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Physiology and health assessment,risk balance,and model for endstage liver disease scores:Postoperative outcome of liver transplantation

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World Journal of Transplantation 2025年第1期15卷 86-94页

作者： Raquel Hohenreuther Andresa ThoméSilveira Edison Moraes Rodrigues Filho Anderson Garcez Bruna Goularth Lacerda Sabrina Alves Fernandes claudio augusto marroni Postgraduate Program in Hepatology Universidade Federal de Ciências da Saúde de Porto AlegrePorto Alegre 90050-170Brazil Department of Intensive Medicine Hospital de Clínicas de Porto AlegrePorto Alegre 90035-903Brazil Department of Public Health University of Vale do Rio dos SinosSao Leopoldo 93022-750Brazil

BACKGROUND Liver transplantation aims to increase the survival of patients with end-stage liver diseases and improve their quality of *** number of organs available for transplantation is lower than the *** provide fair organ distribution,predictive mortality scores have been *** To compare the Acute Physiology and Chronic Health Evaluation IV(APACHE IV),balance of risk(BAR),and model for end-stage liver disease(MELD)scores as predictors of *** Retrospective cohort study,which included 283 adult patients in the postoperative period of deceased donor liver transplantation from 2014 to *** The transplant recipients were mainly male,with a mean age of 58.1 *** were mostly male,with a mean age of 41.6 *** median cold ischemia time was 3.1 hours,and the median intensive care unit stay was 5 *** APACHE IV,a mean of 59.6 was found,BAR 10.7,and MELD *** 28-day mortality rate was 9.5%,and at 90 days,it was 3.5%.The 28-day mortality prediction for APACHE IV was very good[area under the curve(AUC):0.85,P<0.001,95%CI:0.76-0.94],P<0.001,BAR(AUC:0.70,P<0.001,95%CI:0.58–0.81),and MELD(AUC:0.66,P<0.006,95%CI:0.55-0.78),P<*** 90 days,the data for APACHE IV were very good(AUC:0.80,P<0.001,95%CI:0.71–0.90)and moderate for BAR and MELD,respectively,(AUC:0.66,P<0.004,95%CI:0.55–0.77),(AUC:0.62,P<0.026,95%CI:0.51–0.72).All showed good discrimination between deaths and *** for the best value for liver transplantation,it was significant only for APACHE IV(P<0.001).CONCLUSION The APACHE IV assessment score was more accurate than BAR and MELD in predicting mortality in deceased donor liver transplant recipients.

关键词： Liver transplantation Acute physiology and chronic health evaluation IV Balance of risk Model for end-stage liver disease Mortality Intensive care unit

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Antioxidant properties of glutamine and its role in VEGF-Akt pathways in portal hypertension gastropathy

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World Journal of Gastroenterology 2013年第28期19卷 4464-4474页

作者： Camila Marques Francielli Licks Ingrid Zattoni Beatriz Borges Luiz Eduardo Rizzo de Souza claudio augusto marroni Norma Possa marroni Universidade Federal do Rio Grande do Sul-PPG Fisiologia Porto Alegre 90000100 Brazil Universidade Federal do Paraná Curitiba 81531900 Brazil Departamento de Medicina Interna-Gastroenterologia-Universidade Federal de Ciências da Saúde de Porto Alegre Porto Alegre 90000100 Brazil Universidade Federal do Rio Grande do Sul-PPG Fisiologia Universidade Luterana do Brasil Porto Alegre 90000100 Brazil

