Encephalopathy In Patients Research Articles

Frequency of Recurrence of Hepatic Encephalopathy in Patients of Chronic Liver Disease Treated With Rifaximin

Aim: To determine the frequency of recurrence of hepatic encephalopathy in patients treated with Rifaximin. Study design: Observational cross-sectional study. Setting & duration: Department of Medicine, Services institute of Medical Sciences Lahore for duration of 12 months. Methodology: Hepatic encephalopathy was diagnosed using West-Haven classification in patients of chronic liver disease. Recurrence was considered if a new episode of hepatic encephalopathy occurred within 3 months after initiation of treatment. A total 120 patients of chronic liver disease having had an episode of recent hepatic encephalopathy within the last 3 months, of both genders, above 20 years of age with hepatic encephalopathy were included in the study. The patients were followed for 3 months after initiation of therapy and any episode of recurrence of hepatic encephalopathy was recorded. Results: Mean age was 51.5±12.2 years and 52.3±12.8 years respectively in Rifaximin and Placebo groups. Fourteen (23.3%) patients in Rifaximin group and 17(28.3%) in placebo group were younger than 40 years of age. Thirty-three (55%) patients in Rifaximin group were male versus 29(48.3%) patients in Placebo group. Fifteen (25%) patients in Rifaximin Group developed hepatic encephalopathy by 3 months of follow up as compared to 31(51.7%) patients in Placebo Group Conclusion: Frequency of recurrence of hepatic encephalopathy is significantly lower in Rifaximin treated patients. Keywords: Hepatic Encephalopathy, Recurrence, Rifaximin.

Clinical characteristics and outcomes of antibiotic-associated encephalopathy in patients with end-stage kidney disease

Objective End-stage kidney disease (ESKD) patients have a higher risk of antibiotic-associated encephalopathy (AAE) than other patients. We aimed to evaluate the prevalence, risk factors and outcomes of AAE in ESKD patients. Method A retrospective study of ESKD patients treated with intravenous antibiotics in our hospital from Jan. 1, 2006, to Dec. 31, 2015 was performed. AAE was diagnosed by the modified Delphi method. Control individuals were randomly selected from the remaining patients who did not exhibit neurologic symptoms. Logistic regression analysis was used to identify risk factors for AAE as well as the association between AAE and outcome. Result A total of 2104 patients were included in the study. The prevalence of AAE in our study was 4.4% (92/2104). The multivariate logistic regression analysis revealed that anuria (OR = 8.04, 95% CI: 4.13–15.65, p < 0.001), history of central nervous system disorder (OR = 3.03, 95% CI: 1.21–7.56, p = 0.018) and hypoalbuminemia (OR= 1.87, 95% CI: 1.01–3.47, p = 0.046) were independent factors associated with AAE in ESKD patients. After adjustment for confounders, AAE was associated with composite outcomes of in-hospital mortality and treatment withdrawal (OR = 4.36, 95% CI: 2.09–9.10, p < 0.001). Conclusion The prevalence of AAE was 4.4% in ESKD patients and varied among different antibiotics. Anuria, history of central nervous system disorder and hypoalbuminemia were associated with AAE in ESKD patients. AAE is associated with worse outcomes in ESKD patients.

Conservative oxygen therapy in critically ill and perioperative period of patients with sepsis-associated encephalopathy.

