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Sample records for alcohol-related cirrhosis mediated

  1. Circulating granulocyte lifespan in compensated alcohol-related cirrhosis: a pilot study.

    PubMed

    Potts, Jonathan R; Farahi, Neda; Heard, Sarah; Chilvers, Edwin R; Verma, Sumita; Peters, Adrien M

    2016-09-01

    Although granulocyte dysfunction is known to occur in cirrhosis, in vivo studies of granulocyte lifespan have not previously been performed. The normal circulating granulocyte survival half-time (G - t½), determined using indium-111 ((111)In)-radiolabeled granulocytes, is ~7 h. In this pilot study, we aimed to measure the in vivo G - t½ in compensated alcohol-related cirrhosis. Sequential venous blood samples were obtained in abstinent subjects with alcohol-related cirrhosis over 24 h post injection (PI) of minimally manipulated (111)In-radiolabeled autologous mixed leukocytes. Purified granulocytes were isolated from each sample using a magnetic microbead-antibody technique positively selecting for the marker CD15. Granulocyte-associated radioactivity was expressed relative to peak activity, plotted over time, and G - t½ estimated from data up to 12 h PI This was compared with normal neutrophil half-time (N - t½), determined using a similar method specifically selecting neutrophils in healthy controls at a collaborating center. Seven patients with cirrhosis (six male, aged 57.8 ± 9.4 years, all Child-Pugh class A) and seven normal controls (three male, 64.4 ± 5.6 years) were studied. Peripheral blood neutrophil counts were similar in both groups (4.6 (3.5 - 5.5) × 10(9)/L vs. 2.8 (2.7 - 4.4) × 10(9)/L, respectively, P = 0.277). G - t½ in cirrhosis was significantly lower than N - t½ in controls (2.7 ± 0.5 h vs. 4.4 ± 1.0 h, P = 0.007). Transient rises in granulocyte and neutrophil-associated activities occurred in four patients from each group, typically earlier in cirrhosis (4-6 h PI) than in controls (8-10 h), suggesting recirculation of radiolabeled cells released from an unidentified focus. Reduced in vivo granulocyte survival in compensated alcohol-related cirrhosis is a novel finding and potentially another mechanism for immune dysfunction in chronic liver disease. Larger studies are needed to

  2. Rifaximin improves systemic hemodynamics and renal function in patients with alcohol-related cirrhosis and ascites.

    PubMed

    Kalambokis, Georgios N; Mouzaki, Athanasia; Rodi, Maria; Pappas, Konstantinos; Fotopoulos, Andreas; Xourgia, Xanthi; Tsianos, Epameinondas V

    2012-07-01

    Circulating levels of endotoxin, interleukin (IL)-6, and tumor necrosis factor (TNF)-α increase with intestinal bacterial overgrowth and translocation, and are believed to be involved in the pathogenesis of hyperdynamic circulatory syndrome and functional renal failure in patients with advanced cirrhosis. We investigated the effects of the antibiotic rifaximin on systemic hemodynamics and renal function in patients with alcohol-related cirrhosis and ascites. We measured mean arterial pressure, cardiac output (CO) by Doppler ultrasound, systemic vascular resistance (as the ratio of mean arterial pressure:CO), plasma renin activity, levels of plasma aldosterone, the glomerular filtration rate by plasma clearance of technetium-99m-DTPA, natriuresis, levels of plasma endotoxin, and serum levels of IL-6 and TNF-α in 13 patients at baseline and after 4 weeks of treatment with rifaximin. Rifaximin treatment significantly reduced CO and significantly increased systemic vascular resistance, in association with a significant decrease in plasma rennin activity. The therapy also significantly increased the glomerular filtration rate and natriuresis while reducing levels of endotoxin, IL-6, and TNF-α. Intestinal decontamination with rifaximin improved systemic hemodynamics and renal function in patients with advanced cirrhosis. PMID:22391344

  3. Alcohol craving and demand mediate the relation between posttraumatic stress symptoms and alcohol-related consequences.

    PubMed

    Tripp, Jessica C; Meshesha, Lidia Z; Teeters, Jenni B; Pickover, Alison M; McDevitt-Murphy, Meghan E; Murphy, James G

    2015-10-01

    Posttraumatic stress (PTS) symptoms are associated with alcohol-related consequences, but there is a need to understand mediators that may help explain the reasons for this relationship. Individuals with PTS may experience elevated craving and alcohol reward value (demand), which may contribute to risk for alcohol-related consequences. We examined relationships between PTS status, craving, alcohol demand, and alcohol-related consequences in PTS-positive (n = 64) and PTS-negative (n = 200) college students (M age = 21.7; 77% women; 54% Caucasian; 34% African American) who endorsed past-month alcohol use. We tested craving and alcohol demand as mediators of the relation between PTS status and alcohol-related consequences. Craving (B = .04, SE = .02, 95% CI [.01, .10]), demand intensity (B = .02, SE = .02, 95% CI [.001, .07]), and demand elasticity (B = .05, SE = .03, 95% CI [.006, .12]) significantly mediated the association between PTS symptoms and alcohol-related consequences. Craving remained a significant mediator in a multiple mediators model (B = .08, SE = .04, 95% CI [.03, .19]). Craving and alcohol demand may partially explain the relation between PTS status and alcohol-related consequences. Craving may be especially salient for individuals with PTS symptoms, as it may lead to more severe alcohol-related consequences even in the absence of elevated alcohol consumption. PMID:26375513

  4. A Mediational Model of Racial Discrimination and Alcohol-Related Problems Among African American College Students

    PubMed Central

    Boynton, Marcella H; O’Hara, Ross E; Covault, Jonathan; Scott, Denise; Tennen, Howard

    2014-01-01

    Objective: Racial discrimination has been identified as an important predictor of alcohol-related outcomes for African Americans. The goal of the current study was to extend previously found links between lifetime discrimination, alcohol use, and alcohol problems as well as to elucidate the affective mechanisms underlying these associations, as moderated by gender. Method: A multiple-groups structural equation model was computed using survey data collected from 619 students from a historically Black college/university. Results: The final model provided excellent fit to the data, explaining 6% of the variance in alcohol consumption and 37% of the variance in alcohol problems. Discrimination was a significant predictor of alcohol-related problems but not, by and large, level of use. For men, anger—but not discrimination-specific anger—was a significant partial mediator of the link between discrimination and both alcohol use and alcohol problems. Depression partially mediated the link between discrimination and alcohol problems for both men and women. Conclusions: The results suggest that, for African Americans whose drinking leads to drinking-related problems, discrimination and poor affective self-regulation are highly relevant and predictive factors, especially for men. PMID:24650816

  5. Involvement in Intimate Partner Psychological Abuse and Suicide Proneness in College Women: Alcohol Related Problems as a Potential Mediator

    PubMed Central

    Lamis, Dorian A.; Malone, Patrick S.; Langhinrichsen-Rohling, Jennifer

    2010-01-01

    This study examined the relations among involvement in intimate partner psychological abuse, alcohol-related problems, and suicide proneness as measured by the Life Attitudes Schedule – Short Form (LAS-SF) in college women (N = 709). Results revealed that, as expected, being involved in a psychologically abusive relationship was significantly and positively correlated with alcohol-related problems and alcohol-related problems were significantly and positively correlated with suicide proneness. Additionally, the intimate partner psychological abuse involvement-suicide proneness link was significantly mediated by alcohol-related problems. Implications are offered for the improved identification and treatment of young women at risk for suicidal and health-diminishing behaviors. PMID:20544000

  6. Stress and coping mediate relationships between contingent and global self-esteem and alcohol-related problems among college drinkers.

    PubMed

    Tomaka, Joe; Morales-Monks, Stormy; Shamaley, Angelee Gigi

    2013-08-01

    This study examined the hypotheses that contingent self-esteem would be positively associated with alcohol-related problems and that global self-esteem would be negatively associated with such problems. It also examined the hypothesis that high stress and maladaptive coping would mediate these relationships. A sample of college students (n = 399) who were predominantly Hispanic (89%) completed measures of global and contingent self-esteem; stress and coping; and alcohol-related problems. Correlational and latent variable analyses indicated that contingent self-esteem positively related to alcohol-related problems, with maladaptive coping mediating this relationship. In contrast, global self-esteem negatively related to such problems, a relationship that was also mediated by maladaptive coping and stress. Overall, the results highlight the potentially harmful consequences of contingent self-worth and the adaptive nature of non-contingent self-esteem. They also demonstrate the important role that coping plays in mediating self-esteem's associations with alcohol-related problems. PMID:22930540

  7. Cirrhosis

    MedlinePlus

    Cirrhosis is scarring of the liver. Scar tissue forms because of injury or long-term disease. Scar ... the blood, help digest food and store energy. Cirrhosis can lead to Easy bruising or bleeding, or ...

  8. The Role of Alcohol Perceptions as Mediators Between Personality and Alcohol-Related Outcomes Among Incoming College-Student Drinkers

    PubMed Central

    Hustad, John T. P.; Pearson, Matthew R.; Neighbors, Clayton; Borsari, Brian

    2014-01-01

    After high school, college students escalate their drinking at a faster rate than their noncollege-attending peers, and alcohol use in high school is one of the strongest predictors of alcohol use in college. Therefore, an improved understanding of the role of predictors of alcohol use during the critical developmental period when individuals transition to college has direct clinical implications to reduce alcohol-related harms. We used path analysis in the present study to examine the predictive effects of personality (e.g., impulsivity, sensation seeking, hopelessness, and anxiety sensitivity) and three measures of alcohol perception: descriptive norms, injunctive norms, and perceptions regarding the perceived role of drinking in college on alcohol-related outcomes. Participants were 490 incoming freshmen college students. Results indicated that descriptive norms, injunctive norms, and the role of drinking largely mediated the effects of personality on alcohol outcomes. In contrast, both impulsivity and hopelessness exhibited direct effects on alcohol-related problems. The perceived role of drinking was a particularly robust predictor of outcomes and mediator of the effects of personality traits, including sensation seeking and impulsivity on alcohol outcomes. The intertwined relationships observed in this study between personality factors, descriptive norms, injunctive norms, and the role of drinking highlight the importance of investigating these predictors simultaneously. Findings support the implementation of interventions that target these specific perceptions about the role of drinking in college. PMID:24467197

  9. Cirrhosis

    MedlinePlus

    Liver cirrhosis; Chronic liver disease; End-stage liver disease ... Cirrhosis is the end result of chronic liver damage caused by chronic liver disease. Common causes of chronic liver disease in the United States are: Hepatitis B or hepatitis C infection ...

  10. Social anxiety and alcohol-related impairment: The mediational impact of solitary drinking.

    PubMed

    Buckner, Julia D; Terlecki, Meredith A

    2016-07-01

    Social anxiety disorder more than quadruples the risk of developing an alcohol use disorder, yet it is inconsistently linked to drinking frequency. Inconsistent findings may be at least partially due to lack of attention to drinking context - it may be that socially anxious individuals are especially vulnerable to drinking more often in specific contexts that increase their risk for alcohol-related problems. For instance, socially anxious persons may drink more often while alone, before social situations for "liquid courage" and/or after social situations to manage negative thoughts about their performance. Among current (past-month) drinkers (N=776), social anxiety was significantly, positively related to solitary drinking frequency and was negatively related to social drinking frequency. Social anxiety was indirectly (via solitary drinking frequency) related to greater past-month drinking frequency and more drinking-related problems. Social anxiety was also indirectly (via social drinking frequency) negatively related to past-month drinking frequency and drinking-related problems. Findings suggest that socially anxious persons may be vulnerable to more frequent drinking in particular contexts (in this case alone) and that this context-specific drinking may play an important role in drinking problems among these high-risk individuals. PMID:26894561

  11. Personality and alcohol-related outcomes among mandated college students: descriptive norms, injunctive norms, and college-related alcohol beliefs as mediators.

    PubMed

    Pearson, Matthew R; Hustad, John T P

    2014-05-01

    The present study examined three alcohol-perception variables (descriptive norms, injunctive norms, and college-related alcohol beliefs) as mediators of the predictive effects of four personality traits (impulsivity, sensation seeking, anxiety sensitivity, and hopelessness) on alcohol use and alcohol-related consequences in a sample of mandated college students (n=875). Our findings replicated several findings of a previous study of incoming freshman college students (Hustad et al., in press) in that impulsivity and hopelessness had direct effects on alcohol-related problems, sensation seeking and impulsivity had indirect effects on alcohol-related outcomes via college-related alcohol beliefs, and college-related alcohol beliefs predicted both alcohol use and alcohol-related problems. We discuss the implications of our findings for global college student interventions as well as personality-targeted interventions. PMID:24589869

  12. College drinking behaviors: mediational links between parenting styles, impulse control, and alcohol-related outcomes.

    PubMed

    Patock-Peckham, Julie A; Morgan-Lopez, Antonio A

    2006-06-01

    Mediational links between parenting styles (authoritative, authoritarian, permissive), impulsiveness (general control), drinking control (specific control), and alcohol use and abuse were tested. A pattern-mixture approach (for modeling non-ignorable missing data) with multiple-group structural equation models with 421 (206 female, 215 male) college students was used. Gender was examined as a potential moderator of parenting styles on control processes related to drinking. Specifically, the parent-child gender match was found to have implications for increased levels of impulsiveness (a significant mediator of parenting effects on drinking control). These findings suggest that a parent with a permissive parenting style who is the same gender as the respondent can directly influence control processes and indirectly influence alcohol use and abuse. PMID:16784353

  13. Cirrhosis

    MedlinePlus

    ... alcohol use or obesity, and symptoms. A health care provider may test for cirrhosis based on the presence of these ... health care provider finds the disease early. Health care providers use blood tests, ultrasound, or both to screen for liver cancer ...

  14. Mediational Links Among Parenting Styles, Perceptions of Parental Confidence, Self-Esteem, and Depression on Alcohol-Related Problems in Emerging Adulthood*

    PubMed Central

    Patock-Peckham, Julie A.; Morgan-Lopez, Antonio A.

    2009-01-01

    Objective: Depression is often found to be comorbid with alcohol-related problems. Parental overprotection, which may be of particular importance during emerging adulthood, has been linked to internalizing symptoms in offspring. This article evaluates the impact of parenting styles and parental confidence in their offspring on an internalizing pathway to alcohol-related problems through self-esteem and depression. Method: Mediational links were tested among parenting styles (authoritative, authoritarian, permissive), parental confidence (overprotection, autonomy), self-esteem, depression, and alcohol-related problems. A two-group, multiple indicator multiple-cause structural equation model with 441 (216 female, 225 male) college students was examined. Results: Overall, having a father who was confident in his child's ability to make autonomous decisions was protective against depression for both genders. Perceptions of paternal autonomy mediated the impact of the fathers' parenting styles (authoritative, permissive) on depression for both genders. For men, parental overprotection mediated the impact of an authoritarian father on self-esteem, and self-esteem mediated the impact of parental overprotection on depression. Moreover, among men, perceptions of maternal autonomy mediated the impact of the mothers' parenting styles (authoritative, permissive) on self-esteem, and self-esteem mediated the impact of maternal autonomy on depression. Conclusions: The current pattern of findings is distinct from pathways through behavioral undercontrol with influences from the same-sex parent for both genders. These findings indicate that parenting may have differential influences on internalizing pathways to alcohol-related problems. PMID:19261233

  15. Alcohol-Related Problems and Risk of Suicide among College Students: The Mediating Roles of Belongingness and Burdensomeness

    ERIC Educational Resources Information Center

    Lamis, Dorian A.; Malone, Patrick S.

    2011-01-01

    The relationship among alcohol-related problems, perceived burdensomeness, thwarted belongingness, and suicide proneness in undergraduate college students (N = 996) was examined. As hypothesized, alcohol-related problems, perceived burdensomeness, and thwarted belongingness were all significantly and positively correlated with suicide proneness.…

  16. The gender specific mediational pathways between parenting styles, neuroticism, pathological reasons for drinking, and alcohol-related problems in emerging adulthood.

    PubMed

    Patock-Peckham, Julie A; Morgan-Lopez, Antonio A

    2009-03-01

    Mediational links between parenting styles, neuroticism, pathological reasons for drinking, alcohol use and alcohol-related problems were tested. A two-group SEM path model with 441 (216 female, 225 male) college students was examined. In general, pathological reasons for drinking mediated the impact of neuroticism on alcohol use and alcohol-related problems. A different pattern of relationships was found for each of the two genders. Perceptions of having an authoritarian father were positively linked to higher levels of neuroticism among males but this pattern was not found among females. For males, neuroticism mediated the impact of having an authoritarian father on pathological reasons for drinking with pathological reasons for drinking mediating the impact of neuroticism on alcohol-related problems. Perceptions of having a permissive father were linked to lower levels of neuroticism in females (but have been found as a consistent risk factor for other pathways to alcohol use elsewhere). Compared with other work in this area, these findings indicate parental influences regarding vulnerabilities for alcohol use may be specific to parent-child gender matches for some pathways and specific to one parent (irrespective of child gender) for other pathways. PMID:19000941

  17. Alcohol Expectancies Mediate and Moderate the Associations between Big Five Personality Traits and Adolescent Alcohol Consumption and Alcohol-Related Problems

    PubMed Central

    Ibáñez, Manuel I.; Camacho, Laura; Mezquita, Laura; Villa, Helena; Moya-Higueras, Jorge; Ortet, Generós

    2015-01-01

    Personality and expectancies are relevant psychological factors for the development of adolescent alcohol use and misuse. The present study examined their direct, mediated and moderated effects on different drinking behaviors in adolescence. Personality domains of the five-factor model, positive and negative alcohol expectancies (AEs), alcohol use during the week and the weekend, and alcohol-related problems were assessed in a sample of 361 adolescents. Different personality dimensions were directly associated with specific alcohol outcomes: Extraversion, low Conscientiousness and low Openness were associated with weekend alcohol use; low Agreeableness was related to weekday use; whereas low Agreeableness, low Conscientiousness and Extraversion were associated with alcohol-related problems. In addition, positive AEs mediated the relationship between Extraversion and alcohol use, whereas both positive and negative expectancies mediated the association between Neuroticism and alcohol consumption and alcohol-related problems. Finally, both types of expectancies interacted with Extraversion to predict alcohol problems. Our results highlight the importance of examining the complex interplay of comprehensive personality models and AEs to gain a better understanding of the development of different alcohol use and misuse patterns in adolescence. PMID:26635714

  18. ECONOMIC STRESSORS AND ALCOHOL-RELATED OUTCOMES: EXPLORING GENDER DIFFERENCES IN THE MEDIATING ROLE OF SOMATIC COMPLAINTS

    PubMed Central

    BROWN, ROBYN LEWIS; RICHMAN, JUDITH A.; ROSPENDA, KATHLEEN M.

    2015-01-01

    This study examined processes linking economic stressors, somatic complaints, and two alcohol-related outcomes (past-month drinking and problematic drinking). Structural equation models of data from a national survey revealed that somatic complaints partly explain the association between economic stressors and problematic drinking. The associations of both economic stressors and somatic complaints with problematic drinking were significantly greater for men than women. However, the association between economic stressors and somatic complaints was greater for women. These findings clarify the circumstances in which gender matters most for the associations among economy-related stressors, somatic complaints, and drinking. They highlight the significance of difficult economic circumstances for physical health and, in turn, problematic drinking – particularly among men. PMID:25310370

  19. Alcohol-Related Liver Disease

    MedlinePlus

    ... to run events. Please support us. Donate | Volunteer Alcohol-Related Liver Disease Discussion on Inspire Support Community ... Liver > Liver Disease Information > Alcohol-Related Liver Disease Alcohol-Related Liver Disease Explore this section to learn ...

  20. Mortality from alcohol related disease in Italy.

    PubMed Central

    La Vecchia, C; Decarli, A; Mezzanotte, G; Cislaghi, C

    1986-01-01

    Trends in death certification rates from the five major alcohol related causes of death in Italy (cancers of the mouth or pharynx, oesophagus, larynx, liver and cirrhosis of the liver) were analysed over a period (1955-79) in which per capita alcohol consumption almost trebled. Age standardised mortality from liver cirrhosis almost doubled in males and increased over 70% in females. In males, mortality from cancers of the upper digestive or respiratory tract showed increases of between 27% and 44%, and liver cancer increased by over 100%. In the late 1970s, the four alcohol related cancer sites accounted for about 12% of all cancer deaths in males and 4.5% in females. Mortality from liver cirrhosis alone accounted for 4.8% of all deaths in males (9.2% of manpower years lost) and 2.3% in females (6.3% manpower years lost) in females. These figures were even higher in selected areas of north eastern Italy, where alcohol consumption is greater. In absolute terms, the upward trends observed correspond to about 10,000 excess deaths per year in the late 1970s compared with rates observed two decades earlier and are thus second only to the increase in tobacco related causes of death over the same calendar period. PMID:3772284

  1. Hrd1 suppresses Nrf2-mediated cellular protection during liver cirrhosis

    PubMed Central

    Wu, Tongde; Zhao, Fei; Gao, Beixue; Tan, Can; Yagishita, Naoko; Nakajima, Toshihiro; Wong, Pak K.; Chapman, Eli; Fang, Deyu; Zhang, Donna D.

    2014-01-01

    Increased endoplasmic reticulum (ER) stress and reactive oxygen species (ROS) are the salient features of end-stage liver diseases. Using liver tissues from liver cirrhosis patients, we observed up-regulation of the XBP1–Hrd1 arm of the ER stress response pathway and down-regulation of the Nrf2-mediated antioxidant response pathway. We further confirmed this negative regulation of Nrf2 by Hrd1 using Hrd1 conditional knockout mice. Down-regulation of Nrf2 was a surprising result, since the high levels of ROS should have inactivated Keap1, the primary ubiquitin ligase regulating Nrf2 levels. Here, we identified Hrd1 as a novel E3 ubiquitin ligase responsible for compromised Nrf2 response during liver cirrhosis. In cirrhotic livers, activation of the XBP1–Hrd1 arm of ER stress transcriptionally up-regulated Hrd1, resulting in enhanced Nrf2 ubiquitylation and degradation and attenuation of the Nrf2 signaling pathway. Our study reveals not only the convergence of ER and oxidative stress response pathways but also the pathological importance of this cross-talk in liver cirrhosis. Finally, we showed the therapeutic importance of targeting Hrd1, rather than Keap1, to prevent Nrf2 loss and suppress liver cirrhosis. PMID:24636985

  2. [Alcohol-related dementia].

    PubMed

    Matsui, Toshifumi; Yokoyama, Akira; Matsushita, Sachio; Kozaki, Koichi; Higuchi, Susumu

    2014-04-01

    Excessive alcohol use is associated with health problems for the elderly in combination with their chronic conditions. One such complication, alcohol-related dementia (ARD) is brought about by direct or indirect ethanol intoxication, and coexisting nutritional deficiency, liver disease, cerebrovascular disease and traumatic brain injury. The elderly people with ARD have been underestimated and underdiagnosed. In these older alcoholics, atrophic changes, lacunar infarcts and deep white matter lesions of the brain are evident and are associated not only with their cognitive decline, but also with their frailty, leading to high morbidity and mortality ratio. Although lifelong abstinence can recover patients with ARD to temporally lull, aging, the severity of alcohol dependence, and the concomitant nutritional, physical and environmental factors can all impact negatively their outcome. Therefore, a comprehensive approach to lifestyle factors is recommended so that they can minimize preventable risks and maintain health status. Nursing home placement may be an appropriate treatment option for some refractory, long-term patients with ARD. PMID:24796110

  3. Affordability of alcohol and alcohol-related mortality in Belarus.

    PubMed

    Razvodovsky, Yury E

    2013-01-01

    Alcohol abuse has numerous adverse health and social consequences. The consumer response to changes in alcohol affordability is an important issue on alcohol policy debates. Studies from many countries have shown an inverse relationship between alcohol prices and alcohol consumption in the population. There are, however, suggestions that increasing the price of alcohol by rising taxes may have limited effect on alcohol-related problems, associated with long-term heavy drinking. The aim of the present study was to evaluate the relationship between alcohol affordability and alcohol-related mortality rates in post-Soviet Belarus. For this purpose trends in alcohol-related mortality rates (mortality from liver cirrhosis, pancreatitis, alcoholism and alcohol psychoses) and affordability of vodka between 1990 and 2010 were compared. The time series analysis revealed that 1% increase in vodka affordability is associated with an increase in liver cirrhosis mortality of 0,77%, an increase in pancreatitis mortality of 0.53%, an increase in mortality from alcoholism and alcohol psychoses of 0,70%. The major conclusion emerging from this study is that affordability of alcohol is one of the most important predictor of alcohol-related problems in a population. These findings provide additional evidence that decreasing in affordability of alcohol is an effective strategy for reducing alcohol consumption and alcohol-related harm. PMID:23748944

  4. Nanoparticle Based Delivery of Quercetin for the Treatment of Carbon Tetrachloride Mediated Liver Cirrhosis in Rats.

    PubMed

    Verma, Shashi Kant; Rastogil, Shweta; Arora, Indu; Javed, Kalim; Akhtar, Mohd; Samim, Mohd

    2016-02-01

    Liver fibrosis is the common response to chronic liver injury and ultimately leads to cirrhosis. There is a pressing need in the pharmaceutical industry to develop efficient well-targeted drug delivery systems, which are lacking to date. This study was designed to investigate the efficacy of a nanoquercetin NQ; i.e., quercetin encapsulated in PAG (p-aminophenyl-1-thio-β-D-galactopryranoside)-coated NIPAAM (N-isopropyl acrylamide) nanopolymer in liver compared with naked quercetin (Q) using a carbon tetrachloride (CCl₄)-mediated liver cirrhosis model. NQ was more effective at restoring liver membrane integrity as indicated by significantly reduced serum markers, including Alanine Transaminase (ALT), Aspartate Aminotransferase (AST), Alkaline Phosphatase (ALP) and Lactate Dehydrogenase (LDH), compared with naked Q. The findings of reduced collagen and histopathology also show that the NQ effects were much better than those of naked Q. Biochemical parameters, including antioxidant defense enzymes, also provide supporting evidence. Furthermore, the decrease in NF-κB and NOS-2 expression in the NQ-treated groups was also much stronger than in the naked Q-treated group. Thus, the data clearly suggest that NQ not only provides significant hepatoprotection compared with naked Q, but it also substantially lowered the required concentration (1,000 to 10,000-fold lower) by increasing the bioavailability. PMID:27305761

  5. Alcohol-Related Problems in High-Risk Groups. EURO Reports and Studies 109. Report on a WHO Study.

    ERIC Educational Resources Information Center

    Plant, Martin, Ed.

    Alcohol consumption has risen dramatically in many countries since the Second World War. Accompanying this rise has been a rise in alcohol-related problems, including liver cirrhosis mortality, alcohol dependence, and alcohol-related crimes and accidents. Alcohol misuse presents huge health, social, and legal problems throughout most of Europe and…

  6. Human alcohol-related neuropathology

    PubMed Central

    Kril, Jillian J.

