상단 PDF Factors associated with Liver Stiffness in Chronic Liver Disease

Clinical application of liver stiffness measurement using transient elastography in chronic liver disease from longitudinal perspectives

Clinical application of liver stiffness measurement using transient elastography in chronic liver disease from longitudinal perspectives

as a novel ultrasound based technology, has allowed a noninvasive measurement of liver stiffness and has gained in popularity over recent years. In the past few years, additional roles for transient TE beyond the initial purpose of a non-invasive surrogate for LB have included the prediction of the most two critical conse- quences of fibrosis progression: the development of portal hypertension-related complications and hepato- cellular carcinoma. This indicates that the role of tran- sient TE is not merely limited to reducing the need for LB, but transient TE can enable the establishment of tailored management strategies by providing more de- tailed prognostic information. In particular, under the concept in which the clinical course of liver fibrosis is dynamic and bidirectional, especially when appropriate intervention is commenced, transient TE can be used to track the dynamic changes in fibrotic burden during antiviral or antifibrotic treatment. This review discus- sed extended applications of transient TE in prediction of the development of real clinical endpoints from a longitudinal perspective.
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Liver transplantation for acute on chronic liver disease; when and how?

Liver transplantation for acute on chronic liver disease; when and how?

Lecture: Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of chronic liver disease associ- ated with organ failures and high short-term mortality. Alcohol and chronic viral hepatitis are the most common underlying liver dis- eases. Up to 40%–50% of the cases of ACLF have no identifiable trigger; in the remaining patients, sepsis, active alcoholism and relapse of chronic viral hepatitis are the most common reported precipitating factors. An excessive systemic inflammatory response seems to play a crucial role in the development of ACLF. Using a liver-adapted sequential organ assessment failure score, it is possible to triage and prognosticate the outcome of patients with ACLF. When evaluating prognosis in patients with ACLF, it should be noted that this is a dynamic syndrome that may improve or worsen during hospitalization. Therefore, the ideal scoring system should be able to re- flect the dynamic nature of the disease and the responsiveness to medical treatment. Considering the scoring systems and recent data indicating that sequential assessment of prognosis seems to have higher accuracy than prognosis evaluated at the diagnosis of ACLF, stepwise algorithms have been proposed to assess prognosis and help decision making in ACLF patients.
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The imbalance of procoagulant and anticoagulant factors in patients with chronic liver diseases in North India

The imbalance of procoagulant and anticoagulant factors in patients with chronic liver diseases in North India

of IGH gene rearrangements to develop molecular markers for minimal residual disease in B-lineage acute lymphoblastic leukemia. J Mol Diagn 2009;11:194-200. 10. Ghorbian S, Jahanzad I, Javadi GR, Sakhinia E. Evaluation of IGK and IGL molecular gene rearrangements according to the BIOMED-2 protocols for clinical diagnosis of Hodgkin lymphoma. Hematology 2016;21:133-7.

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Perioperative risk factors of progressive chronic kidney  disease following liver transplantation: analyses of a  10-year follow-up single-center cohort

Perioperative risk factors of progressive chronic kidney disease following liver transplantation: analyses of a 10-year follow-up single-center cohort

Intraoperative patient care Intraoperative fluid therapy consisting of crystalloids and 5% albumin was administered as determined appropriate by the anesthesiologist. The transfusion and coagulation management guidelines at our institution were as follows. The hemoglobin concentration was maintained at >8 g/dL. Two units of FFP were administered if the PT INR was >3.0. Three hundred milliliters of platelets were administered for patients with a platelet count <30,000/μL. Cryoprecipitate was administered as either 1,200 or 2,400 mL if the serum fibrinogen concentration was <80 mg/dL coupled with a platelet count of either >50,000 or <50,000/μL, respectively. The intraoperative vasopressors used during the study period were phenylephrine, ephedrine, epinephrine, norepinephrine, dopamine, and vasopressin. The vasopressor was given as a single agent or in combination and as either a bolus or continuous infusion. Inferior v ena cava was partially clamped during the living donor LT. Anastomosis of the liver graft was performed with a piggyback technique without a venovenous bypass in deceased donor LT. Histidine–
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Fatigue and related factors after liver transplantation

