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Cost-effectiveness analysis of beta-blockers vs endoscopic surveillance in patients with cirrhosis and small varices

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World Journal of Gastroenterology 2014年第30期20卷 10464-10469页

作者： Lorenza Di Pascoli Alessra Buja Massimo Bolognesi Sara Montagnese Angelo Gatta Dario Gregori Carlo Merkel hepatic hemodynamic laboratory and Clinica Medica 5 Department of MedicineUniversity of Padua35128 PadovaItaly laboratory of Epidemiological Methodology and Biostatistics Department of Environmental Medicine and Public HealthUniversity of Padua35128 PadovaItaly

AIM: To evaluate the most cost-effectiveness strategy for preventing variceal growth and bleeding in patients with cirrhosis and small esophageal varices.

关键词： Pharmaco-economical analysis Cirrhosis Esophageal varices Variceal bleeding Primary prophylaxis

Animal models of portal hypertension

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World Journal of Gastroenterology 2006年第41期12卷 6577-6584页

作者： Juan G Abraldes Marcos Pasarín Juan Carlos García-Pagán hepatic hemodynamic laboratory Liver UnitICMDiMHospital ClinicIDIBAPSUniversity of BarcelonaSpain

Animal models have allowed detailed study of hemodynamic alterations typical of portal hypertension and the molecular mechanisms involved in abnormalities in splanchnic and systemic circulation associated with this syndrome. Models of prehepatic portal hypertension can be used to study alterations in the splanchnic circulation and the pathophysiology of the hyperdynamic circulation. Models of cirrhosis allow study of the alterations in intrahepatic microcirculation that lead to increased resistance to portal flow. This review summarizes the currently available literature on animal models of portal hypertension and analyzes their relative utility. The criteria for choosing a particular model, depending on the specific objectives of the study, are also discussed.

关键词： Cirrhosis Nitric Oxide Portal vein

Extrahepatic portal vein thrombosis in children and adolescents:Influence of genetic thrombophilic disorders

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World Journal of Gastroenterology 2010年第48期16卷 6123-6127页

作者： Andrea Pietrobattista Matteo Luciani Juan G Abraldes Manila Candusso Simona Pancotti Massimo Soldati Lidia Monti Giuliano Torre Valerio Nobili Liver Unit Research InstituteBambino Gesù Children's Hospital Department of Hematology Bambino Gesù Children's Hospital hepatic hemodynamic laboratory Liver UnitHospital ClínicIDIBAPS and CIBERhedUniversity of Barcelona Department of laboratory Pediatrics Bambino Gesù Children's Hospital Radiology Department Bambino Gesù Children's Hospital

AIM:To explore the prevalence of local and genetic thrombophilic disorders as risk factors for portal vein thrombosis (PVT) in our series,the largest ever published in pediatric literature. METHODS:We conducted a case-control study enrolling 31 children with PVT and 26 age-matched controls. All were screened for thrombophilia,including genetic disorders,protein C,protein S and homocysteine deficiencies. All coagulation parameters were studied at least 3 mo after the diagnosis of portal vein ***:In our study we showed that most pediatric patients with PVT have local prothrombotic risk factors,which are probably the most important factors leading to PVT. However,there is a clear association between the presence of prothrombotic disorders and PVT,suggesting that these increase the risk of thrombosis in patients with local factors such as perinatal umbilical vein catheterization or sepsis. CONCLUSION:Patients with PVT should be screened for inherited prothrombotic disorders regardless of a history of an obvious local risk factor.

关键词： Portal vein thrombosis Children Thrombophilic disorders Protein C Protein S

Clinical algorithms for the prevention of variceal bleeding and rebleeding in patients with liver cirrhosis

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World Journal of Hepatology 2021年第7期13卷 731-746页

作者： Nikolaus Pfisterer Lukas W Unger Thomas Reiberger Medizinische Abteilung für Gastroenterologie und Hepatologie Klinik Landstraße/Krankenanstalt RudolfstiftungVienna 1030Austria vienna hepatic hemodynamic Lab Medical University of ViennaVienna 1090Austria Division of Visceral Surgery Department of General SurgeryMedical University of ViennaVienna 1090Austria Cambridge Institute of Therapeutic Immunology and Infectious Disease Jeffrey Cheah Biomedical CentreUniversity of CambridgeCambridge CB20AWUnited Kingdom Division of Gastroenterology and Hepatology Department of Medicine IIIMedical University of ViennaVienna 1090Austria Christian Doppler laboratory for Portal Hypertension and Liver Fibrosis Medical University of ViennaVienna 1090Austria

Portal hypertension(PH),a common complication of liver cirrhosis,results in development of esophageal *** esophageal varices rupture,they cause significant upper gastrointestinal bleeding with mortality rates up to 20%despite state-of-the-art ***,prophylactic measures are of utmost importance to improve outcomes of patients with *** high-quality studies have demonstrated that non-selective beta blockers(NSBBs)or endoscopic band ligation(EBL)are effective for primary prophylaxis of variceal *** secondary prophylaxis,a combination of NSBB+EBL should be routinely *** esophageal varices develop and variceal bleeding occurs,standardized treatment algorithms should be followed to minimize bleeding-associated *** attention should be paid to avoidance of overtransfusion,early initiation of vasoconstrictive therapy,prophylactic antibiotics and early endoscopic ***-emptive transjugular intrahepatic portosystemic shunt should be used in all Child C10-C13 patients experiencing variceal bleeding,and potentially in Child B patients with active bleeding at *** use of carvedilol,safety of NSBBs in advanced cirrhosis(*** refractory ascites)and assessment of hepatic venous pressure gradient response to NSBB is *** the present review,we give an overview on the rationale behind the latest guidelines and summarize key papers that have led to significant advances in the field.