    2015-01-01

    Alcohol-related diseases of the nervous system are caused by excessive exposures to alcohol, with or without co-existing nutritional or vitamin deficiencies. Toxic and metabolic effects of alcohol (ethanol) vary with brain region, age/developmental stage, dose, and duration of exposures. In the mature brain, heavy chronic or binge alcohol exposures can cause severe debilitating diseases of the central and peripheral nervous systems, and skeletal muscle. Most commonly, long-standing heavy alcohol abuse leads to disproportionate loss of cerebral white matter and impairments in executive function. The cerebellum (especially the vermis), cortical-limbic circuits, skeletal muscle, and peripheral nerves are also important targets of chronic alcohol-related metabolic injury and degeneration. Although all cell types within the nervous system are vulnerable to the toxic, metabolic, and degenerative effects of alcohol, astrocytes, oligodendrocytes, and synaptic terminals are major targets, accounting for the white matter atrophy, neural inflammation and toxicity, and impairments in synaptogenesis. Besides chronic degenerative neuropathology, alcoholics are predisposed to develop severe potentially life-threatening acute or subacute symmetrical hemorrhagic injury in the diencephalon and brainstem due to thiamine deficiency, which exerts toxic/metabolic effects on glia, myelin, and the microvasculature. Alcohol also has devastating neurotoxic and teratogenic effects on the developing brain in association with fetal alcohol spectrum disorder/fetal alcohol syndrome. Alcohol impairs function of neurons and glia, disrupting a broad array of functions including neuronal survival, cell migration, and glial cell (astrocytes and oligodendrocytes) differentiation. Further progress is needed to better understand the pathophysiology of this exposure-related constellation of nervous system diseases and better correlate the underlying pathology with in vivo imaging and biochemical lesions

  7. Human alcohol-related neuropathology.

    PubMed

    de la Monte, Suzanne M; Kril, Jillian J

    2014-01-01

    Alcohol-related diseases of the nervous system are caused by excessive exposures to alcohol, with or without co-existing nutritional or vitamin deficiencies. Toxic and metabolic effects of alcohol (ethanol) vary with brain region, age/developmental stage, dose, and duration of exposures. In the mature brain, heavy chronic or binge alcohol exposures can cause severe debilitating diseases of the central and peripheral nervous systems, and skeletal muscle. Most commonly, long-standing heavy alcohol abuse leads to disproportionate loss of cerebral white matter and impairments in executive function. The cerebellum (especially the vermis), cortical-limbic circuits, skeletal muscle, and peripheral nerves are also important targets of chronic alcohol-related metabolic injury and degeneration. Although all cell types within the nervous system are vulnerable to the toxic, metabolic, and degenerative effects of alcohol, astrocytes, oligodendrocytes, and synaptic terminals are major targets, accounting for the white matter atrophy, neural inflammation and toxicity, and impairments in synaptogenesis. Besides chronic degenerative neuropathology, alcoholics are predisposed to develop severe potentially life-threatening acute or subacute symmetrical hemorrhagic injury in the diencephalon and brainstem due to thiamine deficiency, which exerts toxic/metabolic effects on glia, myelin, and the microvasculature. Alcohol also has devastating neurotoxic and teratogenic effects on the developing brain in association with fetal alcohol spectrum disorder/fetal alcohol syndrome. Alcohol impairs function of neurons and glia, disrupting a broad array of functions including neuronal survival, cell migration, and glial cell (astrocytes and oligodendrocytes) differentiation. Further progress is needed to better understand the pathophysiology of this exposure-related constellation of nervous system diseases and better correlate the underlying pathology with in vivo imaging and biochemical lesions

  8. Pathogenesis of liver cirrhosis

    PubMed Central

    Zhou, Wen-Ce; Zhang, Quan-Bao; Qiao, Liang

    2014-01-01

    Liver cirrhosis is the final pathological result of various chronic liver diseases, and fibrosis is the precursor of cirrhosis. Many types of cells, cytokines and miRNAs are involved in the initiation and progression of liver fibrosis and cirrhosis. Activation of hepatic stellate cells (HSCs) is a pivotal event in fibrosis. Defenestration and capillarization of liver sinusoidal endothelial cells are major contributing factors to hepatic dysfunction in liver cirrhosis. Activated Kupffer cells destroy hepatocytes and stimulate the activation of HSCs. Repeated cycles of apoptosis and regeneration of hepatocytes contribute to pathogenesis of cirrhosis. At the molecular level, many cytokines are involved in mediation of signaling pathways that regulate activation of HSCs and fibrogenesis. Recently, miRNAs as a post-transcriptional regulator have been found to play a key role in fibrosis and cirrhosis. Robust animal models of liver fibrosis and cirrhosis, as well as the recently identified critical cellular and molecular factors involved in the development of liver fibrosis and cirrhosis will facilitate the development of more effective therapeutic approaches for these conditions. PMID:24966602

  9. Cirrhosis - discharge

    MedlinePlus

    ... to your stomach) Placement of a tube or shunt ( TIPS or TIPSS ) to help prevent too much ... varices Cirrhosis Primary biliary cirrhosis Transjugular intrahepatic portosystemic shunt (TIPS) Patient Instructions How to read food labels ...

  10. Alcohol-Related Problems of Older Persons.

    ERIC Educational Resources Information Center

    Staples, Pamela A.

    The study of older adults is relatively new for the social sciences. There is a growing awareness of the alcohol-related problems in this population. Between 2 and 10 percent of older social drinkers present severe alcohol-related problems of different kinds. Three terms describe the major consequences of "too much" alcohol: intoxication,…

  11. Susceptibility to alcohol-related liver injury.

    PubMed

    Lieber, C S

    1994-01-01

    Alcohol affects the liver through metabolic disturbances associated with its oxidation. Redox changes produced by the hepatic alcohol dehydrogenase pathway affect lipid, carbohydrate and protein metabolism. Ethanol is also oxidized in liver microsomes by the ethanol-inducible cytochrome P4502E1, resulting in ethanol tolerance and selective hepatic perivenular damage. Furthermore, P4502E1 activates various xenobiotics, explaining the increased susceptibility of the heavy drinker to the toxicity of anesthetics, commonly used medications (i.e. isoniazid), analgesics (i.e. acetaminophen), and chemical carcinogens. Induction of microsomal enzymes also contributes to vitamin A depletion, enhances its hepatotoxicity and results in increased acetaldehyde generation from ethanol, with formation of protein adducts, glutathione depletion, free-radical-mediated toxicity, and lipid peroxidation. Chronic ethanol consumption strikingly enhances the number of hepatic collagen-producing activated lipocytes. Both in vivo (in our baboon model of alcoholic cirrhosis) and in vitro (in cultured myofibroblasts and activated lipocytes) ethanol and/or its metabolite acetaldehyde increase collagen accumulation and mRNA for collagen. Gender differences are related, in part, to lower gastric ADH activity (with consequent reduction of first pass ethanol metabolism) in young women, decreased hepatic fatty acid binding protein and increased free-fatty acid levels as well as lesser omega-hydroxylation, all of which result in increased vulnerability to ethanol. Elucidation of the biochemical effects of ethanol are now resulting in improved therapy: in baboons, S-adenosyl-L-methionine attenuates the ethanol-induced glutathione depletion and associated mitochondrial lesions, and polyenylphosphatidylcholine opposes the ethanol-induced hepatic phospholipid depletion, the decrease in phosphatidylethanolamine methyltransferase activity and the activation of hepatic lipocytes, with full prevention of

  12. [Alcohol-related problems in Cantabria].

    PubMed

    Gutiérrez Pérez, A M; Díez Manrique, J F; Peña Martín, C; García Usieto, E

    1995-01-01

    It is a cross sectorial epidemiological community survey into a random sample of 1,816 adult people. The objetivo of our work is to test the existence of some social-demographic variables that can be accumulated to the existence of alcohol related problems. We found that the men, the young people, with low socioeconomic level, and semiurban style of life have the highest risk of alcohol related problems. 48% of the sample men have recognized any alcohol related problems during the previous year to our study. The highest problem prevalence is associated to increased alcohol consumption. After all, there are many people with low alcohol consumption who have alcohol related problems. PMID:7717148

  13. Alcohol Related Birth Defects: Implications for Education.

    ERIC Educational Resources Information Center

    Lamanna, Michael

    1982-01-01

    Discusses background and nature of alcohol-related birth defects. Describes a continuum of impairment to offspring of drinking mothers that is dose-related and produces serious behavioral/learning deficits. The continuum includes young people of normal intelligence who perform below expected levels and find school adjustment difficult. Offers…

  14. Inequalities in Alcohol-Related Mortality in 17 European Countries: A Retrospective Analysis of Mortality Registers

    PubMed Central

    Mackenbach, Johan P.; Kulhánová, Ivana; Bopp, Matthias; Borrell, Carme; Deboosere, Patrick; Kovács, Katalin; Looman, Caspar W. N.; Leinsalu, Mall; Mäkelä, Pia; Martikainen, Pekka; Menvielle, Gwenn; Rodríguez-Sanz, Maica; Rychtaříková, Jitka; de Gelder, Rianne

    2015-01-01

    Background Socioeconomic inequalities in alcohol-related mortality have been documented in several European countries, but it is unknown whether the magnitude of these inequalities differs between countries and whether these inequalities increase or decrease over time. Methods and Findings We collected and harmonized data on mortality from four alcohol-related causes (alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental poisoning by alcohol) by age, sex, education level, and occupational class in 20 European populations from 17 different countries, both for a recent period and for previous points in time, using data from mortality registers. Mortality was age-standardized using the European Standard Population, and measures for both relative and absolute inequality between low and high socioeconomic groups (as measured by educational level and occupational class) were calculated. Rates of alcohol-related mortality are higher in lower educational and occupational groups in all countries. Both relative and absolute inequalities are largest in Eastern Europe, and Finland and Denmark also have very large absolute inequalities in alcohol-related mortality. For example, for educational inequality among Finnish men, the relative index of inequality is 3.6 (95% CI 3.3–4.0) and the slope index of inequality is 112.5 (95% CI 106.2–118.8) deaths per 100,000 person-years. Over time, the relative inequality in alcohol-related mortality has increased in many countries, but the main change is a strong rise of absolute inequality in several countries in Eastern Europe (Hungary, Lithuania, Estonia) and Northern Europe (Finland, Denmark) because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries, alcohol-related causes now account for 10% or more of the socioeconomic inequality in total mortality. Because our study relies on routinely collected underlying causes of

  15. Countermeasures for Reducing Alcohol-Related Crashes.

    PubMed

    Voas, R B

    2000-01-01

    Programs to prevent alcohol-related crashes occur at several levels. Although most of the public thinks of drunk-driving prevention only in terms of the criminal justice system, much can be done to prevent alcohol-related highway deaths before the drinking-and-driving offender gets on the road. In recent years, the field of alcohol safety has merged with the area of public health concerned with preventing alcohol- and drug-related traumatic injury and death. This paper provides an overview of the status of road safety programs directed at reducing impaired driving. It covers ten topics falling into the three levels of prevention: primary programs to reduce alcohol consumption; secondary programs to prevent driving after drinking; and tertiary programs to prevent recidivism among convicted drinking drivers. PMID:26256029

  16. [Toxic cirrhosis].

    PubMed

    Kawasaki, H; Murawaki, Y; Yamada, S; Yamamoto, T

    1994-01-01

    Carbon tetrachloride induces diffuse fatty degeneration and centrilobular necrosis in the liver and the severity of liver injury is roughly proportional to the dosage administered. Nonetheless, the incidence of cirrhosis by this agent is rare. Several drugs, including methyldopa, methotrexate, isoniazid and vitamin A, have occasionally been reported to cause chronic active hepatitis, fibrosis and cirrhosis. There is no question that continued administration of the drug in the presence of clinically apparent hepatitis can lead to chronic active hepatitis, fibrosis and cirrhosis. Early recognition that a therapeutic drug is the probable cause of liver injury, followed by prompt withdrawal of such a drug, generally suffices in the management of drug-induced chronic liver disease. PMID:8114307

  17. Alcohol-related Cues Promote Automatic Racial Bias.

    PubMed

    Stepanova, Elena V; Bartholow, Bruce D; Saults, J Scott; Friedman, Ronald S

    2012-07-01

    Previous research has shown that alcohol consumption can increase the expression of race bias by impairing control-related processes. The current study tested whether simple exposure to alcohol-related images can also increase bias, but via a different mechanism. Participants viewed magazine ads for either alcoholic or nonalcoholic beverages prior to completing Payne's (2001) Weapons Identification Task (WIT). As predicted, participants primed with alcohol ads exhibited greater race bias in the WIT than participants primed with neutral beverages. Process dissociation analyses indicated that these effects were due to automatic (relative to controlled) processes having a larger influence on behavior among alcohol-primed relative to neutral-primed participants. Structural equation modeling further showed that the alcohol-priming effect was mediated by increases in the influence of automatic associations on behavior. These data suggest an additional pathway by which alcohol can potentially harm inter-racial interactions, even when no beverage is consumed. PMID:22798699

  18. IQ and alcohol-related morbidity and mortality among Swedish men and women: the importance of socioeconomic position

    PubMed Central

    Sjölund, Sara; Hemmingsson, Tomas; Gustafsson, Jan-Eric; Allebeck, Peter

    2015-01-01

    Aims To investigate the association between intelligence in childhood and later risk of alcohol-related disease and death by examining (1) the mediating effect of social position as an adult and (2) gender as a possible moderator. Design Cohort study. Setting and participants 21 809 Swedish men and women, born in 1948 and 1953, from the Swedish “Evaluation Through Follow-up” database were followed until 2006/2007. Measurements IQ was measured in school at the age of 13 and alcohol-related disease and death (International Classification of Disease codes) were followed from 1971 and onwards. Findings We found an increased crude HR of 1.23 (95% CI 1.18 to 1.29) for every decrease in group of IQ test results for alcohol-related admissions and 1.14 (95% CI 1.04 to 1.24) for alcohol-related death. Social position as an adult was found to mediate both outcomes. Gender was not found to moderate the association. However, adjusting for socioeconomic position lowered the risk more among men than among women. Conclusions There was an inverse, graded association between IQ and alcohol-related disease and death, which at least partially was mediated by social position as an adult. For alcohol-related death, complete mediation by socioeconomic position as an adult was found. Gender does not moderate this association. The role of socioeconomic position may differ between the genders. PMID:26163557

  19. The green eyed monster in the bottle: Relationship contingent self-esteem, romantic jealousy, and alcohol-related problems.

    PubMed

    DiBello, Angelo M; Rodriguez, Lindsey M; Hadden, Benjamin W; Neighbors, Clayton

    2015-10-01

    Previous research suggests that both jealousy and relationship contingent self-esteem (RCSE) are related to alcohol use and alcohol-related problems. No work, however, has examined these two constructs together as they relate to motives for alcohol use and alcohol-related problems. The current study aims to build upon emerging literature examining different types of jealousy (i.e., emotional, cognitive, and behavioral), relationship quality (i.e., satisfaction, commitment, closeness), RCSE, and alcohol use. More specifically, the current study aimed to examine the associations between RCSE and drinking to cope and RCSE and alcohol-related problems, in the context of the different types of jealousy. Moreover, the current study aimed to assess whether the associations between RCSE, jealousy, and drinking outcomes vary as a function of relationship quality. Two hundred and seventy seven individuals (87% female) at a large southern university participated in the study. They completed measures of RCSE, relationship satisfaction, commitment, closeness, and jealousy as well as alcohol-related outcomes. Using PROCESS, moderated mediational analyses were used to evaluate different types of jealousy as mediators of the association between RCSE and drinking to cope/alcohol-related problems. Further, we aimed to examine whether relationship quality moderated the association between RCSE and jealousy in predicting alcohol-related variables. Results indicated that cognitive jealousy mediated the association between both RCSE and drinking to cope and RCSE and alcohol-related problems. Further, relationship satisfaction, commitment, and closeness were all found to moderate the association between RSCE and cognitive jealousy such that at lower, but not higher levels of satisfaction, commitment, and closeness, cognitive jealousy mediated the association between RCSE and drinking to cope and RCSE and alcohol-related problems. PMID:26046402

  20. Liver cirrhosis.

    PubMed Central

    Williams, E. J.; Iredale, J. P.

    1998-01-01

    Liver fibrosis and its related complications continue to represent a significant worldwide healthcare burden. Over the past decade there has been considerable improvement in our understanding of the cellular mechanisms and pathophysiology underlying hepatic fibrosis. This greater insight into the relevant basic sciences may lead to the development of novel treatment strategies designed to block the fibrogenic cascade or even enhance matrix degradation. In addition, there have been significant advances in the management of the complications of cirrhosis, with specific treatments now available for some conditions. Perhaps most notably, liver transplantation is now a highly successful treatment for end-stage liver disease and should be considered in all patients with chronic liver disease. PMID:9683971

  1. PTSD Symptoms, Emotion Dysregulation, and Alcohol-Related Consequences Among College Students with a Trauma History

    PubMed Central

    Tripp, Jessica C.; McDevitt-Murphy, Meghan E.; Avery, Megan L.; Bracken, Katherine L.

    2015-01-01

    Objective Posttraumatic stress disorder (PTSD), alcohol use, and alcohol-related consequences have been linked to emotion dysregulation. Sex differences exist in both emotion regulation dimensions and alcohol use patterns. This investigation examined facets of emotion dysregulation as potential mediators of the relationship between PTSD symptoms and alcohol-related consequences and whether differences may exist across sexes. Methods Participants included 240 college students with a trauma history who reported using alcohol within the past three months and completed measures of PTSD symptoms, emotion dysregulation, alcohol consumption, alcohol-related consequences, and negative affect. The six facets of emotion dysregulation were examined as mediators of the relationship between PTSD symptoms and alcohol-related consequences in the full sample and by sex. Results There were differences in sexes on several variables, with women reporting higher PTSD scores and Lack of Emotional Awareness. Men reported significantly higher drinks per week in a typical week and a heavy week. There were significant associations between the variables for the full sample, with PTSD showing associations with five facets of emotion dysregulation subscales: Impulse Control Difficulties when Upset, Difficulties Engaging in Goal-Directed Behavior, Nonacceptance of Emotional Responses, Lack of Emotional Clarity, and Limited Access to Emotion Regulation Strategies. Alcohol-related consequences were associated with four aspects of emotion dysregulation: Impulse Control Difficulties when Upset, Difficulties Engaging in Goal-Direct Behavior, Nonacceptance of Emotional Reponses, and Limited Access to Emotion Regulation Strategies. Two aspects of emotion regulation, Impulse Control Difficulties and Difficulties Engaging in Goal Directed Behavior, mediated the relationship between PTSD symptoms and alcohol-related consequences in the full sample, even after adjusting for the effects of negative affect

  2. Nutritional status in cirrhosis. Italian Multicentre Cooperative Project on Nutrition in Liver Cirrhosis.

    PubMed

    1994-09-01

    Malnutrition frequently occurs in patients with chronic liver disease and may represent a risk factor influencing both short- and long-term survival in these patients. Previously published studies have tended to be confined to alcoholic patients and there are few data on the prevalence of nutritional abnormalities in patients with cirrhosis not of alcoholic origin. Anthropometric measurements and a clinical evaluation of the nutritional status of 1402 patients with cirrhosis (883 males and 519 females) were recorded between January 1988 and 1989 by the Italian Multicentre Cooperative project on Nutrition in Liver Cirrhosis. The origin of liver disease was alcohol-related in 37% of patients. Child-Pugh criteria were used to establish the severity of the liver disease. Patients with cirrhosis exhibited a wide range of nutritional abnormalities. While 29% of females and 18% of males appeared to be overnourished, a significant reduction in fat stores, as estimated by the mid-arm fat area, and/or muscle mass, as estimated by mid-arm muscle area, was observed in 30% of patients with cirrhosis. The prevalence of signs of nutritional depletion increased in both sexes as liver function deteriorated. Mean values for mid-arm fat area decreased by 30% in males and by 40% in females with moderate to severe liver failure (Child-Pugh Classes B and C). The reduction in mid-arm muscle area was more evident in males (17% decrease) than in females (9% decrease). Patients with alcohol-related cirrhosis showed a higher prevalence of malnutrition and had more frequent severe liver impairment (Child-Pugh Classes B and C).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7836699

  3. Alcohol-Related Brain Damage in Humans

    PubMed Central

    Erdozain, Amaia M.; Morentin, Benito; Bedford, Lynn; King, Emma; Tooth, David; Brewer, Charlotte; Wayne, Declan; Johnson, Laura; Gerdes, Henry K.; Wigmore, Peter; Callado, Luis F.; Carter, Wayne G.

    2014-01-01

    Chronic excessive alcohol intoxications evoke cumulative damage to tissues and organs. We examined prefrontal cortex (Brodmann’s area (BA) 9) from 20 human alcoholics and 20 age, gender, and postmortem delay matched control subjects. H & E staining and light microscopy of prefrontal cortex tissue revealed a reduction in the levels of cytoskeleton surrounding the nuclei of cortical and subcortical neurons, and a disruption of subcortical neuron patterning in alcoholic subjects. BA 9 tissue homogenisation and one dimensional polyacrylamide gel electrophoresis (PAGE) proteomics of cytosolic proteins identified dramatic reductions in the protein levels of spectrin β II, and α- and β-tubulins in alcoholics, and these were validated and quantitated by Western blotting. We detected a significant increase in α-tubulin acetylation in alcoholics, a non-significant increase in isoaspartate protein damage, but a significant increase in protein isoaspartyl methyltransferase protein levels, the enzyme that triggers isoaspartate damage repair in vivo. There was also a significant reduction in proteasome activity in alcoholics. One dimensional PAGE of membrane-enriched fractions detected a reduction in β-spectrin protein levels, and a significant increase in transmembranous α3 (catalytic) subunit of the Na+,K+-ATPase in alcoholic subjects. However, control subjects retained stable oligomeric forms of α-subunit that were diminished in alcoholics. In alcoholics, significant loss of cytosolic α- and β-tubulins were also seen in caudate nucleus, hippocampus and cerebellum, but to different levels, indicative of brain regional susceptibility to alcohol-related damage. Collectively, these protein changes provide a molecular basis for some of the neuronal and behavioural abnormalities attributed to alcoholics. PMID:24699688

  4. 49 CFR 655.35 - Other alcohol-related conduct.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 7 2013-10-01 2013-10-01 false Other alcohol-related conduct. 655.35 Section 655... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT OPERATIONS Prohibited Alcohol Use § 655.35 Other alcohol-related conduct. (a) No employer shall permit...

  5. 49 CFR 382.505 - Other alcohol-related conduct.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 5 2013-10-01 2013-10-01 false Other alcohol-related conduct. 382.505 Section 382... SUBSTANCES AND ALCOHOL USE AND TESTING Consequences for Drivers Engaging in Substance Use-Related Conduct § 382.505 Other alcohol-related conduct. (a) No driver tested under the provisions of subpart C of...

  6. 49 CFR 655.35 - Other alcohol-related conduct.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 7 2014-10-01 2014-10-01 false Other alcohol-related conduct. 655.35 Section 655... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT OPERATIONS Prohibited Alcohol Use § 655.35 Other alcohol-related conduct. (a) No employer shall permit...

  7. 49 CFR 199.237 - Other alcohol-related conduct.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 3 2012-10-01 2012-10-01 false Other alcohol-related conduct. 199.237 Section 199... MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY DRUG AND ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.237 Other alcohol-related conduct. (a) No operator...

  8. 49 CFR 199.237 - Other alcohol-related conduct.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 3 2014-10-01 2014-10-01 false Other alcohol-related conduct. 199.237 Section 199... MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY DRUG AND ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.237 Other alcohol-related conduct. (a) No operator...

  9. 49 CFR 655.35 - Other alcohol-related conduct.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 7 2012-10-01 2012-10-01 false Other alcohol-related conduct. 655.35 Section 655... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT OPERATIONS Prohibited Alcohol Use § 655.35 Other alcohol-related conduct. (a) No employer shall permit...

  10. 49 CFR 382.505 - Other alcohol-related conduct.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 49 Transportation 5 2012-10-01 2012-10-01 false Other alcohol-related conduct. 382.505 Section 382... SUBSTANCES AND ALCOHOL USE AND TESTING Consequences for Drivers Engaging in Substance Use-Related Conduct § 382.505 Other alcohol-related conduct. (a) No driver tested under the provisions of subpart C of...

  11. 49 CFR 382.505 - Other alcohol-related conduct.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 49 Transportation 5 2014-10-01 2014-10-01 false Other alcohol-related conduct. 382.505 Section 382... SUBSTANCES AND ALCOHOL USE AND TESTING Consequences for Drivers Engaging in Substance Use-Related Conduct § 382.505 Other alcohol-related conduct. (a) No driver tested under the provisions of subpart C of...

  12. 49 CFR 199.237 - Other alcohol-related conduct.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 49 Transportation 3 2013-10-01 2013-10-01 false Other alcohol-related conduct. 199.237 Section 199... MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY DRUG AND ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.237 Other alcohol-related conduct. (a) No operator...

  13. 49 CFR 199.237 - Other alcohol-related conduct.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 3 2011-10-01 2011-10-01 false Other alcohol-related conduct. 199.237 Section 199... MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY DRUG AND ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.237 Other alcohol-related conduct. (a) No operator...

  14. 49 CFR 655.35 - Other alcohol-related conduct.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 7 2011-10-01 2011-10-01 false Other alcohol-related conduct. 655.35 Section 655... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT OPERATIONS Prohibited Alcohol Use § 655.35 Other alcohol-related conduct. (a) No employer shall permit...

  15. 49 CFR 382.505 - Other alcohol-related conduct.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 5 2010-10-01 2010-10-01 false Other alcohol-related conduct. 382.505 Section 382... SUBSTANCES AND ALCOHOL USE AND TESTING Consequences for Drivers Engaging in Substance Use-Related Conduct § 382.505 Other alcohol-related conduct. (a) No driver tested under the provisions of subpart C of...

  16. 49 CFR 199.237 - Other alcohol-related conduct.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 3 2010-10-01 2010-10-01 false Other alcohol-related conduct. 199.237 Section 199... MATERIALS SAFETY ADMINISTRATION, DEPARTMENT OF TRANSPORTATION (CONTINUED) PIPELINE SAFETY DRUG AND ALCOHOL TESTING Alcohol Misuse Prevention Program § 199.237 Other alcohol-related conduct. (a) No operator...

  17. 49 CFR 382.505 - Other alcohol-related conduct.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 49 Transportation 5 2011-10-01 2011-10-01 false Other alcohol-related conduct. 382.505 Section 382... SUBSTANCES AND ALCOHOL USE AND TESTING Consequences for Drivers Engaging in Substance Use-Related Conduct § 382.505 Other alcohol-related conduct. (a) No driver tested under the provisions of subpart C of...

  18. 49 CFR 655.35 - Other alcohol-related conduct.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 7 2010-10-01 2010-10-01 false Other alcohol-related conduct. 655.35 Section 655... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION PREVENTION OF ALCOHOL MISUSE AND PROHIBITED DRUG USE IN TRANSIT OPERATIONS Prohibited Alcohol Use § 655.35 Other alcohol-related conduct. (a) No employer shall permit...

  19. Normative perceptions of alcohol-related consequences among college students.

    PubMed

    Brett, Emma I; Leavens, Eleanor L; Miller, Mary Beth; Lombardi, Nathaniel; Leffingwell, Thad R

    2016-07-01

    College students in the U.S. continue to drink in hazardous ways and experience a range of alcohol-related consequences. Personalized feedback interventions (PFIs), which often include normative components comparing personal drinking to that of similar peers, have been effective in reducing alcohol outcomes among college students. Though normative perceptions of the quantity and frequency of alcohol use have been examined in many studies, norms for alcohol-related consequences have received less attention. The current study examined self-other discrepancies (SODs) for alcohol-related consequences among college students. Participants overestimated how often alcohol-related consequences are experienced by other same-sex students on campus and rated consequences as more acceptable for others to experience than themselves. No differences in SODs were found between those who did and did not report alcohol use. Future studies should examine the efficacy of PFIs that incorporate normative feedback on alcohol-related consequences. PMID:26896561

  20. Unplanned Drinking and Alcohol-Related Problems: A Preliminary Test of the Model of Unplanned Drinking Behavior

    PubMed Central

    Pearson, Matthew R.; Henson, James M.

    2013-01-01

    Much research links impulsivity with alcohol use and problems. In two studies, unplanned (or impulsive) drinking is assessed directly to determine whether it has direct effects on alcohol use and alcohol-related problems. In study 1, we examined whether unplanned drinking serves as a proximal mediator of the effects of impulsivity-like traits on alcohol-related outcomes. With a sample of 211 college student drinkers, we found that the Unplanned Drinking Scale was significantly related to alcohol use, and perhaps more importantly, had a direct effect on alcohol-related problems even after controlling for frequency and quantity of alcohol use. Further, unplanned drinking partially mediated the effects of negative urgency on alcohol-related problems. In study 2, we examined whether unplanned drinking accounts for unique variance in alcohol-related outcomes when controlling for use of protective behavioral strategies. With a sample of 170 college students, we replicated the findings of Study 1 in that the Unplanned Drinking Scale had a significant direct effect on alcohol-related problems even after controlling for alcohol use; further, this effect was maintained when controlling for use of protective behavioral strategies. Limitations include the modest sample sizes and the cross-sectional design. Future directions for testing the Model of Unplanned Drinking Behavior are proposed. PMID:23276312

  1. Exposure to Alcohol Advertisements and Teenage Alcohol-Related Problems

    PubMed Central

    Dent, Clyde W.; Stacy, Alan W.

    2013-01-01

    OBJECTIVE: This study used prospective data to test the hypothesis that exposure to alcohol advertising contributes to an increase in underage drinking and that an increase in underage drinking then leads to problems associated with drinking alcohol. METHODS: A total of 3890 students were surveyed once per year across 4 years from the 7th through the 10th grades. Assessments included several measures of exposure to alcohol advertising, alcohol use, problems related to alcohol use, and a range of covariates, such as age, drinking by peers, drinking by close adults, playing sports, general TV watching, acculturation, parents’ jobs, and parents’ education. RESULTS: Structural equation modeling of alcohol consumption showed that exposure to alcohol ads and/or liking of those ads in seventh grade were predictive of the latent growth factors for alcohol use (past 30 days and past 6 months) after controlling for covariates. In addition, there was a significant total effect for boys and a significant mediated effect for girls of exposure to alcohol ads and liking of those ads in 7th grade through latent growth factors for alcohol use on alcohol-related problems in 10th grade. CONCLUSIONS: Younger adolescents appear to be susceptible to the persuasive messages contained in alcohol commercials broadcast on TV, which sometimes results in a positive affective reaction to the ads. Alcohol ad exposure and the affective reaction to those ads influence some youth to drink more and experience drinking-related problems later in adolescence. PMID:23359585

  2. Primary biliary cirrhosis

    MedlinePlus

    Primary biliary cirrhosis is irritation and swelling (inflammation) of the bile ducts of the liver. This blocks the flow ... ducts in the liver is not known. However, primary biliary cirrhosis is an autoimmune disorder. That means your body's ...