AIM: To investigate the effects of glutamine on oxidative/nitrosative stress and the vascular endothelial growth factor (VEGF)-Akt-endothelial nitric oxide synthase (eNOS) signaling pathway in an experimental model of portal hypertension induced by partial portal vein ligation (PPVL). METHODS: Portal hypertension was induced by PPVL. The PPVL model consists of a partial obstruction of the portal vein, performed using a 20 G blunt needle as a guide, which is gently removed after the procedure. PPVL model was performed for 14 d beginning treatment with glutamine on the seventh day. On the fifteenth day, the mesenteric vein pressure was checked and the stomach was removed to test immunoreactivity and oxidative stress markers. We evaluated the expression and the immunoreactivity of proteins involved in the VEGF-Akt-eNOS pathway by Western blotting and immunohistochemical analysis. Oxidative stress was measured by quantification of the cytosolic concentration of thiobarbituric acid reactive substances (TBARS) as well as the levels of total glutathione (GSH), superoxide dismutase (SOD) activity, nitric oxide (NO) production and nitrotyrosine immunoreactivity. RESULTS: All data are presented as the mean ± SE. The production of TBARS and NO was significantly increased in PPVL animals. A reduction of SOD activity was detected in PPVL + G group. In the immunohistochemical analyses of nitrotyrosine, Akt and eNOS, the PPVL group exhibited significant increases, whereas decreases were observed in the PPVL + G group, but no difference in VEGF was detected between these groups. Western blotting analysis detected increased expression of phosphatidylinositol-3-kinase (PI3K), P-Akt and eNOS in the PPVL group compared with the PPVL + G group, which was not observed for the expression of VEGF when comparing these groups. Glutamine administration markedly alleviated oxidative/nitrosative stress, normalized SOD activity, increased levels of total GSH and blocked NO overproduction as well

关键词： Partial portal vein ligation Oxidative stress Glutamine Portal hypertension Rats

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The evolution of available pharmacological treatments for variceal bleeding secondary to portal hypertension: A scope review

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iLIVER 2023年第3期2卷 170-176页

作者： Eduarda Raisa Coser Raphael Bernardo Neto Izabel Cristina Meister Martins Coelho Norma Possa marroni claudio augusto marroni Camila Moraes Marques Faculdades Pequeno Principe Brazil Universidade Federal de Ciencias da Saude de Porto Alegre Brazil

The texts analyzed in full totaled 110,of which 36 articles published between 2001 and 2020 were selected,with quantitative approaches,case reviews,liter-ature reviews,meta-analyses,and *** is concluded that beta-blockers are the drugs of choice for primary prophylaxis of variceal *** for secondary prophylaxis,there is an association of these with nitrates and endoscopic *** regard to acute bleeding,the use of vasoactive drugs is chosen,especially ***,it is important to emphasize that there is a shortage of clinical studies and a need for investment in new therapies.

关键词： Portal hypertension Clinical treatment pharmacology and variceal bleeding

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Phase angle and non-alcoholic fatty liver disease before and after bariatric surgery

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World Journal of Hepatology 2020年第11期12卷 1004-1019页

作者： Joise Teixeira claudio augusto marroni Paula Rosales Zubiaurre Ana Henz Lais Faina Lilian KethelynPinheiro claudio Cora Mottin Sabrina Alves Fernandes Department of Postgraduate Program in Medicine:Hepatology Universidade Federal de Ciências da Saúde de Porto AlegrePorto Alegre 90050170RSBrazil Department of Gastroenterology and Hepatology Universidade Federal de Ciências da Saúde de Porto Alegre(UFCSPA)Porto Alegre 91760470RSBrazil Department of Center of Morbid Obesity Pontificia Universidade Catolica do Rio Grande do Sul(PUCRS)Porto Alegre 90610000RSBrazil Department of Nutrition Centro Universitario Metodista(IPA)Porto Alegre 90420060RSBrazil Department of Vascular Surgery Hospital Federal dos Servidores do Estado do Rio de JaneiroRio de Janeiro 20221161RJBrazil Department of Obesity and Metabolic Syndrome Center Pontificia Universidade Catolica do Rio Grande do Sul(PUCRS)Porto Alegre 90619-900RSBrazil

