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| 1 | 改善肝硬化患者生理功能和预防不良事件的干预措施显示文摘肝硬化常会并发一些致人虚弱的并发症,严重影响患者生理功能,大大降低了患者生活质量。由于肝硬化患者出现肌肉减少症、营养不良及肝性脑病的概率较高,因此,功能损害或虚弱是其常见并发症。虚弱又会进一步增加患者住院治疗、意外跌倒和骨折、甚至死亡的风险。对虚弱及其相关不良反应的积极干预对于改善肝硬化患者的总体预后是非常必要的。治疗的关键是通过合理的营养和锻炼改善生理功能。补充蛋白质的营养治疗的益处已被证实,但对于锻炼的作用一直存在争议。最新的研究结果倾向于肯定锻炼对于提高生活质量的获益。在肝病管理时的技术支持已显示出良好的应用前景。Fitbits手环及其他可佩戴装置有助于记录和指导患者的锻炼过程和营养搭配。此外,用于诊断和监测肝硬化并发症的智能手机软件的不断开发,可以为肝硬化患者提供更加精细的管理。 | Hirsh D.Trivedi Elliot B.Tapper | 2018 | Gastroenterology Report2018，6，1： | 1 |
| 2 | The efficacy and safety profile of albumin administration for patients with cirrhosis at high risk of hepatorenal syndrome is dose dependent显示文摘Background:Albumin is a critical component in the standard therapeutic approach to acute renal failure(ARF)and spontaneous bacterial peritonitis(SBP)in the setting of ascites.However,data regarding the safety and minimumeffective dose are limited.Methods:We conducted a retrospective review of patients with decompensated cirrhosis who received albumin within the first 48 hours of hospitalization at Beth Israel Deaconess Medical Center between 2010 and 2013.Outcomes included 90-day risk of death or transplantation(primary)and(secondary)complications of albumin infusion(length of stay(LOS)and need for critical care),all adjusted for comorbidity and severity of illness.Results:We included 169 patients with ARF and 88 patients with SBP.The optimal doses of albumin for a survival benefit were found to be 87.5 g and 100 g in the ARF and SBP cohorts,respectively.The odds ratio(OR)for the 90-day risk of death or liver transplantation associated with the optimal loading dose was 0.36(95%CI:0.17-0.76,P=0.008)and 0.28(95%CI:0.07-0.97,P=0.04)for the ARF and SBP cohorts,respectively.This effect persisted for patients with ARF who had neither hepatorenal syndrome(HRS)nor SBP(OR:0.13,95%CI:0.007-0.79,P=0.02).LOS(beta coefficient per log albumin dose:1.69;95%CI:0.14-3.24,P=0.03)and risk of critical care(OR/g albumin:1.03;95%CI:1.01-1.05,P=0.01)were also dose dependent.Conclusion:Albumin has a dose-dependent effect on both survival and complications in patients with cirrhosis with ARF(HRS and otherwise)and/or SBP. | Yuliya Afinogenova Elliot B.Tapper | 2015 | Gastroenterology Report2015，3，3： | 1 |
| 3 | Pill or procedure?Patient preferences on beta-blockers as an alternative to endoscopic variceal screening during the COVID-19 pandemic显示文摘Introduction Certain patients at low risk of clinically significant esophageal varices by Baveno criteria can safely avoid screening esophagogastroduodenoscopy(EGD)[1,2].However,regardless of variceal status,the PREDESCI study suggests that earlier betablocker(BB)use in compensated disease with clinically significant portal hypertension by hepatic venous pressure gradient may result in benefit by delaying the time to decompensated cirrhosis[3,4].This carries significant ramifications for future clinical guidelines and decision-making for whom we decide to initiate BB. | Zheng Che Jeremy Louissaint Ihab Kassab Elliot B.Tapper | 2022 | Gastroenterology Report2022，10，1： | 0 |
| 4 | 医学定制配餐治疗有症状的腹水:SALTYFOOD随机对照临床预试验显示文摘背景:腹水是一种处理起来费时费力的肝硬化并发症。尽管低盐饮食是临床上治疗腹水的核心,但其疗效受限于患者的低依从性。我们旨在评估一种低盐的医学定制配餐(MTM)用于腹水治疗的可行性及疗效。方法:前瞻性纳入40例肝硬化腹水患者进行一个为期12周的1:1随机对照预试验,接受标准治疗(SOC)的患者遵照低盐饮食教育手册自由饮食;MTM组患者的配餐中,盐<2000 mg,热量>2100 kcal,蛋白质≥80 g。我们测算了入组患者的比例及其对MTM的依从性。本研究的主要结局指标是12周内穿刺抽水的次数,同时,我们还记录了腹水特异性生活质量(ASI-7)评分。结果:入组病例的中位年龄为54(IQR:47-63)岁,46%是女性,中位MELD-Na评分为18(IQR:11-23),中位白蛋白水平2.7(IQR:2.5-3.3)g/dL。作为基线资料,研究开始前4周内,患者接受穿刺抽水的中位次数为2(IQR:1-3)。入组病例住院期间对于配餐计划的依从性良好。12周后,MTM组患者每周所需的穿刺抽水次数显著低于SOC组[中位数(IQR):0.34(0.14-0.54)vs 0.45(0.25-0.64)]。研究期间,4例(20%)SOC组患者死亡,MTM组中2例死亡,1例行肝移植术。腹水特异性生活质量改善程度MTM组优于SOC组,分别为25%(IQR:-11%-61%)和13%(IQR:-28%-54%)。结论:对于腹水患者开展MTM临床试验是可行的,也是潜在有效的。两组患者都有获益,需要强调的是,该研究挑战性高,需加强宣教和密切监测。 | Elliot B.Tapper Jad Baki Samantha Nikirk Scott Hummel Sumeet K.Asrani Anna SLok | 2020 | Gastroenterology Report2020，8，6： | 0 |