  3. Comorbidity in cirrhosis

    PubMed Central

    Jepsen, Peter

    2014-01-01

    Cirrhosis patients’ comorbidities are their other diseases than cirrhosis. Comorbidities are neither causes nor consequences of cirrhosis, but they can increase mortality and are therefore clinically important. They are also an important source of confounding in epidemiologic studies. Comorbidity scoring systems have been developed as tools to measure the cirrhosis patient’s total burden of comorbidity, and they are useful in the clinic and for epidemiologic studies. The recently developed CirCom score is the only comorbidity scoring system developed specifically for cirrhosis patients, and it may be preferred over the older, generic, and more complex Charlson comorbidity index. Studies of individual comorbid diseases can provide insight into the interactions between cirrhosis and other diseases and thus into the pathophysiology of cirrhosis. This article reviews the literature on comorbidity in cirrhosis. PMID:24966593

  4. Cirrhosis and Portal Hypertension

    MedlinePlus

    MENU Return to Web version Cirrhosis and Portal Hypertension Overview What is cirrhosis? In people who have ... lead to coma and death. What is portal hypertension? Normally, blood is carried to the liver by ...

  5. Kupffer cell depletion attenuates leptin-mediated methoxamine-stimulated portal perfusion pressure and thromboxane A2 release in a rodent model of NASH-cirrhosis.

    PubMed

    Yang, Ying-Ying; Huang, Yi-Tsau; Tsai, Tung-Hu; Hou, Ming-Chih; Lee, Fa-Yauh; Lee, Shou-Dong; Lin, Han-Chieh

    2012-12-01

    Cirrhotic portal hypertension is characterized by increased hepatic oxidative stress, AA (arachidonic acid)-derived TXA(2) (thromboxane A(2)) release and exaggerated hepatic response to the α-adrenergic agonist MTX (methoxamine). Besides promoting hepatic fibrosis, the role of hyperleptinaemia in the modulation of vascular response in NASH (non-alcoholic steatohepatitis) rat livers remains unknown. The aim of the present study was to explore the possible links between hyperleptinaemia and the disarrangement in the hepatic microcirculation. NASH-cirrhosis with hyperleptinaemia was induced in lean rats by feeding with an HF/MCD (high-fat/methionine-choline-deficient) diet. Portal haemodynamics, various substances, protein and mRNA expression and PUFA (polyunsaturated fatty acid) composition were measured. Finally, the effects of leptin pre-infusion on TXA(2) release and concentration-PPP (portal perfusion pressure) curves in response to MTX were evaluated by simultaneously pre-treatment with the Kupffer cell inactivators GdCl(3) (gadolinium chloride) or EC (encapsulated clodronate), the TXS (TXA(2) synthase) inhibitor furegrelate, the TP receptor (TXA(2) receptor) antagonist SQ29548 and the dual TXS/TP receptor antagonist BM567. In HF/MCD+leptin-lean rats, cirrhosis-induced PPP and MTX hyper-responsiveness were associated with increased hepatic TXA(2) production, TBARS (thiobarbituric acid-reacting substances) levels and the AA (arachidonic acid)/n-3 PUFA ratio, and up-regulation of hepatic leptin, FAS (fatty acid synthase), NADPH oxidase subunits, TXS, TP receptor, TGFβ(1) (transforming growth factor β(1)) proteins and mRNAs. Pre-infusion of leptin significantly enhanced MTX-stimulated PPP elevation and TXA(2) release, which were attenuated by GdCl(3) and EC pre-treatment. Concomitantly pre-incubation with BM567, but not furegrelate or SQ29548, significantly abolished the leptin-enhanced MTX-stimulated increase in PPP in NASH-cirrhotic rats. Hyperleptinaemia

  6. Protective Behavioral Strategies, Social Norms, and Alcohol-Related Outcomes

    PubMed Central

    Arterberry, Brooke J.; Smith, Ashley E.; Martens, Matthew P.; Cadigan, Jennifer M.; Murphy, James G.

    2014-01-01

    The present study examined the unique contributions of protective behavioral strategies and social norms in predicting alcohol-related outcomes. Participants were 363 students from a large public university in the Midwest who reported at least one binge-drinking episode (5+/4+ drinks for men/women in one sitting) in the past 30 days. Data were collected 1/2010–3/2011. We used SEM to test models where protective behavioral strategies (PBS) and social norms were predictors of both alcohol use and alcohol-related problems, after controlling for the effects of gender. Both PBS and descriptive norms had relationships with alcohol use. PBS also had a relationship with alcohol-related problems. Overall, the findings suggest that PBS and social norms have unique associations with distinct alcohol-related outcomes. PMID:25419202

  7. Macrophages and Alcohol-Related Liver Inflammation

    PubMed Central

    Ju, Cynthia; Mandrekar, Pranoti

    2015-01-01

    Recent studies have suggested that macrophages have a critical role in the development of alcohol-induced inflammation in the liver. To define the precise pathogenic function of these cells during alcoholic liver disease (ALD), it is extremely important to conduct extensive studies in clinical settings that further elucidate the phenotypic diversity of macrophages in the context of ALD. Research to date already has identified several characteristics of macrophages that underlie the cells’ actions, including macrophage polarization and their phenotypic diversity. Other analyses have focused on the contributions of resident versus infiltrating macrophages/monocytes, as well as on the roles of macrophage mediators, in the development of ALD. Findings point to the potential of macrophages as a therapeutic target in alcoholic liver injury. Future studies directed toward understanding how alcohol affects macrophage phenotypic switch in the liver and other tissues, whether the liver microenvironment determines macrophage function in ALD, and if targeting of macrophages alleviates alcoholic liver injury, will provide promising strategies to manage patients with alcoholic hepatitis. PMID:26717583

  8. Unique Direct and Indirect Effects of Impulsivity-Like Traits on Alcohol-Related Outcomes via Protective Behavioral Strategies

    ERIC Educational Resources Information Center

    Pearson, Matthew R.; Kite, Benjamin A.; Henson, James M.

    2012-01-01

    In the present study, we examined whether the use of protective behavioral strategies (PBS) mediates the effects of impulsivity-like traits on alcohol-related problems using a sample of 278 college students. Validating the 5-factor model of impulsivity, we showed that each impulsivity-like trait had a distinct pattern of relationships with PBS…

  9. Dyadic conflict, drinking to cope, and alcohol-related problems: A psychometric study and longitudinal actor-partner interdependence model.

    PubMed

    Lambe, Laura; Mackinnon, Sean P; Stewart, Sherry H

    2015-10-01

    The motivational model of alcohol use posits that individuals may consume alcohol to cope with negative affect. Conflict with others is a strong predictor of coping motives, which in turn predict alcohol-related problems. Two studies examined links between conflict, coping motives, and alcohol-related problems in emerging adult romantic dyads. It was hypothesized that the association between conflict and alcohol-related problems would be mediated by coping-depression and coping-anxiety motives. It was also hypothesized that this would be true for actor (i.e., how individual factors influence individual behaviors) and partner effects (i.e., how partner factors influence individual behaviors) and at the between- (i.e., does not vary over the study period) and within-subjects (i.e., varies over the study period) levels. Both studies examined participants currently in a romantic relationship who consumed ≥12 alcoholic drinks in the past year. Study 1 was cross-sectional using university students (N = 130 students; 86.9% female; M = 21.02 years old, SD = 3.43). Study 2 used a 4-wave, 4-week longitudinal design with romantic dyads (N = 100 dyads; 89% heterosexual; M = 22.13 years old, SD = 5.67). In Study 2, coping-depression motives emerged as the strongest mediator of the conflict-alcohol-related problems association, and findings held for actor effects but not partner effects. Supplemental analyses revealed that this mediational pathway only held among women. Within any given week, alcohol-related problems changed systematically in the same direction between romantic partners. Interventions may wish to target coping-depression drinking motives within couples in response to conflict to reduce alcohol-related problems. PMID:26075735

  10. Nutritional status of Korean male patients with alcoholic and viral liver cirrhosis.

    PubMed

    Chang, Yukyung; Lee, Seokhwa; Lee, Minho; Lee, Ohyoung

    2003-01-01

    This descriptive cross-sectional study aimed to investigate whether malnutrition occurs in outpatients with liver cirrhosis, and to compare the nutritional status of patients with alcoholic and viral liver cirrhosis using a variety of objective measures. This study also aimed to provide useful information about nutritional education and nutritional therapies for medical teams and patients with liver cirrhosis. Sixty-six Korean men between the ages of 30 and 69 with liver cirrhosis (24 alcohol-related and 42 virus-related) were recruited from the Internal Medicine Centres, Hanyang University Hospital, Seoul, Korea. The results showed that patients with alcoholic liver cirrhosis (ALC) were significantly lower in socio-economic status than patients with viral liver cirrhosis (VLC) (P<0.05). The energy intakes (excluding alcohol-derived energy) were 1448kcal and 1769kcal in the ALC and the VLC groups, respectively (P<0.05). As well, vitamin C intake was found to be higher in the VLC group than the ALC group, yet still more than 125% of the RDA for both groups (P<0.05). Among nutritional indices, only the TSF thickness showed interaction with the aetiology and the severity of the cirrhosis (P<0.05). Thus, these findings indicate that outpatients with liver cirrhosis in this study, particularly those with alcoholic liver cirrhosis, consumed a lower energy intake than suggested, but may not have been in a status of malnutrition. Body fat is more affected than other nutritional parameters in patients with liver cirrhosis. PMID:12810412

  11. p53-Mediated Biliary Defects Caused by Knockdown of cirh1a, the Zebrafish Homolog of the Gene Responsible for North American Indian Childhood Cirrhosis

    PubMed Central

    Wilkins, Benjamin J.; Lorent, Kristin; Matthews, Randolph P.; Pack, Michael

    2013-01-01

    North American Indian Childhood Cirrhosis (NAIC) is a rare, autosomal recessive, progressive cholestatic disease of infancy affecting the Cree-Ojibway first Nations of Quebec. All NAIC patients are homozygous for a missense mutation (R565W) in CIRH1A, the human homolog of the yeast nucleolar protein Utp4. Utp4 is part of the t-Utp subcomplex of the small subunit (SSU) processome, a ribonucleoprotein complex required for ribosomal RNA processing and small subunit assembly. NAIC has thus been proposed to be a primary ribosomal disorder (ribosomopathy); however, investigation of the pathophysiologic mechanism of this disease has been hindered by lack of an animal model. Here, using a morpholino oligonucleotide (MO)-based loss-of-function strategy, we have generated a model of NAIC in the zebrafish, Danio rerio. Zebrafish Cirhin shows substantial homology to the human homolog, and cirh1a mRNA is expressed in developing hepatocytes and biliary epithelial cells. Injection of two independent MOs directed against cirh1a at the one-cell stage causes defects in canalicular and biliary morphology in 5 dpf larvae. In addition, 5 dpf Cirhin-deficient larvae have dose-dependent defects in hepatobiliary function, as assayed by the metabolism of an ingested fluorescent lipid reporter. Previous yeast and in vitro studies have shown that defects in ribosome biogenesis cause stabilization and nuclear accumulation of p53, which in turn causes p53-mediated cell cycle arrest and/or apoptosis. Thus, the nucleolus appears to function as a cellular stress sensor in some cell types. In accordance with this hypothesis, transcriptional targets of p53 are upregulated in Cirhin-deficient zebrafish embryos, and defects in biliary function seen in Cirhin-deficient larvae are completely abrogated by mutation of tp53. Our data provide the first in vivo evidence of a role for Cirhin in biliary development, and support the hypothesis that congenital defects affecting ribosome biogenesis can activate

  12. Alcohol-related advertisements in a college newspaper.

    PubMed

    Walfish, S; Stenmark, D E; Wentz, D; Myers, C; Linares, D

    1981-07-01

    The college newspaper is a powerful socializing force on the university campus. Within the general context of a university-based Alcohol Abuse Prevention Project, the present investigation examined alcohol related advertising in a college newspaper at one southern university. Ads were categorized into those: (1) promoting the responsible use of alcohol, (2) promoting the irresponsible use of alcohol, and (3) having a neutral content. Results indicated that a great deal of alcohol-related advertising was presented in this publication, and the majority of advertising did not promote responsible use of the beverage. The potential role of the community-oriented professional as an intervention strategist is discussed. PMID:7327776

  13. Alcohol use and prior alcohol-related convictions as predictors of probation officer perceptions and sentencing.

    PubMed

    Harrell, W A

    1980-11-01

    Presentence reports for 740 offenders were content analyzed. Regression techniques were used to evaluate a number of predictors of sentencing, including the effects of number of prior alcohol-related convictions and whether the offender was intoxicated while committing the offense he was charged with. The two most prominent variables affecting the severity of sentence were the probation officer's assessment of the offender's probable success on probation and the legal seriousness of the offense. While failing to have any significant direct effects on sentencing, our measures of alcohol use had significant indirect effects which were mediated by the probation officer's assessment of success on probation and legal seriousness. An extensive criminal record of prior alcohol-related convictions resulted in a poorer prognosis for success on probation this, in turn, led to more severe sentences for these offenders. Intoxication while committing an offense was related to the commission of minor crimes which, subsequently, yielded more lenient treatment for alcohol-users compared to nonusers. Finally, native offenders were more likely than nonnatives to have many prior alcohol-related convictions and to have been intoxicated while committing an offense. PMID:7216566

  14. Missouri Curriculum Guide for Alcohol-Related Traffic Offenders' Program.

    ERIC Educational Resources Information Center

    Pierce, Don; McClain, Robert

    This document contains the second edition of the Alcohol or Drug Related Traffic Offenders' Program (ARTOP) curriculum guide developed by the Missouri Department of Mental Health to reduce alcohol-related traffic offenses by presenting factual information about the physical effects of alcohol on the body and on driving skills. The materials…

  15. Alcohol-Related Content of Animated Cartoons: A Historical Perspective

    PubMed Central

    Klein, Hugh; Shiffman, Kenneth S.

    2013-01-01

    This study, based on a stratified (by decade of production) random sample of 1,221 animated cartoons and 4,201 characters appearing in those cartoons, seeks to determine the prevalence of alcohol-related content; how, if at all, the prevalence changed between 1930 and 1996 (the years spanned by this research); and the types of messages that animated cartoons convey about beverage alcohol and drinking in terms of the characteristics that are associated with alcohol use, the contexts in which alcohol is used in cartoons, and the reasons why cartoon characters purportedly consume alcohol. Approximately 1 cartoon in 11 was found to contain alcohol-related content, indicating that the average child or adolescent viewer is exposed to approximately 24 alcohol-related messages each week just from the cartoons that he/she watches. Data indicated that the prevalence of alcohol-related content declined significantly over the years. Quite often, alcohol consumption was shown to result in no effects whatsoever for the drinker, and alcohol use often occurred when characters were alone. Overall, mixed, ambivalent messages were provided about drinking and the types of characters that did/not consume alcoholic beverages. PMID:24350176

  16. Family Supports for Children Who Have Alcohol-Related Disabilities

    ERIC Educational Resources Information Center

    Brown, James D.

    2004-01-01

    Since the first publication on fetal alcohol syndrome appeared in the scientific literature over 30 years ago, there has been a great deal of research interest in the topic. This paper reviews findings within the past 10 years related to causes, frequency, and diagnosis of alcohol-related disabilities, before turning to the impact these…

  17. [ENT emergency treatment and alcohol related head and neck injuries].

    PubMed

    Teudt, I; Grundmann, T; Pueschel, K; Hogan, B; Leventli, B

    2013-08-01

    The spectrum of ENT-diseases can differ widely among emergency departments (ED) of different geographic regions. Especially in terms of head and neck trauma a higher number of injuries can be expected in large cities due to alcohol related violence.The ED of a large hospital situated in the center of Hamburg Germany was analysed for ENT-emergency treatments in 2011 retrospectively. Beside usual patient statistics, the study focused on alcohol related injuries with an ENT-surgeon involved. All data were compared to reports by other EDs in Germany and alcohol related costs were approximated for initiation of prevention programs in the future.2 339 ENT-patients were admitted to the ED. 19% of all patients used an ambulance whereas 80% reached the ED by private transportation. The majority of patients were between 21 and 30 years of age. For 143 of all trauma cases alcohol involvement was documented. Subanalysis revealed male dominance and a high use of ambulance transportation.The high number of traumata differs considerably from other ENT studies. One reason is the hospital's close proximity to all time party districts like "Reeperbahn" and the "Port of Hamburg". In those areas high amounts of alcohol ingestion takes place leading to more injuries at the head- and neck region. Theoretically financial resources would be plenty after the initiation of those programs as the severe costs for alcohol related medical treatment would decline. PMID:23568584

  18. Alcohol-related dementia: an update of the evidence

    PubMed Central

    2013-01-01

    The characteristics of dementia relating to excessive alcohol use have received increased research interest in recent times. In this paper, the neuropathology, nosology, epidemiology, clinical features, and neuropsychology of alcohol-related dementia (ARD) and alcohol-induced persisting amnestic syndrome (Wernicke-Korsakoff syndrome, or WKS) are reviewed. Neuropathological and imaging studies suggest that excessive and prolonged use of alcohol may lead to structural and functional damage that is permanent in nature; however, there is debate about the relative contributions of the direct toxic effect of alcohol (neurotoxicity hypothesis), and the impact of thiamine deficiency, to lasting damage. Investigation of alcohol-related cognitive impairment has been further complicated by differing definitions of patterns of alcohol use and associated lifestyle factors related to the abuse of alcohol. Present diagnostic systems identify two main syndromes of alcohol-related cognitive impairment: ARD and WKS. However, 'alcohol-related brain damage' is increasingly used as an umbrella term to encompass the heterogeneity of these disorders. It is unclear what level of drinking may pose a risk for the development of brain damage or, in fact, whether lower levels of alcohol may protect against other forms of dementia. Epidemiological studies suggest that individuals with ARD typically have a younger age of onset than those with other forms of dementia, are more likely to be male, and often are socially isolated. The cognitive profile of ARD appears to involve both cortical and subcortical pathology, and deficits are most frequently observed on tasks of visuospatial function as well as memory and higher-order (executive) tasks. The WKS appears more heterogeneous in nature than originally documented, and deficits on executive tasks commonly are reported in conjunction with characteristic memory deficits. Individuals with alcohol-related disorders have the potential to at least

  19. Alcohol-related harm among university students in Hanoi, Vietnam

    PubMed Central

    Diep, Pham Bich; Knibbe, Ronald A.; Giang, Kim Bao; De Vries, Nanne

    2013-01-01

    Introduction and Aim This study examines the prevalence of and risk factors for alcohol-related harm and types of harm among medical students from Hanoi Medical University (Vietnam). Risk factors include aspects of drinking patterns and relevant socio-demographic variables. Study Design and Methods A cross-sectional study involving 1st to 6th year students (N=1216; response rate 96.5%). Of these, 210 students from each academic year were randomly selected from a sampling frame covering all students from each academic year. Data were collected using a questionnaire distributed in class by researchers. Drinkers completed 23 questions on alcohol-related harm categorized into: 1) ‘negative influence on daily activities’; 2) ‘social conflict’; 3) ‘loss of control, acute consequences, and withdrawal’; 4) ‘mental health conditions’; and 5) ‘physical and medical health problems’. Logistic and Poisson regression models were used to identify the predictors of alcohol-related harm and the amount of harm, respectively. Results The prevalence of alcohol use associated with at least one or more of the five types of harm was higher in men (81.8%) than in women (60.4%). In female and male students, the most common harm category was ‘loss of control, acute consequences, and withdrawal’ (51.8 and 75.6%, respectively), followed by ‘negative influence on daily activities’ (29.4 and 55.8%, respectively). Age, living away from home, and average number of standard drinks per occasion among male drinkers, and age and frequency of drinking per week among female drinkers were associated with alcohol-related harm. Conclusions These data suggest that alcohol-related harm represents a serious public health problem among young educated individuals in Vietnam. The risk factors indicate that prevention should be aimed at aspects of drinking patterns and specific subpopulations defined by gender, age, and (for men only) type of living situation. PMID:23374703

  20. Alcohol-related dementia: an update of the evidence.

    PubMed

    Ridley, Nicole J; Draper, Brian; Withall, Adrienne

    2013-01-01

    The characteristics of dementia relating to excessive alcohol use have received increased research interest in recent times. In this paper, the neuropathology, nosology, epidemiology, clinical features, and neuropsychology of alcohol-related dementia (ARD) and alcohol-induced persisting amnestic syndrome (Wernicke-Korsakoff syndrome, or WKS) are reviewed. Neuropathological and imaging studies suggest that excessive and prolonged use of alcohol may lead to structural and functional damage that is permanent in nature; however, there is debate about the relative contributions of the direct toxic effect of alcohol (neurotoxicity hypothesis), and the impact of thiamine deficiency, to lasting damage. Investigation of alcohol-related cognitive impairment has been further complicated by differing definitions of patterns of alcohol use and associated lifestyle factors related to the abuse of alcohol. Present diagnostic systems identify two main syndromes of alcohol-related cognitive impairment: ARD and WKS. However, 'alcohol-related brain damage' is increasingly used as an umbrella term to encompass the heterogeneity of these disorders. It is unclear what level of drinking may pose a risk for the development of brain damage or, in fact, whether lower levels of alcohol may protect against other forms of dementia. Epidemiological studies suggest that individuals with ARD typically have a younger age of onset than those with other forms of dementia, are more likely to be male, and often are socially isolated. The cognitive profile of ARD appears to involve both cortical and subcortical pathology, and deficits are most frequently observed on tasks of visuospatial function as well as memory and higher-order (executive) tasks. The WKS appears more heterogeneous in nature than originally documented, and deficits on executive tasks commonly are reported in conjunction with characteristic memory deficits. Individuals with alcohol-related disorders have the potential to at least

  1. A Longitudinal Examination of the Associations between Shyness, Drinking Motives, Alcohol Use, and Alcohol-related Problems

    PubMed Central

    Young, Chelsie M.; DiBello, Angelo M.; Traylor, Zachary K.; Zvolensky, Michael J.; Neighbors, Clayton

    2015-01-01

    Background The current study evaluated the roles of drinking motives and shyness in predicting problem alcohol use over two years. Methods First-year college student drinkers (N=818) completed assessments of alcohol use and related problems, shyness, and drinking motives every six months over a two year period. Results Generalized linear mixed models indicated that shyness was associated with less drinking, but more alcohol-related problems. Further, shyness was associated with coping, conformity, and enhancement drinking motives, but was not associated with social drinking motives. However, when examining coping motives, moderation analyses revealed that social drinking motives were more strongly associated with coping motives among individuals higher in shyness. In addition, coping, conformity, and enhancement motives, but not social motives, mediated associations between shyness and alcohol-related problems over time. Finally, coping motives mediated the association between the interaction of shyness and social motives and alcohol-related problems. Conclusions Together, the results suggest that shy individuals may drink to reduce negative affect, increase positive affect, and fit in with others in social situations, which may then contribute to greater risk for subsequent alcohol-related problems. PMID:26207856

  2. Inflammatory status in human hepatic cirrhosis

    PubMed Central

    Martínez-Esparza, María; Tristán-Manzano, María; Ruiz-Alcaraz, Antonio J; García-Peñarrubia, Pilar

    2015-01-01

    This review focuses on new findings about the inflammatory status involved in the development of human liver cirrhosis induced by the two main causes, hepatitis C virus (HCV) infection and chronic alcohol abuse, avoiding results obtained from animal models. When liver is faced to a persistent and/or intense local damage the maintained inflammatory response gives rise to a progressive replacement of normal hepatic tissue by non-functional fibrotic scar. The imbalance between tissue regeneration and fibrosis will determine the outcome toward health recovery or hepatic cirrhosis. In all cases progression toward liver cirrhosis is caused by a dysregulation of mechanisms that govern the balance between activation/homeostasis of the immune system. Detecting differences between the inflammatory status in HCV-induced vs alcohol-induced cirrhosis could be useful to identify specific targets for preventive and therapeutic intervention in each case. Thus, although survival of patients with alcoholic cirrhosis seems to be similar to that of patients with HCV-related cirrhosis (HCV-C), there are important differences in the altered cellular and molecular mechanisms implicated in the progression toward human liver cirrhosis. The predominant features of HCV-C are more related with those that allow viral evasion of the immune defenses, especially although not exclusively, inhibition of interferons secretion, natural killer cells activation and T cell-mediated cytotoxicity. On the contrary, the inflammatory status of alcohol-induced cirrhosis is determined by the combined effect of direct hepatotoxicity of ethanol metabolites and increases of the intestinal permeability, allowing bacteria and bacterial products translocation, into the portal circulation, mesenteric lymph nodes and peritoneal cavity. This phenomenon generates a stronger pro-inflammatory response compared with HCV-related cirrhosis. Hence, therapeutic intervention in HCV-related cirrhosis must be mainly focused to

  3. Hepatic erythropoietin response in cirrhosis.

    PubMed

    Risør, Louise M; Fenger, Mogens; Olsen, Niels V; Møller, Søren

    2016-05-01

    Background Erythropoietin (EPO) is produced in the liver during fetal life, but after birth the production shifts to the kidneys. The liver maintains a production capacity of 10% of the total EPO-production, but can be up-regulated to 100%. Previous studies have demonstrated both elevated and reduced concentrations of EPO in cirrhosis. Increased EPO concentrations could be expected due to anemia, hypoxia, renal hypoperfusion, or EPO-mediated hepatoprotective mechanisms. In contrast, poor hepatic production capacity may cause reduced EPO concentrations in cirrhosis. In the present paper we aimed to study hepatic and renal venous concentrations of EPO in relation to the severity of the disease. Materials and methods We included 24 patients with alcoholic cirrhosis and eight age-matched healthy controls. All had a full catheterization performed with the determination of EPO concentrations in the hepatic, renal and femoral veins and artery. All patients were clinically, biochemically, and hemodynamically characterized. Results The median arterial EPO concentrations in the cirrhotic patients and controls were 7.1 mIU/mL (range 3.5-179) and 7.2 mIU/mL (range 3.8-15.3), respectively. In the patient group we found no significant correlations to stage of disease of hemodynamic derangement. Conclusion We found no significant differences in EPO concentrations across the liver, kidney, or peripheral circulation in the patient or control groups; and no significant correlations to clinical, biochemical, or hemodynamic characteristics. This suggests that hepatic EPO synthesis is not enhanced in cirrhosis, but larger scale studies are needed to clarify this question. PMID:26924722

  4. Research Note: Patterns of Alcohol-Related Mortality in Russia

    PubMed Central

    Pridemore, William Alex; Kim, Sang-Weon

    2006-01-01

    The level of alcohol consumption in Russia is among the highest in the world and is often associated with a variety of problems in the country. Until recently, however, it was impossible to examine the health and social burdens associated with consumption in Russia due to Soviet secrecy surrounding vital statistics and health data related to alcohol and other topics. This study employed newly available mortality data to describe the demographic, temporal, and spatial patterns of mortality resulting directly from chronic and acute alcohol consumption in the country. The data reveal that in spite of high overall rates of alcohol-related mortality in Russia, levels of mortality vary considerably along these dimensions. Although descriptive in nature, the patterns of alcohol-related mortality in Russia presented here should provide initial observations with which to generate and test hypotheses concerning the causes and consequences of these patterns. PMID:16900263

  5. Therapeutic reversal of chronic alcohol-related steatohepatitis with the ceramide inhibitor myriocin

    PubMed Central

    Tong, Ming; Longato, Lisa; Ramirez, Teresa; Zabala, Valerie; Wands, Jack R; Monte, Suzanne M

    2014-01-01

    Alcohol-related liver disease (ALD) is associated with steatohepatitis and insulin resistance. Insulin resistance impairs growth and disrupts lipid metabolism in hepatocytes. Dysregulated lipid metabolism promotes ceramide accumulation and oxidative stress, leading to lipotoxic states that activate endoplasmic reticulum (ER) stress pathways and worsen inflammation and insulin resistance. In a rat model of chronic alcohol feeding, we characterized the effects of a ceramide inhibitor, myriocin, on the histopathological and ultrastructural features of steatohepatitis, and the biochemical and molecular indices of hepatic steatosis, insulin resistance and ER stress. Myriocin reduced the severity of alcohol-related steatohepatitis including the abundance and sizes of lipid droplets and mitochondria, inflammation and architectural disruption of the ER. In addition, myriocin-mediated reductions in hepatic lipid and ceramide levels were associated with constitutive enhancement of insulin signalling through the insulin receptor and IRS-2, reduced hepatic oxidative stress and modulation of ER stress signalling mechanisms. In conclusion, ceramide accumulation in liver mediates tissue injury, insulin resistance and lipotoxicity in ALD. Reducing hepatic ceramide levels can help restore the structural and functional integrity of the liver in chronic ALD due to amelioration of insulin resistance and ER stress. However, additional measures are needed to protect the liver from alcohol-induced necroinflammatory responses vis-à-vis continued alcohol abuse. PMID:24456332

  6. A Mechanistic Pharmacokinetic Model for Liver Transporter Substrates Under Liver Cirrhosis Conditions

    PubMed Central

    Li, R; Barton, HA; Maurer, TS

    2015-01-01

    Liver cirrhosis is a disease characterized by the loss of functional liver mass. Physiologically based pharmacokinetic (PBPK) modeling was applied to interpret and predict how the interplay among physiological changes in cirrhosis affects pharmacokinetics. However, previous PBPK models under cirrhotic conditions were developed for permeable cytochrome P450 substrates and do not directly apply to substrates of liver transporters. This study characterizes a PBPK model for liver transporter substrates in relation to the severity of liver cirrhosis. A published PBPK model structure for liver transporter substrates under healthy conditions and the physiological changes for cirrhosis are combined to simulate pharmacokinetics of liver transporter substrates in patients with mild and moderate cirrhosis. The simulated pharmacokinetics under liver cirrhosis reasonably approximate observations. This analysis includes meta-analysis to obtain system-dependent parameters in cirrhosis patients and a top-down approach to improve understanding of the effect of cirrhosis on transporter-mediated drug disposition under cirrhotic conditions. PMID:26225262

  7. A Mechanistic Pharmacokinetic Model for Liver Transporter Substrates Under Liver Cirrhosis Conditions.

    PubMed

    Li, R; Barton, H A; Maurer, T S

    2015-06-01

    Liver cirrhosis is a disease characterized by the loss of functional liver mass. Physiologically based pharmacokinetic (PBPK) modeling was applied to interpret and predict how the interplay among physiological changes in cirrhosis affects pharmacokinetics. However, previous PBPK models under cirrhotic conditions were developed for permeable cytochrome P450 substrates and do not directly apply to substrates of liver transporters. This study characterizes a PBPK model for liver transporter substrates in relation to the severity of liver cirrhosis. A published PBPK model structure for liver transporter substrates under healthy conditions and the physiological changes for cirrhosis are combined to simulate pharmacokinetics of liver transporter substrates in patients with mild and moderate cirrhosis. The simulated pharmacokinetics under liver cirrhosis reasonably approximate observations. This analysis includes meta-analysis to obtain system-dependent parameters in cirrhosis patients and a top-down approach to improve understanding of the effect of cirrhosis on transporter-mediated drug disposition under cirrhotic conditions. PMID:26225262

  8. Alcohol and Cirrhosis

    MedlinePlus

    ... that a non-drinker with hepatitis C has. Alcohol and hepatitis C both damage the liver, so together, the risk of serious liver damage (cirrhosis) is much higher than with either alone. < Previous Living with Hepatitis ...

