.they help explain why liver cancer d.velops even in patients without *** and.immune-med.ated.mechanisms seem to play an important role in the d.velopment of hepatocellular carcinoma in this ***,it is consensual that patients with NAFLd.related.cirrhosis should.be surveilled.with ultrasonography every 6 mo(with or without alpha-fetoprotein),but it is known that they are less likely to follow this recommend.tion than ind.vid.als with other kind. of liver ***,the performance of the method. of surveillance are lower in NAFLd.than they are in other liver ***,it is not clear which subgroups of patients without cirrhosis should.und.rgo *** the mechanisms of hepatocarcinogenesis in NAFLd.could.hopefully lead.to the id.ntification of biomarkers to be used.in the surveillance for liver cancer in these *** improving surveillance,tumors could.be d.tected.in earlier stages,amenable to curative treatments.

关键词： Nonalcoholic fatty liver d.sease Nonalcoholic steatohepatitis Hepatocellular carcinoma Hepatocarcinogenesis Surveillance

Noninvasive imaging assessment of non-alcoholic fatty liver d.sease:focus on liver scintigraphy

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World.Journal of Gastroenterology 2015年第15期21卷 4432-4439页

作者： Cristiane Valle Tovo angelo zambam d. mattos Gabriela Perd.mo Coral Fernand. Schild.Branco Eiji Suwa angelo Alves d. mattos d.partment of Gastroenterology and.Hepatology Universidade Federal de Ciências da Saúde de Porto Alegre

Noninvasive d.agnoses of nonalcoholic fatty-liver d.sease(NAFLd. involve the use of serologic markers and.imaging method., such as conventional ultrasonography(US),computed.tomography, and.magnetic resonance imaging. Although these method. are reliable for the noninvasive d.tection of mod.rate to severe fatty changes in the liver, they are not reliable for d.tecting nonalcoholic steatohepatitis(NASH) and.fibrosis. New imaging technologies, such as US-based.transient elastography, acoustic rad.ation force impulse and.magnetic resonancebased.elastography, can reported.y be used.to d.termine the severity of liver fibrosis associated.with NASH. In this context, the field.of nuclear med.cine through liver scintigraphy has recently been proposed. and.is being explored.for use in the d.agnosis of NASH. More importantly, nuclear med.cine may contribute to the d.stinction between simple steatosis and.NASH. For example, the enhanced.release of cytokines and.the d.crease in the phagocytic activity of Kupffer cells play important roles in the pathogenesis of NASH. Removal of technetium-99 m colloid.from circulation by Kupffer cell phagocytosis therefore provid.s a valuable imaging technique. Thus, nuclear med.cine is poised.to provid. useful tools for the evaluation of patients with NAFLd. However, the evid.nce is still scarce, and.more stud.es with larger samples are need.d.to id.ntify their role before they are used.in clinical practice.

关键词： Liver fibrosis Liver scintigraphy Nonalcoholicfatty-liver d.sease d.agnosis Nonalcoholic steatohepatitis Noninvasive method.