Sepsis-associated encephalopathy (SAE) patients in the intensive care unit (ICU) and perioperative period are administrated supplemental oxygen. However, the correlation between oxygenation status with SAE and the target for oxygen therapy remains unclear. This study aimed to examine the relationship between oxygen therapy and SAE patients. Patients diagnosed with sepsis 3.0 in the intensive care unit (ICU) were enrolled. The data were collected from the Medical Information Mart for Intensive Care IV (MIMIC IV) database and the eICU Collaborative Research Database (eICU-CRD) database. The generalized additive models were adopted to estimate the oxygen therapy targets in SAE patients. The results were confirmed by multivariate Logistic, propensity score analysis, inversion probability-weighting, doubly robust model, and multivariate COX analyses. Survival was analyzed by the Kaplan-Meier method. A total of 10055 patients from eICU-CRD and 1685 from MIMIC IV were included. The incidence of SAE patients was 58.43%. The range of PaO2 (97-339) mmHg, PaO2/FiO2 (189-619), and SPO2≥93% may reduce the incidence of SAE, which were verified by multivariable Logistic regression, propensity score analysis, inversion probability-weighting, and doubly robust model estimation in MIMIC IV database and eICU database. The range of PaO2/FiO2 (189-619) and SPO2≥93% may reduce the hospital mortality of SAE were verified by multivariable COX regression. SAE patients in ICU, including perioperative period, require conservative oxygen therapy. We should maintain SPO2≥93%, PaO2 (97-339) mmHg and PaO2/FiO2 (189-619) in SAE patients.

A shortened Stroop test to identify covert hepatic encephalopathy and predict overt hepatic encephalopathy in patients with cirrhosis.

Covert hepatic encephalopathy (CHE) adversely affects the clinical outcomes of patients with cirrhosis but remains largely undiagnosed and untreated. Although the Stroop test is a useful method for CHE detection, a faster, simpler, and more accurate test is required to diagnose CHE. This prospective study aimed to develop a new shortened Stroop test that can detect CHE and predict overt hepatic encephalopathy (OHE) in Japanese patients with cirrhosis. Patients who underwent neuropsychological tests (NPT) and the Stroop test between November 2018 and December 2021 were enrolled and followed until OHE occurrence or March 2022. The discriminative ability of various run combinations in the off and on states to detect CHE was evaluated using the area under the receiver-operating characteristic curve (AUC) and compared with that of the total Stroop test time. Among the 227 eligible patients, the On1-2Time cutoff value of 44.4s had a comparable discriminative ability with the total Stroop test time to detect CHE, with an AUC of 0.791, a sensitivity of 0.827, and a specificity of 0.685. During a median follow-up period of 16months, 37 patients developed OHE. On1-2Time ≥ 44.4s (hazard ratio [HR], 3.93; 95% confidence interval [CI] 1.36-11.36) and serum albumin levels (HR, 0.28; 95% CI 0.11-0.67) were independently associated with OHE occurrence. The shortened Stroop test (On1-2Time) is equivalent to the total Stroop test not only for identifying CHE but also for estimating the risk of progression to OHE.

Comparison of the Efficacy of Lactobacillus rhamnosus GG and Lactulose Treatments in Minimal Hepatic Encephalopathy

Objective: Minimal hepatic encephalopathy is a condition characterized by decreased perception and consequently deterioration in quality of life, and there is still limited data on its treatment. The aim of this study is to compare the efficacy of lactulose and Lactobacillus rhamnosus GG treatments by critical flicker frequency test in minimal hepatic encephalopathy patients. Methods: Patients with a critical flicker frequency test result of &lt;39 Hz were considered to have minimal hepatic encephalopathy. Eighty-four minimal hepatic encephalopathy patients were divided into 3 groups as lactulose, Lactobacillus rhamnosus GG, and control group. Critical flicker frequency control was performed 4 weeks after treatment. Critical flicker frequency values before and after treatment were compared according to the treatment groups and evaluated. Results: Minimal hepatic encephalopathy was detected in 84 (54.5%) of 154 cirrhosis patients. Of the patients with minimal hepatic encephalopathy, 31 (36.9%) received lactulose, 31 (36.9%) Lactobacillus rhamnosus GG treatment, and 22 (26.2%) did not receive any treatment. In patients with minimal hepatic encephalopathy compared to those without minimal hepatic encephalopathy, there were statistically significant differences in terms of age (P=.003), body mass index (BMI) (P=.019), albumin (P &lt; .001), sodium (P = .010), model for end-stage liver diseases score (P &lt; .001), and Child Pugh Classification (CHILD) score (P &lt; .001).There was no significant difference between cirrhosis etiology and treatment response (P=.535). Statistically significant increase was found in critical flicker frequency values in the lactulose (P=.011) and Lactobacillus rhamnosus GG (P=.007) groups after treatment. No statistically significant difference was found in the placebo group (P=.804). There was no statistically significant difference between lactulose and Lactobacillus rhamnosus GG (P=.576). Conclusion: In the treatment of minimal hepatic encephalopathy, Lactobacillus rhamnosus GG treatment is as effective like lactulose treatment and can be used safely