BACKGROUND Obesity is a global health problem that is continuing to increase in the young *** Brazil,the frequency of obesity in 2018 was 19.8%.Several comorbidities are directly associated with obesity,such as non-alcoholic fatty liver disease(NAFLD),which is considered the most common liver disorder in Western countries and affects up to 46%of *** surgery is effective in treating obesity and can improve NAFLD;however,the effect of bariatric surgery on body composition,phase angle(PA),and improving NAFLD needs to be further *** To analyze the PA in the postoperative period of bariatric surgery and to correlate it with changes in body composition and liver *** This study is a retrospective cohort study of the analysis of the medical records of patients undergoing bariatric surgery in a reference center of a teaching hospital in Porto Alegre over a 2-year *** older than 18 years whose record contained all information relevant to the study were *** data analyzed were body composition and PA through electrical bioimpedance and NAFLD through liver biopsy in the pre-and postoperative *** level of significance adopted for the statistical analyses was 5%.RESULTS We evaluated 379 patients with preoperative *** PA,169 patients were analyzed,and 33 patients had liver biopsy pre-and postoperatively with NAFLD *** total,79.4%were female,with a mean age of 39.1±10.6 *** average body mass index(BMI)was 45.9±7.5 kg/m².The PA showed a mean of 5.8±0.62°in the preoperative period and a significant reduction in the postoperative period.A postoperative reduction in body composition data(skeletal muscle mass,fat percentage,fat mass,body cell mass,BMI and visceral fat area)was shown as *** liver disease,all patients presented a reduction in the degrees and stages of liver disease in the postoperative period,and some had no degree of liver disease at *** PA decreased af

关键词： Obesity Body composition Bariatric surgery Phase angle Non-alcoholic fatty liver disease Liver disease

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Liver transplantation and alcoholic liver disease:History,controversies,and considerations

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World Journal of Gastroenterology 2018年第26期24卷 2785-2805页

作者： claudio augusto marroni Alfeu de Medeiros Fleck Jr Sabrina Alves Fernandes Lucas Homercher Galant Marcos Mucenic Mario Henrique de Mattos Meine Guilherme Mariante-Neto Ajacio Bandeira de Mello Brandao Graduate Program in Medicine:Hepatology Universidade Federal de Ciências da Saúde de Porto Alegre(UFCSPA)Porto Alegre 90430-080RSBrazil Liver Transplant Adult Group Irmandade da Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90035-072RSBrazil Nutrition at the Centro Universitário Metodista(IPA) Porto Alegre 90420-060RSBrazil

Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease(ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation(LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a "self-inflicted disease". One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this "6-mo rule" is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help

关键词： Alcoholic liver disease Alcoholic hepatitis Alcoholic cirrhosis Alcoholism Liver transplantation Alcoholic recurrence Controversies Alcoholic abstinence Relapse Selection criteria

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Artificial intelligence and human liver allocation:Potential benefits and ethical implications

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Artificial Intelligence in Gastroenterology 2022年第1期3卷 21-27页

作者： Marcos Mucenic Ajacio Bandeira de Mello Brandão claudio augusto marroni Liver Transplant Adult Group Irmandade da Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090RSBrazil Hepatology Universidade Federal de Ciencias da Saude de Porto AlegrePorto Alegre 90050-170RSBrazil

Since its implementation almost two decades ago,the urgency allocation policy has improved the survival of patients on the waiting list for liver transplantation *** Model for End-Stage Liver Disease score is widely used to predict waiting list *** to some limitations related to its use,there is an active investigation to develop other prognostic *** allocation(LA)entails complex decision-making,and grafts are occasionally not directed to the recipients who are more likely to *** scores have,thus far,failed to predict post-operatory ***,the increasing use of marginal donors is associated with worse *** donor-recipient pairing could help avoid retransplantation or futile procedures and reduce postoperative complications,mortality,hospitalization time,and *** intelligence has applications in several medical *** learning algorithms(MLAs)use large amounts of data to detect unforeseen patterns and complex interactions between *** neural networks and decision trees were the most common forms of MLA tested on *** researchers have shown them to be superior for predicting waiting list mortality and graft failure than conventional statistical *** promising techniques are increasingly being considered for implementation.