| 5 | Simple non-invasive biomarkers of advanced fibrosis in the evaluation of non-alcoholic fatty liver disease显示文摘Background and aims.Non-alcoholic fatty liver disease(NAFLD)is a common,morbid disease with profound implications for the overall health of the patient.We set out to determine the clinical predictors of advanced histology in the referral population.Methods.We performed a retrospective review of all biopsy-proven NAFLD patients,including 358 unique patients first seen between 1996 and 2009.Liver histology and ultrasound images were reviewed prospectively by clinicians who were blinded to clinical information and test indication.Results.Compared with men,women tended to present at an older age(51.4-10.6 vs 45.3-11.2 years,P<0.001),were more likely to be Caucasian(P=0.003),less likely to present with an elevated alanine aminotransferase(ALT)(75.2%vs 88.8%),and more likely to have advanced non-alcoholic steatohepatitis(NASH)(44.7%vs 29.9%;P=0.04)and advanced fibrosis(23.3%vs 14.1%;P=0.03).In multivariate logistic regression,body mass index(BMI)-30 kg/m^(2)(odds ratio(OR)2.21;95%confidential interval(CI):1.23–4.08),female gender(OR 1.76;95%CI:1.01–3.10)and aspartate aminotransferase(AST)>40 IU/L(OR 2.00;95%CI:1.14–3.55)were associated with a NAFLD activity score>4.The sensitivity and specificity of an AST to platelet ratio index(APRI)>1 for significant fibrosis was 30.0%(95%CI:17.2–45.4%)and 92.8%(95%CI:88.2-95.8%),respectively;the likelihood ratio is 4.2.In multivariate logistic regression,APRI>1 was the most significant predictor of advanced fibrosis(OR 3.85;95%CI:1.55–9.59).In patients without ultrasound-detected steatosis,20%had advanced fibrosis and 16.7%had active NASH.Conclusion.Patients with suspected NAFLD should routinely be evaluated for advanced liver disease,including non-invasive indices of fibrosis such as APRI,and serious consideration given to liver biopsy. | Elliot B.Tapper Katherine Krajewski Michelle Lai Tracy Challies Robert Kane Nezam Afdhal Daryl Lau | 2014 | Gastroenterology Report2014，2，4： | 0 |
| 6 | The aspartate aminotransferase-to-platelet ratio and the evaluation of non-alcoholic fatty liver disease显示文摘Dear Editor,We thank Agilli et al.and Kayadibi et al.for their interest in our manuscript[1].Taken together,their letters raise points of clarification regarding the utility and general applicability of the‘aspartate aminotransferase-to-platelet ratio index’(APRI)test in the evaluation of liver fibrosis.Our first comment is that their concern over confounders of the APRI unrelated to liver disease is valid.Indeed,confounders would diminish the ability of APRI to predict advanced liver fibrosis,leading to false negatives.Given that our results were significant,this insight strengthens our findings.Also,in defense of APRI,most other non-invasive predictors of liver fibrosis are vulnerable to confounding by extraneous conditions,which could instead lead to false positives.The‘hepascore’and‘fibrotest’,for example,utilizes bilirubin(confounded by Gilbert’s)and Gamma-Glutamyl Transferase(GGT)(confounded by cholestasis)[2]. | Elliot B.Tapper | 2014 | Gastroenterology Report2014，2，4： | 0 |
| 7 | 送餐入户方案治疗有症状腹水的前瞻性对照研究的设计与合理性:SALTYFOOD试验显示文摘Background:When patients with cirrhosis develop ascites,it is associated with sharply increasedmortality and healthcare utilization with decreased quality of life.Dietary salt restriction is first-line therapy for ascites but it is limited by poor adherence.Methods:We will recruit 40 patients with cirrhosis and ascites who have received a recent paracentesis or hospitalization for a 1:1 randomized trial of standard care(education on salt restriction)versus home-delivered meals.Our primary outcome is the number of paracenteses needed over 12 weeks.Secondary outcomes include hospital-bed days,health-related quality of life(HRQOL,Ascites Symptom Inventory-7 and Visual Analogue Scale)and performance on batteries of physical function including hand grip(kg)and walk speed(m/s).All subjects follow up through a series of calls where any paracenteses,hospital readmissions,weight changes and diuretic dosage changes are recorded.In a final Week 12 visit,knowledge of dietary sodium intake,quality of life and frailty are reassessed,and satisfaction with the meal-delivery program is evaluated.Paired comparison testing will be conducted between the two arms.Discussion:A nutritionally standardized meal-delivery program for patients with cirrhosis and ascites post discharge has a variety of potential patient-based benefits,including the effective management of ascites,reduction of healthcare utilization and improvement of HRQOL.We have three core hypotheses.First,patients will report interest in and satisfaction with a home-delivered meals program.Second,subjects on a salt-restricted(2 g sodium)meal-delivery program will have fewer therapeutic paracenteses and all-cause readmissions than subjects receiving standard of care.Third,subjects on a saltrestricted(2 g sodium)meal-delivery program will report increased HRQOL compared to subjects receiving standard of care. | Elliot B.Tapper Jad Baki Scott Hummel Anna Lok | 2019 | Gastroenterology Report2019，7，2： | 0 |
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