  9. Primary biliary cirrhosis

    MedlinePlus

    ... body's immune system mistakenly attacks healthy tissue. The disease more commonly affects middle-aged women. Long-term bile obstruction is believed to lead to liver cirrhosis . The disease may be linked to autoimmune ...

  10. Inflammasome activation in decompensated liver cirrhosis

    PubMed Central

    González-Navajas, José M

    2016-01-01

    Inflammation participates in the pathogenesis of many liver diseases, including liver cirrhosis. Certain inflammatory citokines, such as interleukin (IL)-1β and IL-18, are produced after the activation of a multiprotein complex known as the inflammasome. Activation of the inflammasome has been documented in several liver diseases, but its role in the development and progression of liver cirrhosis or the complications associated with this disease is still largely unknown. We have recently studied the impact of the inflammasome in the sterile inflammatory response that takes place in the ascitic fluid of patients with decompensated cirrhosis, providing evidence that activation of the absent in melanoma 2 (AIM2) inflammasome is an important response in these patients. Ascitic fluid-derived macrophages were able to mount a very robust AIM2-mediated response even in the absence of a priming signal, which is usually required for the full activation of all the inflammasomes. In addition, high level of inflammasome activation in these patients was associated with a higher degree of liver disease and an increased incidence of spontaneous bacterial peritonitis. These results may help explain the exacerbated inflammatory response that usually occurs in patients with decompensated cirrhosis in the absence of detectable infections. Thus, inflammasomes should be considered as possible therapeutic targets in sterile inflammatory complications in patients with cirrhosis. PMID:26855691

  11. Adolescent alcohol-related risk cognitions: the roles of social norms and social networking sites.

    PubMed

    Litt, Dana M; Stock, Michelle L

    2011-12-01

    The present study examined the impact of socially based descriptive norms on willingness to drink alcohol, drinker prototype favorability, affective alcohol attitudes, and perceived vulnerability for alcohol-related consequences within the Prototype Willingness model. Descriptive norms were manipulated by having 189 young adolescents view experimenter-created profile pages from the social networking site Facebook, which either showed older peers drinking or not. The results provided evidence that descriptive norms for alcohol use, as portrayed by Facebook profiles, significantly impact willingness to use, prototypes, attitudes toward use, and perceived vulnerability. A multiple mediation analysis indicated that prototypes, attitudes, and perceptions of use mediated the relationship between the content of the Facebook profile and willingness. These results indicate that adolescents who perceive that alcohol use is normative, as evidenced by Facebook profiles, are at higher risk for cognitions shown to predict alcohol use than adolescents who do not see alcohol use portrayed as frequently on Facebook. PMID:21644803

  12. Alcoholic cirrhosis and hepatocellular carcinoma.

    PubMed

    Stickel, Felix

    2015-01-01

    Hepatocellular carcinoma shows a rising incidence worldwide, and the largest burden of disease in Western countries derives from patients with alcoholic liver disease (ALD) and cirrhosis, the latter being the premier premalignant factor for HCC. The present chapter addresses key issues including the epidemiology of alcohol-associated HCC, and its link to other coexisting non-alcoholic liver diseases, and additional host and environmental risk factors including the underlying genetics. Also discussed are molecular mechanisms of alcohol-associated liver cancer evolution involving the mediators of alcohol toxicity and carcinogenicity, acetaldehyde and reactive oxygen species, as well as the recently described mutagenic adducts which these mediators form with DNA. Specifically, interference of alcohol with retinoids and cofactors of transmethylation processes are outlined. Information presented in this chapter illustrates that the development of HCC in the context of ALD is multifaceted and suggests several molecular targets for prevention and markers for the screening of risk groups. PMID:25427904

  13. Coffee, alcohol and other beverages in relation to cirrhosis mortality: the Singapore Chinese Health Study

    PubMed Central

    Goh, George Boon-Bee; Chow, Wan-Cheng; Renwei-Wang; Yuan, Jian-Min; Koh, Woon-Puay

    2014-01-01

    Limited experimental and epidemiologic data suggest that coffee may reduce hepatic damage in chronic liver disease. The association between consumption of coffee and other beverages, and risk of cirrhosis mortality was evaluated in The Singapore Chinese Health Study. This is a prospective population-based cohort of 63,275 middle-aged and older Chinese subjects who provided data on diet, lifestyle and medical histories through in-person interviews using structured questionnaire at enrollment between 1993 and 1998. Mortality from cirrhosis in the cohort was ascertained through linkage analysis with nationwide death registry. After a mean follow-up of 14.7 years, 114 subjects died from cirrhosis; 33 of them from viral hepatitis B (29%), two from hepatitis C (2%), and 14 from alcohol-related cirrhosis (12%). Compared to non-drinkers, daily alcohol drinkers had a strong dose-dependent positive association between amount of alcohol and risk of cirrhosis mortality. Conversely, there was a strong dose-dependent inverse association between coffee intake and risk of non-viral hepatitis related cirrhosis mortality (p for trend=0.014). Compared to non-daily coffee drinkers, those who drank two or more cups per day had 66% reduction in mortality risk (HR=0.34, 95% CI=0.14–0.81). However, coffee intake was not associated with hepatitis B related cirrhosis mortality. The inverse relationship between caffeine intake and nonviral hepatitis-related cirrhosis mortality became null after adjustment for coffee drinking. The consumption of black tea, green tea, fruit juices or soft drinks was not associated with risk of cirrhosis death. Conclusion This study demonstrates the protective effect of coffee on non-viral hepatitis related cirrhosis mortality, and provides further impetus to evaluate coffee as a potential therapeutic agent in patients with cirrhosis. PMID:24753005

  14. Clinical and pathological features of alcohol-related brain damage.

    PubMed

    Zahr, Natalie M; Kaufman, Kimberley L; Harper, Clive G

    2011-05-01

    One of the sequelae of chronic alcohol abuse is malnutrition. Importantly, a deficiency in thiamine (vitamin B(1)) can result in the acute, potentially reversible neurological disorder Wernicke encephalopathy (WE). When WE is recognized, thiamine treatment can elicit a rapid clinical recovery. If WE is left untreated, however, patients can develop Korsakoff syndrome (KS), a severe neurological disorder characterized by anterograde amnesia. Alcohol-related brain damage (ARBD) describes the effects of chronic alcohol consumption on human brain structure and function in the absence of more discrete and well-characterized neurological concomitants of alcoholism such as WE and KS. Through knowledge of both the well-described changes in brain structure and function that are evident in alcohol-related disorders such as WE and KS and the clinical outcomes associated with these changes, researchers have begun to gain a better understanding of ARBD. This Review examines ARBD from the perspective of WE and KS, exploring the clinical presentations, postmortem brain pathology, in vivo MRI findings and potential molecular mechanisms associated with these conditions. An awareness of the consequences of chronic alcohol consumption on human behavior and brain structure can enable clinicians to improve detection and treatment of ARBD. PMID:21487421

  15. The Japanese society of alcohol-related problems.

    PubMed

    Maruyama, Katsuya; Higuchi, Susumu

    2004-04-01

    This paper presents an outline of the Japanese Society of Alcohol-Related Problems. The precursor of the Society was the Japan Alcoholism Treatment Research Group, inaugurated in 1979, by merging two local research groups in the Tokyo and Osaka areas, both of which were exclusive gatherings of psychiatrists associated with alcoholism clinics. The Research Group developed into the Society in 1992, as the number of participants including those from other medical professions increased yearly, and the subjects of the group widened to include all addictive behaviours. In reflecting the process of establishment, it is unique in many aspects as a scientific society. The Society is not a science-orientated body for presentation of new research findings. The main programme of the annual meeting is therefore a set of symposia in which members participate and discuss clinical and/or social problems arising from dependency on alcohol or drugs. Perhaps because of its content, the annual meeting is attended each year by the largest number of participants among all the societies in Japan concerned with alcohol and drugs. For the next several years, the Society's activities will be directed at (1) establishment of guidelines for early identification of and intervention in alcohol-related problems; (2) expansion of its membership to include those in related fields of medicine and non-medical professions; (3) improvement of the system of journal publication; and (4) creation of a system for timely adequate response to social problems associated with drugs and alcohol. PMID:15049741

  16. [Diabetes in liver cirrhosis].

    PubMed

    García-Compeán, Diego; Jáquez-Quintana, Joel O; González-González, José A; Lavalle-González, Fernando J; Villarreal-Pérez, Jesús Z; Maldonado-Garza, Hector J

    2013-01-01

    The prevalence of overt diabetes mellitus (DM) in liver cirrhosis is about 30%. However, DM or impaired glucose tolerance can be observed in 90% after an oral glucose tolerance test in patients with normal fasting plasma glucose. Type 2 DM may produce cirrhosis, whereas DM may be a complication of cirrhosis. The latter is known as «hepatogenous diabetes». Overt and subclinical DM is associated with liver complications and death in cirrhotic patients. Treating diabetes is difficult in cirrhotic patients because of the metabolic impairments due to liver disease and because the most appropriate pharmacologic treatment has not been defined. It is also unknown if glycemic control with hypoglycemic agents has any impact on the course of the liver disease. PMID:23628170

  17. Severe sepsis in cirrhosis.

    PubMed

    Gustot, Thierry; Durand, François; Lebrec, Didier; Vincent, Jean-Louis; Moreau, Richard

    2009-12-01

    Sepsis is physiologically viewed as a proinflammatory and procoagulant response to invading pathogens. There are three recognized stages in the inflammatory response with progressively increased risk of end-organ failure and death: sepsis, severe sepsis, and septic shock. Patients with cirrhosis are prone to develop sepsis, sepsis-induced organ failure, and death. There is evidence that in cirrhosis, sepsis is accompanied by a markedly imbalanced cytokine response ("cytokine storm"), which converts responses that are normally beneficial for fighting infections into excessive, damaging inflammation. Molecular mechanisms for this excessive proinflammatory response are poorly understood. In patients with cirrhosis and severe sepsis, high production of proinflammatory cytokines seems to play a role in the worsening of liver function and the development of organ/system failures such as shock, renal failure, acute lung injury or acute respiratory distress syndrome, coagulopathy, or hepatic encephalopathy. In addition, these patients may have sepsis-induced hyperglycemia, defective arginine-vasopressin secretion, adrenal insufficiency, or compartmental syndrome. In patients with cirrhosis and spontaneous bacterial peritonitis (SBP), early use of antibiotics and intravenous albumin administration decreases the risk for developing renal failure and improves survival. There are no randomized studies that have been specifically performed in patients with cirrhosis and severe sepsis to evaluate treatments that have been shown to improve outcome in patients without cirrhosis who have severe sepsis or septic shock. These treatments include recombinant human activated C protein and protective-ventilation strategy for respiratory failure. Other treatments should be evaluated in the cirrhotic population with severe sepsis including the early use of antibiotics in "non-SBP" infections, vasopressor therapy, hydrocortisone, renal-replacement therapy and liver support systems, and

  18. Primary Biliary Cirrhosis

    MedlinePlus

    ... liver cancer every 6 to 12 months. Health care providers use blood tests, ultrasound, or both to check for signs of ... the diagnosis of primary biliary cirrhosis. A health care provider uses the test selectively when he or she is concerned that ...

  19. Cortical morphology in children with alcohol-related neurodevelopmental disorder

    PubMed Central

    Rajaprakash, Meghna; Chakravarty, M Mallar; Lerch, Jason P; Rovet, Joanne

    2014-01-01

    Introduction It is well established that individuals exposed to alcohol in utero have reduced cortical grey matter volumes. However, the candidate determinants of these reductions, cortical thickness (CT) and surface area (SA), have not been investigated exclusively in alcohol-related neurodevelopmental disorder (ARND), the most prevalent fetal alcohol spectrum disorder subgroup that lacks the characteristic facial dysmorphology. Methods T1-weighted magnetic resonance imaging scans were obtained from 88 participants (8–16 years), 36 diagnosed with ARND and 52 typically developing controls. Scans were submitted to the CIVET pipeline (version 1.1.10). Deformable models were used to construct the inner white matter surfaces and pial surfaces from which CT and SA measures were derived. Group differences in cortical volume, CT, and SA were computed using a general linear model covaried for age, sex, and handedness. Results Global cortical volume reductions in ARND did not reflect CT, which did not differ between groups. Instead, volume decreases were consistent with global SA reductions in bilateral frontal and temporal as well as right occipital regions. Local reductions in SA were observed in the right superior temporal gyrus and the right occipital-temporal region. Conclusion Results suggest that in ARND, prenatal alcohol exposure perturbs global SA to a greater degree than CT, particularly in the right temporal lobe. PMID:24653953

  20. [Clinical application of neuroimaging to alcohol-related dementia].

    PubMed

    Matsui, Toshifumi; Sakurai, Hideki; Toyama, Tomomi; Yoshimura, Atsushi; Matsushita, Sachio; Higuchi, Susumu

    2012-06-01

    Alcohol-related dementia (ARD) is one of the most common dementing disorders in middle-aged people and occurs in heavy drinkers who are estimated to be 10 - 15 % of the adult men in a community. While the concept of ARD is multifactorial and includes all cognitive deficits in alcoholics, the central clinical manifestations are exemplified by Korsakoff's syndrome (KS), a persistent neuropsychiatric syndrome, characterized by amnesia and disorientation that is caused by thiamine deficiency along with excessive alcohol consumption. Antemortem detection of intracranial changes has been made possible by MRI and many studies have revealed that alcoholics have atrophic changes in frontal lobe, cerebellum, medial temporal lobe and hippocampus. However, these brain regions are vulnerable to excessive alcohol and seem to be independent of cognitive deficits in alcoholics. This review shows the regional differences in gray matter volumes between cognitively normal alcoholics and patients with KS. By employing a 3-dimensional MRI method for voxel-based morphometry that enables an automated, unbiased, comprehensive assessment, we demonstrate that parahippocampal/hippocampal atrophy is specific to KS and thalamic atrophy and the third ventricle enlargement are more severe in patients with KS than in cognitively normal alcoholics. PMID:22894053

  1. Repair of liver mediated by adult mouse liver neuro-glia antigen 2-positive progenitor cell transplantation in a mouse model of cirrhosis

    PubMed Central

    Zhang, Hongyu; Siegel, Christopher T.; Shuai, Ling; Lai, Jiejuan; Zeng, Linli; Zhang, Yujun; Lai, Xiangdong; Bie, Ping; Bai, Lianhua

    2016-01-01

    NG2-expressing cells are a population of periportal vascular stem/progenitors (MLpvNG2+ cells) that were isolated from healthy adult mouse liver by using a “Percoll-Plate-Wait” procedure. We demonstrated that isolated cells are able to restore liver function after transplantation into a cirrhotic liver, and co-localized with the pericyte marker (immunohistochemistry: PDGFR-β) and CK19. Cells were positive for: stem cell (Sca-1, CD133, Dlk) and liver stem cell markers (EpCAM, CD14, CD24, CD49f); and negative for: hematopoietic (CD34, CD45) and endothelial markers (CD31, vWf, von Willebrand factor). Cells were transplanted (1 × 106 cells) in mice with diethylnitrosamine-induced cirrhosis at week 6. Cells showed increased hepatic associated gene expression of alpha-fetoprotein (AFP), Albumin (Alb), Glucose-6-phosphatase (G6Pc), SRY (sex determining region Y)-box 9 (Sox9), hepatic nuclear factors (HNF1a, HNF1β, HNF3β, HNF4α, HNF6, Epithelial cell adhesion molecule (EpCAM), Leucine-rich repeated-containing G-protein coupled receptor 5-positive (Lgr5) and Tyrosine aminotransferase (TAT). Cells showed decreased fibrogenesis, hepatic stellate cell infiltration, Kupffer cells and inflammatory cytokines. Liver function markers improved. In a cirrhotic liver environment, cells could differentiate into hepatic lineages. In addition, grafted MLpvNG2+ cells could mobilize endogenous stem/progenitors to participate in liver repair. These results suggest that MLpvNG2+ cells may be novel adult liver progenitors that participate in liver regeneration. PMID:26905303

  2. Repair of liver mediated by adult mouse liver neuro-glia antigen 2-positive progenitor cell transplantation in a mouse model of cirrhosis.

    PubMed

    Zhang, Hongyu; Siegel, Christopher T; Shuai, Ling; Lai, Jiejuan; Zeng, Linli; Zhang, Yujun; Lai, Xiangdong; Bie, Ping; Bai, Lianhua

    2016-01-01

    NG2-expressing cells are a population of periportal vascular stem/progenitors (MLpvNG2(+) cells) that were isolated from healthy adult mouse liver by using a "Percoll-Plate-Wait" procedure. We demonstrated that isolated cells are able to restore liver function after transplantation into a cirrhotic liver, and co-localized with the pericyte marker (immunohistochemistry: PDGFR-β) and CK19. Cells were positive for: stem cell (Sca-1, CD133, Dlk) and liver stem cell markers (EpCAM, CD14, CD24, CD49f); and negative for: hematopoietic (CD34, CD45) and endothelial markers (CD31, vWf, von Willebrand factor). Cells were transplanted (1 × 10(6) cells) in mice with diethylnitrosamine-induced cirrhosis at week 6. Cells showed increased hepatic associated gene expression of alpha-fetoprotein (AFP), Albumin (Alb), Glucose-6-phosphatase (G6Pc), SRY (sex determining region Y)-box 9 (Sox9), hepatic nuclear factors (HNF1a, HNF1β, HNF3β, HNF4α, HNF6, Epithelial cell adhesion molecule (EpCAM), Leucine-rich repeated-containing G-protein coupled receptor 5-positive (Lgr5) and Tyrosine aminotransferase (TAT). Cells showed decreased fibrogenesis, hepatic stellate cell infiltration, Kupffer cells and inflammatory cytokines. Liver function markers improved. In a cirrhotic liver environment, cells could differentiate into hepatic lineages. In addition, grafted MLpvNG2(+) cells could mobilize endogenous stem/progenitors to participate in liver repair. These results suggest that MLpvNG2(+) cells may be novel adult liver progenitors that participate in liver regeneration. PMID:26905303

  3. Different digital paths to the keg? How exposure to peers' alcohol-related social media content influences drinking among male and female first-year college students.

    PubMed

    Boyle, Sarah C; LaBrie, Joseph W; Froidevaux, Nicole M; Witkovic, Yong D

    2016-06-01

    Despite speculation that peers' alcohol-related content on social media sites (SMS) may influence the alcohol use behaviors of SMS frequenting college students, this relationship has not been investigated longitudinally. The current prospective study assesses the relationship between exposure to peers' alcohol-related SMS content and later-drinking among first-year college students. Among 408 first-year students, total exposure to peers' alcohol-related content on Facebook, Instagram, and Snapchat during the initial 6 weeks of college predicted alcohol consumption 6 months later. The rather robust relationship persisted even after students' and close friends drinking were accounted for, indicating that alcohol references on SMS do not simply reflect alcohol use behaviors that would otherwise be observed in the absence of SMS and be predictive of later alcohol use. Findings also illuminate important gender differences in the degree to which peers' alcohol-related SMS content influenced later drinking behavior as well as psychological mediators of this relationship. Among females, enhancement drinking motives and beliefs about the role of alcohol in the college experience fully mediated the relationship between SMS alcohol exposure and later drinking. Males, however, evidenced a much stronger predictive relationship between SMS alcohol exposure and second semester drinking, with this relationship only partially explained by perceptions of drinking norms, enhancement drinking motives, and beliefs about the role of alcohol in the college experience. Implications of these findings for college drinking prevention efforts and directions for future research are discussed. PMID:26835604

  4. Insulin Resistance, Ceramide Accumulation, and Endoplasmic Reticulum Stress in Human Chronic Alcohol-Related Liver Disease

    PubMed Central

    Longato, Lisa; Ripp, Kelsey; Setshedi, Mashiko; Dostalek, Miroslav; Akhlaghi, Fatemeh; Branda, Mark; Wands, Jack R.; de la Monte, Suzanne M.

    2012-01-01

    Background. Chronic alcohol-related liver disease (ALD) is mediated by insulin resistance, mitochondrial dysfunction, inflammation, oxidative stress, and DNA damage. Recent studies suggest that dysregulated lipid metabolism with accumulation of ceramides, together with ER stress potentiate hepatic insulin resistance and may cause steatohepatitis to progress. Objective. We examined the degree to which hepatic insulin resistance in advanced human ALD is correlated with ER stress, dysregulated lipid metabolism, and ceramide accumulation. Methods. We assessed the integrity of insulin signaling through the Akt pathway and measured proceramide and ER stress gene expression, ER stress signaling proteins, and ceramide profiles in liver tissue. Results. Chronic ALD was associated with increased expression of insulin, IGF-1, and IGF-2 receptors, impaired signaling through IGF-1R and IRS1, increased expression of multiple proceramide and ER stress genes and proteins, and higher levels of the C14, C16, C18, and C20 ceramide species relative to control. Conclusions. In human chronic ALD, persistent hepatic insulin resistance is associated with dysregulated lipid metabolism, ceramide accumulation, and striking upregulation of multiple ER stress signaling molecules. Given the role of ceramides as mediators of ER stress and insulin resistance, treatment with ceramide enzyme inhibitors may help reverse or halt progression of chronic ALD. PMID:22577490

  5. Skin Immunization Obviates Alcohol-Related Immune Dysfunction

    PubMed Central

    Brand, Rhonda M.; Stottlemyer, John Mark; Cline, Rachel A.; Donahue, Cara; Behari, Jaideep; Falo, Louis D.

    2015-01-01

    Alcoholics suffer from immune dysfunction that can impede vaccine efficacy. If ethanol (EtOH)-induced immune impairment is in part a result of direct exposure of immune cells to EtOH, then reduced levels of exposure could result in less immune dysfunction. As alcohol ingestion results in lower alcohol levels in skin than blood, we hypothesized that the skin immune network may be relatively preserved, enabling skin-targeted immunizations to obviate the immune inhibitory effects of alcohol consumption on conventional vaccines. We employed the two most common chronic EtOH mouse feeding models, the liver-damaging Lieber-DeCarli (LD) and liver-sparing Meadows-Cook (MC) diets, to examine the roles of EtOH and/or EtOH-induced liver dysfunction on alcohol related immunosuppression. Pair-fed mice were immunized against the model antigen ovalbumin (OVA) by DNA immunization or against flu by administering the protein-based influenza vaccine either systemically (IV, IM), directly to liver (hydrodynamic), or cutaneously (biolistic, ID). We measured resulting tissue EtOH levels, liver stress, regulatory T cell (Treg), and myeloid-derived suppressor cell (MDSC) populations. We compared immune responsiveness by measuring delayed-type hypersensitivity (DTH), antigen-specific cytotoxic T lymphocyte (CTL), and antibody induction as a function of delivery route and feeding model. We found that, as expected, and independent of the feeding model, EtOH ingestion inhibits DTH, CTL lysis, and antigen-specific total IgG induced by traditional systemic vaccines. On the other hand, skin-targeted vaccines were equally immunogenic in alcohol-exposed and non-exposed subjects, suggesting that cutaneous immunization may result in more efficacious vaccination in alcohol-ingesting subjects. PMID:26561838

  6. Seasonality of alcohol-related phenomena in Estonia

    NASA Astrophysics Data System (ADS)

    Silm, Siiri; Ahas, Rein

    2005-03-01

    We studied alcohol consumption and its consequences as a seasonal phenomenon in Estonia and analysed the social and environmental factors that may cause its seasonal rhythm. There are two important questions when researching the seasonality of human activities: (1) whether it is caused by natural or social factors, and (2) whether the impact of the factors is direct or indirect. Often the seasonality of social phenomena is caused by social factors, but the triggering mechanisms are related to environmental factors like temperature, precipitation, and radiation via the circannual calendar. The indicators of alcohol consumption in the current paper are grouped as: (1) pre-consumption phenomena, i.e. production, tax and excise, sales (beer, wine and vodka are analysed separately), and (2) post-consumption phenomena, i.e. alcohol-related crime and traffic accidents and the number of people detained in lockups and admitted to alcohol treatment clinics. In addition, seasonal variability in the amount of alcohol advertising has been studied, and a survey has been carried out among 87 students of Tartu University. The analysis shows that different phenomena related to alcohol have a clear seasonal rhythm in Estonia. The peak period of phenomena related to beer is in the summer, from June to August and the low point is during the first months of the year. Beer consumption correlates well with air temperature. The consumption of vodka increases sharply at the end of the year and in June; the production of vodka does not have a significant correlation with negative temperatures. The consumption of wine increases during summer and in December. The consequences of alcohol consumption, expressed as the rate of traffic accidents or the frequency of medical treatment, also show seasonal variability. Seasonal variability of alcohol consumption in Estonia is influenced by natural factors (temperature, humidity, etc.) and by social factors (celebrations, vacations, etc.). However

  7. Disregulated Alcohol-Related Behavior among College Drinkers: Associations with Protective Behaviors, Personality, and Drinking Motives

    ERIC Educational Resources Information Center

    Isaak, Matthew I.; Perkins, David R.; Labatut, Tiffany R.

    2011-01-01

    Objective: This study investigated the psychometric properties of the Disregulated Alcohol-Related Behaviors Inventory (DARBI), a measure of harmful alcohol-related behavior, and the relationship between protective behavior use and scores on the DARBI and several other measures. Participants: Participants were 281 undergraduate volunteers (60%…

  8. Alcohol-Related Consequences among Intercollegiate Student Athletes: The Role of Drinking Motives

    ERIC Educational Resources Information Center

    Doumas, Diana M.

    2013-01-01

    This study examined drinking motives as predictors of alcohol-related consequences among student athletes and nonathletes. Results indicated that the highest level of alcohol-related consequences was reported by student athletes with high levels of both coping and conformity motives. (Contains 2 tables and 2 figures.)

