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| 1 | Liver transplantation and alcoholic liver disease:History,controversies,and considerations显示文摘Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease(ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation(LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a 'self-inflicted disease'. One of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this '6-mo rule' is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help support abstinence. Nutritional therapy helps to reverse muscle wasting, weight loss, vitamin deficiencies, and trace element deficiencies associated with ALD. For muscular recovery, supervised physical activity has been shown to lead to a gain in muscle mass and improvement of functional activity. Early LT for acute alcoholic hepatitis has been the subject of recent clinical studies, with encouraging results in highly selected patients. The survival rates after LT for ALD are comparable to those of patients who underwent LT for other indications. Patients that undergo LT for ALD and survive over 5 years have a higher risk of cardiorespiratory disease, cerebrovascular events, and de novo malignancy. | Claudio Augusto Marroni Alfeu de Medeiros Fleck Jr Sabrina Alves Fernandes Lucas Homercher Galant Marcos Mucenic Mario Henrique de Mattos Meine Guilherme Mariante-Neto Ajacio Bandeira de Mello Brandao | 2018 | World Journal of Gastroenterology2018，24，26： | 7 |
| 2 | Nutritional evaluation in cirrhosis: Emphasis on the phase angle显示文摘Protein-calorie malnutrition(PCM) is a common condition in cirrhotic patients, leading to a worse prognosis, complications, poor quality of life and lower survival rates. Among ways of assessing nutritional status, there are anthropometric methods such as the evaluation of the triceps skinfold, the arm circumference, the arm muscle circumference and the body mass index, and nonanthropometric methods such as the subjective global assessment, the handgrip strength of non-dominant hand, and the bioelectrical impedance analysis(BIA). PCM is frequently under-diagnosed in clinical settings in patients with cirrhosis due to the limitations of nutritional evaluation methods in this population. BIA is a useful method, but cannot be indicated in patients with abnormal body composition. In these situations, the phase angle(PA) has been used, and can become an important tool in assessing nutritional status in any situation. The PA is superior to anthropometric methods and might be considered as a nutritional indicator in cirrhosis. The early characterization of the nutritional status in patients with cirrhosis means an early nutritional intervention, with a positive impact on patients' overall prognosis. Among the usually accepted methods for nutritional diagnosis, the PA provides information in a quick and objective manner. | Sabrina Alves Fernandes Angelo Alves de Mattos Cristiane Valle Tovo Claudio Augusto Marroni | 2016 | World Journal of Hepatology2016，8，29： | 6 |
| 3 | Vehicle dynamics objective metrics显示文摘 | Claudio Fernandes Fabio Jum Okano | 2003 | SAE2003，，： | 1 |
| 4 | Prenatal Diagnosis of Treacher-Collins Syndrome Using Three-Dimensional Ultrasonography and Differential Diagnosis with Other Acrofacial Dysostosis Syndromes显示文摘 | Daniela Cardoso Pereira Luiz Claudio Silva Bussamra Edward Araujo Júnior Carolina Leite Drummond Luciano Marcondes Machado Nardozza Antonio Fernandes Moron José Mendes Aldrighi C. Ficicioglu E. C. Nwosu E. Vaisbuch | 2013 | Case Reports in Obstetrics and Gynecology2013，，： | 1 |
| 5 | First-Line Paclitaxel and Carboplatin in Persistent/Recurrent or Advanced Cervical Cancer: A Retrospective Analysis of Patients Treated at Brazilian National Cancer Institute显示文摘 | álvaro Henrique Ingles Garces Paulo Alexandre Ribeiro Mora Flávia Vieira Guerra Alves Claudio Calazan do Carmo Rachele Grazziotin Anna Cristina Ferr?o Mangia Fernandes Angélica Nogueira-Rodrigues Andréia Cristina de Melo | 2013 | International Journal of Gynecological Cancer2013，，4： | 1 |
| 6 | Phase angle and non-alcoholic fatty liver disease before and after bariatric surgery显示文摘BACKGROUND Obesity is a global health problem that is continuing to increase in the young population.In Brazil,the frequency of obesity in 2018 was 19.8%.Several comorbidities are directly associated with obesity,such as non-alcoholic fatty liver disease(NAFLD),which is considered the most common liver disorder in Western countries and affects up to 46%of adults.Bariatric surgery is effective in treating obesity and can improve NAFLD;however,the effect of bariatric surgery on body composition,phase angle(PA),and improving NAFLD needs to be further studied.AIM To analyze the PA in the postoperative period of bariatric surgery and to correlate it with changes in body