关键词： Liver transplantation Liver cirrhosis Artificial intelligence Prognosis Survival Machine learning

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Nutritional evaluation in cirrhosis: Emphasis on the phase angle

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World Journal of Hepatology 2016年第29期8卷 1205-1211页

作者： Sabrina Alves Fernandes Angelo Alves de Mattos Cristiane Valle Tovo claudio augusto marroni Postgraduate Program at Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA) Post Graduation Program in Bioscience and Rehabilitation and the Post Graduation Program in Rehabilitation and Inclusion Methodist University-IPA

Protein-calorie malnutrition (PCM) is a common condition in cirrhotic patients, leading to a worse prognosis, complications, poor quality of life and lower survival rates. Among ways of assessing nutritional status, there are anthropometric methods such as the evaluation of the triceps skinfold, the arm circumference, the arm muscle circumference and the body mass index, and non-anthropometric methods such as the subjective global assessment, the handgrip strength of non-dominant hand, and the bioelectrical impedance analysis (BIA). PCM is frequently under-diagnosed in clinical settings in patients with cirrhosis due to the limitations of nutritional evaluation methods in this population. BIA is a useful method, but cannot be indicated in patients with abnormal body composition. In these situations, the phase angle (PA) has been used, and can become an important tool in assessing nutritional status in any situation. The PA is superior to anthropometric methods and might be considered as a nutritional indicator in cirrhosis. The early characterization of the nutritional status in patients with cirrhosis means an early nutritional intervention, with a positive impact on patients’ overall prognosis. Among the usually accepted methods for nutritional diagnosis, the PA provides information in a quick and objective manner.

关键词： Malnutrition Bioelectrical impedance Phase angle Sarcopenia Nutrition

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Machine learning approaches using blood biomarkers in nonalcoholic fatty liver diseases

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Artificial Intelligence in Gastroenterology 2022年第3期3卷 80-87页

作者： Randhall B Carteri Mateus Grellert Daniela Luisa Borba claudio augusto marroni Sabrina Alves Fernandes Department of Nutrition Methodist University Center-IPAPorto Alegre 90420-060Rio Grande do SulBrazil Department of Health and Behaviour Catholic University of PelotasPelotas 96015-560Rio Grande do SulBrazil Department of Informatics and Statistics Federal University of Santa CatarinaFlorianópolis 88040-900Santa CatarinaBrazil Postgraduate Program in Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90050-170Rio Grande do SulBrazil Department of Gastroenterology and Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90050-170Rio Grande do SulBrazil

The prevalence of nonalcoholic fatty liver disease(NAFLD)is an important public health *** diagnosis of NAFLD and potential progression to nonalcoholic steatohepatitis(NASH),could reduce the further advance of the disease,and improve patient *** to support patient diagnostic and predict specific outcomes,the interest in artificial intelligence(AI)methods in hepatology has dramatically increased,especially with the application of lessinvasive *** this review,our objective was twofold:Firstly,we presented the most frequent blood biomarkers in NAFLD and NASH and secondly,we reviewed recent literature regarding the use of machine learning(ML)methods to predict NAFLD and NASH in large ***,these studies provide insights into ML application in NAFLD patients'prognostics and ranked blood biomarkers are able to provide a recognizable signature allowing cost-effective NAFLD prediction and also differentiating NASH *** studies should consider the limitations in the current literature and expand the application of these algorithms in different populations,fortifying an already promising tool in medical science.

关键词： Artificial intelligence Liver diseases Healthcare Hepatology Prognosis Diagnostics

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Bioelectrical impedance vector analysis evaluates cellularity and hydration in cirrhotic patients

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World Journal of Hepatology 2020年第12期12卷 1276-1288页

作者： Sabrina Alves Fernandes Lara Rigon Leonhardt Daniella Miranda da Silva Fernanda Donner Alves claudio augusto marroni Department of Nutrition Centro Universitario Metodista IPAPorto Alegre 90420-060RSBrazil Gastroenterology and Hepatology Universidade Federal de Ciências da Saúde de Porto Alegre(UFCSPA)Porto Alegre 91760-470RSBrazil Postgraduate Program in Hepatology Universidade Federal de Ciências da Saúde de Porto Alegre(UFCSPA)Porto Alegre 90050-170RSBrazil Department of Nutrition Centro Universitario Ritter dos Reis-UniritterPorto Alegre 90840-440Rio Grande do SulBrazil

