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Bacterial Infections in Cirrhotic Patients in a tertiary Care Hospital

Journal of Clinical and translational Hepatology 2021年第1期9卷 32-39页

作者： Vivek A.Lingiah nikolaos t.pyrsopoulos Department of Medicine Division of Gastroenterology and HepatologyRutgers UniversityNew Jersey Medical SchoolNewarkNJUSA

Background and Aims:Patients with cirrhosis are immunocompromised and at higher risk of developing infections compared to the general *** aim of this study was to assess the incidence of infections in cirrhotic patients in a large academic liver center and investigate potential associations between infections,bacteria isolated,therapeutic regimens used,and ***:this was a retrospective chart review study,including 192 *** patients had a diagnosis of cirrhosis and were admitted to University *** collected included demographics,etiology of cirrhosis,identification of bacteria from cultures,multidrug-resistant(MDR)status,antibiotics administered,intensive care unit(ICU)admission,and patient ***:Infections were present in 105(54.6%)patients,and 60(31.2%)patients had multiple infections during a hospitalization(s)for infections.A total of 201 infections were *** tract infections(UtIs)were the most common infection(37.8%),followed by bacteremia(20.4%),pneumonia(12.9%),spontaneous bacterial peritonitis(SBP)(11.9%),abscess/cellulitis(6.0%),infectious diarrhea(6.0%),and other(5.0%).Escherichia coli was the most common bacteria isolated(13.4%),both among sensitive and MDR *** bacteria were the cause for 41.3%of all infections *** accounted for 9.5%of infections.21.9%of patients had decompensation from their infection(s)that required ICU care,and 14.6%of patients died during hospitalization or soon after ***:the incidence of infections in cirrhotic patients is much higher than in their non-cirrhotic counterparts(54.6%),even higher than prior studies *** many of these infections are caused by MDR bacteria and fungal organisms,stronger empiric antibiotics and antifungals should be considered when initially treating this immunocompromised ***,once organism sensitivities are discovered,narrowing of antibiotic regimens must occur to maintain g

关键词： Cirrhosis Bacterial infections Multidrug resistance Fungal infections

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Management and treatment of Hepatocellular Carcinoma with Immunotherapy:A Review of Current and Future Options

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Journal of Clinical and translational Hepatology 2020年第2期8卷 168-176页

作者： Shima Ghavimi tehila Apfel Hamed Azimi Alana Persaud nikolaos t.pyrsopoulos Division of Gastroenterology and Hepatology Department of MedicineRutgers New Jersey Medical SchoolNewarkNJUSA

With mortality rates of liver cancer doubling in the last 20 years, this disease is on the rise and has become the fifth most common cancer in men and the seventh most common cancer in women. Hepatocellular carcinoma (HCC) represents approximately 90% of all primary liver cancers and is a major global health concern. Patients with HCC can be managed curatively with surgical resection or with liver transplantation, if they are diagnosed at an early stage. Unfortunately, most patients with HCC present with ad-vanced stages of the disease and have underlying liver dysfunction, which allows only 15%of patients to be eligible for curative treatment. Several different treatment modal-ities are available, including locoregional therapy radiofre-quency ablation, microwave ablation, percutaneous ethanol injection, trans-arterial chemoembolization, transarterial radio-embolization, cryoablation, radiation therapy, stereo-tactic radiotherapy, systemic chemotherapy, molecularly targeted therapies, and immunotherapy. Immunotherapy has recently become a promising method for inhibiting HCC tumor progression, recurrence, and metastasis. the term"Immunotherapy"is a catch-all, encompassing a wide range of applications and targets, including HCC vaccines, adoptive cell therapy, immune checkpoint inhibitors, and use of oncolytic viruses to treat HCC. Immunotherapy in HCC is a relatively safe option for treating patients with advanced disease in the USA who are either unable to receive or failed sorafenib/lenvatinib therapy and thus may offer an addi-tional survival benefit for these patients. the purpose of this review is to elaborate on some of the most recent advance-ments in immunotherapy.

