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L-Arginine and Omega-3 Fatty Acids in Adjuvant Treatment for Type 2 Diabetes and Chronic Kidney Disease
Published in Robert Fried, Richard M. Carlton, Flaxseed, 2023
Robert Fried, Richard M. Carlton
Nonalcoholic fatty liver disease (NAFLD; steatohepatitis) is rapidly becoming the most common liver disease worldwide. It can progress to liver cirrhosis and, it is thought, even to hepatocarcinoma. The prevalence of NAFLD is 80% to 90% in obese adults, 30% to 50% in patients with diabetes and up to 90% in patients with hyperlipidemia. (29)
Clinical Perspective on Dual Energy Computed Tomography
Published in Katsuyuki Taguchi, Ira Blevis, Krzysztof Iniewski, Spectral, Photon Counting Computed Tomography, 2020
Charis McNabney, Shamir Rai, Darra T. Murphy
A background of liver cirrhosis is both a predisposing factor for and a challenging background on which to detect hepatocellular carcinoma on conventional ultrasound, MRI, and CT (Mannelli & Rosenkrantz 2013). Post-processing of data in DECT offers superior lesion detection in cirrhotic patients compared to SECT and an alternative for patients with contraindications to MRI. DECT can produce a spectrum of monoenergetic images, which show increased contrast between lesions and background tissue at lower energies, meaning lesions are more distinct against background tissue. Furthermore, iodine images also play a critical role in lesion detection particularly when color-mapped and overlaid on grayscale CT images, to further increase lesion conspicuity (Grajo et al. 2016).
Using evidence and logic in everyday clinical reasoning, communication and legal and scientific argumentation
Published in Milos Jenicek, Foundations of Evidence-Based Medicine, 2019
The classical argument (syllogism) is replaced by a fuzzy argument, which may be based then, on one or more fuzzy premises and its conclusion will necessarily be fuzzy. It may lead to a deductively invalid argument such as:In dispositional reasoning, propositions are not necessarily always true; Heavy alcohol drinking is a leading cause of liver cirrhosis. To avoid liver cirrhosis, avoid heavy drinking of alcohol.In qualitative reasoning, the input-output is expressed as a collection of fuzzy if-then rules in which the antecedents (premises) and consequents (conclusions) involve linguistic variables. This kind of reasoning bears some similarity to the if-then reasoning in the artificial intelligence domain.49
Decompensation as initial presentation in patients with liver cirrhosis is associated with an increased risk of future decompensation and mortality
Published in Scandinavian Journal of Gastroenterology, 2023
Koos de Wit, Thijs Kuipers, Koen Van der Ploeg, Lubbertus C. Baak, Ulrich Beuers, R. Bart Takkenberg
Liver cirrhosis is a pathophysiologic entity resulting from chronic liver injury. The development of cirrhosis is characterized by chronic inflammation leading to fibrosis in the liver [1]. As fibrosis progresses, increased structural and functional hepatic vascular resistance is observed. As a result, cirrhosis is associated with impaired liver function and hyperdynamic circulation and splanchnic vasodilation. Subsequently increased inflow in the portal vein leads to portal hypertension. Furthermore, the risk of development of hepatocellular carcinoma (HCC) is increased [2]. Chronic alcohol misuse and chronic hepatitis C (CHC) are still the main underlying causes of liver cirrhosis in developed countries [2]. But due to effective therapeutic options in CHC on the one hand and the obesity epidemic on the other hand, the incidence of cirrhosis due to non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) is rising alarmingly [3].
The potential value of serum GP73 in the ancillary diagnosis and grading of liver cirrhosis
Published in Scandinavian Journal of Clinical and Laboratory Investigation, 2023
Chen Hui-ling, Huang Kang-ming, Zhao Yu, Deng Yin-han, Du Huang, Xiao Shu-ping, Chen Hong-bin
Patients had to have received a confirmed diagnosis of liver cirrhosis. The diagnoses of liver cirrhosis and related complications were made according to the ‘Chinese guidelines on the management of liver cirrhosis (abbreviated version) [15]’ as follows: (1) histological cirrhosis; (2) gastroesophageal varices or digestive tract ectopic varices on the basis of excluding noncirrhotic portal hypertension; (3) imaging of cirrhosis or portal hypertension, e.g. splenomegaly and portal vein ≥ 1.3 cm; (4) liver stiffness measurement (LSM) result complying with the diagnostic cutoff of cirrhosis of different causes; and (5) meeting two or more of the following criteria: (a) platelets (PLT) < 100 × 109/L without any other reason; (b) serum ALB < 35 g/L not caused by malnutrition or kidney diseases; (c) international normalized ratio (INR) > 1.3 or prolonged prothrombin time (PT) (after discontinuing thrombolysis or anticoagulant drugs for over 7 d); and (d) aspartate aminotransferase (AST)/PLT ratio index (APRI) score > 2 (adult). The exclusion criteria were (1) malignant tumors in the liver, lungs, gastrointestinal tract, prostate, etc.; and (2) severe heart, brain, kidney disease, and mental illness.
A potential novel inflammation biomarker for predicting the prognosis of decompensated liver cirrhosis
Published in Annals of Medicine, 2022
Several predictive scoring systems have been developed to assess the prognosis of patients with advanced liver disease, such as the MELD score, sequential organ failure assessment and CLIF-C ADs [32,33,48–50]. However, most predictive scoring systems do not consider the systemic inflammatory response, which is significantly associated with the progression of cirrhosis and related complications, except CLIF-C ADs [42–45]. In previous studies, CLIF-C ADs have been shown to be an independent predictor of mortality in patients with DLC [33,51,52]. Based on the results of our study, we found that LWR had comparable predictive power to CLIF-C ADs at all follow-up endpoints, while CLIF-C ADs had better predictive power than the MELD score in the development cohort and all patients at 6-month follow-up endpoints (Supplementary Table 3). The results were similar to the findings of the above studies. Previous studies have identified various inflammatory indicators associated with prognosis in patients with liver cirrhosis, such as neutrophil- LYM ratio, monocyte-LYM ratio and platelet-WBC ratio [19–24], and these indicators may be complementary to the widely used prognostic scoring systems, as discussed earlier. Our results showed that the LWR may be used as a potential indicator to predict prognosis in patients with DLC.