关键词： Portal hypertension Endoscopy Non-selective betablockers Transjugular intrahepatic portosystemic shunt

Intrahepatic vascular changes in non-alcoholic fatty liver disease: potential role of insulin-resistance and endothelial dysfunction

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World Journal of Gastroenterology 2017年第37期23卷 6777-6787页

作者： Marcos Pasarín Juan G Abraldes Eleonora Liguori Beverley Kok Vincenzo La Mura hepatic hemodynamic laboratory Liver UnitHospital ClinicIDIBAPS(Institut d'Investigacions Biomèdiques August Pi i Sunyer) University of Barcelona Cirrhosis Care Clinic Division of Gastroenterology(Liver Unit)CEGIIR University of Alberta Internal Medicine IRCCS San Donato Department of Biomedical Sciences for HealthUniversity of Milan

Metabolic syndrome is a cluster of several clinical conditions characterized by insulin-resistance and high cardiovascular risk. Non-alcoholic fatty liver disease is the liver expression of the metabolic syndrome, and insulin resistance can be a frequent comorbidity in several chronic liver diseases, in particular hepatitis C virus infection and/or cirrhosis. Several studies have demonstrated that insulin action is not only relevant for glucose control, but also for vascular homeostasis. Insulin regulates nitric oxide production, which mediates to a large degree the vasodilating, antiinflammatory and antithrombotic properties of a healthy endothelium, guaranteeing organ perfusion. The effects of insulin on the liver microvasculature and the effects of IR on sinusoidal endothelial cells have been studied in animal models of non-alcoholic fatty liver disease. The hypotheses derived from these studies and the potential translation of these results into humans are critically discussed in this review.

关键词： Non-alcoholic fatty liver disease Endothelial dysfunction Insulin resistance Metabolic syndrome

Effect of transjugular intrahepatic portosystemic shunt on pulmonary gas exchange in patients with portal hypertension and hepatopulmonary syndrome

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World Journal of Gastroenterology 2005年第43期11卷 6858-6862页

作者： Graciela Martínez-Pallí Britt B Drake Joan-Carles García-Pagán Joan-Albert Barberà Miguel R Arguedas Robert Rodriguez-Roisin Jaume Bosch Michael B Fallon Servei d'Anestesiologia i Reanimació. Hospital Clínic University of Alabama at Birmingham Liver Center hepatic hemodynamic laboratory Servei de Pneumologia i Al.lèrgia Respiratòria

AIM: To assess the impact of transjugular intrahepatic portosystemic shunt (TIPS) on pulmonary gas exchange and to evaluate the use of TIPS for the treatment of hepatopulmonary syndrome (HPS).METHODS: Seven patients, three of them with advanced HPS, in whom detailed pulmonary function tests were performed before and after TIPS placementat the University of Alabama Hospital and at the Hospital Clinic, Barcelona, were ***: TIPS patency was confirmed by hemodynamic evaluation. No changes in arterial blood gases were observed in the overall subset of patients. Transient arterial oxygenation improvement was observed in only one HPS patient, early after TIPS, but this was not sustained 4 mo ***: TIPS neither improved nor worsened pulmonary gas exchange in patients with portal hypertension. This data does not support the use of TIPS as a specific treatment for HPS. However, it does reinforce the view that TIPS can be safely performed for the treatment of other complications of portal hypertension in patients with HPS.

关键词： Portal hypertension Transjugular intrahepaticportosystemic shunt Pulmonary gas exchange Hepatopulmonary syndrome

Management of small hepatocellular carcinoma in cirrhosis:Focus on portal hypertension

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World Journal of Gastroenterology 2013年第8期19卷 1193-1199页

作者： Virginia Hernandez-Gea Fanny Turon Annalisa Berzigotti Augusto Villanueva Hepatocellular Carcinoma Translational Research laboratory Barcelona-Clinic Liver Cancer GroupInstitut d'Investigacions Biomediques August Pi i SunyerLiver UnitHospital Clinic08036 BarcelonaSpain hepatic hemodynamic laboratory Liver UnitHospital ClinicUniversity of Barcelona08036 BarcelonaSpain Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas Instituto Carlos Ⅲ08036 BarcelonaSpain

The incidence of hepatocellular carcinoma(HCC) is rising worldwide being currently the fifth most common cancer and third cause of cancer-related *** detection of HCC through surveillance programs have enabled the identification of small nodules with higher frequency,and nowadays account for 10%-15% of patients diagnosed in the West and almost 30% in *** with small HCC can be candidates for potential curative treatments:liver transplantation,surgical resection and percutaneous ablation,depending on the presence of portal hypertension and *** review will analyze recent advancements in the clinical management of these individuals,focusing on issues related to the role of portal hypertension,the debate between resection and ablative therapies and the future impact of molecular technologies.