Association of Serum Ammonia Levels with Severity of Grades of Hepatic Encephalopathy in Patients Presenting to er of a Tertiary Care Hospital

Objective: To determine the association of serum Ammonia levels with severity of grades of hepatic encephalopathy in patients presenting to the department.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Emergency Department, Pak Emirates Military Hospital Rawalpindi Pakistan, from Dec 2020 to May 2021.&#x0D; Methodology: This study was conducted on 100 patients presenting with hepatic encephalopathy at the emergency department of our hospital. Based on clinical findings and relevant investigations, a consultant gastroenterologist or emergency medicine physician diagnosed hepatic encephalopathy or the underlying cause. In addition, serum Ammonia levels were done on all the patients at the time of presentation and associated with grades of hepatic encephalopathy and other factors.&#x0D; Results: Out of 100 patients included in the final analysis, 67 were males, and 33 were females. Infection (29%) was the commonest aetiology of hepatic encephalopathy, followed by Constipation (23%). In addition, 59% had normal serum ammonia levels, while 41% had raised ammonia levels in their serum. High grade of hepatic encephalopathy and raised Child-Turcotte-Pugh score were statistically significantly associated with raised ammonia levels in our study participants.&#x0D; Conclusion: Raised serum ammonia levels were a common finding among patients with hepatic encephalopathy. Therefore, patients with a high grade of hepatic encephalopathy and a high Child-Turcotte-Pugh score at the time of presentation should be considered at a higher risk of having hyperammonemia.

Baclofen-induced Encephalopathy in Patients with End-stage Kidney Disease – A Case Series

Introduction/Background: Baclofen is a centrally acting GABA B receptor agonist, widely used for the treatment of neurological diseases ranging from hiccups to multiple sclerosis. As the drug is mainly renally excreted, intoxication can rapidly develop in those patients with a reduced glomerular filtration rate. A strong index of clinical suspicion is essential to correctly diagnose the condition. Case Presentation: We report a case series of patients with advanced kidney disease and baclofen-induced encephalopathy that settled with discontinuation of the drug and hemodialysis sessions. Conclusion: We report this cluster of patients with baclofen toxicity to highlight the common occurrence of neurotoxicity after its use in patients with end-stage renal disease and its resolution after cessation of the drug and hemodialysis sessions.

Predictive Risk Model for the Development of Encephalopathy in Patients with Nutritional Pancreatic Necrosis

The objective: to develop a predictive model for assessing the risk of developing encephalopathy (EP) in patients with nutritional pancreatic necrosis.Subjects and Methods. A single-center prospective cohort study was conducted at Faculty Surgery Clinic of Volgograd State Medical University from 2010 to 2020. Logistic regression analysis was used to build a model for predicting the risk of developing EP.Results. A total of 429 patients were included in the study. It was determined that in the majority of patients EP manifested in the first three days after hospitalization. A statistically significant predictive model of correlation of the risk to develop EP with clinical and demographic variables showed that an increase in the severity of the patient's condition (according to the SOFA scale) by 1 point increased the risk by 1.9 times, and an increase in bilirubin levels by 1 μmol/l, and urea by 1 mmol/l increased the risk of AED by 8.0% and 28.0%, respectively. In non-alcoholic pancreatic necrosis, compared with the alcoholic genesis of the disease, and when using early (before day 3) enteral nutrition, there was a significant reduction in the risk of developing EP by 175.5% and 137% of cases. The specificity and sensitivity of the model were 78.7% and 82.8%, respectively.Conclusions. In nurtitional pancreatic necrosis, an increase in the severity of the patient's condition, alcoholic genesis of the disease, progression of signs of liver and kidney failure significantly increased the risk of developing EP. At the same time, early enteral nutrition contributed to a significant reduction in the risk of this complication. The presented predictive model is recommended to be used in routine clinical practice.