  9. Demographic and Academic Trends in Drinking Patterns and Alcohol-Related Problems on Dry College Campuses

    ERIC Educational Resources Information Center

    Taylor, Dexter M.; Johnson, Mark B.; Voas, Robert B.; Turrisi, Robert

    2006-01-01

    Restricting alcohol consumption on campus is a measure often used by college administrators to prevent alcohol abuse and-alcohol-related problems. The effect of dry campus policies on alcohol consumption and alcohol-related problems, however, remains poorly understood. This report will compare characteristics of two dry campuses with descriptions…

  10. Community off-sales provision and the presence of alcohol-related detritus in residential neighbourhoods.

    PubMed

    Forsyth, Alasdair J M; Davidson, Neil

    2010-03-01

    This paper investigates the relationship between community off-sales premises and alcohol-related detritus (litter/remains) in residential neighbourhoods. This was accomplished by photographing all brand-identifiable alcohol product detritus (glass, packaging, etc.) where they lay and mapping these against the presence of off-sales outlets (licensed convenience stores) in the community. It was hypothesised that alcohol-related detritus would be greatest near to such alcohol outlets. However, although there was some evidence of a "broken bottles effect", accumulations of alcohol-related detritus near some off-sales premises, it is concluded that local area deprivation is a better predictor of such alcohol-related incivility than is outlet provision. The implications of these findings are discussed in relation to current social responsibility policy developments which are designed to make the alcohol industry liable for alcohol-related incivilities. PMID:20004129

  11. Diastolic dysfunction in cirrhosis.

    PubMed

    Møller, Søren; Wiese, Signe; Halgreen, Hanne; Hove, Jens D

    2016-09-01

    Development of esophageal varices, ascites, and hepatic nephropathy is among the major complications of cirrhosis. The presence of cirrhotic cardiomyopathy, which includes a left ventricular diastolic dysfunction (DD), seems to deteriorate the course of the disease and the prognosis. Increased stiffness of the cirrhotic heart may decrease the compliance and result in DD. The prevalence of DD in cirrhotic patients averages about 50 %. It can be evaluated by transmitral Doppler echocardiography, tissue Doppler echocardiography, and cardiac magnetic resonance imaging. There seems to be a relation between DD and the severity of liver dysfunction and the presence of ascites. After liver transplantation, DD worsens the prognosis and increases the risk of graft rejection, but DD improves after few months. Insertion of a transjugular intrahepatic portosystemic shunt increases left ventricular diastolic volumes, and DD is a predictor of poorer survival in these patients. Future studies should aim at disclosing pathophysiological mechanisms behind the developing of DD in cirrhosis in relation to patient characteristics, development of complications, treatment, and risk associated with interventional procedures. PMID:27075496

  12. Differential alcohol-related mortality among American Indian tribes in Oklahoma, 1968-1978.

    PubMed

    Christian, C M; Dufour, M; Bertolucci, D

    1989-01-01

    Tribal differences in alcohol-related mortality were examined among 11 Indian tribes living in Oklahoma. Data on alcohol-related deaths from 1968 to 1978 were compiled and assigned to various tribes on the basis of population distributions by county. Results showed significant differences in alcohol-related mortality among the various tribes. Of the 267,238 total deaths in Oklahoma during the study period, 9.3% of Indian deaths were alcohol-related while only 3.2% of those among blacks and 2.4% of those among whites were classified as such. Indian males and females are far more likely to die of alcohol-related deaths than their black and white counterparts. Cheyenne-Arapaho, Comanche and Kiowa areas (located in the western++ part of the state) have higher alcohol-related deaths than Cherokee, Choctaw, Creek, Seminole and Pawnee areas (located in eastern Oklahoma). Indian residents of the Seminole area have the lowest percentage of deaths identified as alcohol-related. The patterns which emerge may be due to different cultural and historical factors among the Indian tribes. PMID:2784011

  13. American Indian/Alaska Native Alcohol-Related Incarceration and Treatment

    PubMed Central

    Feldstein, Sarah W.; Venner, Kamilla L.; May, Philip A.

    2010-01-01

    American Indian/Alaska Natives have high rates of alcohol-related arrests and are overrepresented in justice systems. To understand the relationship between alcohol dependence, treatment, and alcohol-related incarceration, this study queried American Indian/Alaska Natives currently in remission from alcohol dependence. Participants reported receiving 0 to 43 treatment experiences. Moreover, participants had a significantly greater number of alcohol-related incarcerations than all other treatments combined. These findings underline the importance of making alcohol treatment available within criminal justice settings. PMID:17602406

  14. Primary biliary cirrhosis.

    PubMed

    Nguyen, Douglas L; Juran, Brian D; Lazaridis, Konstantinos N

    2010-10-01

    Primary biliary cirrhosis (PBC) is an idiopathic chronic autoimmune liver disease that primarily affects women. It is believed that the aetiology for PBC is a combination between environmental triggers in genetically vulnerable persons. The diagnosis for PBC is made when two of the three criteria are fulfilled and they are: (1) biochemical evidence of cholestatic liver disease for at least 6 month's duration; (2) anti-mitochondrial antibody (AMA) positivity; and (3) histologic features of PBC on liver biopsy. Ursodeoxycholic acid (UDCA) is the only FDA-approved medical treatment for PBC and should be administered at a recommended dose of 13-15 mg/kg/day. Unfortunately despite adequate dosing of UDCA, approximately one-third of patients does not respond adequately and may require liver transplantation. Future studies are necessary to elucidate the role of environmental exposures and overall genetic impact not only in the development of PBC, but on disease progression and variable clinical response to therapy. PMID:20955967

  15. Interactive and Indirect Effects of Anxiety and Negative Urgency on Alcohol-Related Problems

    PubMed Central

    Menary, Kyle R.; Corbin, William R.; Leeman, Robert F.; Fucito, Lisa M.; Toll, Benjamin A.; DeMartini, Kelly; O’Malley, Stephanie S.

    2015-01-01

    Background Although drinking for tension reduction has long been posited as a risk factor for alcohol-related problems, studies investigating anxiety in relation to risk for alcohol problems have returned inconsistent results, leading researchers to search for potential moderators. Negative urgency (the tendency to become behaviorally dysregulated when experiencing negative affect) is a potential moderator of theoretical interest because it may increase risk for alcohol problems among those high in negative affect. The present study tested a cross-sectional mediated moderation hypothesis whereby an interactive effect of anxiety and negative urgency on alcohol problems is mediated through coping-related drinking motives. Method The study utilized baseline data from a hazardously drinking sample of young adults (N = 193) evaluated for participation in a randomized controlled trial of naltrexone and motivational interviewing for drinking reduction. Results The direct effect of anxiety on physiological dependence symptoms was moderated by negative urgency such that the positive association between anxiety and physiological dependence symptoms became stronger as negative urgency increased. Indirect effects of anxiety and negative urgency on alcohol problems (operating through coping motives) were also observed. Conclusions Although results of the current cross-sectional study require replication using longitudinal data, the findings suggest that the simultaneous presence of anxiety and negative urgency may be an important indicator of risk for AUDs via both direct interactive effects and indirect additive effects operating through coping motives. These findings have potentially important implications for prevention/intervention efforts for individuals who become disinhibited in the context of negative emotional states. PMID:26031346

  16. Is local alcohol outlet density related to alcohol-related morbidity and mortality in Scottish cities?

    PubMed Central

    Richardson, E.A.; Hill, S.E.; Mitchell, R.; Pearce, J.; Shortt, N.K.

    2015-01-01

    Alcohol consumption may be influenced by the local alcohol retailing environment. This study is the first to examine neighbourhood alcohol outlet availability (on- and off-sales outlets) and alcohol-related health outcomes in Scotland. Alcohol-related hospitalisations and deaths were significantly higher in neighbourhoods with higher outlet densities, and off-sales outlets were more important than on-sales outlets. The relationships held for most age groups, including those under the legal minimum drinking age, although were not significant for the youngest legal drinkers (18–25 years). Alcohol-related deaths and hospitalisations were higher in more income-deprived neighbourhoods, and the gradient in deaths (but not hospitalisations) was marginally larger in neighbourhoods with higher off-sales outlet densities. Efforts to reduce alcohol-related harm should consider the potentially important role of the alcohol retail environment. PMID:25840352

  17. Is local alcohol outlet density related to alcohol-related morbidity and mortality in Scottish cities?

    PubMed

    Richardson, E A; Hill, S E; Mitchell, R; Pearce, J; Shortt, N K

    2015-05-01

    Alcohol consumption may be influenced by the local alcohol retailing environment. This study is the first to examine neighbourhood alcohol outlet availability (on- and off-sales outlets) and alcohol-related health outcomes in Scotland. Alcohol-related hospitalisations and deaths were significantly higher in neighbourhoods with higher outlet densities, and off-sales outlets were more important than on-sales outlets. The relationships held for most age groups, including those under the legal minimum drinking age, although were not significant for the youngest legal drinkers (18-25 years). Alcohol-related deaths and hospitalisations were higher in more income-deprived neighbourhoods, and the gradient in deaths (but not hospitalisations) was marginally larger in neighbourhoods with higher off-sales outlet densities. Efforts to reduce alcohol-related harm should consider the potentially important role of the alcohol retail environment. PMID:25840352

  18. Exploring College Students' Use of General and Alcohol-Related Social Media and Their Associations with Alcohol-Related Behaviors

    ERIC Educational Resources Information Center

    Hoffman, Eric W.; Pinkleton, Bruce E.; Weintraub Austin, Erica; Reyes-Velázquez, Wanda

    2014-01-01

    Objective: Alcohol marketers have increasingly moved their advertising efforts into digital and social media venues. As a result, the purpose of this study is to investigate associations between students' use of social media, their exposure to alcohol marketing messages through social media, and their alcohol-related beliefs and behaviors.…

  19. Brand preferences of underage drinkers who report alcohol-related fights and injuries

    PubMed Central

    Roberts, Sarah P.; Siegel, Michael B.; DeJong, William; Naimi, Timothy S.; Jernigan, David H.

    2014-01-01

    Background A significant body of research has demonstrated an association between adolescent alcohol consumption and subsequent fights and injuries. To date, however, no research has identified which brands are associated with alcohol-related fights and injuries among underage drinkers. Objectives We aimed to: 1) report the prevalence of alcohol-related fights and injuries among a national sample of underage drinkers in the U.S. and 2) describe the relationship between specific alcohol brand consumption and these alcohol-related negative consequences. Methods We recruited 1,031 self-reported drinkers (ages 13–20 years) via an internet panel maintained by Knowledge Networks to complete an online survey. Respondents reported their past-month overall and brand-specific alcohol consumption, risky drinking behavior, and past-year alcohol-related fights and injuries. Results Over one-quarter of the respondents (26.7%, N=232) reported at least one alcohol-related fight or injury in the past year. Heavy episodic drinkers were over six times more likely to report one of these negative alcohol-related consequences (AOR: 6.4, 95% CI: 4.1–9.9). Respondents of black race and those from higher-income households were also significantly more likely to report that experience (AOR: 2.2, 95% CI: 1.3–3.7; AOR: 1.8, 95% CI: 1.1–3.0 and 1.1–3.2, respectively). We identified eight alcohol brands that were significantly associated with alcohol-related fights and injuries. Conclusions/Importance Alcohol-related fights and injuries were frequently reported by adolescent respondents. Eight alcohol brands were significantly more popular among drinkers who experienced these adverse consequences. These results point to the need for further research on brand-specific correlates of underage drinking and negative health outcomes. PMID:25612075

  20. Asian American Women and Alcohol-Related Problems: The Role of Multidimensional Feminine Norms.

    PubMed

    Iwamoto, Derek Kenji; Grivel, Margaux; Cheng, Alice; Clinton, Lauren; Kaya, Aylin

    2016-04-01

    Increasing rates of heavy episodic drinking (HED; four or more drinks in one sitting) and alcohol use disorders among young adult Asian American women signify the need to identify the risk and protective factors for HED and alcohol-related problems in this demographic. Multidimensional feminine norms, or the beliefs and expectations of what it means to be a woman, are theoretically relevant factors that may help elucidate within-group variability in HED and alcohol-related problems. The present study examined associations between nine salient feminine norms, HED, and alcohol-related problems among 398 second-generation Asian American college women. Our findings reveal that certain feminine norms are protective of HED and alcohol-related problems, while others are risk factors, even when controlling for well-established correlates of HED and alcohol-related problems, such as perceived peer drinking norms. The results elucidate the importance of multidimensional feminine norms and their relationship to HED and alcohol-related problems among the increasingly at-risk group, Asian American college women. PMID:25634626

  1. Alcohol-Related Visual Cues Impede the Ability to Process Auditory Information: Seeing but Not Hearing

    PubMed Central

    Monem, Ramey G.; Fillmore, Mark T.

    2015-01-01

    Studies of visual attention find that drinkers spend more time attending to images of alcohol-related stimuli compared to neutral images. It is believed that this attentional bias contributes to the maintenance of alcohol use. However, no research has examined the possibility that this bias of visual attention might actually impede the functioning of other modalities, such as the processing of accompanying auditory stimuli. This study aimed to determine if alcohol-related images engender greater sensory dominance than neutral images, such that processing accompanying information from another modality (audition) would be impeded. Drinkers who had an attentional bias to alcohol-related images performed a multisensory perception task that measured how alcohol-related versus neutral visual images affected their ability to detect and respond to simultaneously presented auditory signals. In accord with the hypothesis, compared with neutral images, the presentation of alcohol-related images impaired the ability to detect and respond to auditory signals. Increased dominance of the visual modality was demonstrated by more bimodal targets being misclassified as visual-only targets in the alcohol target condition compared with that of the neutral. Findings suggest that increased processing of alcohol-related stimuli may impede an individual’s ability to encode and interpret information obtained from other sensory modalities. PMID:26653149

  2. Genetics Home Reference: cryptogenic cirrhosis

    MedlinePlus

    ... liver function. People with this condition develop irreversible liver disease caused by scarring of the liver (cirrhosis), typically ... result from a condition called non-alcoholic fatty liver disease (NAFLD). In NAFLD, fat accumulates in the liver , ...

  3. [Liver cirrhosis: pulmonary function].

    PubMed

    Marichal, I; Dublet, P; Medrano, G; Hinestrosa, H; Tálamo, C; Korchoff, W; Alvarado, R; Quirós, E

    1991-01-01

    We performed a functional respiratory examination which consisted of arterial gasometry, spirometry, diffusion capacity to CO2, alveolo-arterial gradient of O2 and pulmonary volumes to 8 patients with cirrhosis diagnosed by clinical history, laboratory exams, abdominal ultrasound and histology. Our results showed a slight obstructive pattern of peripheric airways (FMM: 88.87 +/- 8.7%) in the spirometry, no difference in arterial gases at upright and recumbent position was observed, with low values of apO2 (75.51 +/- 1.16 upright and 75.87 +/- 2.16 mmHg recumbent) without statistic significance. The gradient G(Aa) O2 increased to (30.89 +/- 1.06 mmHg). Besides there was a diffusion abnormality with a DLCO2/VA of (71.87 +/- 6.05%). Breathing 100% O2, did not change the gradient which allows us to postulate the existence of an abnormality of gaseous interchange due to shunts. We found no relationship between albumin levels and DLCO2/VO neither with pO2 in upright position; there was a relationship at recumbent position between the hepatic disorder and the arterial desaturation. We concluded that there is no significant hypoxia even with position changes, there is increase of G (Aa) O2 by shunt type disorders and that this is probably related with albumin levels. PMID:1843958

  4. Primary Biliary Cirrhosis

    PubMed Central

    Nguyen, Douglas L.; Juran, Brian D.; Lazaridis, Konstantinos N.

    2010-01-01

    Primary biliary cirrhosis (PBC) is an idiopathic chronic autoimmune liver disease that primarily affects women. It is believed that the etiology for PBC is a combination between environmental triggers in genetically vulnerable persons. The diagnosis for PBC is made when two of the three criteria are fulfilled and they are: (1) biochemical evidence of cholestatic liver disease for at least 6 month’s duration; (2) anti-mitochondrial antibody (AMA) positivity; and (3) histologic features of PBC on liver biopsy. Ursodeoxycholic acid (UDCA) is the only FDA-approved medical treatment for PBC and should be administered at a recommended dose of 13-15mg/kg/day. Unfortunately despite adequate dosing of UDCA, approximately one-third of patients does not respond adequately and may require liver transplantation. Future studies are necessary to elucidate the role of environmental exposures and overall genetic impact not only in the development of PBC, but on disease progression and variable clinical response to therapy. PMID:20955967

  5. Alcohol Related Changes in Regulation of NMDA Receptor Functions

    PubMed Central

    Nagy, József

    2008-01-01

    Long-term alcohol exposure may lead to development of alcohol dependence in consequence of altered neurotransmitter functions. Accumulating evidence suggests that the N-methyl-D-aspartate (NMDA) type of glutamate receptors is a particularly important site of ethanol’s action. Several studies showed that ethanol potently inhibits NMDA receptors (NMDARs) and prolonged ethanol exposition leads to a compensatory “up-regulation” of NMDAR mediated functions. Therefore, alterations in NMDAR function are supposed to contribute to the development of ethanol tolerance, dependence as well as to the acute and late signs of ethanol withdrawal. A number of publications report alterations in the expression and phosphorylation states of NMDAR subunits, in their interaction with scaffolding proteins or other receptors in consequence of chronic ethanol treatment. Our knowledge on the regulatory processes, which modulate NMDAR functions including factors altering transcription, protein expression and post-translational modifications of NMDAR subunits, as well as those influencing their interactions with different regulatory proteins or other downstream signaling elements are incessantly increasing. The aim of this review is to summarize the complex chain of events supposedly playing a role in the up-regulation of NMDAR functions in consequence of chronic ethanol exposure. PMID:19305787

  6. Hepatosplanchnic circulation in cirrhosis and sepsis

    PubMed Central

    Prin, Meghan; Bakker, Jan; Wagener, Gebhard

    2015-01-01

    Hepatosplanchnic circulation receives almost half of cardiac output and is essential to physiologic homeostasis. Liver cirrhosis is estimated to affect up to 1% of populations worldwide, including 1.5% to 3.3% of intensive care unit patients. Cirrhosis leads to hepatosplanchnic circulatory abnormalities and end-organ damage. Sepsis and cirrhosis result in similar circulatory changes and resultant multi-organ dysfunction. This review provides an overview of the hepatosplanchnic circulation in the healthy state and in cirrhosis, examines the signaling pathways that may play a role in the physiology of cirrhosis, discusses the physiology common to cirrhosis and sepsis, and reviews important issues in management. PMID:25759525

  7. Recurring alcohol-related care between 1998 and 2007 among people treated for an alcohol-related disorder in 1997: A register study in Stockholm County

    PubMed Central

    2011-01-01

    Background Inpatient care for alcohol intoxication is increasing in Sweden, especially among young women. Since it is well known that alcohol disorder is a chronic relapsing illness, this study examines the extent to which people return for more care. Method All inpatients with alcohol-related diagnoses in Stockholm County during 1997 were followed prospectively to 2007 through registers. The proportion reappearing for the same diagnosis, other alcohol-related inpatient, or outpatient care each year after baseline, as well as the number of years the inpatients reappeared were calculated (n = 2735). Three diagnoses were examined separately; alcohol dependence, harmful use of alcohol, and alcohol intoxication. Results Three out of five inpatients with an alcohol diagnoses reappeared for more alcohol-related inpatient care during the following decade. The proportion returning was largest the year after baseline and then decreased curvilinearly over time. The inclusion of outpatient care increased proportions, but did not change patterns. Of those with an alcohol dependence diagnosis at baseline 42 percent returned for more alcohol-related inpatient care the first, 28 percent the fifth, and 25 percent the tenth year. Corresponding proportions for harmful use and intoxication were smaller. One in five among those with an alcohol dependence returned for more than five of the ten years. Ordered logistic regressions confirmed that besides diagnosis, age and gender were independently related to the number of years returning to care. Conclusions While middle-aged males with alcohol dependence were in a revolving door, young female inpatients with intoxication diagnosis returned to a comparably lower degree. PMID:21771291

  8. Brief Report: Genetics of Alcoholic Cirrhosis - GenomALC multinational Study

    PubMed Central

    Whitfield, John B.; Rahman, Khairunnessa; Haber, Paul S.; Day, Christopher P.; Masson, Steven; Daly, Ann K.; Cordell, Heather J.; Mueller, Sebastian; Seitz, Helmut K.; Liangpunsakul, Suthat; Westerhold, Chi; Liang, Tiebing; Lumeng, Lawrence; Foroud, Tatiana; Nalpas, Bertrand; Mathurin, Philippe; Stickel, Felix; Soyka, Michael; Botwin, Gregory J.; Morgan, Timothy R.; Seth, Devanshi

    2015-01-01

    Background The risk of alcohol-related liver cirrhosis increases with increasing alcohol consumption, but many people with very high intake escape liver disease. We postulate that susceptibility to alcoholic cirrhosis has a complex genetic component, and propose that this can be dissected through a large and sufficiently-powered genome-wide association study (GWAS). Methods The GenomALC Consortium comprises researchers from Australia, France, Germany, Switzerland, United Kingdom and United States, with a joint aim of exploring the genetic and genomic basis of alcoholic cirrhosis. For this NIH/NIAAA funded study, we are recruiting high-risk drinkers who are either cases (with alcoholic cirrhosis) or controls (drinking comparable amounts over similar time, but free of significant liver disease). Extensive phenotypic data are obtained using semi-structured interviews and patient records, and blood samples are collected. Results We have successfully recruited 859 participants including 538 matched case-control samples as of September 2014, using study specific inclusion-exclusion criteria and data collection protocols. Of these, 580 are cases (442 men, 138 women) and 279 are controls (205 men, 74 women). Duration of excessive drinking was slightly greater in cases than controls and was significantly less in women than men. Cases had significantly lower lifetime alcohol intake than controls. Both cases and controls had a high prevalence of reported parental alcohol problems, but cases were significantly more likely to report that a father with alcohol problems had died from liver disease (Odds Ratio 2.53, 95% CI 1.31–4.87, p = 0.0055). Conclusions Recruitment of participants for a GWAS of alcoholic cirrhosis has proved feasible across countries with multiple sites. Affected patients often consume less alcohol than unaffected ones, emphasising the existence of individual vulnerability factors. Cases are more likely to report liver disease in a father with alcohol

  9. Oxidative stress, metabolism of ethanol and alcohol-related diseases.

    PubMed

    Zima, T; Fialová, L; Mestek, O; Janebová, M; Crkovská, J; Malbohan, I; Stípek, S; Mikulíková, L; Popov, P

    2001-01-01

    Alcohol-induced oxidative stress is linked to the metabolism of ethanol. Three metabolic pathways of ethanol have been described in the human body so far. They involve the following enzymes: alcohol dehydrogenase, microsomal ethanol oxidation system (MEOS) and catalase. Each of these pathways could produce free radicals which affect the antioxidant system. Ethanol per se, hyperlactacidemia and elevated NADH increase xanthine oxidase activity, which results in the production of superoxide. Lipid peroxidation and superoxide production correlate with the amount of cytochrome P450 2E1. MEOS aggravates the oxidative stress directly as well as indirectly by impairing the defense systems. Hydroxyethyl radicals are probably involved in the alkylation of hepatic proteins. Nitric oxide (NO) is one of the key factors contributing to the vessel wall homeostasis, an important mediator of the vascular tone and neuronal transduction, and has cytotoxic effects. Stable metabolites--nitrites and nitrates--were increased in alcoholics (34.3 +/- 2.6 vs. 22.7 +/- 1.2 micromol/l, p < 0.001). High NO concentration could be discussed for its excitotoxicity and may be linked to cytotoxicity in neurons, glia and myelin. Formation of NO has been linked to an increased preference for and tolerance to alcohol in recent studies. Increased NO biosynthesis also via inducible NO synthase (NOS, chronic stimulation) may contribute to platelet and endothelial dysfunctions. Comparison of chronically ethanol-fed rats and controls demonstrates that exposure to ethanol causes a decrease in NADPH diaphorase activity (neuronal NOS) in neurons and fibers of the cerebellar cortex and superior colliculus (stratum griseum superficiale and intermedium) in rats. These changes in the highly organized structure contribute to the motor disturbances, which are associated with alcohol abuse. Antiphospholipid antibodies (APA) in alcoholic patients seem to reflect membrane lesions, impairment of immunological

  10. Acute Kidney Injury in Cirrhosis.

    PubMed

    Karvellas, Constantine J; Durand, Francois; Nadim, Mitra K

    2015-10-01

    Acute kidney injury (AKI) is a frequent complication of end-stage liver disease, especially in those with acute-on-chronic liver failure, occurring in up to 50% of hospitalized patients with cirrhosis. There is no specific blood or urine biomarker that can reliably identify the cause of AKI in cirrhotic patients. This review examines studies used to assess renal dysfunction in cirrhotic patients including new diagnostic criteria and potential novel biomarkers. Although biomarker development to differentiate the cause of AKI in cirrhosis has promise, the utility of biomarkers to determine irreversible renal dysfunction with liver transplant remains lacking, warranting further investigation. PMID:26410141

  11. An unusual case of cirrhosis.

    PubMed

    Alkaddour, Ahmad; Vega, Kenneth J; Shujaat, Adil

    2014-01-01

    49-year-old white female with remote h/o sarcoidosis was referred to GI when her liver was noted to be nodular. Physical examination revealed normal vital signs and no icterus, spider nevi, clubbing, ascites, hepatosplenomegaly, or ankle edema. LFTs, hepatitis serologies, ANA, AMA, ASMA, Ferritin, Ceruloplasmin, and α 1-AT, level were unremarkable. Liver biopsy showed cirrhosis. She developed worsening of baseline SOB and was hospitalized. She was eventually diagnosed with constrictive pericarditis. A diagnosis of cardiac cirrhosis was made. PMID:24782928

  12. Spontaneous Bacterial Peritonitis Due to Methicillin-Resistant Staphylococcus Aureus in a Patient with Cirrhosis: The Potential Role for Daptomycin and Review of the Literature

    PubMed Central

    Falcone, Marco; Russo, Alessandro; Pacini, Giovanni; Merli, Manuela; Venditti, Mario

    2015-01-01

    Gram-positive cocci are emerging causes of spontaneous bacterial peritonitis (SBP), especially in patients with healthcare-associated infections. We report the case of a 68-year-old man with hepatitis C virus and alcohol-related cirrhosis who developed SBP due to methicillin-resistant Staphylococcus aureus treated with daptomycin. We discuss the potential role of daptomycin in this setting with a review of the literature about the use of daptomycin in primary or secondary bacterial peritonitis. PMID:26500743

  13. Management options in decompensated cirrhosis

    PubMed Central

    Shah, Neeral L; Banaei, Yasmin Pourkazemi; Hojnowski, Kristen L; Cornella, Scott L

    2015-01-01

    Chronic injury to the liver from a variety of different sources can result in irreversible scarring of the liver, known as cirrhosis. Cirrhosis is a major cause of morbidity and mortality in the USA, and according to the Centers for Disease Control and Prevention was responsible for 31,903 deaths in 2010 alone. It is thus of the utmost importance to appropriately manage these patients in the inpatient and outpatient setting to improve morbidity and mortality. In this review, we address four major areas of cirrhosis management: outpatient management of portal hypertension with decompensation, hepatic encephalopathy, hepatorenal syndrome, and bleeding/coagulation issues. Outpatient management covers recommendations for health care maintenance and screening. Hepatic encephalopathy encompasses a brief review of pathophysiology, treatment in the acute setting, and long-term prevention. Hepatorenal syndrome is discussed in regards to pathophysiology and treatment in the hospital setting. Finally, a discussion of the assessment of coagulation profiles in cirrhosis and recommendations for bleeding and thrombosis complications is included. These topics are not all encompassing with regard to this complicated population, but rather an overview of a few medical problems that are commonly encountered in their care. PMID:26203291

  14. Questionnaire Based Assessment of Risk Factors for Primary Biliary Cirrhosis

    PubMed Central

    Lammert, Craig; Nguyen, Douglas L.; Juran, Brian D.; Schlicht, Erik; Larson, Joseph J.; Atkinson, Elizabeth J.; Lazaridis, Konstantinos N.

    2013-01-01

    Background Primary Biliary Cirrhosis is a cholestatic liver disease characterized by immune-mediated destruction of bile ducts. Its pathogenesis is largely unknown, although complex interactions between environment and genetic predisposition are proposed. Aims Identify disease risk factors using a detailed patient questionnaire and compare study findings to 3 published reports. Methods Questionnaire data were prospectively collected from 522 cases and 616 controls of the Mayo Clinic Primary Biliary Cirrhosis Genetic Epidemiology Registry. Case and control responses were compared using logistic regression, adjusting for recruitment age, sex, and education level. Results Cases reported ever regularly smoking cigarettes more frequently than controls (P < 0.001). History of urinary tract infection (UTI) was similar between groups; however, cases reported multiple UTIs more commonly than controls (P < 0.001). Frequency of other autoimmune disease was higher in cases than controls (P < 0.001). As well, prevalence of primary biliary cirrhosis among first-degree relatives was higher in case families than control families (P < 0.001). Conclusions Our study confirms prior reported risk factors associated with disease risk. Given the potential importance of gene and environment interactions, further examination of environmental risk factors considering genetic background may provide new insight into primary biliary cirrhosis pathogenesis. PMID:23490343

  15. Hepatic erythropoietin response in cirrhosis. A contemporary review.

    PubMed

    Risør, Louise Madeleine; Fenger, Mogens; Olsen, Niels Vidiendal; Møller, Søren

    2016-01-01

    The main function of erythropoietin (EPO) is to maintain red blood cell mass, but in recent years, increasing evidence has suggested a wider biological role not solely related to erythropoiesis, e.g. angiogenesis and tissue protection. EPO is produced in the liver during fetal life, but the main production shifts to the kidney after birth. The liver maintains a production capacity of up to 10% of the total EPO synthesis in healthy controls, but can be up-regulated to 90-100%. However, the hepatic EPO synthesis has been shown not to be adequate for correction of anemia in the absence of renal-derived EPO. Elevated circulating EPO has been reported in a number of diseases, but data from cirrhotic patients are sparse and the level of plasma EPO in patients with cirrhosis is controversial. Cirrhosis is characterized by liver fibrosis, hepatic dysfunction and the release of proinflammatory cytokines, which lead to arterial hypotension, hepatic nephropathy and anemia. An increase in EPO due to renal hypoperfusion, hypoxia and anemia or an EPO-mediated hepato-protective and regenerative mechanism is plausible. However, poor hepatic synthesis capacity, a decreasing co-factor level and inflammatory feedback mechanisms may explain a potential insufficient EPO response in end-stage cirrhosis. Finally, the question remains as to whether a potential increase in EPO production in certain stages of cirrhosis originates from the kidney or liver. This paper aims to review contemporary aspects of EPO relating to chronic liver disease. PMID:26919118

  16. Protective Behavioral Strategies and Negative Alcohol-Related Consequences in College Students

    ERIC Educational Resources Information Center

    Araas, Teresa E.; Adams, Troy B.