composition and liver disease.METHODS This study is a retrospective cohort study of the analysis of the medical records of patients undergoing bariatric surgery in a reference center of a teaching hospital in Porto Alegre over a 2-year period.Patients older than 18 years whose record contained all information relevant to the study were included.The data analyzed were body composition and PA through electrical bioimpedance and NAFLD through liver biopsy in the pre-and postoperative period.The level of significance adopted for the statistical analyses was 5%.RESULTS We evaluated 379 patients with preoperative data.Regarding PA,169 patients were analyzed,and 33 patients had liver biopsy pre-and postoperatively with NAFLD information.In total,79.4%were female,with a mean age of 39.1±10.6 years.The average body mass index(BMI)was 45.9±7.5 kg/m².The PA showed a mean of 5.8±0.62°in the preoperative period and a significant reduction in the postoperative period.A postoperative reduction in body composition data(skeletal muscle mass,fat percentage,fat mass,body cell mass,BMI and visceral fat area)was shown as well.Regarding liver disease,all patients presented a reduction in the degrees and stages of liver disease in the postoperative period,and some had no degree of liver disease at all.CONCLUSION PA decreased after bariatric surgery,with a direct correlation with weight loss and changes in body composition.The decrease in PA was not correlated with the improvement in NAFLD. | Joise Teixeira Claudio Augusto Marroni Paula Rosales Zubiaurre Ana Henz Lais Faina Lilian KethelynPinheiro Claudio Cora Mottin Sabrina Alves Fernandes | 2020 | World Journal of Hepatology2020，12，11： | 0 |
| 7 | Bioelectrical impedance vector analysis evaluates cellularity and hydration in cirrhotic patients显示文摘BACKGROUND Malnutrition in cirrhotic patients is correlated with mortality and a better response to liver transplantation.However,recovery of the nutritional status in these patients is a challenge due to the difficulty in establishing a reliable nutritional diagnosis.The bioelectrical impedance vector analysis(BIVA)method appears as a feasible tool in clinical practice to define the physiological state of cirrhotic patients by assessing hydration and body cellularity.AIM To evaluate body composition in cirrhotic patients using BIVA.METHODS This retrospective cross-sectional study was carried out by following cirrhotic outpatients at a hospital in Porto Alegre,Brazil.A tetrapolar bioelectrical impedance analysis device was used to evaluate cellularity and hydration and to perform the BIVA.The BIVA graphic was elaborated by software and for statistical analysis a significance level of 5%(P≤0.05)was considered.RESULTS One hundred and ninety patients,61.1%males,with a mean age of 56.6±11.0 years,were evaluated.Of these,56.3%had Child-Turcotte-Pugh(CTP)A score,and the prevalent etiology was hepatitis C virus(47.4%).The patients were classified according to cellularity and hydration by the quadrants and ellipses of the BIVA method,quadrant 1(47.9%);quadrant 2(18.9%);quadrant 3(14.2%);and quadrant 4(18.9%).Those classified in quadrant 1 and 2 had a higher phase angle compared to those in quadrants 3 and 4(P<0.001).Quadrant 2 patients had a lower average age than the other groups.The association with CTP score showed that patients in quadrant 2 had a higher proportion of CTP A,and those in quadrant 4 had a higher proportion of CTP C(P<0.052).CONCLUSION The BIVA method allows identification of the cellularity and hydration status of cirrhotic patients,and its association with clinical factors determines the disease severity,age and prognostic index. | Sabrina Alves Fernandes Lara Rigon Leonhardt Daniella Miranda da Silva Fernanda Donner Alves Claudio Augusto Marroni | 2020 | World Journal of Hepatology2020，12，12： | 0 |
| 8 | Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant显示文摘BACKGROUND Cholangiocarcinoma(CC)is a rare tumor that arises from the epithelium of the bile ducts.It is classified according to anatomic location as intrahepatic,perihilar,and distal.Intrahepatic CC(ICC)is rare in patients with cirrhosis due to causes other than primary sclerosing cholangitis.Mixed hepatocellular carcinoma-CC(HCC-CC)is a rare neoplasm that shows histologic findings of both HCC and ICC within the same tumor mass.Due to the difficulties in arriving at the correct diagnosis,patients eventually undergo liver transplantation(LT)with a presumptive diagnosis of HCC on imaging when,in fact,they have ICC or HCC-CC.AIM To evaluate the outcomes of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma on pathological examination after liver transplant.METHODS Propensity score matching was used to analyze tumor recurrence(TR),overall mortality(OM),and recurrence-free survival(RFS)in LT