Effects of nitric oxide inhibition by methylene blue in cirrhotic patients with ascites

Physiological network approach to prognosis in cirrhosis: A shifting paradigm

Decompensated liver disease is complicated by multi-organ failure and poor prognosis. The prognosis of patients with liver failure often dictates clinical management. Current prognostic models have focused on biomarkers considered as individual isolated units. Network physiology assesses the interactions among multiple physiological systems in health and disease irrespective of anatomical connectivity and defines the influence or dependence of one organ system on another. Indeed, recent applications of network mapping methods to patient data have shown improved prediction of response to therapy or prognosis in cirrhosis. Initially, different physical markers have been used to assess physiological coupling in cirrhosis including heart rate variability, heart rate turbulence, and skin temperature variability measures. Further, the parenclitic network analysis was recently applied showing that organ systems connectivity is impaired in patients with decompensated cirrhosis and can predict mortality in cirrhosis independent of current prognostic models while also providing valuable insights into the associated pathological pathways. Moreover, network mapping also predicts response to intravenous albumin in patients hospitalized with decompensated cirrhosis. Thus, this review highlights the importance of evaluating decompensated cirrhosis through the network physiologic prism. It emphasizes the limitations of current prognostic models and the values of network physiologic techniques in cirrhosis.

Does it mean anything if your own name is wrong in your published paper?

Journals instruct authors to proofread their accepted manuscripts before signing them off for publication and expect them to submit errata to correct any mistakes identified thereafter. Herein, I examine papers with obvious errors in the author name list. I queried PubMed for papers under common Greek forenames looking for citations where author surnames and forenames are swapped. I identified 113 such papers from 101 journals. Author names are corrected with errata only in 20, after a median of 6.5 mo. Time to name correction is shorter for journals with impact factor above the median (P=0.015). To further explore this suggested association of apparent author sloppiness with journal impact, I use as controls all errata published between 1996 and 2008 in 5 top-cited general medical journals (New England Journal of Medicine, JAMA, The Lancet, Annals of Internal Medicine, and British Medical Journal); 3.4% of the latter contain name corrections (vs. 18.1% of all errata in the 101 journals during the same period, P<10(-6)). Egregious errors may be markers of cursory if any proofreading and, therefore, markers for additional unidentified inaccuracies. In addition, I wonder whether authors may be as reluctant to rectify other, nonobvious (yet potentially consequential) mistakes after a paper's publication.

Advances in drug treatment of portal hypertension

Intrahepatic vascular resistance augmentation and portal blood flow increase are main mechanisms of portal hypertension. The former as an initial factor is mainly due to liver structure changes and motivity changes (reversible). It has been demonstrated that this reversible resistance can be reduced by 20%-30% with drugs. Portosystemic shunt or transjugular intrahepatic portosystemic shunt (TIPS) may induce many severe complications such as hepatic encephalopathy and stent re-obstruction. Therefore, researchers have performed plenty of experimental investigations about drug treatment of portal hypertension, and this article introduces their new advances in this field.

Portal hypertension

PURPOSE OF REVIEW

Significant advances in the pathophysiology, diagnosis and management of the complications of portal hypertension that have occurred in the last year are reported.

RECENT FINDINGS

The specific areas reviewed are those that refer to experimental studies aimed at modifying the factors that lead to portal hypertension (increased intrahepatic vascular resistance and splanchnic vasodilatation) and recent advances in the diagnosis and management of the complications of portal hypertension. The specific complications reviewed in this paper are varices and variceal bleeding (primary prophylaxis, treatment of the acute episode and secondary prophylaxis), ascites and hepatorenal syndrome, spontaneous bacterial peritonitis and hepatic encephalopathy, as well as recent studies of predictors of death in cirrhosis.

SUMMARY

Important studies, mostly prospective, regarding the management of the complications of portal hypertension are reviewed, including a trial of beta-blockers in the prevention of varices, a randomized trial of endoscopic variceal ligation plus nadolol in preventing recurrent variceal bleeding and several meta-analyses on trials comparing large-volume paracentesis with transjugular intrahepatic portosystemic shunt in the management of refractory ascites.