Fatigue and related factors after liver transplantation

respectively. 15 The quality of life after LT has become a major concern. In spite of improved quality of life after LT, fatigue remains one of the most distressing symptoms after LT, and fatigued recipients report poorer quality of life compared to non-fatigued recipients. 1-8 In a previous longitudinal study of liver transplant recipients, 20% re- ported being fatigued, 40% reported being severely fa- tigued, and the remaining 40% reported no fatigue. These percentages did not decrease during the 2-year follow-up, suggesting that fatigue is a chronic problem following LT. 10 However, there are only a few studies on fatigue after LT. Furthermore, previous studies about it have been performed mainly in patients with hepatitis C virus related liver disease, primary biliary cirrhosis, or primary scleros- ing cholangitis in Western countries. 2,4,7,8,10,16
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Notch signaling affects biliary fibrosis via transcriptional regulation of RBP-jk in an animal model of chronic liver disease

Notch signaling affects biliary fibrosis via transcriptional regulation of RBP-jk in an animal model of chronic liver disease

Received August 6, 2015; Accepted September 25, 2015; Epub October 1, 2015; Published October 15, 2015 Abstract: Liver repair in patients with a chronic liver disease requires the orchestrated action of epithelial, mesen- chymal, and inflammatory cells. Notch components are expressed in both the epithelial and mesenchymal compart- ments of the adult liver and are differentially regulated after injury. However, the functional role of Notch signaling in regulating epithelial/mesenchymal cross-talk during fibrogenic pathologic repair remains unknown. The aim of this study was to investigate how proliferation of the bile duct influences biliary fibrosis and to recognize the effect of inhibiting Notch signaling in biliary fibrotic tissue of the injured liver. We designed a synthetic decoy oligodeoxynu- cleotide (ODN) for recombination signal binding protein immunoglobulin kappa J (RBP-jκ), which is a common DNA- binding partner of Notch receptors. The effect of blocking RBP-jκ on fibrogenesis was assessed in the 3,5-Diethoxy- carbonyl-1,4-dihydrocollidine (DDC) diet mouse model. We observed the reduced fibrosis and decreased expression of associated signaling molecules after the RBP-jκ decoy ODN treatment. These data demonstrate that Notch signal- ing may play an important role in progression of ductular reaction and fibrosis. Further studies are required to unveil how ductular cells interact with other liver cell types, such as hepatic stellate cells or Kupffer cells,in patients with cholestatic liver diseases based on Notch signaling. These results suggest that controlling the ductular reaction us- ing a synthetic ring type decoy RBP-jκ ODN will help develop a novel therapeutic approach targeting biliary fibrosis in patients with chronic liver diseases.
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Functions of hepatic non-parenchymal cells in alcoholic liver disease

Functions of hepatic non-parenchymal cells in alcoholic liver disease

6. Limitations of the current approaches in the study of ALD The discovery of novel therapeutic targets for ALD has been limited by the fact that there are no reliable animal models that mimic the entire spectrum of ALD in humans. Most animal models induce varying degrees of hepatic steatosis but little or no liver in flammation and fibrosis. Recently, a model of chronic ethanol feeding (8 e12 weeks)-plus-binge ethanol feeding in mice (single or multiple) has been recommended, which shows severe steatosis and in flammation with mild fibrosis. 111 From its transcriptome analysis, it is encouraging that this model mimics severe ASH in human patients, but further studies are needed to con firm this model. Moreover, there is no appropriate model that mimics advanced to end-stage ALD with moderate to severe alcoholic fibrosis and cirrhosis. Due to the limitations of rodent models, human samples are probably the most suitable way to understand the pathogenesis of ALD and to identify therapeutic targets. How- ever, we should be cautious to interpret the results from human samples due to confounding factors as exempli fied by anti-TNF- a therapies for patients with AH. Based on data from animal models and human studies that TNF- a contributes to the pathogenesis of ALD as described previously, Etanercept, one of the agents that block TNF- a signals, was tried in patients with AH, which showed a disappointing outcome. 112 Two valuable lessons can be inferred from this study. First, rodent models that mostly mimic early-stage ALD cannot be extrapolated to humans with AH where in flamma- tion is more severe. Second, con firming data from animal models in human samples are usually carried out by cross-sectional studies, for which it is dif ficult to determine a causal relationship. For instance, increased levels of TNF- a in AH patients might be due to impaired liver clearance or bacterial infections. Because of the above limitations based on current approaches, it is necessary to develop animal models that re flect the full spectrum of ALD in humans. In addition, the serial collection of human samples could help substantially in the understanding of the pathogenesis of ALD.
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Non-alcoholic fatty liver disease in polycystic ovary syndrome women