recipients with pathologically confirmed ICC or HCC-CC matched 1:8 to those with HCC.Progression-free survival and overall mortality rates were computed with the Kaplan-Meier method using Cox regression for comparison.RESULTS Of 475 HCC LT recipients,1.7%had the diagnosis of ICC and 1.5%of HCC-CC on pathological examination of the explant.LT recipients with ICC had higher TR(46%vs 11%;P=0.006),higher OM(63%vs 23%;P=0.002),and lower RFS(38%vs 89%;P=0.002)than those with HCC when matched for pretransplant tumor characteristics,as well as higher TR(46%vs 23%;P=0.083),higher OM(63%vs 35%;P=0.026),and lower RFS(38%vs 59%;P=0.037)when matched for posttransplant tumor characteristics.Two pairings were performed to compare the outcomes of LT recipients with HCC-CC vs HCC.There was no significant difference between the outcomes in either pairing.CONCLUSION Patients with ICC had worse outcomes than patients undergoing LT for HCC.The outcomes of patients with HCC-CC did not differ significantly from those of patients with HCC. | Ajacio Bandeira de Mello Brandão Santiago Rodriguez Alfeu de Medeiros Fleck Jr Claudio Augusto Marroni Mário B Wagner Alex Hörbe Matheus V Fernandes Carlos TS Cerski Gabriela Perdomo Coral | 2022 | World Journal of Clinical Oncology2022，13，8： | 0 |
| 9 | Machine learning approaches using blood biomarkers in nonalcoholic fatty liver diseases显示文摘The prevalence of nonalcoholic fatty liver disease(NAFLD)is an important public health concern.Early diagnosis of NAFLD and potential progression to nonalcoholic steatohepatitis(NASH),could reduce the further advance of the disease,and improve patient outcomes.Aiming to support patient diagnostic and predict specific outcomes,the interest in artificial intelligence(AI)methods in hepatology has dramatically increased,especially with the application of lessinvasive biomarkers.In this review,our objective was twofold:Firstly,we presented the most frequent blood biomarkers in NAFLD and NASH and secondly,we reviewed recent literature regarding the use of machine learning(ML)methods to predict NAFLD and NASH in large cohorts.Strikingly,these studies provide insights into ML application in NAFLD patients'prognostics and ranked blood biomarkers are able to provide a recognizable signature allowing cost-effective NAFLD prediction and also differentiating NASH patients.Future studies should consider the limitations in the current literature and expand the application of these algorithms in different populations,fortifying an already promising tool in medical science. | Randhall B Carteri Mateus Grellert Daniela Luisa Borba Claudio Augusto Marroni Sabrina Alves Fernandes | 2022 | Artificial Intelligence in Gastroenterology2022，3，3： | 0 |
| 10 | Role of the phase angle in the prognosis of the cirrhotic patient:15 years of follow-up显示文摘BACKGROUND In 2019,cirrhosis accounted for 2.4%of global deaths.The projection for 2030 is an increase in this index.In recent years,hospitalization costs have escalated by 36%for compensated cirrhosis and 24%for decompensated cirrhosis.Therefore,it is necessary to identify a tool capable of predicting the mortality of these patients according to their clinical condition and consequently extending their survival time.Different studies have shown that the phase angle(PA)can be a feasible method in clinical practice,with the potential to guide assertive patient management in the therapeutic of chronic liver disease.AIM To evaluate the prognostic role of PA in cirrhotic patients over a 15-year followup period.METHODS Retrospective cohort study with 129 cirrhotic patients of both sexes over 18 years old.Diagnosis of cirrhosis by liver biopsy.The first year of data collection was 2007,and data regarding outcomes was collected in 2023.Data were gathered from medical records,such as esophageal varices(EV),EV bleeding,ascites,spontaneous bacterial peritonitis(SBP),encephalopathy,laboratory findings and PA.The cut-off value for the PA was 5.4°,a value described in 2012 by Fernandes et al for 129 patients evaluated in this study and the cut-off points for the Brazilian population presented in percentiles(P),as described by Mattiello et al.The mortality was assessed using the PA percentile through Kaplan-Meier curves and multivariate binary logistic regression models.RESULTS Patients were divided into two groups according to the PA 5.4th(PA>5.4°,n=40;PA≤5.4°,n=89)PA percentile( | Letícia Pereira Pinto Claudio Augusto Marroni Juliana Czermainski Maria Luiza Fernandes Dahlem Randhall B Carteri Sabrina Alves Fernandes | 2023 | World Journal of Methodology2023，13，4： | 0 |