关键词： Carcinoma Hepatocellular Immunotherapy Immunotherapy Adoptive Nivolumab

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Hepatocellular Carcinoma Incidence and Mortality in the USA by Sex, Age, and Race: A Nationwide Analysis of two Decades

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Journal of Clinical and translational Hepatology 2024年第2期12卷 172-181页

作者： Yazan Abboud Mohamed Ismail Hamza Khan Esli Medina-Morales Saqr Alsakarneh Fouad Jaber nikolaos t.pyrsopoulos Department of Internal Medicine Rutgers New Jersey Medical SchoolNewarkNJUSA Department of Internal Medicine University of Missouri-Kansas CityKansas CityMOUSA Division of Gastroenterology and Hepatology Rutgers New Jersey Medical SchoolNewarkNJUSA

Background and Aims:While the incidence rates of hepa-tocellular carcinoma(HCC)are increasing,there are limited comprehensive data on demographic-specific incidence and mortality trends in the *** aimed to evaluate recent trends in HCC incidence and mortality among different de-mographic groups in the ***:Age-adjusted HCC incidence rates were calculated from the Centers for Disease Control's United States Cancer Statistics database,which combines incidence data on newly diagnosed cancer cases and covers approximately 98%of the population in the ***,age-adjusted HCC mortality rates were obtained from the Centers for Disease Control's National Center for Health Statistics database,which offers comprehensive Cov-erage spanning nearly 100%of deaths attributed to HCC in the *** were stratified by sex,age(older[≥55 years]and younger[ts),race and ethnicity(Non-Hispanic White,Non-Hispanic Black,Hispanic,Non-Hispanic Asian/Pacific Islander,and Non-Hispanic American Indian/Alaska Native),and tumor stage at diagnosis(early and late).Annual and average annual percentage change(AAPC)were calculated using joinpoint regression.A sex-specific pairwise comparison was ***:Between 2001 and 2020,there were 467,346 patients diagnosed with HCC(26.0%women),with increasing incidence in both sexes without significant difference(p=0.65).In younger adults(78,169 patients),the incidence decreased in men but not in women(AAPC difference=-2.39,p=0.002).this was seen in various racial and ethnic groups,mostly driven by early-stage tumors(AAPC difference=-2.65,p=0.02).there were 329,973 deaths attributed to HCC between 2000 and 2020(28.4%women).In younger adults(43,093 deaths),mortal-ity decreased in men at a greater rate than in women(AAPC difference=1.61,p=0.007).this was seen in various racial and ethnic groups,most notably in non-Hispanic American Indian/Alaska Natives(AAPC difference=-4.51,p=0.01).Conclusions:Nationwide USA data,coveri

关键词： Liver cancer Hepatocellular carcinoma Incidence Mortality Epidemiology Health disparity

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A Case Report of Alloimmune Hepatitis after Direct-acting Antiviral treatment in a Liver transplant Patient

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Journal of Clinical and translational Hepatology 2020年第4期8卷 459-462页

作者： Catherine Choi Youssef Botros Jamil Shah Pei Xue Anja Jones Mark Galan Raquel Olivo Mumtaz Niazi Flavio Paterno James Guarrera nikolaos t.pyrsopoulos Department of Internal Medicine Rutgers New Jersey Medical SchoolNewarkNJUSA Division of Gastroenterology St.Joseph’s University Medical CenterPatersonNJUSA Division of Gastroenterology&Hepatology The Brooklyn Hospital CenterBrooklynNYUSA Rutgers New Jersey Medical School NewarkNJUSA Department of Pathology Immunology&Laboratory MedicineRutgers New Jersey Medical SchoolNewarkNJUSA Division of Gastroenterology&Hepatology Department of MedicineRutgers New Jersey Medical SchoolNewarkNJUSA Division of Liver transplantation&Hepatobiliary Surgery Department of SurgeryRutgers New Jersey Medical SchoolNewarkNJUSA

Direct-acting antiviral (DAA) therapy is often well-tolerated, and adverse events from DAA therapy are uncommon. We report a case of a woman who underwent orthotopic liver transplant for chronic hepatitis C infection and later devel-oped alloimmune hepatitis shortly after starting DAA therapy for recurrent hepatitis C infection. the patient developed acute alloimmune hepatitis approximately 2 weeks after starting treatment with sofosbuvir, velpatasvir, and voxilap-revir. this case report proposes a dysregulation of immune surveillance due to the DAA stimulation of host immunity and rapid elimination of hepatitis C viral load as a precipitating factor for the alloimmune process, leading to alloimmune hepatitis in a post-transplant patient who starts on DAA.

