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| 1 | Osteoporosis in primary biliary cholangitis显示文摘Primary biliary cholangitis(PBC) is an autoimmune cholestatic liver disease with multiple debilitating complications. Osteoporosis is a common complication of PBC resulting in frequent fractures and leading to significant morbidity in this population, yet evidence for effective therapy is lacking. We sought to summarize our current understanding of the pathophysiology of osteoporosis in PBC, as well as current and emerging therapies in order to guide future research directions. A complete search with a comprehensive literature review was performed with studies from Pub Med, EMBASE, Web of Science, Cochrane database, and the Countway Library. Osteoporosis in PBC is driven primarily by decreased bone formation, which differs from the increased bone resorption seen in postmenopausal osteoporosis. Despite this fundamental difference, current treatment recommendations are based primarily on experience with postmenopausal osteoporosis. Trials specific to PBC-related osteoporosis are small and have not consistently demonstrated a benefit in this population. As it stands, prevention of osteoporosis in PBC relies on the mitigation of risk factors such as smoking and alcohol use, as well as encouraging a healthy diet and weight-bearing exercise. The primary medical intervention for the treatment of osteoporosis in PBC remains bisphosphonates though a benefit in terms of fracture reduction has never been shown. This review outlines what is known regarding the pathogenesis of bone disease in PBC and summarizes current and emerging therapies. | Christopher J Danford Hirsh D Trivedi Konstantinos Papamichael Elliot B Tapper Alan Bonder | 2018 | World Journal of Gastroenterology2018，24，31： | 13 |
| 2 | Hagen-Poiseuille's law:The link between cirrhosis,liver stiffness,portal hypertension and hepatic decompensation显示文摘The onset of hepatic decompensation in cirrhosis heralds an accelerated downhill course with poor outcome. The sole predictor of this decompensationin cirrhosis is increased hepatic vein to portal vein gradient hepatic venous pressure gradient(HVPG). Surrogate markers of liver function or hepatic reserve appear to be less relevant. The hepatic sinusoids become less elastic and more rigid as liver fibrosis and cirrhosis progress. We propose that the HagenPoiseuille's law,which applies to rigid,but not elastic vessels,determines the pressure-flow characteristics in the sinusoids. In the rigid cirrhotic liver,HVPG rises dramatically with any change in net surface area or radius,r4 of the vasculature that follows surgical resection. This review relates liver stiffness to the risk of decompensation in patients with cirrhosis. The liver has a unique dual blood supply comprising a low pressure portal vein and high pressure hepatic artery. We compare the complexity of autoregulation in the normal elastic liver with that in the rigid cirrhotic liver. Therapeutic modalities to reduce portal pressure may reduce the risk of hepatic decompensation and improve outcomes in cirrhosis. | Gerond Lake-Bakaar Muneeb Ahmed Amy Evenson Alan Bonder Salomao Faintuch Vinay Sundaram | 2015 | World Journal of Hepatology2015，7，1： | 2 |
| 3 | Effective use of FibroTest to generate decision trees in hepatitis C显示文摘AIM:To assess the usefulness of FibroTest to forecast scores by constructing decision trees in patients with chronic hepatitis C.METHODS:We used the C4.5 classification algorithm to construct decision trees with data from 261 patients with chronic hepatitis C without a liver biopsy.The FibroTest attributes of age,gender,bilirubin,apolipoprotein,haptoglobin,α2 macroglobulin,and γ-glutamyl transpeptidase were used as predictors,and the FibroTest score as the target.For testing,a 10-fold cross validation was used.RESULTS:The overall classification error was 14.9%(accuracy 85.1%).FibroTest's cases with true scores of F0 and F4 were classified with very high accuracy(18/20 for F0,9/9 for F0-1 and 92/96 for F4) and the largest confusion centered on F3.The algorithm produced a set of compound rules out of the ten classification trees and was used to classify the 261 patients.The rules for the classification of patients in F0 and F4 were effective in more than 75% of the cases in which they were tested.CONCLUSION:The recognition of clinical subgroups should help to enhance our ability to assess differences in fibrosis scores in clinical studies and improve our understanding of fibrosis progression. | Dana Lau-Corona Luís Alberto Pineda Héctor Hugo Avilés Gabriela Gutiérrez-Reyes Blanca Eugenia Farfan-Labonne Rafael Núez-Nateras Alan Bonder Rosalinda Martínez-García Clara Corona-Lau Marco Antonio Olivera-Martínez Maria Concepción Gutiérrez-Ruiz Guillermo Robles-Díaz David Kershenobich | 2009 | World Journal of Gastroenterology2009，15，21： | 2 |