Elevation of enterococcus-specific antibodies associated with bacterial translocation is predictive of survival rate in chronic liver disease

Introduction/purposeThe gut-liver axis contributes to disease progression, a rise in infection rate, organ failure and a poor overall outcome in chronic liver diseases (CLD). Monitoring of the gut-liver axis is critical in understanding disease status, but biomarkers have not been elucidated. The aim of this study is to determine the level of serum antibodies against Enterococcus (E.) faecalis in evaluating patients with CLD, including those treated with rifaximin (a minimally absorbed antibiotic), and in patients with alcohol-associated liver disease (ALD).Materials and methodsWe enrolled 109 CLD patients (cohort 1), 30 hepatic encephalopathy patients treated with rifaximin (cohort 2), 53 inpatients with ALD undergoing alcohol cessation (cohort 3) and 33 healthy subjects. To assess the consequences of E. faecalis translocation, we developed an assay for the detection of a serum antibody against E. faecalis capsular polysaccharide (E.CPS).ResultsSerum E.CPS antibody titer was elevated only in those patients with advanced CLD and ALD. The E.CPS antibody titer was an independent prognostic factor (p < 0.05), while Mac-2 binding protein and albumin-bilirubin score were not independent predictors of survival. The improvement of predictive model in integrated factors was significant [continuous net reclassification index (value 0.699, p < 0.05) and integrated discrimination improvement (value 0.164, p = 0.051)]. Furthermore, rifaximin treatment led to a decrease of serum E.CPS antibody titer resulting in a significantly longer overall rate of survival.ConclusionThe E.CPS antibody titer appears to be a strong predictor of survival in CLD patients. Serum E.CPS levels decrease in CLD patients receiving rifaximin, and may be associated with an overall improvement in rate of survival.

Molecular Dynamics of CYFIP2 Protein and Its R87C Variant Related to Early Infantile Epileptic Encephalopathy.

The CYFIP2 protein (cytoplasmic FMR1-interacting protein 2) is part of the WAVE regulatory complex (WRC). CYFIP2 was recently correlated to neurological disorders by the association of the R87C variant with early infantile epileptic encephalopathy (EIEE) patients. In this set of syndromes, the epileptic spasms and seizures since early childhood lead to impaired neurological development in children. Inside the WRC, the variant residue is at the CYFIP2 and WAVE1 protein interface. Thus, the hypothesis is that the R87C modification weakens this interaction, allowing the WRC complex’s constant activation. This work aimed to investigate the impacts of the mutation on the structure of the WRC complex through molecular dynamics simulation. For that, we constructed WRC models containing WAVE1-NCKAP1 proteins complexed with WT or R87C CYFIP2. Our simulations showed a flexibilization of the loop comprising residues 80–110 due to the loss of contacts between internal residues in the R87C CYFIP2 as well as the key role of residues R/C87, E624, and E689 in structural modification. These data could explain the mechanism by which the mutation impairs the stability and proper regulation of the WRC.

Hepatic encephalopathy and strategies to prevent readmission from inadequate transitions of care.

One of the most costly and frequent causes of hospital readmissions in the United States is hepatic encephalopathy in patients with underlying liver cirrhosis. In this narrative review, we cover current practices in inpatient management, transitions of care, and strategies to prevent hospital readmissions. Bundled approaches using a model such as the "Ideal Transitions of Care" appear to be more likely to prevent readmissions and assist patients as they transition to outpatient care. Numerous strategies have been evaluated to prevent readmissions in patients with hepatic encephalopathy, including technologic interventions, involvement of nonphysician team members, early follow-up strategies, and involvement of palliative care when appropriate.

