Digestive and Liver Disease, Год журнала: 2023, Номер 55(8), С. 997 - 1000
Опубликована: Июнь 13, 2023
Язык: Английский
JHEP Reports, Год журнала: 2023, Номер 6(1), С. 100911 - 100911
Опубликована: Сен. 23, 2023
Cirrhotic cardiomyopathy (CCM) is defined as systolic or diastolic dysfunction in the absence of prior heart disease another identifiable cause patients with cirrhosis, whom it an important determinant outcome. Its underlying pathogenic/pathophysiological mechanisms are rooted two distinct pathways: 1) factors associated portal hypertension, hyperdynamic circulation, gut bacterial/endotoxin translocation and resultant inflammatory phenotype; 2) hepatocellular insufficiency altered synthesis metabolism substances such proteins, lipids, carbohydrates, bile acids hormones. Different criteria have been proposed to diagnose CCM; first 2005 by World Congress Gastroenterology, more recently 2019 Cardiomyopathy Consortium. These mainly utilised echocardiographic evaluation, latter refining evaluation function integrating global longitudinal strain into function, addition since haemodynamic changes that occur advanced cirrhosis may lead overestimation left ventricular ejection fraction. Advances cardiac imaging, magnetic resonance imaging incorporation exercise challenge, help further refine diagnosis CCM. Over recent years, CCM has shown contribute increased mortality morbidity after major interventions, liver transplantation transjugular intrahepatic portosystemic shunt insertion, play a pathophysiologic role genesis hepatorenal syndrome. In this review, we discuss pathogenesis/pathophysiology CCM, its clinical implications, modalities including MRI. We also compare diagnostic review potential electrocardiographic QT prolongation. At present, no definitive medical therapy exists, but some promising treatment strategies for reviewed.
Язык: Английский
Процитировано
30
Journal of Hepatology, Год журнала: 2024, Номер 80(5), С. 744 - 752
Опубликована: Янв. 11, 2024
Background and AimsNon-invasive tests (NIT) for assessing the probability of clinically significant portal hypertension (CSPH) including ANTICIPATE±NASH models based on liver stiffness measurement (LSM), platelet count (PLT)±body mass index (BMI), von Willebrand factor antigen (VWF) to PLT ratio (VITRO) have fundamentally changed management compensated advanced chronic disease (cACLD). However, their prognostic utility has not been compared head-to-head against hepatic venous pressure gradient (HVPG) as gold standard.MethodscACLD (LSM≥10 kPa) patients who underwent characterization via same-day HVPG/NIT assessment from 2007-2022 were retrospectively included. Long-term follow-up data decompensation was recorded.ResultsFour hundred twenty cACLD (51.9% viral hepatitis, 20.5% ALD, 18.6% MASLD/MetALD, 9.0% other) with a CSPH prevalence 67.6% included.The cumulative incidence at 1 2 years 4.7% 8.0%, respectively. HVPG, VITRO, ANTICIPATE±NASH-CSPH-probability showed similar time-dependent value (AUROC 0.683-0.811 0.699-0.801 years).In competing risk analyses adjusted MELD albumin, HVPG (adjusted subdistribution hazard [aSHR]:1.099 [95%CI:1.054–1.150) per mmHg; p<0.001), or VITRO (aSHR:1.134 [1.062–1.211] unit; (aSHR:1.232 [1.094–1.387] 10%; p<0.001) all predicted first during follow-up.Previously proposed cut-offs (HVPG≥10mmHg vs.<10mmHg, VITRO≥2.5 vs.<2.5, ANTICIPATE-CSPH probability≥60% vs.<60%) accurately discriminated between negligible those substantial decompensation.ConclusionsThe performance is comparable that supporting identifying may benefit medical therapies preventing decompensation.Impact implicationsNon-invasive revolutionized diagnosis in (cACLD) patients. limited exists regarding NIT direct comparison standard prognostication cACLD, i.e., (HVPG). In our study 420 patients, NIT, most importantly, model (PLT) (VITRO), yielded AUROC within one two years. Thus, should be applied updated yearly intervals clinical routine identify short-term risk, thereby treatment aiming prevention decompensation.
