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Prevalence and risk factors of lymphatic dysfunction in cirrhosis patients with refractory ascites:An often unconsidered mechanism

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World Journal of Hepatology 2023年第10期15卷 1140-1152页

作者： rahul arya Ramesh Kumar Tarun Kumar Sudhir Kumar Utpal Anand Rajeev Nayan Priyadarshi Tanmoy Maji Department of Gastroenterology All India Institute of Medical SciencesPatna 801507BiharIndia Department of Pathology All India Institute of Medical SciencesPatna 801507BiharIndia Department of Surgical Gastroenterology All India Institute of Medical SciencesPatna 801507BiharIndia Department of Radiodiagnosis All India Institute of Medical SciencesPatna 801507BiharIndia

BACKGROUND The lymphatic system is crucial in maintaining the body fluid homeostasis.A dysfunctional lymphatic system may contribute to the refractoriness of ascites and edema in cirrhosis ***,assessment of lymphatic dysfunction in cirrhosis patients with refractory ascites(RA)can be crucial as it would call for using different strategies for fluid *** To assessing the magnitude,spectrum,and clinical associations of lymphatic dysfunction in liver cirrhosis patients with *** This observational study included 155 consecutive cirrhosis patients with *** presence of clinical signs of lymphedema,such as peau d’orange appearance and positive Stemmer sign,intestinal lymphangiectasia(IL)on duodenal biopsy seen as dilated vessels in the lamina propria with strong D2-40 immunohistochemistry,and chylous ascites were used to diagnose the overt lymphatic *** A total of 69(44.5%)patients out of 155 had evidence of lymphatic *** lymphedema,found in 52(33.5%)patients,was the most common manifestation,followed by IL in 42(27.0%)patients,and chylous ascites in 2(1.9%)*** to patients without lymphedema,those with lymphedema had higher mean age,median model for end-stage liver disease scores,mean body mass index,mean ascitic fluid triglyceride levels,and proportion of patients with hypoproteinemia(serum total protein<5 g/dL)and lymphocytopenia(<15%of total leukocyte count).Patients with IL also had a higher prevalence of lymphocytopenia and hypoproteinemia(28.6%vs.9.1%,P=0.004).Seven(13%)patients with lymphedema had lower limb cellulitis compared to none in those without *** multivariate regression analysis,factors independently associated with lymphatic dysfunction included obesity[odds ratio(OR):4.2,95%confidence intervals(95%CI):1.1–15.2,P=0.027],lymphocytopenia[OR:6.2,95%CI:2.9–13.2,P<0.001],and hypoproteinemia[OR:3.7,95%CI:1.5–8.82,P=0.003].CONCLUSION Lymphatic dysfunction is common in cirrho

关键词： Cirrhosis Lymphedema Lymphangicetasia Refractory ascites Chylous ascites Lymphocytopenia

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Association of COVID-19 with hepatic metabolic dysfunction

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World Journal of Virology 2022年第5期11卷 237-251页

作者： Ramesh Kumar Vijay Kumar rahul arya Utpal Anand Rajeev Nayan Priyadarshi Department of Gastroenterology All India Institute of Medical SciencesPatnaPatna 801507BiharIndia Department of Medicine All India Institute of Medical SciencesPatnaPatna 801507BiharIndia Department of Surgical Gastroenterology All India Institute of Medical SciencesPatnaPatna 801507BiharIndia Department of Radiodiagnosis All India Institute of Medical SciencesPatnaPatna 801507BiharIndia

The coronavirus disease 2019(COVID-19)pandemic continues to be a global problem with over 438 million cases reported so *** it mostly affects the respiratory system,the involvement of extrapulmonary organs,including the liver,is not *** the beginning of the pandemic,metabolic comorbidities,such as obesity,diabetes,hypertension,and dyslipidemia,have been identified as poor prognostic *** metabolic and lipidomic studies have identified several metabolic dysfunctions in patients with *** metabolic alterations appear to be linked to the course of the disease and inflammatory reaction in the *** liver is an important organ with high metabolic activity,and a significant proportion of COVID-19 patients have metabolic comorbidities;thus,this factor could play a key role in orchestrating systemic metabolic changes during *** suggests that metabolic dysregulation in COVID-19 has both short-and long-term metabolic ***,COVID-19 has adverse associations with metabolic-associated fatty liver *** to the ensuing effects on the renin-angiotensin-aldosterone system and ammonia metabolism,COVID-19 can have significant implications in patients with advanced chronic liver disease.A thorough understanding of COVID-19-associated metabolic dysfunction could lead to the identification of important plasma biomarkers and novel treatment *** this review,we discuss the current understanding of metabolic dysfunction in COVID-19,focusing on the liver and exploring the underlying mechanistic pathogenesis and clinical implications.

关键词： COVID-19 Coronavirus Metabolism Metabolic syndrome Metabolic inflammation Hepatic dysfunction

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