    2009-01-01

    Objective: Alcohol abuse among college students is associated with a quality of life burden. The current study replicated and extended previous research on protective behavioral strategies (PBS) by examining relationships between PBS use and negative alcohol-related consequences. Method: A national sample of 29,792 U. S. college students who…

  17. An Employee Assistance Model of Health Care Management for Employees with Alcohol-Related Problems.

    ERIC Educational Resources Information Center

    Carson, Kerry D.; Balkin, David B.

    1992-01-01

    Describes employee assistance model in which cost-effective, high-quality treatment can be offered for a complex range of alcohol-related problems. Notes that this system of care allows the employee to be treated in the least restrictive therapeutic environment, thus encouraging continued productivity at work. (Author/NB)

  18. The origin of alcohol-related social norms in the Saami minority.

    PubMed

    Larsen, S

    1993-04-01

    The present paper addressed the problem of the origin of alcohol-related social norms in the Saami minority in northern Norway. Based on data from studies of comparable ethnic minorities in Greenland, North America and Australia it could be expected that alcohol use- and abuse would be more prevalent in the Saami than in the Norwegian populations of northern Norway. No data to support this hypothesis exist. On the contrary, available data suggest that drinking problems in this group are similar to those of the majority in the area. The present paper developed the hypothesis that Saami alcohol-related social norms originated in the Laestadian religious revival. The paper investigated the impact of the Laestadian culture in the formation of alcohol-related social norms. It was concluded that the Laestadian sobriety norm, and the norm of abstinence from the use of adiafora, have influenced alcohol-related behaviour in the Saami group in such a way that this group does not conform to the drinking behaviour found in comparable minorities. PMID:8485427

  19. The Effects of Sleep Problems and Depression on Alcohol-Related Negative Consequences among College Students

    ERIC Educational Resources Information Center

    Wattenmaker McGann, Amanda

    2013-01-01

    Previous literature provides an overview of the multiple relationships between alcohol use, protective behavioral strategies (PBS), alcohol-related negative consequences, depression, and sleep problems among college students, as well as differences by individual level characteristics, such as age, gender, and race/ethnicity. The purpose of this…

  20. Truancy, Alcohol Use and Alcohol-Related Problems in Secondary School Pupils in Norway

    ERIC Educational Resources Information Center

    Mounteney, J.; Haugland, S.; Skutle, A.

    2010-01-01

    This study focuses on a vulnerable group of pupils often missed by mainstream school surveys. It explores alcohol use and alcohol-related problems for a sample of truants of secondary school age, comparing behaviours with a school-based sample from the same geographical area. Analyses are based on a survey among truants (n = 107) and a school…

  1. The moderating role of implicit alcohol-related cognitions in hazardous alcohol use

    PubMed Central

    Cavanagh, Lucia; Obasi, Ezemenari M.

    2015-01-01

    The present study applied the Go/No-Go Association Test (GNAT; Nosek & Banaji, 2001) to measure alcohol-related implicit cognitions. Additionally, it assessed the role of implicit cognitions as a potential moderator in the relationship between explicit predictors of alcohol use and hazardous drinking behavior. University undergraduate students (N = 214) completed self-report questionnaires assessing reasons for drinking and reported alcohol use. Participants also completed two GNATs assessing implicit-alcohol-related cognitions associated with attitude (good-bad) and perceived safety (safe-dangerous). As expected, participants held implicit appraisals of alcohol as ‘‘bad’’ and ‘‘dangerous’’ in the context of nonalcoholic drinks, and as ‘‘good’’ and ‘‘safe’’ in the context of licit and illicit drugs. Implicit alcohol-related cognitions moderated the relationship between drinking to cope with negative affect and hazardous drinking and drinking due to cues or craving and hazardous drinking. These findings highlight the multidimensional nature of implicit cognitions and the role of negative implicit alcohol-related associations in moderating relationships between explicit processes and subsequent alcohol use behaviors. PMID:26989352

  2. An Examination of College Students' Receptiveness to Alcohol-Related Information and Advice

    ERIC Educational Resources Information Center

    Leahy, Matthew M.; Jouriles, Ernest N.; Walters, Scott T.

    2013-01-01

    This project examined the reliability and validity of a newly developed measure of college students' receptiveness to alcohol related information and advice. Participants were 116 college students who reported having consumed alcohol at some point in their lifetime. Participants completed a measure of receptiveness to alcohol-related…

  3. Positive and Negative Alcohol-Related Consequences: Associations with Past Drinking

    ERIC Educational Resources Information Center

    Lee, Christine M.; Maggs, Jennifer L.; Neighbors, Clayton; Patrick, Megan E.

    2011-01-01

    While recent attention suggests that positive and negative alcohol-related expectancies are important determinants of alcohol use, less is known about what types of consequences young people report actually experiencing when drinking alcohol. The present study (N = 742, 54% women) examined positive (Fun/Social, Relaxation/Coping, Positive Image)…

  4. Alcohol-Related Vehicular Death Rates for College Students in the Commonwealth of Virginia

    ERIC Educational Resources Information Center

    Turner, James; Bauerle, Jennifer; Keller, Adrienne

    2011-01-01

    Objective: Determine rate of college student alcohol-related vehicular traffic fatalities in Virginia during 2007. Participants: Undergraduates at colleges and universities in Virginia. Methods: Institutions with membership in the American College Health Association were invited to participate in a survey. Data collected from institutional reports…

  5. Binge Drinking and Alcohol-Related Problems among Community College Students: Implications for Prevention Policy

    ERIC Educational Resources Information Center

    Sheffield, Felicia D.; Darkes, Jack; Del Boca, Frances K.; Goldman, Mark S.

    2005-01-01

    Binge drinking and alcohol-related problems among students at traditional 4-year universities have been well documented. However, little is known about the frequency of their such behaviors and its consequences among community college students, who comprise roughly 44% of all undergraduate students in the United States. The present study examined…

  6. Perfectionism, Perceived Stress, Drinking to Cope, and Alcohol-Related Problems among College Students

    ERIC Educational Resources Information Center

    Rice, Kenneth G.; Van Arsdale, Amy C.

    2010-01-01

    This study investigated the association between perfectionism (categorized by adaptive perfectionistic, maladaptive perfectionistic, or nonperfectionistic groups), perceived stress, drinking alcohol to cope, and alcohol-related problems in a large sample of college students (N = 354). Maladaptive perfectionists reported significantly higher levels…

  7. Alcohol-Related Incident Guardianship and Undergraduate College Parties: Enhancing the Social Norms Marketing Approach

    ERIC Educational Resources Information Center

    Gilbertson, Troy A.

    2006-01-01

    This randomized experiment examines the effects of contextual information on undergraduate college student's levels of alcohol-related incident guardianship at college parties. The research is conceptualized using routine activities theory and the theory of planned behavior. The experiment examines attitudinal variations about heavy drinking…

  8. Social and Environmental Predictors of Alcohol-Related Legal Infractions in College Students

    ERIC Educational Resources Information Center

    Juth, Vanessa; Smyth, Joshua M.; Thompson, Kevin; Nodes, Jennifer

    2010-01-01

    Research on alcohol consumption among college students is often limited by self-reported outcomes and a narrow focus of predictor factors. This study examined both traditional risk factors for alcohol use as well as broader factors (e.g., weather, seasons) in predicting objective negative outcomes of alcohol use--alcohol-related legal infractions…

  9. A Duty of Care: Non-Drinkers and Alcohol Related Harm among an Australian University Sample

    ERIC Educational Resources Information Center

    Mikhailovich, Katja; George, Amanda; Rickwood, Debra; Parker, Rhian

    2011-01-01

    Studies documenting the harm associated with excessive drinking amongst university students are numerous. Fewer studies have explored the experience of non-drinkers in the university setting. In 2008, 826 students aged 18-29 years responded to an online survey aiming to investigate alcohol use and alcohol related harm at an Australian university.…

  10. Genderedness of Bar Drinking Culture and Alcohol-Related Harms: A Multi-Country Study

    ERIC Educational Resources Information Center

    Roberts, Sarah C. M.; Bond, Jason; Korcha, Rachael; Greenfield, Thomas K.

    2013-01-01

    This study explores whether associations between consuming alcohol in bars and alcohol-related harms are consistent across countries and whether country-level characteristics modify associations. We hypothesized that genderedness of bar drinking modifies associations, such that odds of harms associated with bar drinking increase more rapidly in…

  11. Motivating Learning Disabled Offenders with Alcohol-Related Problems: A Pilot Study.

    ERIC Educational Resources Information Center

    Mendel, Elizabeth; Hipkins, Jane

    2002-01-01

    A study aimed to apply motivational interviewing techniques in assisting seven individuals with mental retardation and alcohol-related problems through the stages of change. The group met for one hour over three sessions and staff training was provided. Results demonstrated increases in motivation, self-efficacy, and determination to change their…

  12. American Indian/Alaska Native Alcohol-Related Incarceration and Treatment

    ERIC Educational Resources Information Center

    Feldstein, Sarah W.; Venner, Kamilla L.; May, Philip A.

    2006-01-01

    American Indian/Alaska Natives have high rates of alcohol-related arrests and are overrepresented in justice systems. To understand the relationship between alcohol dependence, treatment, and alcoholrelated incarceration, this study queried American Indian/Alaska Natives currently in remission from alcohol dependence. Participants reported…

  13. Prevalence and Psychosocial Correlates of Alcohol-Related Sexual Assault among University Students

    ERIC Educational Resources Information Center

    Howard, Donna E.; Griffin, Melinda A.; Boekeloo, Bradley O.

    2008-01-01

    This study examined the psychosocial correlates of alcohol-related sexual assault. Undergraduate students (N = 551) were recruited to complete a web-based survey. The outcome was a composite of 2 items: "experienced an unwanted sexual advance" or "was the victim of sexual assault or date rape" as a result of another's alcohol use. The predictors…

  14. Hospitalizations for Students with an Alcohol-Related Sanction: Gender and Pregaming as Risk Factors

    ERIC Educational Resources Information Center

    Ahmed, Rimsha; Hustad, John T. P.; LaSalle, Linda; Borsari, Brian

    2014-01-01

    Objective: The purpose of this study is to investigate whether pregaming (ie, drinking prior to a social event) is a risk factor for hospitalization. Participants: Participants (N = 516) were undergraduate students with an alcohol-related sanction. Methods: Participants completed a survey about alcohol use, as well as behaviors and experiences,…

  15. Harnessing the Power of Perception: Reducing Alcohol-Related Harm among Rural Teenagers

    ERIC Educational Resources Information Center

    Hughes, Clarissa; Julian, Roberta; Richman, Matthew; Mason, Ron; Long, Gillian

    2008-01-01

    This paper outlines early findings from the Tasmanian-based Social Norms Analysis Project (SNAP). The Social Norms model is presented as a theoretically informed, evidence-based model for reducing alcohol-related harm in youthful populations by utilising the complex and often positive contributions peer groups make to adolescent health and…

  16. Alcohol-Related Emergency Department Visits Associated with Collegiate Football Games

    ERIC Educational Resources Information Center

    Shook, Janice; Hiestand, Brian C.

    2011-01-01

    Objective: In 2003, after several post-college football game riots, multiple strategies including strict enforcement of open container laws were instituted by the authors' city and university. The authors compared alcohol-related visits to the on-campus emergency department (ED) associated with home football games in 2002 and 2006, hypothesizing…

  17. Differential trajectories of alcohol-related behaviors across the first year of college by parenting profiles

    PubMed Central

    Abar, Caitlin C.; Turrisi, Robert J.; Mallett, Kimberly A.

    2015-01-01

    This study examined the extent to which profiles of perceived parenting are associated with trajectories of alcohol-related behaviors across the first year of college. Method Participants were surveyed five times from the summer prior to college to the fall of the second year. A total 285 college students were enrolled from the incoming classes of consecutive cohorts of students at a large, public university in the Northeastern U.S. At baseline, participants provided information on their parents’ alcohol-related behaviors (e.g., parental modeling of use; perceived approval of underage use) and parenting characteristics (e.g., parental monitoring; parent-child relationship quality). Students also reported on their personal alcohol-related behaviors at each time point. Results Latent profile analysis was used to identify four subgroups based on the set of parenting characteristics: High Quality (14%) – highest parent-teen relationship quality; High Monitoring (31%) – highest parental monitoring and knowledge; Low Involvement (30%) – poor relationship quality, little monitoring and communication; and Pro-Alcohol (21%) – highest parental modeling and approval. Students were then assigned to profiles, and their alcohol-related behaviors were examined longitudinally using latent growth curve modeling. In general, students in the Pro-Alcohol profile displayed the highest baseline levels of typical weekend drinking, heavy episodic drinking, and peak BAC, in addition to showing steeper increases in typical weekend drinking across the first year of college. Discussion Results support the notion that parental behaviors remain relevant across the first year of college. Differential alcohol-related behaviors across parenting profiles highlight the potential for tailored college intervention. PMID:23915366

  18. Successful pregnancy with autoimmune cirrhosis.

    PubMed

    Braga, António; Braga, Jorge

    2016-01-01

    Pregnancy with liver cirrhosis is a rare and dangerous event that exposes mother and fetus to potentially lethal risks. During pregnancy, hepatic decompensation could suffice and the development of hepatic failure and encephalopathy could occur. The incidence of obstetric complications is also increased with a high rate of pre-eclampsia, postpartum bleeding, preterm delivery and stillbirth. We report a case of a 27-year-old woman with autoimmune hepatitis and liver cirrhosis complicated by splenomegaly, oesophageal varices and severe thrombocytopaenia. During pregnancy, close clinical and analytical surveillance was performed. She was medicated with corticosteroids, azathioprine and propranolol. At the 25th week of gestation, an upper gastrointestinal endoscopy was performed to control oesophageal varices. This patient had an uneventful pregnancy until 37 weeks. At 37th week of gestation, after spontaneous rupture of membranes, signs of acute fetal distress were observed, and an urgent caesarean was performed. Good neonatal and maternal outcomes were achieved. PMID:26825934

  19. Arrhythmia risk in liver cirrhosis

    PubMed Central

    Mozos, Ioana

    2015-01-01

    Interactions between the functioning of the heart and the liver have been described, with heart diseases affecting the liver, liver diseases affecting the heart, and conditions that simultaneously affect both. The heart is one of the most adversely affected organs in patients with liver cirrhosis. For example, arrhythmias and electrocardiographic changes are observed in patients with liver cirrhosis. The risk for arrhythmia is influenced by factors such as cirrhotic cardiomyopathy, cardiac ion channel remodeling, electrolyte imbalances, impaired autonomic function, hepatorenal syndrome, metabolic abnormalities, advanced age, inflammatory syndrome, stressful events, impaired drug metabolism and comorbidities. Close monitoring of cirrhotic patients is needed for arrhythmias, particularly when QT interval-prolonging drugs are given, or if electrolyte imbalances or hepatorenal syndrome appear. Arrhythmia risk may persist after liver transplantation due to possible QT interval prolongation, persistence of the parasympathetic impairment, post-transplant reperfusion and chronic immunosuppression, as well as consideration of the fact that the transplant itself is a stressful event for the cardiovascular system. The aims of the present article were to provide a review of the most important data regarding the epidemiology, pathophysiology, and biomarkers of arrhythmia risk in patients with liver cirrhosis, to elucidate the association with long-term outcome, and to propose future research directions. PMID:25866603

  20. Cirrhosis and hepatopulmonary syndrome.

    PubMed

    Tumgor, Gokhan

    2014-03-14

    Hepatopulmonary syndrome (HPS) is characterized as a triad: liver disease, intrapulmonary vascular dilatation and arterial hypoxemia. HPS is reported to be present in 4% to 32% of adult patients with end-stage liver disease and in 9%-20% of children. The pathogenesis of HPS has not been clearly identified. Portal hypertension causes impairment in the perfusion of the bowel and increases the enteral translocation of Gram (-) bacteria and endotoxins. This stimulates the release of vasoactive mediators, such as tumor necrosis factor-alpha, heme oxygenase-derived carbon monoxide and nitric oxide. Genetic alterations have not been associated with this syndrome yet; however, cytokines and chemokines have been suggested to play a role. Recently, it was reported that cumulated monocytes lead to the activation of vascular endothelial growth factor-dependent signaling pathways and pulmonary angiogenesis, which plays an important role in HPS pathogenesis. At present, the most effective and only radical treatment is a liver transplant (LT). Cirrhotic patients who are on the waiting list for an LT have a shorter survival period if they develop HPS. Therefore, it is suggested that all cirrhotic cases should be followed closely for HPS and they should have priority in the waiting list. PMID:24627594

  1. Cirrhosis and hepatopulmonary syndrome

    PubMed Central

    Tumgor, Gokhan

    2014-01-01

    Hepatopulmonary syndrome (HPS) is characterized as a triad: liver disease, intrapulmonary vascular dilatation and arterial hypoxemia. HPS is reported to be present in 4% to 32% of adult patients with end-stage liver disease and in 9%-20% of children. The pathogenesis of HPS has not been clearly identified. Portal hypertension causes impairment in the perfusion of the bowel and increases the enteral translocation of Gram (-) bacteria and endotoxins. This stimulates the release of vasoactive mediators, such as tumor necrosis factor-alpha, heme oxygenase-derived carbon monoxide and nitric oxide. Genetic alterations have not been associated with this syndrome yet; however, cytokines and chemokines have been suggested to play a role. Recently, it was reported that cumulated monocytes lead to the activation of vascular endothelial growth factor-dependent signaling pathways and pulmonary angiogenesis, which plays an important role in HPS pathogenesis. At present, the most effective and only radical treatment is a liver transplant (LT). Cirrhotic patients who are on the waiting list for an LT have a shorter survival period if they develop HPS. Therefore, it is suggested that all cirrhotic cases should be followed closely for HPS and they should have priority in the waiting list. PMID:24627594

  2. The role of medical schools in the prevention of alcohol-related problems.

    PubMed Central

    Negrete, J C

    1990-01-01

    There is agreement that physicians can play a major role in the prevention of alcohol problems among their patients and that medical schools should prepare physicians for this role by teaching three major subject areas: knowledge, attitudes and clinical skills. Despite this agreement and the acknowledged high prevalence of alcohol problems in clinical populations, medical school coverage of these problems is not proportional to their importance. Barriers to adequate coverage of alcohol problems are traditional attitudes, confusion as to whether such problems are "medical" and lack of adequate faculty role models. These problems could be remedied by encouragement and training of interested faculty members, establishment of substance abuse centres in university medical schools, integration of alcohol-related material with relevant topics in all departments and inclusion of alcohol-related questions on medical qualifying exams. PMID:2224672

  3. Alcohol and alcohol-related harm in China: policy changes needed.

    PubMed

    Tang, Yi-lang; Xiang, Xiao-jun; Wang, Xu-yi; Cubells, Joseph F; Babor, Thomas F; Hao, Wei

    2013-04-01

    In China, alcohol consumption is increasing faster than anywhere else in the world. A steady increase in alcohol production has also been observed in the country, together with a rise in alcohol-related harm. Despite these trends, China's policies on the sale and consumption of alcoholic beverages are weak compared with those of other countries in Asia. Weakest of all are its policies on taxation, drink driving laws, alcohol sale to minors and marketing licenses. The authors of this descriptive paper draw attention to the urgent need for public health professionals and government officials in China to prioritize population surveillance, research and interventions designed to reduce alcohol use disorders. They describe China's current alcohol policies and recent trends in alcohol-related harm and highlight the need for health officials to conduct a thorough policy review from a public health perspective, using as a model the World Health Organization's global strategy to reduce the harmful use of alcohol. PMID:23599550

  4. Drinking, Driving, and Crashing: A Traffic-Flow Model of Alcohol-Related Motor Vehicle Accidents*

    PubMed Central

    Gruenewald, Paul J.; Johnson, Fred W.

    2010-01-01

    Objective: This study examined the influence of on-premise alcohol-outlet densities and of drinking-driver densities on rates of alcohol-related motor vehicle crashes. A traffic-flow model is developed to represent geographic relationships between residential locations of drinking drivers, alcohol outlets, and alcohol-related motor vehicle crashes. Method: Cross-sectional and time-series cross-sectional spatial analyses were performed using data collected from 144 geographic units over 4 years. Data were obtained from archival and survey sources in six communities. Archival data were obtained within community areas and measured activities of either the resident population or persons visiting these communities. These data included local and highway traffic flow, locations of alcohol outlets, population density, network density of the local roadway system, and single-vehicle nighttime (SVN) crashes. Telephone-survey data obtained from residents of the communities were used to estimate the size of the resident drinking and driving population. Results: Cross-sectional analyses showed that effects relating on-premise densities to alcohol-related crashes were moderated by highway traffic flow. Depending on levels of highway traffic flow, 10% greater densities were related to 0% to 150% greater rates of SVN crashes. Time-series cross-sectional analyses showed that changes in the population pool of drinking drivers and on-premise densities interacted to increase SVN crash rates. Conclusions: A simple traffic-flow model can assess the effects of on-premise alcohol-outlet densities and of drinking-driver densities as they vary across communities to produce alcohol-related crashes. Analyses based on these models can usefully guide policy decisions on the siting of on-premise alcohol outlets. PMID:20230721

  5. Alcohol-related cues potentiate alcohol impairment of behavioral control in drinkers.

    PubMed

    Weafer, Jessica; Fillmore, Mark T

    2015-06-01

    The acute impairing effects of alcohol on inhibitory control are well-established, and these disinhibiting effects are thought to play a role in its abuse potential. Alcohol impairment of inhibitory control is typically assessed in the context of arbitrary cues, yet drinking environments are comprised of an array of alcohol-related cues that are thought to influence drinking behavior. Recent evidence suggests that alcohol-related stimuli reduce behavioral control in sober drinkers, suggesting that alcohol impairment of inhibitory control might be potentiated in the context of alcohol cues. The current study tested this hypothesis by examining performance on the attentional-bias behavioral activation (ABBA) task that measures the degree to which alcohol-related stimuli can reduce inhibition of inappropriate responses in a between-subjects design. Social drinkers (N = 40) performed the task in a sober condition, and then again following placebo (0.0 g/kg) and a moderate dose of alcohol (0.65 g/kg) in counterbalanced order. Inhibitory failures were greater following alcohol images compared to neutral images in sober drinkers, replicating previous findings with the ABBA task. Moreover, alcohol-related cues exacerbated alcohol impairment of inhibitory control as evidenced by more pronounced alcohol-induced disinhibition following alcohol cues compared to neutral cues. Finally, regression analyses showed that greater alcohol-induced disinhibition following alcohol cues predicted greater self-reported alcohol consumption. These findings have important implications regarding factors contributing to binge or "loss of control" drinking. That is, the additive effect of disrupted control mechanisms via both alcohol cues and the pharmacological effects of the drug could compromise an individual's control over ongoing alcohol consumption. (PsycINFO Database Record PMID:25134023

  6. Prevalence of alcohol-related pathologies at autopsy: Estonian Forensic Study of Alcohol and Premature Death

    PubMed Central

    Tuusov, Jana; Lang, Katrin; Väli, Marika; Pärna, Kersti; Tõnisson, Mailis; Ringmets, Inge; McKee, Martin; Helander, Anders; Leon, David A

    2014-01-01

    Aims Alcohol can induce diverse serious pathologies, yet this complexity may be obscured when alcohol-related deaths are classified according to a single underlying cause. We sought to quantify this issue and its implications for analysing mortality data. Design, Setting and Participants Cross-sectional study included 554 men aged 25–54 in Estonia undergoing forensic autopsy in 2008–09. Measurements Potentially alcohol-related pathologies were identified following macroscopic and histological examination. Alcohol biomarkers levels were determined. For a subset (26%), drinking behaviour was provided by next-of-kin. The Estonian Statistics Office provided underlying cause of death. Findings Most deaths (75%) showed evidence of potentially alcohol-related pathologies, and 32% had pathologies in two or more organs. The liver was most commonly affected [60.5%, 95% confidence interval (CI) = 56.3–64.6] followed by the lungs (18.6%, 95% CI = 15.4–22.1), stomach (17.5%, 95% CI = 14.4–20.9), pancreas (14.1%, 95% CI = 11.3–17.3), heart (4.9%, 95% CI = 3.2–7.0) and oesophagus (1.4%, 95% CI = 0.6–2.8). Only a minority with liver pathology had a second pathology. The number of pathologies correlated with alcohol biomarkers (phosphatidylethanol, gamma-glytamyl transpeptidase in blood, ethylglucuronide, ethylsulphate in urine). Despite the high prevalence of liver pathology, few deaths had alcoholic liver disease specified as the underlying cause. Conclusion The majority of 554 men aged 25–54 undergoing forensic autopsy in Estonia in 2008–09 showed evidence of alcohol-related pathology. However, the recording of deaths by underlying cause failed to capture the scale and nature of alcohol-induced pathologies found. PMID:25066373

  7. School performance and alcohol-related disorders in early adulthood: a Swedish national cohort study

    PubMed Central

    Gauffin, Karl; Vinnerljung, Bo; Hjern, Anders

    2015-01-01

    Background Alcohol misuse is an important global health determinant and a major contributor to health inequalities. We aimed to investigate the association between school performance and alcohol-related disorders in early adulthood in a longitudinal register-based national cohort study. Methods We followed a register-based national cohort of Swedish citizens born 1973–1984 (N = 948 440) from compulsory school graduation at age 15–16 to 2009. We divided the population into five groups: high school marks (> mean + 1 SD); high average (between mean and mean + 1 SD); low average (between mean and mean − 1 SD); low (< mean – 1SD); and missing. Cox proportional hazard models were used to investigate the relation between school marks at time of graduation and hospital care for alcohol-related disorders in early adulthood. Results There was a steep gradient in the risk of alcohol-related disorders related to school performance. In comparison with peers in the top category of school marks, students with low marks had adjusted hazard ratios of 8.02 [95% confidence interval (CI) 7.20 to 8.91], low average 3.02 (2.72 to 3.35) and high average 1.55 (1.39 to 1.73). The risk associated with low school marks was stronger in the male population and in the group from high socioeconomic background. Conclusions The study demonstrated a strong graded relation between low school performance and alcohol-related disorders in young adulthood. School performance should be taken into account when developing prevention programmes/policies targeting alcohol misuse among teenagers and young adults, especially if the aim is to reach high-risk groups. PMID:25797580

  8. Consilience in sarcopenia of cirrhosis.

    PubMed

    Dasarathy, Srinivasan

    2012-12-01

    Cirrhosis is the consequence of progression of many forms of necro-inflammatory disorders of the liver with hepatic fibrosis, hepatocellular dysfunction, and vascular remodeling. Reversing the primary hepatic disorder, liver transplantation, and controlling the complications are the major management goals. Since the former options are not available to the majority of cirrhotics, treating complications remains the mainstay of therapy. Sarcopenia and/or cachexia is the most common complication and adversely affects survival, quality of life, development of other complications of cirrhosis, and outcome after liver transplantation. With the increase in number of cirrhotic patients with hepatitis C and nonalcoholic fatty liver disease, the number of patients waiting for a liver transplantation is likely to continue to increase above the currently estimated 72.3/100,000 population. One of the critical clinical questions is to determine if we can treat sarcopenia of cirrhosis without transplantation. No effective therapies exist to treat sarcopenia because the mechanism(s) of sarcopenia in cirrhosis is as yet unknown. The reasons for this include the predominantly descriptive studies to date and the advances in our understanding of skeletal muscle biology and molecular regulation of atrophy and hypertrophy not being translated into the clinical practice of hepatology. Satellite cell biology, muscle autophagy and apoptosis, and molecular signaling abnormalities in the skeletal muscle of cirrhotics are also not known. Aging of the cirrhotic and transplanted population, use of mTOR inhibitors, and the lack of definitive outcome measures to define sarcopenia and cachexia in this population add to the difficulty in increasing our understanding of hepatic sarcopenia/cachexia and developing treatment options. Recent data on the role of myostatin, AMP kinase, impaired mTOR signaling resulting in anabolic resistance in animal models, and the rapidly developing field of