关键词： Autoimmune hepatitis Hepatitis C Liver transplant

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Efficacy and safety of anti-hepatic fibrosis drugs

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World Journal of Gastroenterology 2020年第41期26卷 6304-6321页

作者： Konstantinos Damiris Zaid H tafesh nikolaos pyrsopoulos Department of Medicine Rutgers-New Jersey Medical SchoolNewarkNJ 07103United States Medicine-Gastroenterology and Hepatology Rutgers-New Jersey Medical SchoolNewarkNJ 07103United States

Recent progress in our understanding of the pathways linked to progression from hepatic insult to cirrhosis has led to numerous novel therapies being investigated as potential cures and inhibitors of hepatic fibrogenesis. Liver cirrhosis is the final result of prolonged fibrosis, which is an intimate balance between fibrogenesis and fibrinolysis. A number of these complex mechanisms are shared across the various etiologies of liver disease. thankfully, investigation has yielded some promising results in regard to reversal of fibrosis, particularly the indirect benefits associated with antiviral therapy for the treatment of hepatitis B and C and the farnesoid receptor agonist for the treatment of primary biliary cholangitis and metabolic associated fatty liver disease. A majority of current clinical research is focused on targeting metabolic associated fatty liver disease and its progression to metabolic steatohepatitis and ultimately cirrhosis, with some hope of potential standardized therapeutics in the near future. With our ever-evolving understanding of the underlying pathophysiology, these therapeutics focus on either controlling the primary disease(the initial trigger of fibrogenesis), interrupting receptor ligand interactions and other intracellular communications, inhibiting fibrogenesis, or even promoting resolution of fibrosis. It is imperative to thoroughly test these potential therapies with the rigorous standards of clinical therapeutic trials in order to ensure the highest standards of patient safety. In this article we will briefly review the key pathophysiological pathways that lead to liver fibrosis and present current clinical and experimental evidence that has shown reversibility of liver fibrosis and cirrhosis, while commenting on therapeutic safety.

关键词： Liver Fibrosis Cirrhosis Antifibrotic Pharmacotherapy Clinical trial Safety

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Emerging concepts in alcoholic hepatitis

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World Journal of Hepatology 2017年第12期9卷 567-585页

作者： Phoenix Fung nikolaos pyrsopoulos Department of Medicine Division of Gastroenterology and HepatologyRutgers New Jersey Medical SchoolNewarkNJ 07103United States

Severe alcoholic hepatitis is implicated as a costly,worldwide public health issue with high morbidity and mortality. the one-month survival for severe alcoholic hepatitis is low with mortality rates high as 30%-50%. Abstinence from alcohol is the recommended firstline treatment. Although corticosteroids remain as the current evidence based option for selected patients with discriminant function > 32, improvement of short-term survival rate may be the only benefit. Identification of individuals with risk factors for the development of severe alcoholic hepatitis may provide insight to the diverse clinical spectrum and prognosis of the disease. the understanding of the complex pathophysiologic processes of alcoholic hepatitis is the key to elucidating new therapeutic treatments. Newer research describes the use of gut microbiota modification, immune modulation, stimulation of liver regeneration, caspase inhibitors, farnesoid X receptors, and the extracorporeal liver assist device to aid in hepatocellular recovery. Liver transplantation can be considered as the last medical option for patients failing conventional medical interventions. Although the preliminary data is promising in patients with low risk of recividism, controversy remains due to organ scarcity. this review article comprehensively summarizes the epidemiology, pathophysiology, risk factors, and prognostic indicators of severe alcoholic hepatitis with a focus on the current and emerging therapeutics.

关键词： Immune modulation Alcoholic hepatitis Gut microbiota modification Extracorporeal liver assist device Apoptosis inhibitors

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Cardiac Syndromes in Liver Disease:A Clinical Conundrum

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Journal of Clinical and translational Hepatology 2023年第4期11卷 975-986页

作者： Milos Brankovic Paul Lee nikolaos pyrsopoulos Mark Klapholz Department of Medicine Rutgers New Jersey Medical SchoolNewarkNJUSA transatlantic Cardiovascular Study Group BloomfieldNJUSA Division of Gastroenterology and Hepatology Department of MedicineRutgers New Jersey Medical SchoolNewarkNJUSA Division of Cardiology Heart Failure Prevention and Treatment ProgramRutgers New Jersey Medical SchoolNewarkNJUSA

Understanding the interaction between the heart and liver is pivotal for managing patients in whom both organs are *** have shown that cardio-hepatic interactions are bidirectional and that their identification,assessment,and treatment remain *** hepatopathy is a condition that develops in the setting of long-standing systemic venous *** left untreated,congestive hepatopathy may lead to hepatic *** cardiogenic liver injury develops as a combination of venous stasis and sudden arterial hypoperfusion due to cardiac,circulatory,or pulmonary *** treatment of both conditions should be directed toward optimizing the cardiac *** syndrome may develop in patients with advanced liver disease and lead to multiorgan *** cardiomyopathy or abnormalities in pulmonary vasculature,such as hepatopulmonary syndrome and portopulmonary hypertension may also *** complication has unique treatment challenges and implications for liver *** presence of atrial fibrillation and atherosclerosis in liver disease brings another layer of complexity,particularly in terms of anticoagulation and statin *** article provides an overview of cardiac syndromes in liver disease,focusing on current treatment options and future perspectives.