| 11 | Correction:Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellularcholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant显示文摘Rereading the article“Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant”(DOI:10.5306/wjco.v13.i8.688),published on August 24,we observe,with concern,that figures 3 and 4 are wrong.The authors have attached the correct figures for correction. | Ajacio Bandeira de Mello Brandão Santiago Rodriguez Alfeu de Medeiros Fleck Jr Claudio Augusto Marroni Mário B Wagner Alex Hörbe Matheus V Fernandes Carlos TS Cerski Gabriela Perdomo Coral | 2023 | World Journal of Clinical Oncology2023，14，6： | 0 |
| 12 | Resting energy expenditure in cirrhotic patients with and without hepatocellular carcinoma显示文摘BACKGROUND The diagnosis of malnutrition in patients with independent hepatocellular carcinoma(HCC)varies from 20%to 50%,is related to important complications and has a direct impact on the prognosis.Determination of the resting energy expenditure(REE)has become an important parameter in this population,as it allows therapeutic adjustments to recover their nutritional status.The REE in cirrhosis,with and without HCC,is not clearly defined,and requires the identification and definition of the best nutritional approach.AIM To evaluate the REE of patients with cirrhosis,with and without HCC.METHODS This is a prospective observational study evaluating the REE of 118 patients,33 with cirrhosis and hepatocellular carcinoma and a control group of 85 patients with cirrhosis without HCC,using indirect calorimetry(IC),bioimpedance,and predictive formulas.RESULTS The REE determined by IC in cirrhotic patients with HCC was 1643±364 and in those without HCC was 1526±277(P=0.064).The REE value as assessed by bioimpedance was 1529±501 for those with HCC and 1660±385 for those without HCC(P=0.136).When comparing the values of REE determined by IC and predictive formulas in cirrhotics with HCC,it was observed that only the formulas of the Food and Agriculture Organization(FAO)/World Health Organization(WHO)(1985)and Cunningham(1980)presented values similar to those determined by IC.When comparing the REE values determined by IC and predictive formulas in cirrhotics without HCC,it was observed that the formulas of Schofield(1985),FAO/WHO(1985),WHO(2000),Institute of Medicine(IOM)(2005)and Katch and McArdie(1996)presented values similar to those determined by IC.CONCLUSION The FAO/WHO formula(1985)could be used for cirrhotic patients with or without HCC;as it is the one with the values closest to those obtained by IC in these cirrhotic patients. | Ana Cristhina Henz Claudio Augusto Marroni Daniella Miranda da Silva Joise Munari Teixeira ThiagoThoméSilveira Shaiane Ferreira Andresa ThoméSilveira Natalia Perin Schmidt Jessica Taina Stein Roberta Goulart Rayn Sabrina Alves Fernandes | 2021 | World Journal of Gastrointestinal Pharmacology and Therapeutics2021，12，1： | 0 |
| 13 | Punica granatum Leaf Lipophilic Fraction Favours Mortality by Attenuating Inflammation in Mice with Polymicrobial Sepsis显示文摘Punica granatum L.possesses known antimicrobial and anti-inflammatory actions.Preparations of different parts of this plant have been commonly used in the folk medicine to prevent and treat infections;and studies have supported the use of P.granatum extracts for this purpose.However,little is known of the effects of P.granatum-derived fractions in severe infectious diseases such as sepsis.Here,we investigated the actions of the hexane fraction(HF),rich in lipophilic compounds,obtained from the leaves of this plant,in a murine model of polymicrobial sepsis.Oral pre-treatment with HF increased mortality in septic mice.The same animals presented with lower levels of interleukin-6,nitric oxide and hydrogen peroxide in their peritoneal lavage samples than vehicle mice.HF also increased polymorphonuclear cell accumulation in to the peritoneum of mice with sepsis.Macrophage-derived nitric oxide upon lipopolysaccharide stimuli was markedly reduced by incubation with HF.Diterpenes,triterpenes,phytosterols,vitamin E and ascorbyl palmitate were detected in the HF.These results indicate that P.granatum leaf lipophilic fractions may worsen sepsis outcome.This effect may be associated with its bioactive compounds which act synergistically or not,increasing sepsis mortality in vivo. | Nagila Caroline Fialho Sousa Isabella Fernandes da Silva Figueiredo Mizael Calacio de Araujo Elaine Pereira de Andrade Thais Costa Alves Bruna Letícia Rosa da Silva Domingos Magno Santos Pereira Saulo JoseFigueiredo Mendes Joao Francisco Silva Rodrigues Jaqueline Pessoa Pontes Simone Aparecida Teixeira AndreAlvares Marques Vale Marcus Vinicius Dias-Souza Lidio Goncalves Lima-Neto Vera Lucia dos Santos Ana Paula Azevedo-Santos Marcelo Nicolas Muscara Valerio Monteiro-Neto Andrea de Souza Monteiro Luis Claudio Nascimento da Silva Elizabeth Soares Fernandes | 2019 | Journal of Pharmacy and Pharmacology2019，7，7： | 0 |
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