Non-alcoholic fatty liver disease in polycystic ovary syndrome women

Metabolic disturbances in the relatively young reproductive age women may also result in complications during pregnancy and delivery 8 . Being exposed to the hyperandrogenic environment of PCOS for a longer time could in effect be associated with a higher chance of metabolic complications later on. Non-alcoholic fatty liver disease (NAFLD) encompasses an extensive range of liver diseases, including liver steatosis, non-alcoholic steatohepatitis, liver fibrosis, and liver cirrhosis, which may develop into liver failure and even hepatocellular carcinoma 9 . Androgens such as testosterone, dihydrotestosterone, and dehydroepiandros- terone (DHEA) are recognized as pro-apoptotic agents that act on peripheral cells such as hepatocytes 10 . The overproduction of these androgens promotes an androgen-dependent pro-apoptotic PCOS environment that may directly contribute to liver disease progression. The emphasis between the risk factors leading to NAFLD such as insulin resistance, central obesity, hypertension, and dyslipidemia and their involvement with PCOS is being highlighted in recent times 6 . Studies investigating the relationship between NAFLD and PCOS have revealed that NAFLD was more prevalent in girls with PCOS than in those without, with a prevalence of 36%
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Accumulation of mutations in the precore and the basal core promoter enhance s the progression of the chronic liver disease in patients with hepatitis B virus infection

Accumulation of mutations in the precore and the basal core promoter enhance s the progression of the chronic liver disease in patients with hepatitis B virus infection

The A1762T/G1764A mutations have fewer occurrences in HBeAg-positive asymptomatic carriers than other clinical manifestations. However, A1762T/G1764A mutations occurred more frequently in patients with chronic hepatitis B and liver cirrhosis than that in inactive HBsAg carriers, but there were no significant differences between the patients with chronic hepatitis B patients and liver cirrhosis. This finding suggests that A1762T/G1764A mutations occur after immune systems recognize the HBV and attack the HBV. Interestingly, we found that the double mutations (A1762T/G1764A) were comparable between inactive HBsAg carriers and chronic hepatitis B patients. However, there were no significant differences between chronic hepatitis B and liver cirrhosis patients. This finding suggests that these double mutations (T1762A/G1764A) might contribute to the persistence of hepatitis B virus in host, but these mutations by themselves would not be associated with the progression from chronic hepatitis to liver cirrhosis.
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KASL clinical practice guidelines:
Management of nonalcoholic fatty liver disease

KASL clinical practice guidelines: Management of nonalcoholic fatty liver disease

Therefore, in cases that are clinically suspicious for chronic liver diseases or that have abnormal findings on liver function tests, medical history taking and serological testing must be performed to exclude critical causes of chronic liver disease in Korea, such as chronic hepatitis virus B or C infection, alcoholic liver diseases, drug-induced liver diseases, autoimmune liver diseases, and Wil- son’s disease. In addition, abdominal ultrasonography can be per- formed to assess the liver for steatosis. In cases of a lack of abnor- mal findings on liver function tests, which patients should be candidates for NAFLD screening? There is currently no consensus on the answer to this question. Insulin resistance is known to be a critical risk factor for the incidence of NAFLD. However, perform- ing a screening test remains controversial for identifying the pres- ence of NAFLD in patients with metabolic syndrome, in whom in- sulin resistance plays a crucial role in NAFLD pathogenesis. The 2009 Special Conference of the European Association for the Study of the Liver recommended blood tests and abdominal ultra- sonography for NAFLD in patients who present with insulin resis- tance and related diseases, because they are likely to have NASH. 54 However, in the 2012 Clinical Practice Guideline of AAS- LD, these examinations were not recommended because the diag- nosis and treatment of NAFLD remained unclear and the long- term benefit and cost-effectiveness of screening tests had not been clarified. 3 The importance of performing screening tests on family members of patients with NAFLD has also been unclear un- til now. According to one report, NASH occurred in 18% of the brothers/sisters of patients with NAFLD. 55 According to another study, fatty liver disease was observed in 59% of siblings and 78% of parents of overweight children with NAFLD. In contrast, NAFLD was detected in 17% of siblings and 37% of parents of overweight children without NAFLD. Therefore, the probability of having NAFLD is significantly higher among the family members of overweight children with NAFLD. 56 Similarly, some studies with a small sample size have reported that NAFLD is significantly corre- lated with family history and genetic predisposition. However, a study of twins failed to show a significant relationship between genetic factors and the presence of NAFLD. 57
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Elevated serum bilirubin levels are inversely associated with nonalcoholic fatty liver disease