Hepatik Ensefalopati Tip C Hastalarında Tetikleyici Faktörler ve Kliniko-Endoskopik Çalışma

Introduction: Hepatic encephalopathy (HE) is a decline in brain function as a result of severe liver disease and its inadequacy to remove toxins from the body. It is characterized by personality changes, intellectual impairment, and loss of consciousness. This study was conducted to determine the precipitating factors and endoscopic features of hepatic encephalopathy in patients with liver cirrhosis and evaluate the associated clinical features admitted in a tertiary hospital in Central India. Materials and Methods: This hospital-based descriptive cross-sectional study was conducted from November 2016 to October 2018 on 102 patients with hepatic encephalopathy type C, aged above 18. All patients were carefully examined, relevant investigations performed, and data collected through pre-designed proforma. They were sent for statistical analysis where categorical outcomes were compared between study groups using the Chi-square test /Fisher's Exact test. Results: The prevalence of HE was 19.6% in our study. In this study, we observed that constipation (26.5%), electrolyte imbalance (21.6%), renal failure (18.6%), and upper GI bleeding (18.6%) be among the leading precipitants for HE. Besides liver failure, the associated abnormalities in various factors like coagulation abnormalities, renal derangement, and changes in serum sodium levels can lead to the progression of HE to higher grades. Conclusion: It is essential to identify the different factors like constipation, electrolyte imbalance, renal failure, and upper GI bleeding early in the course of cirrhosis to help prevent the development of HE.

Brain volumes and functional outcomes in children without cerebral palsy after therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy.

To investigate whether brain volumes were reduced in children aged 6 to 8 years without cerebral palsy, who underwent therapeutic hypothermia for neonatal hypoxic-ischaemic encephalopathy (patients), and matched controls, and to examine the relation between subcortical volumes and functional outcome. We measured regional brain volumes in 31 patients and 32 controls (median age 7 years and 7 years 2 months respectively) from T1-weighted magnetic resonance imaging (MRI). We assessed cognition using the Wechsler Intelligence Scales for Children, Fourth Edition and motor ability using the Movement Assessment Battery for Children, Second Edition (MABC-2). Patients had lower volume of whole-brain grey matter, white matter, pallidi, hippocampi, and thalami than controls (false discovery rate-corrected p < 0.05). Differences in subcortical grey-matter volumes were not independent of total brain volume (TBV). In patients, hippocampal and thalamic volumes correlated with full-scale IQ (hippocampi, r=0.477, p=0.010; thalami, r=0.452, p=0.016) and MABC-2 total score (hippocampi, r=0.526, p=0.004; thalami, r=0.505, p=0.006) independent of age, sex, and TBV. No significant correlations were found in controls. In patients, cortical injury on neonatal MRI was associated with reduced volumes of hippocampi (p=0.001), thalami (p=0.002), grey matter (p=0.015), and white matter (p=0.013). Children who underwent therapeutic hypothermia have reduced whole-brain grey and white-matter volumes, with associations between hippocampal and thalamic volumes and functional outcomes.