  9. A Comparison of Victim, Offender, and Event Characteristics of Alcohol- and Non-Alcohol-Related Homicides

    PubMed Central

    Pridemore, William Alex; Eckhardt, Krista

    2009-01-01

    The authors used narrative data from court and police records of homicides in Russia to compare alcohol- and non-alcohol-related incidents on victim, offender, and event characteristics. Binary logistic regression models were estimated for neither participant drinking, offender drinking, victim drinking, and both drinking. Consistent differences were found between alcohol- and non-alcohol-related homicides across the models. Alcohol-related homicides were significantly more likely to occur overnight, to occur on weekends, and to result from acute arguments and significantly less likely to occur between strangers, to be profit motivated or premeditated, and to be carried out to hide other crimes. No significant differences between the drinking and nondrinking samples were found for victim’s gender, primary weapon used, or event location. The authors place these findings into the literature on the situational context of crime and create a tentative typology of homicide events, grounded in the results of their inductive approach, based on alcohol use by homicide offenders and victims. PMID:19802358

  10. Alcohol-related expectancies in adults and adolescents: Similarities and disparities.

    PubMed

    Monk, Rebecca L; Heim, Derek

    2016-01-01

    This study aimed to contrast student and not student outcome expectancies, and explore the diversity of alcohol-related cognitions within a wider student sample. Participants (n=549) were college students (higher education-typically aged 15-18 years), university students (further education-typically aged 18-22 years) and business people (white collar professionals <50 years) who completed questionnaires in their place of work or education. Overall positive expectancies were higher in the college students than in the business or university samples. However, not all expectancy subcategories followed this pattern. Participant groups of similar age were therefore alike in some aspects of their alcohol-related cognitions but different in others. Similarly, participant groups whom are divergent in age appeared to be alike in some of their alcohol-related cognitions, such as tension reduction expectancies. Research often homogenises students as a specific sub-set of the population, this paper hi-lights that this may be an over-simplification. Furthermore, the largely exclusive focus on student groups within research in this area may also be an oversight, given the diversity of the findings demonstrated between these groups. PMID:26990388

  11. Drinking motives as moderators of the effect of ambivalence on drinking and alcohol-related problems

    PubMed Central

    Foster, Dawn W.; Neighbors, Clayton; Prokhorov, Alexander

    2014-01-01

    The current study seeks to evaluate relationships between drinking motives and alcohol-related ambivalence in the prediction of problem drinking. We expected that: 1) main effects would emerge such that alcohol-related ambivalence would be positively associated with peak drinking and problems; drinking motives would be positively associated with drinking and problems, and 2) interactions would emerge between motives and ambivalence in predicting problematic drinking such that drinking motives would be positively associated with peak drinking and problems, especially among those high in ambivalence over drinking. Six hundred sixty-nine undergraduate students (mean age = 22.95, SD = 5.47, 82.22% female) completed study materials. Results showed that consistent with expectations, ambivalence was positively associated with peak drinking and problems. Further, consistent with expectations, drinking motives were positively associated with peak drinking and problems. Additionally, ambivalence was positively associated with drinking motives. Significant interactions emerged between drinking motives (social and coping) and ambivalence when predicting peak drinking and alcohol-related problems. These findings highlight the importance of considering motives in the relationship between ambivalence and drinking. Clinical implications include the need for tailoring interventions to target individual difference factors that increase risk for heavy drinking and associated problems. This is especially important among college students who may be at risk for problematic behavior. PMID:24094922

  12. Use of Novel Technology-Based Techniques to Improve Alcohol-Related Outcomes in Clinical Trials

    PubMed Central

    Gurvich, Eugenia M.; Kenna, George A.; Leggio, Lorenzo

    2013-01-01

    With a better understanding of the biologic basis of alcohol dependence and the considerable financial burden of alcohol abuse and dependence, the number of alcohol-related clinical pharmacotherapy trials has been on the rise. Subsequently, the potential to find efficacious treatments is more promising. Unfortunately, alcohol-related trials face a number of challenges, as a result of the difficulties that arise from traditional and outdated methods to collect data and ensure medication adherence. Novel technology-based assessments, such as ecological momentary assessment, interactive voice response, transdermal sensor and medication-event monitoring system provide a prospective solution—albeit not without possible concerns—to the difficulties faced in alcohol-related clinical trials. Clinical trials are meant to define the efficacy of the treatment and to determine an effective and safe dosage. However, due to lack of adherence a drug could inappropriately or mistakenly be judged as ineffective for treating a specific disorder. The described technologies may be important tools to prevent false negatives in validating drug efficacy, to provide consistency in clinical trials and to improve available data regarding the study of pharmacotherapies for alcohol dependence. PMID:23955872

  13. Drinking norms and alcohol-related problems in the United States.

    PubMed

    Linsky, A S; Colby, J P; Straus, M A

    1986-09-01

    One of Bales's three related hypotheses concerning how cultures or social structures influence the level of alcoholism in a population--that culturally determined attitudes toward drinking and intoxication determine whether alcohol will be used to relieve the stress generated in a society--is examined in the first systematic test of that hypothesis based on American data. A proscriptive norm index was computed for each of the 50 states based on percentage population residing in legally dry areas, the degree of legal restrictions on the sale or consumption of alcoholic beverages and the percentage population of Mormons and Fundamentalists. The most proscriptive states are located in the southern region of the United States. Proscriptive norms are significantly correlated with all of the indicators of alcohol-related problems studied. Most of the correlations remain significant when five other variables are controlled. Proscriptive norms are negatively correlated with the indicators of heavy drinking, but positively correlated with the "social disruptiveness" of alcohol (arrest data). Thus driving while intoxicated and other alcohol-related arrests do not appear to arise as a response to the total amount of drinking. Instead, such alcohol-related problems appear to be a response to the strong cultural disapproval of drinking, with the proscriptively oriented states experiencing the highest rates of disruptive behaviors related to alcohol. The findings are consistent with a social control explanation for this link. PMID:3762162

  14. Cholecystectomy in Patients with Liver Cirrhosis

    PubMed Central

    Sadr-Azodi, Omid

    2015-01-01

    Background. The aim of this population-based study was to describe characteristics of patients with liver cirrhosis undergoing cholecystectomy and evaluate the risk for perioperative and postoperative complications during the 30-day postoperative period. Method. All laparoscopic and open cholecystectomy procedures registered between 2006 and 2011 in the Swedish Registry for Gallstone Surgery and ERCP (GallRiks) were included. Patients with liver cirrhosis were identified by linking data to the Swedish National Patient Registry (NPR). Results. Of 62,488 patients undergoing cholecystectomy, 77 (0.12%) had cirrhosis, of which 29 patients (37.7%) had decompensated cirrhosis. Patients with cirrhosis were older and had more often gallstone complications at the time for surgery. Postoperative complications were registered in 13 (16.9%) patients with liver cirrhosis and in 5,738 (9.2%) patients in the noncirrhotic group (P < 0.05). Univariable analysis showed that patients with liver cirrhosis are more likely to receive postoperative blood transfusion (OR = 4.4, CI 1.08–18.0, P < 0.05) and antibiotic treatment >1 day (OR = 2.3, CI 1.11–4.84, P < 0.05) than noncirrhotic patients. Conclusion. Patients with cirrhosis undergoing cholecystectomy have a higher incidence of postoperative complications than patients without cirrhosis. However, cholecystectomy is safe and if presented with adequate indication, surgery should not be delayed due to fears of surgical complications. PMID:26788053

  15. Genetics Home Reference: North American Indian childhood cirrhosis

    MedlinePlus

    ... Health Conditions North American Indian childhood cirrhosis North American Indian childhood cirrhosis Enable Javascript to view the expand/ ... Download PDF Open All Close All Description North American Indian childhood cirrhosis is a rare liver disorder that ...

  16. Endothelial dysfunction in cirrhosis: Role of inflammation and oxidative stress

    PubMed Central

    Vairappan, Balasubramaniyan

    2015-01-01

    This review describes the recent developments in the pathobiology of endothelial dysfunction (ED) in the context of cirrhosis with portal hypertension and defines novel strategies and potential targets for therapy. ED has prognostic implications by predicting unfavourable early hepatic events and mortality in patients with portal hypertension and advanced liver diseases. ED characterised by an impaired bioactivity of nitric oxide (NO) within the hepatic circulation and is mainly due to decreased bioavailability of NO and accelerated degradation of NO with reactive oxygen species. Furthermore, elevated inflammatory markers also inhibit NO synthesis and causes ED in cirrhotic liver. Therefore, improvement of NO availability in the hepatic circulation can be beneficial for the improvement of endothelial dysfunction and associated portal hypertension in patients with cirrhosis. Furthermore, therapeutic agents that are identified in increasing NO bioavailability through improvement of hepatic endothelial nitric oxide synthase (eNOS) activity and reduction in hepatic asymmetric dimethylarginine, an endogenous modulator of eNOS and a key mediator of elevated intrahepatic vascular tone in cirrhosis would be interesting therapeutic approaches in patients with endothelial dysfunction and portal hypertension in advanced liver diseases. PMID:25848469

  17. Cirrhosis and its complications: Evidence based treatment

    PubMed Central

    Nusrat, Salman; Khan, Muhammad S; Fazili, Javid; Madhoun, Mohammad F

    2014-01-01

    Cirrhosis results from progressive fibrosis and is the final outcome of all chronic liver disease. It is among the ten leading causes of death in United States. Cirrhosis can result in portal hypertension and/or hepatic dysfunction. Both of these either alone or in combination can lead to many complications, including ascites, varices, hepatic encephalopathy, hepatocellular carcinoma, hepatopulmonary syndrome, and coagulation disorders. Cirrhosis and its complications not only impair quality of life but also decrease survival. Managing patients with cirrhosis can be a challenge and requires an organized and systematic approach. Increasing physicians’ knowledge about prevention and treatment of these potential complications is important to improve patient outcomes. A literature search of the published data was performed to provide a comprehensive review regarding the management of cirrhosis and its complications. PMID:24833875

  18. Social Inequalities and Gender Differences in the Experience of Alcohol-Related Problems

    PubMed Central

    Grittner, Ulrike; Kuntsche, Sandra; Graham, Kathryn; Bloomfield, Kim

    2012-01-01

    Aims: To examine the influence of country-level characteristics and individual socio-economic status (SES) on individual alcohol-related consequences. Methods: Data from 42,655 men and women collected by cross-sectional surveys in 25 countries of the Gender, Alcohol and Culture: An International Study study were used. The individual SES was measured by the highest attained educational level. Alcohol-related consequences were defined as the self-report of at least one internal or one external consequence in the last year. The relationship between individuals’ education and alcohol-related consequences was examined by meta-analysis. In a second step, the individual level data and country data were combined in multilevel models. As country-level indicators, we used the purchasing power parity of the gross national income (GNI), the Gini coefficient and the Gender Gap Index. Results: Lower educated men and women were more likely to report consequences than higher educated men and women even after controlling for drinking patterns. For men, this relation was significant for both internal and external problems. For women, it was only significant for external problems. The GNI was significantly associated with reporting external consequences for men such that in lower income countries men were more likely to report social problems. Conclusion: The fact that problems accrue more quickly for lower educated persons even if they drink in the same manner can be linked to the social or environmental dimension surrounding problems. That is, those of fewer resources are less protected from the experience of a problem or the impact of a stressful life event. PMID:22542707

  19. Help-seeking for alcohol-related problems in college students: correlates and preferred resources.

    PubMed

    Buscemi, Joanna; Murphy, James G; Martens, Matthew P; McDevitt-Murphy, Meghan E; Dennhardt, Ashley A; Skidmore, Jessica R

    2010-12-01

    Despite the development of a variety of efficacious alcohol intervention approaches for college students, few student drinkers seek help. The present study assessed students' history of help-seeking for alcohol problems, as well as their estimates of how likely they would be to use various help-seeking resources, should they wish to change their drinking. Participants were 197 college students who reported recent heavy drinking (46% male, 68.5% White, 27.4% African-American). Participants completed measures related to their drinking and their use (both past use and likelihood of future use) of 14 different alcohol help-seeking options. Repeated-measures analyses of variance revealed that students preferred informal help-seeking (e.g., talking to friends and family) over formal (e.g., talking with a counselor or medical provider) and anonymous resources (e.g., internet- or computer-based programs). Higher self-ideal discrepancy, greater depressive symptoms, and more alcohol-related consequences were positively associated with actual past help-seeking. Alcohol-related problems and normative discrepancy were negatively associated with hypothetical likelihood of utilizing all three help-seeking resources. These results suggest that heavy drinking college students prefer low-threshold intervention options including peer, family, computerized, and brief motivational interventions. Only 36 participants (18.3% of the sample) reported that they had utilized any of the help-seeking options queried, suggesting that campus prevention efforts should include both promoting low-threshold interventions and attempting to increase the salience of alcohol-related risk and the potential utility of changing drinking patterns. PMID:21198220

  20. Brain-derived neurotrophic factor Val66Met polymorphism and alcohol-related phenotypes.

    PubMed

    Nedic, Gordana; Perkovic, Matea Nikolac; Sviglin, Korona Nenadic; Muck-Seler, Dorotea; Borovecki, Fran; Pivac, Nela

    2013-01-10

    Alcoholism is a chronic psychiatric disorder affecting neural pathways that regulate motivation, stress, reward and arousal. Brain-derived neurotrophic factor (BDNF) regulates mood, response to stress and interacts with neurotransmitters and stress systems involved in reward pathways and addiction. Aim of the study was to evaluate the association between a single nucleotide polymorphism (BDNF Val66Met or rs6265) and alcohol related phenotypes in Caucasian patients. In ethnically homogenous Caucasian subjects of the Croatian origin, the BDNF Val66Met genotype distribution was determined in 549 male and 126 female patients with alcohol dependence and in 655 male and 259 female healthy non-alcoholic control subjects. Based on the structured clinical interview, additional detailed clinical interview, the Brown-Goodwin Scale, the Hamilton Rating Scale for Depression and the Clinical Global Impression scores, alcoholic patients were subdivided into those with or without comorbid depression, aggression, delirium tremens, withdrawal syndrome, early/late onset of alcohol abuse, prior suicidal attempt during lifetime, current suicidal behavior, and severity of alcohol dependence. The results showed no significant association between BDNF Val66Met variants and alcohol dependence and/or any of the alcohol related phenotypes in either Caucasian women, or men, with alcohol dependence. There are few limitations of the study. The overall study sample size was large (N=1589) but not well-powered to detect differences in BDNF Val66Met genotype distribution between studied groups. Healthy control women were older than female alcoholic patients. Only one BDNF polymorphism (rs6265) was studied. In conclusion, these data do not support the view that BDNF Val66Met polymorphism correlates with the specific alcohol related phenotypes in ethnically homogenous medication-free Caucasian subjects with alcohol dependence. PMID:23023098

  1. Help-Seeking for Alcohol-Related Problems in College Students: Correlates and Preferred Resources

    PubMed Central

    Buscemi, Joanna; Murphy, James G.; Martens, Matthew P.; McDevitt-Murphy, Meghan E.; Pederson, Ashley A.; Skidmore, Jessica R.

    2016-01-01

    Despite the development of a variety of efficacious alcohol intervention approaches for college students, few student drinkers seek help. The present study assessed students’ history of help-seeking for alcohol problems as well as their estimates of how likely they would be to use various help-seeking resources, should they wish to change their drinking. Participants were 197 college students who reported recent heavy drinking (46% male, 68.5% White, 27.4% African-American). Participants completed measures related to their drinking and their use (both past use and likelihood of future use) of 14 different alcohol help-seeking options. Repeated measures ANOVAs revealed that students preferred informal help-seeking (e.g., talking to friends and family) over formal (e.g., talking with a counselor or medical provider) and anonymous resources (e.g., internet- or computer-based programs). Higher self-ideal discrepancy, greater depressive symptoms, and more alcohol-related consequences were positively associated with actual past help-seeking. Alcohol-related problems and normative discrepancy were negatively associated with hypothetical likelihood of utilizing all three help-seeking resources. These results suggest that heavy drinking college students prefer low-threshold intervention options including peer, family, computerized, and brief motivational interventions. Only 36 participants (18.3% of the sample) reported that they had utilized any of the help-seeking options queried, suggesting that campus prevention efforts should include both promoting low-threshold interventions and attempting to increase the salience of alcohol-related risk and the potential utility of changing drinking patterns. PMID:21198220

  2. Alcohol-related adverse consequences: cross-cultural variations in attribution process among young adults

    PubMed Central

    Plant, Martin A.; Plant, Moira L.; Miller, Patrick; Kuntsche, Sandra; Gmel, Gerhard

    2008-01-01

    Background: Social norms around what is culturally accepted in terms of alcohol consumption and drunken comportment appear important regarding the acceptance of alcohol-related adverse consequences; however, investigations often neglect to consider differences in terms of attribution. This study aims at assessing cross-cultural differences in the reporting of alcohol-related adverse consequences. It also considers differences across consequences that might explain which type of consequences (mainly acute or mainly chronic) are most affected by an attribution process. Methods: Conditional regression models were estimated based on data from eight European countries participating in the Gender, Alcohol and Culture—An International Study (GENACIS) project. Cases were matched to controls based on usual drinking patterns in order to control for average volume of alcohol and frequency of ‘risky single occasion drinking’ (RSOD). Results: Differences among the patterns of associations between countries and consequences were evident. The distinction between Nordic and other European countries was persistent. A higher variability of associations was observed for some consequences, namely the mainly acute instances. Finally, the Isle of Man and Switzerland showed specific trends with associations across consequences. Conclusion: Reporting of alcohol-related adverse consequences seemed strongly affected by cultural norms. The latter may be exemplified by viewing drinking as ‘time-out’ behaviour. Respondents in countries with a stereotypical history of being ‘dry’ or with a stereotyped ‘binge’ drinking culture were more likely to attribute consequences to their alcohol consumption than people in ‘wet’ countries. This was particularly true for consequences that related to episodic ‘time-out’ heavy drinking. PMID:18287104

  3. The relationship between temporal profiles and alcohol-related problems in University undergraduates: Results from the United Kingdom.

    PubMed

    Cole, Jon C; Andretta, James R; McKay, Michael T

    2016-04-01

    Time perspective is an individual difference variable which assesses the extent to which orientation to the past, present and future affects current behaviors. The present study investigated the viability of temporal profiles and the degree (if any) to which these predict meaningful differences in alcohol-related problems. Participants were undergraduates recruited from a University in the North West of England. Full survey data were available for 455 individuals (aged 18-25; 49.7% male) on (a) time perspective, and (b) alcohol-related problems. Four profiles emerged and were labeled Future-Positive, Present, Past Negative-Future, and Ambivalent. As hypothesized, the Future-Positive profile was associated with the best alcohol-related outcomes. The Present profile was associated with the worst outcomes. This study demonstrates that temporal profiles are associated with alcohol-related problems. PMID:26735914

  4. Alcohol-Related Antigay Aggression: Theoretical Considerations for Individual-and Societal-Level Interventions

    PubMed Central

    Parrott, Dominic J.; Miller, Cameron A.

    2008-01-01

    A substantial literature has identified risk factors for intoxicated aggression and the mechanisms by which these effects are exerted. This theoretical and empirical foundation is a valuable resource for the development of treatment inventions. In contrast, a comparable literature is not available to guide development of clinical interventions for intoxicated antigay aggression. To address this gap in the literature, the present article 1) identifies risk factors and mechanisms pertinent to alcohol-related antigay aggression, 2) advances predictions regarding how alcohol will increase antigay aggression, and 3) reviews societal- and individual-level considerations for intervention based upon these hypotheses. PMID:19938923

  5. Cirrhosis

    MedlinePlus

    ... Griffin Rodgers, Director of the NIDDK Clinical Trials Current research studies and how you can volunteer Community Outreach and Health Fairs Science-based information and tips for planning an outreach effort or community event For Health Care Professionals Patient and provider resources ...

  6. Cirrhosis

    MedlinePlus

    ... drinking . Take steps to prevent getting or passing hepatitis B or C . ... N, Younossi Z, Lavine JE, et al. The diagnosis and management of ... Hepatitis C Resource Center Program. Management and treatment of ...

  7. The relationship between exposure to alcohol-related content on Facebook and predictors of alcohol consumption among female emerging adults.

    PubMed

    Miller, Joseph; Prichard, Ivanka; Hutchinson, Amanda; Wilson, Carlene

    2014-12-01

    Consuming an unhealthy level of alcohol is a significant problem for some young women. Potential determinants of excess consumption include perceptions of usual consumption among peers-perceptions of what is "normal." The present study examined whether perceptions of social normative endorsement of drinking, operationalized by measures of perceived alcohol consumption of close friends (proximal norms), the consumption of the "average student" (distal norms), and the extent of alcohol-related content posted by peers on Facebook were related to alcohol-related attitudes and self-reported consumption. Female university students (n=129; Mage=21.48 years, SD=3.00) completed an online questionnaire assessing Facebook use, perceived alcohol-related norms, and self-reported alcohol attitudes and consumption. Perceptions of the consumption of the average female student were a negative predictor of attitudes. Positive alcohol attitudes, extent of own alcohol-related photographic posts on Facebook, average female student alcohol consumption, and report of male close friend consumption predicted self-report of own alcohol consumption. Interestingly, female close friend norms failed to predict consumption, whereas male close friend norms predicted consumption but not attitudes, suggesting the possibility of separate cognitive pathways for alcohol-related attitudes and behavior. This study builds on existing research by casting new light on predictors of alcohol-related attitudes, as well as describing the potential role of social networking sites such as Facebook in the formation of social norms and the modulation of drinking behavior. PMID:25489875

  8. The relationship between emotion regulation capacity, heart rate variability, and quality of life in individuals with alcohol-related brain damage.

    PubMed

    Steinmetz, Jean-Paul; Vögele, Claus; Theisen-Flies, Christiane; Federspiel, Carine; Sütterlin, Stefan

    2016-01-01

    The reliable measurement of quality of life (QoL) presents a challenge in individuals with alcohol-related brain damage. This study investigated vagally mediated heart rate variability (vmHRV) as a physiological predictor of QoL. Self- and proxy ratings of QoL and dysexecutive symptoms were collected once, while vmHRV was repeatedly assessed over a 3-week period at weekly intervals in a sample of nine alcohol-related brain damaged patients. We provide robustness checks, bootstrapped correlations with confidence intervals, and standard errors for mean scores. We observed low to very low heart rate variability scores in our patients in comparison to norm values found in healthy populations. Proxy ratings of the QoL scale "subjective physical and mental performance" and everyday executive dysfunctions were strongly related to vmHRV. Better proxy-rated QoL and fewer dysexecutive symptoms were observed in those patients with higher vmHRV. Overall, patients showed low parasympathetic activation favoring the occurrence of dysfunctional emotion regulation strategies. PMID:27616894

  9. The relationship between emotion regulation capacity, heart rate variability, and quality of life in individuals with alcohol-related brain damage

    PubMed Central

    Steinmetz, Jean-Paul; Vögele, Claus; Theisen-Flies, Christiane; Federspiel, Carine; Sütterlin, Stefan

    2016-01-01

    The reliable measurement of quality of life (QoL) presents a challenge in individuals with alcohol-related brain damage. This study investigated vagally mediated heart rate variability (vmHRV) as a physiological predictor of QoL. Self- and proxy ratings of QoL and dysexecutive symptoms were collected once, while vmHRV was repeatedly assessed over a 3-week period at weekly intervals in a sample of nine alcohol-related brain damaged patients. We provide robustness checks, bootstrapped correlations with confidence intervals, and standard errors for mean scores. We observed low to very low heart rate variability scores in our patients in comparison to norm values found in healthy populations. Proxy ratings of the QoL scale “subjective physical and mental performance” and everyday executive dysfunctions were strongly related to vmHRV. Better proxy-rated QoL and fewer dysexecutive symptoms were observed in those patients with higher vmHRV. Overall, patients showed low parasympathetic activation favoring the occurrence of dysfunctional emotion regulation strategies. PMID:27616894

  10. Individual Differences in Subjective Alcohol Responses and Alcohol-Related Disinhibition

    PubMed Central

    Quinn, Patrick D.; Fromme, Kim

    2016-01-01

    There are important individual differences in acute subjective responses to alcohol, which have often been assessed using self-report measures. There is also evidence of meaningful between-persons variation in alcohol’s disinhibiting effects on behavior, such that some individuals become more impaired on tasks of inhibition than do others after an intoxicating dose. The degree to which subjective alcohol responses correspond with these disinhibition effects is not yet clear. In this study, we tested associations among indices of subjective alcohol responses and their correspondence with sensitivity to alcohol-related disinhibition. We recruited recent-binge-drinking emerging adults (N = 82) for a group-administered, placebo-controlled, within-subject, counterbalanced alcohol challenge in a simulated bar laboratory. Confirmatory factor analyses revealed that a two factor model with several cross-loadings explained associations among the subjective measures well, replicating a differentiation between stimulant-like and sedative-like subjective responses. Controlling sex and placebo performance, participants who reported greater subjective stimulant-like effects—but not sedative-like effects—experienced more alcohol-related disinhibition, as measured by Cued Go/No-Go Task inhibitory failures. This association was small-to-moderate in magnitude. The results of this study highlight the distinction between stimulant-like and sedative-like subjective alcohol effects. They suggest, additionally, that there may be modest commonalities between alcohol’s acute impacts on subjective stimulation and objective disinhibition. PMID:26867000

  11. Using autopsy brain tissue to study alcohol-related brain damage in the genomic age

    PubMed Central

    Sutherland, Greg T; Sheedy, Donna; Kril, Jillian J

    2013-01-01

    The New South Wales Tissue Resource Centre (NSW TRC) at the University of Sydney, Australia is one of the few human brain banks dedicated to the study of the effects of chronic alcoholism. The bank was affiliated in 1994 as a member of the National Network of Brain Banks and also focuses on schizophrenia and healthy control tissue. Alcohol abuse is a major problem worldwide, manifesting in such conditions as fetal alcohol syndrome, adolescent binge drinking, alcohol dependency and alcoholic neurodegeneration. The latter is also referred to as alcohol-related brain disease (ARBD). The study of postmortem brain tissue is ideally suited to determining the effects of long-term alcohol abuse, but it also makes an important contribution to understanding pathogenesis across the spectrum of alcohol misuse disorders and potentially other neurodegenerative diseases. Tissue from the bank has contributed to 330 peer-reviewed journal articles including 120 related to alcohol research. Using the results of these articles, this review chronicles advances in alcohol-related brain research since 2003, the so-called genomic age. In particular it concentrates on transcriptomic approaches to the pathogenesis of ARBD and builds on earlier reviews of structural changes (Harper et al. Prog Neuropsychopharmacol Biol Psychiatry 2003;27:951–61) and proteomics (Matsumoto et al. Expert Rev Proteomics 2007;4:539–52). PMID:24033426

  12. Latent Trajectory Classes for Alcohol-Related Blackouts from Age 15 to 19 in ALSPAC

    PubMed Central

    Schuckit, Marc A.; Smith, Tom L.; Heron, Jon; Hickman, Matthew; Macleod, John; Munafo, Marcus R.; Kendler, Kenneth S.; Dick, Danielle M.; Davey-Smith, George

    2014-01-01

    Background Alcohol-related blackouts (ARBs) are reported by ~50% of drinkers. While much is known about the prevalence of ARBs in young adults and their cross-sectional correlates, there are few prospective studies regarding their trajectories over time during mid-adolescence. This paper reports latent trajectory classes of alcohol-related blackouts between ages 15 and 19, along with predictors of those patterns. Methods Latent Class Growth Analysis (LCGA) was used to evaluate the pattern of occurrence of ARBs across four time points for 1402 drinking adolescents from the Avon Longitudinal Study of Parents and Children (ALSPAC). Multinomial regression analyses evaluated age 15 demography, substance-related items, externalizing characteristics, and estimated peer substance use as predictors of latent class membership. Results ARBs were reported at age 15 in 30% and at age 19 in 74% of these subjects. Four latent trajectory classes were identified: Class 1 (5.1%) reported no blackouts; for Class 2 (29.5%) ARBs rapidly increased with age; for Class 3 (44.9%) blackouts slowly increased; and for Class 4 (20.5%) ARBs were consistently reported. Using Class 2 (rapid increasers) as the reference, predictors of class membership included female sex, higher drinking quantities, smoking, externalizing characteristics, and estimated peer substance involvement (pseudo R2 =.22). Conclusions ARBs were common and repetitive in these young subjects, and predictors of their trajectories over time involved multiple domains representing diverse characteristics. PMID:25516068

  13. Drinking Reductions following Alcohol-related Sanctions are associated with Social Norms among College Students

    PubMed Central

    Merrill, Jennifer E.; Carey, Kate B.; Reid, Allecia E.; Carey, Michael P.

