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Impact of an acute hemodynamic response-guided protocol for primary prophylaxis of variceal bleeding

World Journal of Clinical Cases 2018年第13期6卷 611-623页

作者： José Ignacio Fortea ángela Puente Patricia Ruiz Iranzu Ezcurra Javier Vaquero Antonio Cuadrado María Teresa Arias-Loste Joaquín Cabezas susana llerena Paula Iruzubieta Carlos Rodríguez-Lope Patricia Huelin Fernando Casafont Emilio Fábrega Javier Crespo Servicio de Aparato Digestivo Hospital Universitario Marques? de Valdecilla Instituto de Investigación Sanitaria Marqués de Valdecilla Centro de Investigación Biomédica Red de Enfermedades Hepáticas y Digestivas Laboratorio de Investigación en Hepatología y Gastroenterología Hospital General Universitario Gregorio Mara?ón-Instituto de Investigación Sanitaria Gregorio Mara?ón

AIM To evaluate the long-term outcome of an acute hemodynamic response-guided protocol in which acute responders to intravenous propranolol received traditional nonselective beta-blockers(NSBBs) and acute nonresponders received *** Retrospective review of a protocol for primary prophylaxis of variceal bleeding guided by the acute hemodynamic response to intravenous propranolol. Fifty-two acute responders treated with traditional NSBB(i.e. propranolol or nadolol) were compared with 24 acute nonresponders receiving carvedilol. A second hemodynamic study was performed in 27 and 13 patients, respectively. The primary endpoint was development of first or further decompensation. Secondary endpoints included death from any cause, association between acute and chronic hemodynamic response, and baseline clinical and laboratory variables related to the acute hemodynamic *** Acute responders and acute nonresponders presented similar 1, 2, and 3-year probabilities of first decompensation(NSBB: 0%, 13.7%, 26.1% vs carvedilol: 0%, 20%, 20%, P = 0.968) or further decompensation(21.2%, 26.1%, 40.9% vs 21.2%, 50.0%, 50.0%, P = 0.525). A previous episode of hepatic encephalopathy was the only independent predictor of decompensation [hazard ratio(95% confidence interval): 8.03(2.76-23.37)]. Mortality rates were similar in acute responders and acute nonresponders with compensated(P = 0.428) or decompensated cirrhosis(P = 0.429). No clinical, laboratory, endoscopic or hemodynamic parameter predicted the acute hemodynamic response. In patients receiving traditional NSBB, the acute and chronic changes of hepatic venous pressure gradient were correlated(r = 0.59, P = 0.001). Up to 69.2% of acute nonresponders gained chronic response with *** Early identification and treatment with carvedilol of acute nonresponders to intravenous propranolol improves the clinical outcome of this high-risk group of patients, probably due to its greater effects fo

关键词： Gastrointestinal hemorrhage Propranolol Carvedilol Liver cirrhosis Portal hypertension

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Binge drinking: Burden of liver disease and beyond

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World Journal of Hepatology 2015年第27期7卷 2703-2715页

作者： susana llerena María Teresa Arias-Loste Angela Puente Joaquín Cabezas Javier Crespo Emilio Fábrega Gastroenterology and Hepatology Unit Marqués de Valdecilla University HospitalInstituto de Investigación Marqués de Valdecilla

The consumption of alcoholic beverages is harmful to human health. In recent years, consumption patterns of alcoholic beverages have changed in our society, and binge drinking has generalized. It is considered to be a socio-sanitary problem with few known consequences in terms of individual and third-party social impacts(in the form of violence or traffic accidents) and its organic impact(affects the liver and other organs and systems, such as the nervous and cardiovascular systems) and represents an important financial burden due to its increasing economic impact. This review provides a global approach to binge drinking and emphasizes its epidemiological character, the effect of this type of consumption and the possible management of a problem with an increasing tendency in our society.

关键词： Binge drinking Binge drinking adolescent Binge dri

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Plasma betatrophin levels in patients with liver cirrhosis

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World Journal of Gastroenterology 2015年第37期21卷 10662-10668页

作者： Maria Teresa Arias-Loste Maria Teresa García-Unzueta susana llerena Paula Iruzubieta Angela Puente Joaquín Cabezas Carmen Alonso Antonio Cuadrado José Antonio Amado Javier Crespo Emilio Fábrega Gastroenterology and Hepatology Unit Marqués de Valdecilla University HospitalInstituto de Investigación Sanitaria ValdecillaAvenida Valdecilla s/n 39008 Santander Cantabria Spain Endocrinology Unit Marqués de Valdecilla University HospitalInstituto de Investigación Sanitaria Valdecilla Avenida Valdecilla s/n 39008 Santander Cantabria Spain

AIM: To investigate the plasma levels of betatrophin in patients with ***: Forty patients diagnosed at the clinic with liver cirrhosis according to biological, ultrasonographic,or histological criteria were *** severity of cirrhosis was classified according to Pugh's modification of Child's classification and MELD score. Insulin resistance(IR) was assessed by the Homeostasis Model Assessment. A total of 20 patients showed a MELD score higher than 14. The control group consisted in 15 sex-and aged-matched *** blood samples were obtained for subsequent analysis. Serum insulin was determined by Liaison automated immune chemiluminiscence assay(DiaSorin S.p.A.) using a sandwich assay. The sensitivity of the assay was 0.2 μU/mL. The intra and interassay variation coefficients were < 4% and < 10%,respectively. The normal values were between 2 and17 μU/mL. Human active betatrophin was analyzed by specific quantitative sandwich ELISA(Aviscera Bioscience). The sensitivity of the assay was 0.4 ng/mL, and the intra and interassay reproducibility were< 6% and < 10%, ***: Plasma betatrophin levels were significantly increased in patients with cirrhosis compared with those in healthy subjects(P = 0.0001). Betatrophin levels were also associated with disease severity, being higher in Child-Pugh C patients compared to Child-Pugh B(P< 0.0005) and in patients who displayed a MELD score higher than 14 points compared to patients with lower punctuation(P = 0.01). In addition, we found a positive correlation between plasma betatrophin levels and the severity of cirrhosis according to Child-Pugh classification(r = 0.53; P < 0.01) or MELD score(r = 0.45; P <0.01). In the overall cohort, a moderate correlation between serum betatrophin and plasmatic bilirrubin(r= 0.39; P < 0.01) has been observed, as well as an inverse correlation between betatrophin and albumin(r =-0.41; P < 0.01) or prothrombin time(r =-0.44;P <0.01). Moreover, insulin

关键词： Liver cirrhosis Betatrophin Insulin resistance Bet

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