BACKGROUND Malnutrition in cirrhotic patients is correlated with mortality and a better response to liver ***,recovery of the nutritional status in these patients is a challenge due to the difficulty in establishing a reliable nutritional *** bioelectrical impedance vector analysis(BIVA)method appears as a feasible tool in clinical practice to define the physiological state of cirrhotic patients by assessing hydration and body *** To evaluate body composition in cirrhotic patients using *** This retrospective cross-sectional study was carried out by following cirrhotic outpatients at a hospital in Porto Alegre,Brazil.A tetrapolar bioelectrical impedance analysis device was used to evaluate cellularity and hydration and to perform the *** BIVA graphic was elaborated by software and for statistical analysis a significance level of 5%(P≤0.05)was *** One hundred and ninety patients,61.1%males,with a mean age of 56.6±11.0 years,were *** these,56.3%had Child-Turcotte-Pugh(CTP)A score,and the prevalent etiology was hepatitis C virus(47.4%).The patients were classified according to cellularity and hydration by the quadrants and ellipses of the BIVA method,quadrant 1(47.9%);quadrant 2(18.9%);quadrant 3(14.2%);and quadrant 4(18.9%).Those classified in quadrant 1 and 2 had a higher phase angle compared to those in quadrants 3 and 4(P<0.001).Quadrant 2 patients had a lower average age than the other *** association with CTP score showed that patients in quadrant 2 had a higher proportion of CTP A,and those in quadrant 4 had a higher proportion of CTP C(P<0.052).CONCLUSION The BIVA method allows identification of the cellularity and hydration status of cirrhotic patients,and its association with clinical factors determines the disease severity,age and prognostic index.

关键词： Body composition Hydration Cellularity Hepatic cirrhosis Electrical Bioimpedance Bioelectrical impedance vector analysis

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Role of the phase angle in the prognosis of the cirrhotic patient:15 years of follow-up

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World Journal of Methodology 2023年第4期13卷 238-247页

作者： Letícia Pereira Pinto claudio augusto marroni Juliana Czermainski Maria Luiza Fernandes Dahlem Randhall B Carteri Sabrina Alves Fernandes Department of Hepatology Universidade Federal de Ciências da Saúde de Porto AlegrePorto Alegre 90050-170Brazil Department of Veterinary Medicine Universidade Federal do Rio Grande do SulPorto Alegre 91540-000Brazil Department of Nutrition Centro Universitário Metodista IPAPorto Alegre 90420-060Brazil Department of Nutrition Centro Universitário CesucaCachoerinha 94935-630Brazil

BACKGROUND In 2019,cirrhosis accounted for 2.4%of global *** projection for 2030 is an increase in this *** recent years,hospitalization costs have escalated by 36%for compensated cirrhosis and 24%for decompensated ***,it is necessary to identify a tool capable of predicting the mortality of these patients according to their clinical condition and consequently extending their survival *** studies have shown that the phase angle(PA)can be a feasible method in clinical practice,with the potential to guide assertive patient management in the therapeutic of chronic liver *** To evaluate the prognostic role of PA in cirrhotic patients over a 15-year followup *** Retrospective cohort study with 129 cirrhotic patients of both sexes over 18 years *** of cirrhosis by liver *** first year of data collection was 2007,and data regarding outcomes was collected in *** were gathered from medical records,such as esophageal varices(EV),EV bleeding,ascites,spontaneous bacterial peritonitis(SBP),encephalopathy,laboratory findings and *** cut-off value for the PA was 5.4°,a value described in 2012 by Fernandes et al for 129 patients evaluated in this study and the cut-off points for the Brazilian population presented in percentiles(P),as described by Mattiello et *** mortality was assessed using the PA percentile through Kaplan-Meier curves and multivariate binary logistic regression *** Patients were divided into two groups according to the PA 5.4th(PA>5.4°,n=40;PA≤5.4°,n=89)PA percentile(

关键词： Liver cirrhosis Phase angle Prognosis Liver transplantation Electrical bioimpedance

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