关键词： Portal hypertension hepatic venous pressure gradient Clinically significant portal hypertension Liver stiffness Liver cancer Hepatocellular carcinoma Resection Radiofrequency ablation Percutaneous ethanol injection

肝硬化患者β_2肾上腺素能受体基因多态性在血流动力学对普萘洛尔反应的影响

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世界核心医学期刊文摘（胃肠病学分册） 2006年第10期2卷 45-46页

作者： Turnes J. Hernández-Guerra M. Abraldes J.G. J.Bosch 陈云茹 hepatic hemodynamic laboratory Liver UnitHospital ClinicVillarroel 170Barcelona 08036Spain.Dr

The beta-2-adrenergic receptor (β2-AR) has several single- nucleotide polymorphisms. These influence the functional response to adrenergic stimulation; genotypes homozygous for Gly16-Glu27 or Gly16-Gln27 alleles (Gly16-Glu/Gln27 haplotypes) are associated with enhanced response, whereas genotypes homozygous for Arg16-Gln27 alleles (Arg16-Gln27) show a decreased response. We hypothesized that gene polymorphisms at the β2-AR may influence the hemodynamic response to propranolol in patients with cirrhosis. The β2-AR gene polymorphisms were determined by direct sequencing of the polymerase chain reaction (PCR) products in 48 patients with cirrhosis. All patients also had hepatic and systemic hemodynamic studies before and after propranolol administration. Prevalence of Gly16-Glu/Gln27 haplotypes was 29.1%, Arg16-Gln27 haplotype was 16.7%,and 54.2%were compound heterozygotes. Patients with cirrhosis with Gly16-Glu/Ghl27 haplotypes had a greater decrease in heart rate, cardiac index, and hepatic blood flow after propranolol administration than those with Arg16-Gln27 haplotype. However, the HVPG response to propranolol was similar in both groups, whereas estimated hepatic sinusoidal resistance increased significantly in Gly16-Glu/Gln27 haplotypes but not in Arg16-Gln27 (+27.1 ±17.8%vs -17.9 ±13.9%, P = .042), suggesting that unopposed vasoconstrictive activity at the intrahepatic circulation hinders the fall in HVPG despite enhanced hemodynamic response to propranolol in Gly16-Glu/Ghi27 haplotypes. In conclusion, β2-AR gene polymorphisms influence the response to beta-blockade. However, HVPG reduction cannot be predicted from polymorphism analysis. Patients with the Gly16-Glu/Gln27 haplotypesmay benefit from the association of hepatic vasodilators to propranolol therapy.

关键词：普萘洛尔肾上腺素能受体血流动力学基因多态性单倍型心脏指数纯合子血管扩张剂聚合酶链反应

维生素C可改善肝硬化和门脉高压患者肝内皮细胞的功能障碍

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世界核心医学期刊文摘（胃肠病学分册） 2006年第9期2卷 44-45页

作者： Hernández-Guerra M. Garca-Pagán J.C. Turnes J. 陈云茹 hepatic hemodynamic laboratory Liver UnitHospital ClinicC/Villarroel 170Barcelona 08036Spain Dr.

Patients with cirrhosis show intrahepatic endothelial dysfunction,characterized by an impaired flow-dependent *** alteration is responsible for the marked postprandial increase in portal pressure and is attributed to an insufficient release of nitric oxide(NO).Ascorbic acid reverts endothelial dysfunction in other vascular disorders,via the increase of NO bioavailability through the neutralization of superoxide anions,thus preventing the scavenging of NO by *** study examined whether acute ascorbic acid administration might improve endothelial dysfunction in ***-seven portal hypertensive patients with cirrhosis had measurements of hepatic and systemic hemodynamics,ascorbic acid,and malondialdehyde(MDA).Patients were randomly allocated to receive ascorbic acid(3 g,intravenously,n = 15)or placebo(n = 12)followed by a liquid meal.A third group received ascorbic acid followed by a sham meal(n = 10).Measurements were repeated after 30 minutes(hepatic venous pressure gradient at 15 and 30 minutes).Patients with cirrhosis had significantly lower ascorbic acid levels and higher MDA than healthy *** acid significantly reduced MDA levels and markedly attenuated the postprandial increase in the hepatic venous pressure gradient(4%±7%vs.18%±10%in placebo at 30 minutes,P hepatic or systemic *** conclusion,patients with cirrhosis exhibited intrahepatic endothelial dysfunction,associated with decreased levels of ascorbic acid and increased levels of *** acid improved intrahepatic endothelial dysfunction,blunting the postprandial increase in portal *** results encourage the performance of further studies testing antioxidants as adjunctive therapy in the treatment of portal hypertension.

关键词：内皮细胞功能障碍肝硬化患者维生素C 门脉高压性血流动力学检测肝静脉压力梯度静脉内滴注超氧负离子