| 4 | Regional and National Trends of Adult Living Donor Liver Transplantation in the United States Over the Last Two Decades显示文摘Background and Aims:Liver organ shortage remains a major health burden in the US,with more patients being waitlisted than the number of liver transplants(LTs)performed.This study investigated US national and regional trends in living donor LT(LDLT)and identified factors associated with recipient survival.Methods:We retrospectively analyzed LDLT recipients and donors from the United Network Organ Sharing/Organ Procurement Transplant Network database from 1998 until 2019 for clinical characteristics,demographic differences,and survival rate.National and regional trends in LDLT,recipient outcomes,and predictors of survival were analyzed.Results:Of the 223,571 candidates listed for an LT,57.5%received an organ,of which only 4.2%were LDLTs.Annual adult LDLTs first peaked at 412 in 2001 but experienced a significant decline to 168 by 2009.LDLTs then gradually increased to 445 in 2019.Region 2 had the highest LDLT numbers(n=919),while region 1 had the highest proportion(11.1%).Overall,post-LT mortality was 21.4%among LDLT recipients.Post-LDLT survival rates after 1-,5-,and 10-years were 92%,87%,and 70%,respectively.Interval analysis(2004–2019)showed that patients undergoing LDLT in recent years had lower mortality than in earlier years(hazard ratio=0.81,95%confidence interval=0.75–0.88).Conclusions:Following a substantial decline after a peak in 2001,the number of adult LDLTs steadily increased from 2011 to 2019.However,LDLTs still constitute the minority of the transplant pool in the US.Lifesaving policies to increase the use of LDLTs,particularly in regions of high organ demand,should be implemented. | Saleh A.Alqahtani Ahmet Gurakar Hani Tamim Thomas D.Schiano Alan Bonder Zachary Fricker Marwan Kazimi Devin E.Eckhoff Michael P.Curry Behnam Saberi | 2022 | Journal of Clinical and Translational Hepatology2022，10，5： | 0 |
| 5 | Thrombopoietin-receptor agonists in perioperative treatment of patients with chronic liver disease显示文摘Thrombocytopenia is a multifactorial disorder that is common in patients with chronic liver disease(CLD),leading to challenging perioperative planning.As thrombocytopenia in CLD is associated with thrombopoietin(TPO)deficiency,the use of TPO-receptor agonists(TPO-RAs)to increase platelet counts is a promising approach.This has led to the development of various TPO-RAs,including romiplostim,eltrombopag,avatrombopag,and lusutrombopag.Of these,only avatrombopag and lusutrombopag are approved by the United States Food and Drug Administration for the perioperative treatment of thrombocytopenia in patients with CLD.Platelet transfusion is commonly used for the clinical management of thrombocytopenia in patients with CLD undergoing invasive procedures.However,the limitations and possible risks of transfusion,including short duration of efficacy,development of antiplatelet antibodies,risk of infections and such complications as transfusion-related acute lung injury or circulatory overload,and possibility of refractoriness,limit its use.Moreover,there is no consensus among guidelines as to the platelet count at which transfusions are indicated.Results from studies using TPO-RAs perioperatively in patients with thrombocytopenia and CLD are promising and provide an alternative to platelet transfusions in the pre-and post-operative setting.These TPO-RAs are the subject of this review,with focus on their use in the perioperative setting in patients with thrombocytopenia,associated supporting clinical trials,efficacy and safety data,and their use with respect to platelet transfusions. | Kamran Qureshi Alan Bonder | 2020 | World Journal of Meta-Analysis2020，8，3： | 0 |
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