Elevated serum bilirubin levels are inversely associated with nonalcoholic fatty liver disease

Copyright © 2012 by The Korean Association for the Study of the Liver This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. pISSN 2287-2728 eISSN 2287-285X

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Living donor liver transplantation for patients with alcoholic liver disease

Living donor liver transplantation for patients with alcoholic liver disease

Alcohol relapse is a potential problem in liver trans- plantation to ALD patients, in which it can induce liver damage and deteriorate patient compliance to medications and clinic visits. 11 In practice, many liver transplant pro- grams require 6 months of pretransplant abstinence prior to transplanation. However, many of these patients relapse to alcohol drinking, with some even returning to heavy alcohol consumption. However, there is little evidence showing that resumption of drinking has a significant det- rimental effect on graft or patient survival. 12 Posttrans- plant alcohol relapse in ALD patients does not have a sig- nificant effect on liver function or morphology, and the survival rate of these patients does not differ from that of patients who received DDLT for primary diseases other than ALD. 13 Furthermore, the long-term survival rates of relapsed and non-relapsed ADL patients were similar, suggesting that alcohol relapse did not decrease com- pliance with immunosuppressant medications. 14
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Alcoholic liver disease

Alcoholic liver disease

Alcoholic liver disease in Korea 우리나라 간경변증 원인 :B 형 간염 이어 2 위 간세포암종 : B 형 (70% 이상 )>C 형 (12% 대 )> 알코올 우리나라 과다 음주자 : 남성 ( 일 40g), 여성 ( 일 20g) 비율 약 7%

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Emerging need for vaccination against hepatitis A virus in patients with chronic liver disease in Korea

Emerging need for vaccination against hepatitis A virus in patients with chronic liver disease in Korea

In addition to seroprevalence data, the cost of serologic test- ing, the cost of vaccination, patient compliance, and the like- lihood of the occurrence of a clinically significant fatal HAV superinfection should also be determined to facilitate the iden- tification of the most efficient vaccination strategy. In young or childhood CLD patients, the serum anti-HAV rate is very low and the risk of infection is high, but the symptomatic infection rate and the risk of severe hepatic failure are mini- mal and natural life long immunity is frequently attained after a mild or asymptomatic infection. Therefore, the selec- tive HAV vaccination of middle aged adult CLD patients appears more urgent than the universal vaccination for younger CLD patients (24). Further nationwide large scale studies, including the active evaluation of the clinical significance of acute HAV infection and cost-benefit analyses of different vaccination strategies in different age groups of CLD patients will provide firmer data for designing an optimal vaccination strategy.
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Evaluation of factors associated with drug-induced liver injury using electronic medical records

Evaluation of factors associated with drug-induced liver injury using electronic medical records

TCP Transl Clin Pharmacol Hyewon Chung, et al. in patients visiting the SNUBH, focusing on demographic and liver chemistry characteristics and drugs prescribed before the liver injury event. Given DILI diagnosis is complex, the crite- ria for detecting case of DILI is the critical point for successful investigation. This study used standardized criteria, which will facilitate further integration of data from future investigations using the same criteria. Furthermore, this study offers a view of real-world clinical practice. The EMR data used in the study were accumulated over a 10-year period and were analyzed without any prior targeted diseases, drugs, or specific hypoth- eses.
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Hemorrhagic cholecystitis in a patient with alcoholic liver disease

Hemorrhagic cholecystitis in a patient with alcoholic liver disease

Introduction: Hemorrhagic cholecystitis is a rare disease with high morbidity and mortality, especially in patients with cirrhosis. Here, we described a case of perforated hemorrhagic cholecystitis in a patient with alcoholic liver disease. Methods: A 47-year-old male with a history of alcoholic abuse was presented to the hospital with severe right upper quadrant abdom- inal pain. He has never been diagnosed with a specific underlying disease. In the emergency room, the initial hemoglobin level was 11 g/dL, but decreased to 8.4 g/dL after 6 hours. On physical examination, there was a palpable mass with tenderness in the right upper quadrant area. On abdomino-pelvis computed tomography, it showed highly attenuated, homogenous materials in the gallbladder, and a diffuse gallbladder wall thickening with edematous change.
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Alcoholic liver disease has more bleeding tendency during liver transplant operation