Some aspects of the pathogenesis of hepatic encephalopathy

Aim. To study the pathogenesis of hepatic encephalopathy in patients with cirrhosis of the liver. Material and methods.141 patients with liver cirrhosis complicated by hepatic encephalopathy were examined. The diagnosis was established on the basis of anamnesis, clinical, biochemical, instrumental, virological methods of research, including the study of the level of pro-inflammatory cytokines and ammonia in the blood serum. Results and discussion. The level of interleukin-6 in patients with liver cirrhosis in the stage of decompensation averaged 118 ± 14 pg/ml (p &lt; 0,01), and increased to 194 ± 14 pg/ml (p &lt; 0,05) in hepatic encephalopathy. Levels of tumor necrosis factor – α almost doubled. The level of tumor necrosis factor (TNF-α) in patients with liver cirrhosis in the stage of decompensation averaged 121 ± 12 pg/ml (p &lt; 0,001), while in patients with hepatic encephalopathy it made 244 ± 17 pg/ml (p &lt; 0,005). A similar picture was also observed when studying the ammonia in blood serum. In liver cirrhosisin the stage of decompensation level of ammonia was 93,1 + 4,2 (p &lt; 0,001). In patients with hepatic encephalopathy, a decrease in the number of bifidobacteria, lactobacteria and eubacteria by 3-4 times compared with the norm was revealed. At the same time, the number of pathogenic microflora and yeast fungi increased. Conclusion. In the pathogenesis of hepatic encephalopathy, a high content of pro-inflammatory cytokines and nitrogenous compounds play an important role as a result of the syndrome of increased bacterial growth and persistence of Helicobacter pylori in the gastric mucosa.

Subacute and chronic proteomic and phosphoproteomic analyses of a mouse model of traumatic brain injury at two timepoints and comparison with chronic traumatic encephalopathy in human samples

Repetitive mild traumatic brain injury (r-mTBI) is the most widespread type of brain trauma worldwide. The cumulative injury effect triggers long-lasting pathological and molecular changes that may increase risk of chronic neurodegenerative diseases. R-mTBI is also characterized by changes in the brain proteome, where the majority of molecules altered early post-TBI are different from those altered at more chronic phases. This differentiation may contribute to the heterogeneity of available data on potential therapeutic targets and may present an obstacle in developing effective treatments. Here, we aimed to characterize a proteome profile of r-mTBI in a mouse model at two time points – 3 and 24 weeks post last TBI, as this may be a more relevant therapeutic window for individuals suffering negative consequences of r-mTBI. We identified a great number of proteins and phosphoproteins that remain continuously dysregulated from 3 to 24 weeks. These proteins may serve as effective therapeutic targets for sub-acute and chronic stages of post r-mTBI. We also compared canonical pathway activation associated with either total proteins or phosphoproteins and revealed that they both are upregulated at 24 weeks. However, at 3 weeks post-TBI, only pathways associated with total proteins are upregulated, while pathways driven by phosphoproteins are downregulated. Finally, to assess the translatability of our data, we compared proteomic changes in our mouse model with those reported in autopsied human samples of Chronic Traumatic Encephalopathy (CTE) patients compared to controls. We observed 39 common proteins that were upregulated in both species and 24 common pathways associated with these proteins. These findings support the translational relevance of our mouse model of r-mTBI for successful identification and translation of therapeutic targets.

An Epilepsy-Associated Mutation of Salt-Inducible Kinase 1 Increases the Susceptibility to Epileptic Seizures and Interferes with Adrenocorticotropic Hormone Therapy for Infantile Spasms in Mice.

Six mutations in the salt-inducible kinase 1 (SIK1) have been identified in developmental and epileptic encephalopathy (DEE-30) patients, and two of the mutations are nonsense mutations that truncate the C-terminal region of SIK1. In a previous study, we generated SIK1 mutant (SIK1-MT) mice recapitulating the C-terminal truncated mutations using CRISPR/Cas9-mediated genome editing and found an increase in excitatory synaptic transmission and enhancement of neural excitability in neocortical neurons in SIK1-MT mice. NMDA was injected into SIK1-MT males to induce epileptic seizures in the mice. The severity of the NMDA-induced seizures was estimated by the latency and the number of tail flickering and hyperflexion. Activated brain regions were evaluated by immunohistochemistry against c-fos, Iba1, and GFAP. As another epilepsy model, pentylenetetrazol was injected into the adult SIK1 mutant mice. Seizure susceptibility induced by both NMDA and PTZ was enhanced in SIK1-MT mice. Brain regions including the thalamus and hypothalamus were strongly activated in NMDA-induced seizures. The epilepsy-associated mutation of SIK1 canceled the pharmacological effects of the ACTH treatment on NMDA-induced seizures. These results suggest that SIK1 may be involved in the neuropathological mechanisms of NMDA-induced spasms and the pharmacological mechanism of ACTH treatment.