Язык: Английский
Процитировано
16
Nature Reviews Gastroenterology & Hepatology, Год журнала: 2024, Номер 21(7), С. 517 - 527
Опубликована: Март 13, 2024
Язык: Английский
Процитировано
11
International Journal of Oral Science, Год журнала: 2025, Номер 17(1)
Опубликована: Янв. 6, 2025
Abstract Temporomandibular joint osteoarthritis (TMJ-OA) is a common disease often accompanied by pain, seriously affecting physical and mental health of patients. Abnormal innervation at the osteochondral junction has been considered as predominant origin arthralgia, while specific mechanism mediating pain remains unclear. To investigate underlying TMJ-OA an abnormal loading model was used to induce pain. We found that during development TMJ-OA, increased sympathetic nerve subchondral bone precedes sensory nerves. Furthermore, these two types nerves are spatially closely associated. Additionally, it discovered activation neural signals promotes osteoarthritic in mice, whereas blocking effectively alleviates In vitro experiments also confirmed norepinephrine released neurons axonal growth neurons. Moreover, we through releasing norepinephrine, regional were regulate local synergistically with other regulators. This study identified role TMJ-OA. It sheds light on new crosstalk between peripheral nerves, providing potential target for treating
Язык: Английский
Процитировано
2
Journal of Hepatology, Год журнала: 2023, Номер 80(1), С. 124 - 139
Опубликована: Сен. 18, 2023
Язык: Английский
Процитировано
17
Hepatology, Год журнала: 2023, Номер unknown
Опубликована: Окт. 6, 2023
Noninvasive tests (NITs) are used in all aspects of liver disease management. Their most prominent break-through since the millennium has been advancing early detection fibrosis, but their use is not limited to this. In contrast symptom-driven assessment decompensation patients with cirrhosis, NITs provide only opportunities for earlier diagnoses also accurate prognostication, targeted treatment decisions, and a means monitoring disease. can inform management decision-making based on validated cutoffs standardized interpretations as valuable supplement clinical acumen. The Baveno VI VII consensus meetings resulted tangible improvements pathways care compensated decompensated advanced chronic disease, including combination platelet count transient elastography diagnose clinically significant portal hypertension. Furthermore, circulating will play increasingly important roles assessing response interventions against ascites, variceal bleeding, HE, acute kidney injury, infections. However, due NITs’ wide availability, there risk inaccurate use, leading waste resources flawed decisions. this review, we describe uses pitfalls hepatic decompensation, from stratification primary decisions outpatient clinics, well in-hospital acute-on-chronic failure. We summarize which when, what indications, how maximize potential improved patient
Язык: Английский
Процитировано
14
Alimentary Pharmacology & Therapeutics, Год журнала: 2024, Номер 59(10), С. 1196 - 1211
Опубликована: Март 25, 2024
Summary Background Better understanding of disease pathophysiology has led to advances in managing ascites and its associated complications including hepatorenal syndrome‐acute kidney Injury (HRS‐AKI), especially medicinal interventional advances. Aim To review the latest changes management HRS‐AKI. Methods A literature search was conducted Pubmed, using keywords cirrhosis, ascites, renal dysfunction, acute injury, syndrome, beta‐blockers, albumin, TIPS vasoconstrictors, only publications English. Results The include earlier treatment clinically significant portal hypertension delay onset use human albumin solution attenuate systemic inflammation thus improving haemodynamic with cirrhosis. Furthermore, new classes drugs such as sodium glucose co‐transporter 2 are being investigated for patients cirrhosis ascites. For HRS‐AKI management, newer pharmacological agents vasopressin partial agonists relaxin studied. Interventional refinement technique patient selection improve outcomes refractory development alfa pump system study long‐term palliative abdominal drain will also serve quality life Conclusions New strategies emerged from better have shown improved prognosis these patients. future see many approaches confirmed large multi‐centre clinical trials aim benefit
Язык: Английский
Процитировано
4
Clinical and Molecular Hepatology, Год журнала: 2025, Номер 31(2), С. 615 - 619
Опубликована: Янв. 7, 2025
Treating systemic inflammation by transjugular intrahepatic portosystemic shunt
Язык: Английский
Процитировано
0
Clinical and Translational Science, Год журнала: 2025, Номер 18(3)
Опубликована: Март 1, 2025
A target heart rate of 55-60 beats per minute is a goal for propranolol in both primary and secondary prophylaxis variceal hemorrhage (VH). However, dose adjustments are often needed based on baseline rates. This study analyzed the effect reduction from with therapy VH patients cirrhosis. retrospective was conducted cirrhotic receiving prophylaxis, 2008-2023. Patients were categorized as responders or non-responders achievement ≥ 25% baseline. The outcome incidence VH. survival analysis propensity score-inverse probability treatment weighting performed to associate outcome. Among 215 treated 72 (33.5%) 143 (66.5%) non-responders. In 157 included, 52 (33.1%) classified 105 (66.9%) median Child-Pugh score 6 (range 5-12) 7 prophylaxis. Responders showed similar (adjusted hazard ratio (HR) 1.70, 95% CI: 0.82-3.49) HR 1.00, 0.34-2.90). Our did not support achieving response
Язык: Английский
Процитировано
0
Seminars in Liver Disease, Год журнала: 2025, Номер unknown
Опубликована: Март 13, 2025
Acute-on-chronic liver failure (ACLF) is a severe condition in patients with decompensated cirrhosis, marked by high short-term mortality. Recent experimental and clinical evidence has linked intestinal dysfunction to both the initiation of ACLF as well disease outcome. This review discusses significant role gut–liver axis pathogenesis, highlighting recent advances. Gut mucosal barrier disruption, gut dysbiosis, bacterial translocation emerge key factors contributing systemic inflammation ACLF. Different approaches therapeutically targeting via farnesoid X receptor agonists, nonselective beta blockers, antibiotics, probiotics are discussed potential strategies mitigating progression. The importance understanding distinct pathophysiology compared other stages cirrhosis highlighted. In conclusion, research findings suggest that disruption integrity may be an integral component paving way for novel diagnostic therapeutic manage this syndrome more effectively.
Язык: Английский
Процитировано
0