Alcoholic liver disease has more bleeding tendency during liver transplant operation

Methods: Out of 874 recipients who underwent LT, a total of 146 patients were excluded by our exclusion criteria. We compared 728 recipient’s baseline characteristics, operation time, blood loss, and transfusion amounts between ALD and non-ALD according to MELD score. Results: The number of patients in ALD groups was 130 (17.9%), and 598 (82.1%) in non-ALD group. ALD group showed younger age, higher MELD score, and more proportion of deceased donor liver transplantation than non-ALD group. Overall blood loss, RBC, FFP, Platelets transfusion of ALD group were significantly higher than non-ALD group. When we divided the patients into two group ac- cording to the MELD score 20, ALD group showed significant blood loss, RBC, and FFP transfusion in both higher and lower MELD groups even though there were no significant differences of INR and PLT counts between two groups in the higher MELD subgroup.
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Socioeconomic costs of liver disease in Korea

Socioeconomic costs of liver disease in Korea

First, in the process of investigating the healthcare utilization with the health insurance data related to liver disease, the data were extracted with only principal diagnosis as a standard with excluding liver disease as additional diagnosis, so the directs costs and the loss of productivity following sick leave could be underestimated. Second, costs of driving cars to visit outpatient clinics due to liver disease were excluded from the mean traffic costs so that the average round-trip traffic costs per one visit to an outpatient clinic could be underestimated. Third, for costs of caregivers for inpatients with liver disease, the nursing of guardians or paid caregivers might be determined by the severity of disease and the costs of caregivers could be incurred at home as well as at medical institutions. However, because of no data about the rate of the care-giving at home and the correlation between the severity of disease and the utilization rate of care-giving service, this study limited cases to calculate the costs of caregivers to inpatients at medical institutions, so the costs of caregivers was estimated on the assumption that the inpatients needed full-time care-giving. Fourth, in the process of estimating the future income loss due to premature death caused by liver disease and the loss of productivity following sick leave, this study analyzed only employees with income except unemployed persons (job seekers) and economically inactive population (housewives, students and persons waiting to enter the army) among the working-age group aged over 15 years to calculate the scale of objective and valid income loss. So, the exclusion of unpaid
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Presence of fatty liver disease leads to unusual rise of liver enzymes in patients with common bile duct colic

Presence of fatty liver disease leads to unusual rise of liver enzymes in patients with common bile duct colic

EP-136 Introduction: This study compares liver enzymes, inflammatory markers and bilirubin levels in patients with and without fatty liver disease (FLD) presenting with common bile duct (CBD) obstruction. Methods: CBD colic was diagnosed based on clinical, radiological and biochemical criterion. Presence of FLD was diagnosed by ultra sound scan and the macroscopic appearance of liver during surgery. Liver enzymes, inflammatory markers and bilirubin levels were prospectively assessed and compared between the two groups.

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Improved severe hepatopulmonary syndrome after liver
transplantation in an adolescent with end-stage liver
disease secondary to biliary atresia

Improved severe hepatopulmonary syndrome after liver transplantation in an adolescent with end-stage liver disease secondary to biliary atresia

Currently, there are no effective medical therapies for HPS, and LT is the only reliable treatment to cure the patient. Prognosis of HPS patients who did not undergo LT showed significantly poor, median survival for 24 months with a 5-year survival of 23%. 2 Many transplant centers have considered HPS as a contraindica- tion to LT in the early to mid-1980s. 7 However, it is now consid- ered as an indication for LT because of improvement in surgical techniques, perioperative care, organ preservation and immuno- suppression. The 5-year survival of HPS patients who received LT was 76%, 2 which was similar to those without HPS who received LT. Although previous studies showed that the overall mortality rate was relatively high of 16-30%, 1,10,11 recent studies showed less overall mortality rate of 5%. 3,12 It is known that high postoperative mortality was reported in case of preoperative PaO 2 ≤50 mmHg alone or with a shunt fraction of more than 20%. 1 Recovery time of lower PaO 2 and intrapulmonary shunt after LT are variable, depending on the severity of preoperative lower PaO 2 . Although lower preoperative PaO 2 is related to longer recovery period of HPS resolution after LT, 6 in most cases, HPS can be resolved within a year. 2
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