Prevalence And Precipitating Factors Of Hepatic Encephalopathy In Patients With Liver Cirrhosis And Ascites Admitted At Korle Bu Teaching Hospital In Ghana

Background: Hepatic encephalopathy (HE) is one of the most debilitating complications of cirrhosis leading to death and severely affects the lives of patients and their caregivers. Decreases in HE mortality and recurrence have been linked with timely identification and correction of potential precipitating factors and early treatment. The aim of this study was therefore to determine the prevalence and precipitating factors of patients with cirrhotic ascites admitted with overt hepatic encephalopathy at KBTH Accra, Ghana.Materials and Methods: A cross-sectional study was conducted involving one hundred and three (103) patients admitted at medical block in the Korle-Bu Teaching Hospital (KBTH) with cirrhotic ascites from 25th March 2016 to 25th November, 2016. Demographic and clinical features including features of overt hepatic encephalopathy and possible precipitant were collected using a standardized questionnaire. Results: One hundred and three patients with cirrhotic ascites were recruited for the study with a mean age of 43.5 ± 12.2 years. Fifty-eight (56.3%) patients were males. The prevalence of hepatic encephalopathy was 25.24%. Precipitating factors were infections (53.8%),gastrointestinal bleeding (19.2%), electrolyte imbalance (9.2%) and constipation (3.9%). No precipitant was identified for one patient with hepatic encephalopathy.Conclusion: Prevalence of overt hepatic encephalopathy in patients with liver cirrhosis and ascites is not uncommon in our setting and precipitants were identified for almost all of them except one patient. A similar study should be done on a larger scale in multiple centres and regions to get a well-balanced prevalence of hepatic encephalopathy and its precipitating factors.

Brain Metabolic Connectivity Patterns in Patients with Prolonged Disorder of Consciousness after Hypoxic-Ischemic Injury: A Preliminary Study.

Understanding the patterns of brain glucose metabolism and connectivity in hypoxic-ischemic encephalopathy (HIE) patients with prolonged disorders of consciousness (DOC) may be of positive significance to the accurate assessment of consciousness and the optimization of neuromodulation strategy. We retrospectively analyzed the brain glucose metabolism pattern and its correlation with clinical Coma Recovery Scale-Revised (CRS-R) score in six HIE patients with prolonged DOC who had undergone 18F-deoxyglucose brain positron emission tomography scanning (FDG-PET). We also compared the differences in global metabolic connectivity patterns and the characteristics of several brain networks between HIE patients and healthy controls (HC). The metabolism of multiple brain regions decreased significantly in HIE patients, and the degree of local metabolic preservation was correlated with CRS-R score. The internal metabolic connectivity of occipital lobe and limbic system in HIE patients decreased, and their metabolic connectivity with frontal lobe, parietal lobe and temporal lobe also decreased. The metabolic connectivity patterns of default mode network, dorsal attention network, salience network, executive control network and subcortex network of HIE also changed compared with HC. The present study suggested that pattern of cerebral glucose metabolism and network connectivity of HIE patients with prolonged DOC were significantly different from those of healthy people.

Evaluation of Interleukin-6 for stepwise diagnosis of minimal hepatic encephalopathy in patients with liver cirrhosis

Evaluation of Interleukin-6 for stepwise diagnosis of minimal hepatic encephalopathy in patients with liver cirrhosis

FRI492 - A network meta-analysis of numbers needed to treat to prevent an episode of overt hepatic encephalopathy in patients with cirrhosis treated for at least 6 months with lactulose alone, or lactulose plus rifaximin-alpha

FRI492 - A network meta-analysis of numbers needed to treat to prevent an episode of overt hepatic encephalopathy in patients with cirrhosis treated for at least 6 months with lactulose alone, or lactulose plus rifaximin-alpha