关键词： Liver disease Congestive hepatopathy Cardiogenic liver injury Cirrhotic cardiomyopathy Hepatopulmonary syndrome Portopulmonary hypertension

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Liver injury induced by paracetamol and challenges associated with intentional and unintentional use

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World Journal of Hepatology 2020年第4期12卷 125-136页

作者： Laura Rotundo nikolaos pyrsopoulos Department of Medicine Rutgers New Jersey Medical SchoolNewarkNJ 07103United States Department of Gastroenterology and Hepatology Rutgers New Jersey Medical SchoolNewarkNJ 07103United States

Drug induced liver injury(DILI)is a common cause of acute liver ***,also known as acetaminophen,is a widely used anti-pyretic that has long been established to cause liver toxicity once above therapeutic *** from paracetamol overdose,whether intentional or nonintentional,is the most common cause of DILI in the United States and remains a global *** the increased prevalence of combination medications in the form of pain relievers and antihistamines,paracetamol can be difficult to identify and remains a significant cause of acute hepatotoxicity,as evidenced by its contribution to over half of all acute liver failure cases in the United *** is especially concerning given that,when co-ingested with other medications,the rise in serum paracetamol levels may be delayed past the 4-hour post-ingestion mark that is currently used to determine patients that require medical *** review serves to describe the clinical and pathophysiologic features of hepatotoxicity secondary to paracetamol and provide an update on current available knowledge and treatment options.

关键词： Paracetamol Drug-induced liver injury Hepatotoxicity Acute liver failure

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Hepatitis B and Hepatitis C Reactivation in the Biologic Era

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Journal of Clinical and translational Hepatology 2014年第4期2卷 240-246页

作者： Lizza Bojito-Marrero nikolaos pyrsopoulos Division of Gastroenterology and Hepatology Rutgers New Jersey Medical School Newark USA

Hepatitis B (HBV) and hepatitis C (HCV) reactivation may occur after the use of biologic agents. During the last decade, utilization of biologics has changed the fate of many treated for cancer, autoimmune and connective tissue disease, mainte-nance of transplanted organs, and the prevention of graft-versus-host disease among others. HBV reactivation has been reported in up to 50% of HBV carriers undergoing immuno-suppressive therapy, and there is emerging data pointing towards an increased risk for HCV reactivation. If reactivation of HBV and HCV occurs, the spectrum of clinical manifestations can range from asymptomatic hepatitis flares to hepatic decompensation, fulminant hepatic failure, and death. therefore, identifying patients at risk and early diagnosis are imperative to decrease significant morbidity and mortality. the purpose of this article is to review the pathophysiology of the reactivation of HBV and HCV infection in patients receiving biologic therapies and the approaches used to diagnose, prevent, and treat HBV and HCV reactivation.

关键词： Hepatitis B reactivation Hepatitis C reactivation Biologics Immunosuppressive therapy Prophylactic antiviral treatment

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Fatty Liver Disease and Gut Microbiota:A Comprehensive Update

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Journal of Clinical and translational Hepatology 2019年第1期7卷 56-60页

作者： Lyna Campo Sara Eiseler tehilla Apfel nikolaos pyrsopoulos Division of Gastroenterology and Hepatology University HospitalRutgers New Jersey Medical SchoolNewarkNJUSA

Nonalcoholic fatty liver disease(NAFLD)is the accumulation of fat in the liver in the absence of secondary *** is a multifactorial disease that results from the interaction of genetic predisposition and metabolic,inflammatory and environmental *** these factors,dysregulation of gut microbiome has been linked to the development of fatty liver *** microbiome composition can be modified by dietary habits leading to gut microbiome dysbiosis,especially when a diet is rich in saturated fats,animal products and fructose *** species of bacteria in the gut metabolize nutrients differently,triggering different pathways that contribute to the accumulation of fat within the liver and triggering inflammatory cascades that promote liver *** this review,we summarize the current understanding of the roles of gut microbiota in mediating NAFLD development and discuss possible gut microbiota-targeted therapies for *** summarize experimental and clinical evidence,and draw conclusions on the therapeutic potential of manipulating gut microbiota to decrease the incidence and prevalence of fatty liver disease.

关键词： Nonalcoholic fatty liver disease Gut microbiome Dysbiosis Endotoxins Choline metabolism

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