    2014-01-01

    Students mandated for intervention following an alcohol-related sanction event often reduce their drinking prior to intervention. Knowing the determinants of self-initiated change may help identify intervention targets for individuals who do not reduce their drinking. Guided by self-regulation theory, we tested whether fewer past alcohol consequences and higher descriptive and injunctive norms would be associated with higher levels of post-sanction drinking. College students referred for a campus alcohol violation (N=658, 64% male) reported on their drinking during the month before and after their sanction event. Results show that post-sanction drinking was significantly lower than pre-sanction drinking across four outcomes: (a) drinks per drinking day, (b) drinks per week, (c) peak drinks, and (d) peak blood alcohol concentration (BAC). Hypothesized social influence variables (i.e., descriptive and injunctive norms) were consistently associated with all four drinking outcomes; that is, students who perceived that their friends drank more and held more accepting views of drinking were less reactive to alcohol-related sanctions. Past consequences of drinking did not consistently predict subsequent drinking. Therefore, we conclude that alcohol interventions for mandated students should target both descriptive and injunctive norms to optimize their efficacy. PMID:24274435

  14. Alcohol and alcohol-related harm in China: policy changes needed

    PubMed Central

    Tang, Yi-lang; Xiang, Xiao-jun; Wang, Xu-yi; Cubells, Joseph F; Babor, Thomas F

    2013-01-01

    Abstract In China, alcohol consumption is increasing faster than anywhere else in the world. A steady increase in alcohol production has also been observed in the country, together with a rise in alcohol-related harm. Despite these trends, China’s policies on the sale and consumption of alcoholic beverages are weak compared with those of other countries in Asia. Weakest of all are its policies on taxation, drink driving laws, alcohol sale to minors and marketing licenses. The authors of this descriptive paper draw attention to the urgent need for public health professionals and government officials in China to prioritize population surveillance, research and interventions designed to reduce alcohol use disorders. They describe China’s current alcohol policies and recent trends in alcohol-related harm and highlight the need for health officials to conduct a thorough policy review from a public health perspective, using as a model the World Health Organization’s global strategy to reduce the harmful use of alcohol. PMID:23599550

  15. Disruption of Alcohol-Related Memories by mTORC1 Inhibition Prevents Relapse

    PubMed Central

    Barak, Segev; Liu, Feng; Hamida, Sami Ben; Yowell, Quinn V.; Neasta, Jeremie; Kharazia, Viktor; Janak, Patricia H.; Ron, Dorit

    2013-01-01

    Relapse to alcohol abuse is a critical clinical issue, frequently caused by cue-induced drug craving. Therefore, disruption of the memory for the cue-alcohol association is expected to prevent relapse. It is increasingly accepted that memories become labile and erasable soon after their reactivation through retrieval, during a memory reconsolidation process that depends on protein synthesis. Here, we show that reconsolidation of alcohol-related memories triggered by the sensory properties of alcohol itself (odor and taste) activates mammalian target of rapamycin complex 1 (mTORC1) in select amygdalar and cortical regions in rats, resulting in increased levels of several synaptic proteins. Furthermore, systemic or central amygdalar (CeA) inhibition of mTORC1 during reconsolidation disrupts alcohol-cue associated memories, leading to a long-lasting suppression of relapse. Our findings provide evidence that the mTORC1 pathway and its downstream substrates play a crucial role in alcohol-related memory reconsolidation, and highlight this pathway as a therapeutic target to prevent relapse. PMID:23792945

  16. Changes in Alcohol-Related Problems After Alcohol Policy Changes in Denmark, Finland, and Sweden*

    PubMed Central

    Bloomfield, Kim; Wicki, Matthias; Gustafsson, Nina-Katri; Mäkelä, Pia; Room, Robin

    2010-01-01

    Objective: European Union travelers' allowances for alcohol import to Denmark, Sweden, and Finland were abolished in 2004. In addition, excise taxes on alcohol were lowered in 2003 and 2005 in Denmark, and in 2004 in Finland. Using northern Sweden as a control site, this study examines whether levels of reported alcohol problems have changed in Denmark, Finland, and southern Sweden as a consequence of these policy changes. Method: Annual cross-sectional surveys were conducted in Denmark, Finland, and Sweden from 2003 to 2006. Five dependency items and seven extrinsic alcohol-related problems were examined. Changes were analyzed within each country/region with logistic regressions and tested for short- and long-term changes. Differential change was also tested between each country and the control site, northern Sweden. Results: Prevalence of alcohol problems decreased over the study period. Only in selected subgroups did problems increase. This mainly occurred in the samples for northern Sweden and Finland, and mostly among older age groups and men. In relation to the control site, however, no increases in problem prevalence were found. Conclusions: Our findings on a decline in reported alcohol problems largely agree with published reports on alcohol consumption over the same period in the study countries. They do not agree, however, with findings on changes in health and social statistics in Finland and Denmark, where some significant increases in alcohol-related harm have been found. PMID:20105411

  17. Effects of prices, civil and criminal sanctions, and law enforcement on alcohol-related mortality.

    PubMed

    Sloan, F A; Reilly, B A; Schenzler, C

    1994-07-01

    Alcohol use has been linked to several causes of death. This study provides an empirical analysis of the effects of various public policies on mortality rates by state and year for the years 1982-88. Causes of death analyzed are: alcohol primary cause; traffic accident; homicides; suicides; falls, fires and other accidents; and contributory cause deaths (cancers of the alimentary tract). We find that increasing the price of alcohol decreases mortality rates for some of the causes, but not for primary cause deaths. Higher excise taxes on cigarettes reduce contributory cause mortality. Dram shop laws have negative and statistically significant effects not only on mortality rates from traffic accidents, but for several of the other causes. There is a need for further analysis to determine how these reductions are achieved. We find no evidence that imposing mandatory minimum jail terms, fines or license revocation for a DUI conviction affects alcohol-related mortality. However, increased police protection decreases mortality rates for several categories, especially homicides and traffic accidents. We find that imposing the death penalty reduces homicide rates. Reductions in alcohol-related mortality may be achieved by implementing a mix of public policies. No single policy is a panacea. PMID:7934053

  18. The Influence of Gender and Sexual Orientation on Alcohol Use and Alcohol-Related Problems

    PubMed Central

    Hughes, Tonda L.; Wilsnack, Sharon C.; Kantor, Lori Wolfgang

    2016-01-01

    Although there are wide differences in alcohol use patterns among countries, men are consistently more likely than women to be drinkers and to drink heavily. Studies of alcohol use among sexual minorities (SMs), however, reflect a more complex picture. Such research has found higher rates of alcohol use and alcohol-related problems among SM persons than among heterosexuals and greater differences between SM and heterosexual women than between SM and heterosexual men. A variety of factors may contribute to differences in alcohol use and alcohol-related problems between men and women and between SM and heterosexual people. An improved understanding of these factors is important to guide prevention and treatment efforts. Although there is a dearth of literature on use of alcohol by SMs in many parts of the world, especially lower- and middle-income countries, we attempt to review and integrate the sparse data that are available from these lower-resourced countries. The global perspective presented in this article is the first attempt to go beyond a general review of literature in the Western world to document the gender paradox in alcohol use among heterosexuals and SMs in diverse countries worldwide. PMID:27159819

  19. Health and social consequences of an alcohol-related admission to critical care: a qualitative study

    PubMed Central

    McPeake, Joanne; Forrest, Ewan; Quasim, Tara; Kinsella, John; O'Neill, Anna

    2016-01-01

    Objective To examine the impact of critical care on future alcohol-related behaviour. Further, it aimed to explore patterns of recovery for patients with and without alcohol use disorders beyond the hospital environment. Design In-depth, semistructured interviews with participants (patients) 3–7 months post intensive care discharge. Setting The setting for this study was a 20-bedded mixed intensive care unit (ICU), in a large teaching hospital in Scotland. On admission, patients were allocated to one of the three alcohol groups: low risk, harmful/hazardous and alcohol dependency. Participants 21 participants who received mechanical ventilation for greater than 3 days were interviewed between March 2013 and June 2014. Interventions None. Measurements and main results Four themes which impacted on recovery from ICU were identified in this patient group: psychological resilience, support for activities of daily living, social support and cohesion and the impact of alcohol use disorders on recovery. Participants also discussed the importance of personalised goal setting and appropriate and timely rehabilitation for alcohol-related behaviours during the critical care recovery period. Conclusions There is a significant interplay between alcohol misuse and recovery from critical illness. This study has demonstrated that at present, there is a haphazard approach to rehabilitation for patients after ICU. A more targeted rehabilitation pathway for patients leaving critical care, with specific emphasis on alcohol misuse if appropriate, requires to be generated. PMID:27048633

  20. Cirrhosis in children and adolescents: An overview

    PubMed Central

    Pinto, Raquel Borges; Schneider, Ana Claudia Reis; da Silveira, Themis Reverbel

    2015-01-01

    Several conditions, especially chronic liver diseases, can lead to cirrhosis in children and adolescents. Most cases in clinical practice are caused by similar etiologies. In infants, cirrhosis is most often caused by biliary atresia and genetic-metabolic diseases, while in older children, it tends to result from autoimmune hepatitis, Wilson’s disease, alpha-1-antitrypsin deficiency and primary sclerosing cholangitis. The symptoms of cirrhosis in children and adolescents are similar to those of adults. However, in pediatric patients, the first sign of cirrhosis is often poor weight gain. The complications of pediatric cirrhosis are similar to those observed in adult patients, and include gastrointestinal bleeding caused by gastroesophageal varices, ascites and spontaneous bacterial peritonitis. In pediatric patients, special attention should be paid to the nutritional alterations caused by cirrhosis, since children and adolescents have higher nutritional requirements for growth and development. Children and adolescents with chronic cholestasis are at risk for several nutritional deficiencies. Malnutrition can have severe consequences for both pre- and post-liver transplant patients. The treatment of cirrhosis-induced portal hypertension in children and adolescents is mostly based on methods developed for adults. The present article will review the diagnostic and differential diagnostic aspects of end-stage liver disease in children, as well as the major treatment options for this condition. PMID:25848466

  1. Managing Sleep Disturbances in Cirrhosis

    PubMed Central

    Zhao, Xun

    2016-01-01

    Sleep disturbances, particularly daytime sleepiness and insomnia, are common problems reported by patients suffering from liver cirrhosis. Poor sleep negatively impacts patients' quality of life and cognitive functions and increases mortality. Although sleep disturbances can be an early sign of hepatic encephalopathy (HE), many patients without HE still complain of poor quality sleep. The pathophysiology of these disturbances is not fully understood but is believed to be linked to impaired hepatic melatonin metabolism. This paper provides an overview for the clinician of common comorbidities contributing to poor sleep in patients with liver disease, mainly restless leg syndrome and obstructive sleep apnea. It discusses nondrug and pharmacologic treatment options in these patients, such as the use of light therapy and histamine (H1) blockers. PMID:27242950

  2. Portal Vein Thrombosis in Cirrhosis

    PubMed Central

    Raja, Kaiser; Jacob, Mathew; Asthana, Sonal

    2013-01-01

    Portal vein thrombosis (PVT) is being increasingly recognized in patients with advanced cirrhosis and in those undergoing liver transplantation. Reduced flow in the portal vein is probably responsible for clotting in the spleno-porto-mesenteric venous system. There is also increasing evidence that hypercoagulability occurs in advanced liver disease and contributes to the risk of PVT. Ultrasound based studies have reported a prevalence of PVT in 10–25% of cirrhotic patients without hepatocellular carcinoma. Partial thrombosis of the portal vein is more common and may not have pathophysiological consequences. However, there is high risk of progression of partial PVT to complete PVT that may cause exacerbation of portal hypertension and progression of liver insufficiency. It is thus, essential to accurately diagnose and stage PVT in patients waiting for transplantation and consider anticoagulation therapy. Therapy with low molecular weight heparin and vitamin K antagonists has been shown to achieve complete and partial recanalization in 33–45% and 15–35% of cases respectively. There are however, no guidelines to help determine the dose and therapeutic efficacy of anticoagulation in patients with cirrhosis. Anticoagulation therapy related bleeding is the most feared complication but it appears that the risk of variceal bleeding is more likely to be dependent on portal pressure rather than solely related to coagulation status. TIPS has also been reported to restore patency of the portal vein. Patients with complete PVT currently do not form an absolute contraindication for liver transplantation. Thrombectomy or thromboendovenectomy is possible in more than 75% of patients followed by anatomical end-to-end portal anastomosis. When patency of the portal vein and/or superior mesenteric vein is not achieved, only non-anatomical techniques (reno-portal anastomosis or cavo-portal hemitransposition) can be performed. These techniques, which do not fully reverse portal

  3. Leucine metabolism in stable cirrhosis.

    PubMed

    Mullen, K D; Denne, S C; McCullough, A J; Savin, S M; Bruno, D; Tavill, A S; Kalhan, S C

    1986-01-01

    Alterations in protein and amino acid metabolism have been postulated to explain the frequent observations of muscle wasting and decreased plasma branched-chain amino acid concentrations in cirrhosis. In order to investigate the changes in protein metabolism, we have measured the rates of leucine turnover and oxidation in six stable, biopsy-proven cirrhotics and six age and sex-matched healthy control subjects after an overnight fast, using [1-13C]leucine tracer. Following a primed constant-rate infusion of [1-13C]leucine, the 13C enrichments of plasma leucine and expired CO2 were used to estimate leucine turnover and oxidation, respectively. Fat-free body mass was estimated from the measurements of total body water as quantified by H2[18O] tracer dilution. The rates of CO2 production and oxygen consumption were measured hourly during the study period, using open-circuit respiratory calorimetry. Urinary urea, ammonia and total nitrogen excretion rates were quantified from timed urine samples. Even though the plasma leucine levels were lower in cirrhotics as compared with controls (100.5 +/- 17.1 vs. 138.3 +/- 20.4 mumoles per liter, mean +/- S.D., p less than 0.001), the rates of leucine turnover were not significantly different in the two groups (89.4 +/- 19.0 vs. 87.8 +/- 19.0 mumoles per kg X hr). In contrast, the rates of leucine oxidation were significantly reduced in cirrhosis (8.1 +/- 2.5 vs. 12.7 +/- 3.1 mumoles per kg X hr, p less than 0.01). When all subjects were considered, the leucine oxidation rate was correlated with plasma leucine concentration (r = 0.62, p less than 0.03).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3089896

  4. [Pathology of liver cirrhosis and portal hypertension].

    PubMed

    Bläker, H; Theuer, D; Otto, H F

    2001-10-01

    Cirrhosis is a late stage finding in chronic liver diseases of different aetiology. It is defined morphologically as a diffuse process with the presence of fibrosis and structurally abnormal nodules. The consequences of cirrhosis are both, mechanical and functional. The mechanical complications result from intra- and extrahepatic shunting of blood and portal hypertension while the functional relevance bases upon a failure of liver cells to perform their physiological role in metabolism, synthesis and secretion. Beside these complications that are directly linked to liver function cirrhosis in itself is a risk factor for hepatocellular carcinoma. PMID:11715574

  5. Treatment of alcohol use disorder patients affected by liver cirrhosis and/or hepatocellular carcinoma awaiting liver transplantation.

    PubMed

    Testino, Gianni; Leone, Silvia; Borro, Paolo

    2016-08-01

    Alcohol is one of the top three priority areas for public health worldwide. Alcohol is the second leading cause of liver disease, and 45-60% of cirrhosis deaths are alcohol related. In the United States it represents 30% of liver transplants and in Europe 50%. Twenty to 40% of cases of steatosis evolve into steatohepatitis, and l8-20% directly into liver cirrhosis; 20-40% of cases of steatohepatitis evolve into cirrhosis and 4-5% into hepatocellular carcinoma. This cascade of events takes 5 to 40 years. The temporal variability is related to the genetic pattern of the subject and the presence of associated risk factors. Thirty to 40% of patients with alcoholic liver disease (ALD) suffer from HCV, and 70% of HCV patients have a history of risky / harmful alcohol consumption. A severe clinical condition is certainly the overlap of acute alcoholic hepatitis (AAH) with a framework of HCV-related chronic hepatitis: acute chronic liver failure (ACLF). In the case of decompensated cirrhosis, severe AAH or ACLF non responder to medical therapy the indication, in selected patients, is certainly liver transplantation (LT). ALD treatment is important, but not very effective if abstention is not reached. In case of liver disease related or correlated to LT such as decompensated cirrhosis, severe AAH or ACLF the possibility of anticraving therapy is restricted to metadoxine and baclofen. In all alcohol use disorder patients with ALD psycho-social therapy and attendance at SHG groups it is mandatory, even in post-transplant period. PMID:27148681

  6. What I Need to Know about Cirrhosis

    MedlinePlus

    ... buy over the counter such as vitamins and herbal supplements, may have a stronger effect on you. Your ... buy over the counter such as vitamins and herbal supplements. Cirrhosis makes your liver sensitive to certain medicines. ...

  7. [Dental management in patients with cirrhosis].

    PubMed

    Rodríguez Martínez, Sandra; Talaván Serna, Julio; Silvestre, Francisco-Javier

    2016-03-01

    The present article makes a brief review about dental management of the patients with cirrhosis. It focus on problems related with infections, haemorrhagic events and treatment with drugs of common use in odontology. PMID:26541210

  8. Eating Tips for People with Cirrhosis

    MedlinePlus

    ... Combat Veterans & their Families Readjustment Counseling (Vet Centers) War Related Illness & Injury Study Center Homeless Veterans Returning ... with cirrhosis tend to hold onto (or retain) water. This often is shown first by swelling in ...

  9. Encephalopathy after persistent vomiting: Three cases of non-alcohol-related Wernicke's encephalopathy.

    PubMed

    Antel, K; Singh, N; Chisholm, B; Heckmann, J M

    2015-06-01

    Wernicke's encephalopathy (WE) is a medical emergency. Although WE is commonly viewed in the context of alcoholism, it can be caused by thiamine deficiency secondary to persistent vomiting. Non-alcohol-related WE may be more catastrophic in onset and less likely to present with the classic features than WE with alcoholism as a cause. We describe three cases of WE due to persistent vomiting without alcoholism in patients with hyperemesis gravidarum, drug-induced hyperlactataemia, and an acute gastrointestinal illness in an already malnourished individual. Our cases highlight the importance of recognising WE when undernutrition, which may be caused by gastrointestinal disease or surgery, or malignancy, is compounded by vomiting. Expert guidelines suggest that WE must be considered in the emergency room in any individual with disturbed consciousness of unknown cause. Treatment is with parenteral thiamine before glucose administration. PMID:26716155

  10. Global metabolic profiling for the study of alcohol-related disorders.

    PubMed

    Gika, Helen G; Wilson, Ian D

    2014-01-01

    Alcohol-related disorders are multifaceted since ethanol can induce profound metabolic perturbations when taken in excess. Global metabolic profiling strategies may aid the understanding of ethanol-related effects by shedding light on these metabolic changes and potentially revealing unknown mechanisms of ethanol toxicity. Here an overview of studies designed to explore the effects of alcohol (ethanol) consumption using holistic metabolite profiling approaches (metabonomics/metabolomics) is presented, demonstrating the potential of this methodology. The analytical technologies used (NMR, GC-MS and LC-MS), have been applied to the profiling of serum, plasma, urine and tissues, obtained from animal models or humans, after exposure to alcohol. From the metabolic profiling data of a range of biological samples, a number of endogenous metabolites have been proposed as potential ethanol consumption-related biomarkers. The biomarkers suggested by these studies, and the biochemical insights that they provide for understanding the effects of ethanol mechanisms of toxicity, are discussed. PMID:24341495

  11. Identifying the best scenario for using schematic organizers as integration tools for alcohol-related information.

    PubMed

    Peel, J L; Dansereau, D F; Dees, S

    1993-01-01

    The goal of the present study was to examine scenarios for using two schematic organizers--schematic knowledge maps and conceptual matrices--in integrating episodic and semantic knowledge about alcohol. Seventy students from undergraduate general psychology classes participated for course credit. Participants were assigned to either a schematic organizer group or an essay writing group. These groups were subdivided further into two treatment sequences: episodic/semantic and semantic/episodic. The episodic activity required participants to complete materials using their own alcohol-related experiences, whereas the semantic activity required participants to annotate expert materials. Assessment measures used were consumer-satisfaction questionnaires and free-recall tests. While no preferences were established for any one scenario, the episodic activities were rated higher than the semantic activities regardless of integration sequence. The semantic/episodic integration scenario did produce higher recall scores for the expert information. PMID:8487138

  12. Services for prisoners with alcohol-related problems: a survey of U.K. prisons.

    PubMed

    McMurran, M; Baldwin, S

    1989-09-01

    Offenders have been identified as heavy drinkers who admit to a relationship between drinking and offending. Many prisoners express a desire to reduce their alcohol consumption. The extent of alcohol interventions in U.K. prisons was unknown and so a postal survey was conducted to gather basic information about current work. Of all responding establishments, 91% claimed to provide services for prisoners with alcohol-related problems and 58% gave details of these services. Services are provided mainly by probation officers/social workers, prison officers and Alcoholics Anonymous. Group and individual interventions are described. Service development has been haphazard, lacking central co-ordination. A case is made for appointment of a central facilitator responsible for staff training, establishing a communications network, encouraging new interventions to match clients' needs, encouraging closer links with community workers and guiding evaluative research. PMID:2790268

  13. Latent class analysis of alcohol treatment utilization patterns and 3-year alcohol related outcomes.

    PubMed

    Mowbray, Orion; Glass, Joseph E; Grinnell-Davis, Claudette L

    2015-07-01

    People who obtain treatment for alcohol use problems often utilize multiple sources of help. While prior studies have classified treatment use patterns for alcohol use, an empirical classification of these patterns is lacking. For the current study, we created an empirically derived classification of treatment use and described how these classifications were prospectively associated with alcohol-related outcomes. Our sample included 257 participants of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) who first received alcohol treatment in the 3-year period prior to their baseline interview. We used latent class analysis to identify classes of treatment users based on their patterns of treatment use of 13 types of alcohol treatment. Regression models examined how classes of treatment use at baseline were associated with alcohol-related outcomes assessed at a 3-year follow-up interview. Outcomes included a continuous measure of the quantity and frequency of alcohol use and DSM-IV alcohol use disorder status. Four classes of treatment users were identified: (1) multiservice users (8.7%), (2) private professional service users (32.8%), (3) alcoholics anonymous (AA) paired with specialty addiction service users (22.0%), and (4) users of AA alone (36.5%). Those who utilized AA paired with specialty addiction services had better outcomes compared to those who used AA alone. In addition to elucidating the most common treatment utilization patterns executed by people seeking help for their alcohol problems, the results from this study suggest that increased efforts may be needed to refer individuals across sectors of care to improve treatment outcomes. PMID:25744651

  14. Legislation on alcohol detection in alcohol-related traffic accidents involving casualties in Japan and Canada.

    PubMed

    Hattori, H; Komura, S; Furuno, J

    1992-06-01

    A comparative study of the law concerning the arrest and conviction of alcohol-related casualty traffic accident was made between Japan and Canada. In Japan, the incidence of alcohol-related traffic accident has declined since 1970, but the number of fatal traffic accidents remains unchanged over the last 6 years, and amount to 9% of the total number of fatalities in traffic accidents. Hence, an effort is being made to reduce this number. According to the Road Traffic Act, a driver can be convicted for drunken driving if his or her blood alcohol level is above 0.5 mg/ml or above 0.25 mg/l in exhaled air, and if driver is judged as a drunken state by sobriety test. Unlike Canada, however, police officer cannot demand a blood sample from a suspected drunken driver. Instead, they must rely on the breath analysis and sobriety test. These tests are considered to be less accurate than blood test. These drawbacks are reflected in a number of court cases which are related to the relationship between alcohol concentration and the state of driving. In Canada, the operation of a motor vehicle with a blood alcohol level of over 0.8 mg/ml is a criminal offense punishable by fine or imprisonment or both, and results in the suspension of driving privileges for 6 months. Initially, a breath alcohol analysis is performed on everyone suspected of motor vehicle after consuming alcohol within the preceding two hours. Subsequently, with the suspect's consent, a police officer is allowed to request a blood sample for further analysis.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:1524523

  15. Detecting alcohol-related problems in developing countries: A comparison of two screening measures in India

    PubMed Central

    Nayak, Madhabika B.; Bond, Jason C.; Cherpitel, Cheryl; Patel, Vikram; Greenfield, Thomas K.

    2009-01-01

    Background There is inadequate recognition of alcohol misuse as a public health issue in India. Information on screening measures is critical for prevention and early intervention efforts. This study critically evaluated the full and shorter versions of the AUDIT and RAPS4-QF as screening measures for alcohol use disorders (AUDs) in a community sample of male drinkers in Goa, India. Methods Data from male drinking respondents in a population study on alcohol use patterns and sexual risk behaviors in randomly selected rural and urban areas of North Goa are reported. Overall, 39% (n=743) of the 1899 screened men, age 18 to 49, reported consuming alcohol in the last 12 months. These current drinkers were administered the screening measures as part of detailed interviews on drinking patterns and AUD symptoms. Receiver Operating Characteristic (ROC) analysis was conducted for each combination of screening measure and criterion (alcohol dependence or any AUD). Reliability and correlations among the 4 measures were also examined. Results All four measures performed well with area under the curves (AUCs) of at least .79. The full screeners that included both drinking patterns and problem items (the AUDIT and the RAP4-QF) performed better than their shorter versions (the AUDIT-C and the RAPS4) in detecting AUDs. Performance of the AUDIT and RAPS4-QF improved with lowered and raised thresholds, respectively, and alternate cut-off scores are suggested. Scores on the full measures were significantly correlated (.80). Reliability estimates for the AUDIT measures were higher than those for the RAPS4 measures. Conclusions All measures were efficient at detecting AUDs. When screening for alcohol-related problems among males in the general population in India, cut-off scores for screeners may need to be adjusted. Selecting an appropriate screening measure and cut-off score necessitates careful consideration of the screening context and resources available to confirm alcohol-related

  16. How economic crises affect alcohol consumption and alcohol-related health problems: a realist systematic review.

    PubMed

    de Goeij, Moniek C M; Suhrcke, Marc; Toffolutti, Veronica; van de Mheen, Dike; Schoenmakers, Tim M; Kunst, Anton E

    2015-04-01

    Economic crises are complex events that affect behavioral patterns (including alcohol consumption) via opposing mechanisms. With this realist systematic review, we aimed to investigate evidence from studies of previous or ongoing crises on which mechanisms (How?) play a role among which individuals (Whom?). Such evidence would help understand and predict the potential impact of economic crises on alcohol consumption. Medical, psychological, social, and economic databases were used to search for peer-reviewed qualitative or quantitative empirical evidence (published January 1, 1990-May 1, 2014) linking economic crises or stressors with alcohol consumption and alcohol-related health problems. We included 35 papers, based on defined selection criteria. From these papers, we extracted evidence on mechanism(s), determinant, outcome, country-level context, and individual context. We found 16 studies that reported evidence completely covering two behavioral mechanisms by which economic crises can influence alcohol consumption and alcohol-related health problems. The first mechanism suggests that psychological distress triggered by unemployment and income reductions can increase drinking problems. The second mechanism suggests that due to tighter budget constraints, less money is spent on alcoholic beverages. Across many countries, the psychological distress mechanism was observed mainly in men. The tighter budget constraints mechanism seems to play a role in all population subgroups across all countries. For the other three mechanisms (i.e., deterioration in the social situation, fear of losing one's job, and increased non-working time), empirical evidence was scarce or absent, or had small to moderate coverage. This was also the case for important influential contextual factors described in our initial theoretical framework. This realist systematic review suggests that among men (but not among women), the net impact of economic crises will be an increase in harmful

  17. The effects of chronic smoking on the pathology of alcohol-related brain damage.

    PubMed

    McCorkindale, A N; Sheedy, D; Kril, J J; Sutherland, G T

    2016-06-01

    Both pathological and neuroimaging studies demonstrate that chronic alcohol abuse causes brain atrophy with widespread white matter loss limited gray matter loss. Recent neuroimaging studies suggest that tobacco smoking also causes brain atrophy in both alcoholics and neurologically normal individuals; however, this has not been confirmed pathologically. In this study, the effects of smoking and the potential additive effects of concomitant alcohol and tobacco consumption were investigated in autopsied human brains. A total of 44 cases and controls were divided into four groups: 16 non-smoking controls, nine smoking controls, eight non-smoking alcoholics, and 11 smoking alcoholics. The volumes of 26 gray and white matter regions were measured using an established point-counting technique. The results showed trends for widespread white matter loss in alcoholics (p < 0.007) but no effect on gray matter regions. In contrast, smoking alone had no effect on brain atrophy and the combination of smoking and alcohol showed no additional effect. Neuronal density was analyzed as a more sensitive assay of gray matter integrity. Similar to the volumetric analysis, there was a reduction in neurons (29%) in the prefrontal cortex of alcoholics, albeit this was only a trend when adjusted for potential confounders (p < 0.06). There were no smoking or combinatorial effects on neuronal density in any of the three regions examined. These results do not support the hypothesis that smoking exacerbates alcohol-related brain damage. The trends here support previous studies that alcohol-related brain damage is characterized by focal neuronal loss and generalized white matter atrophy. These disparate effects suggest that two different pathogenic mechanisms may be operating in the alcoholic brain. Future studies using ultrastructural or molecular techniques will be required to determine if smoking has more subtle effects on the brain and how chronic alcohol consumption leads to

  18. Prospective Effects of Family Cohesion on Alcohol-Related Problems in Adolescence: Similarities and Differences by Race/Ethnicity.

    PubMed

    Reeb, Ben T; Chan, Sut Yee Shirley; Conger, Katherine J; Martin, Monica J; Hollis, Nicole D; Serido, Joyce; Russell, Stephen T

    2015-10-01

    Research increasingly finds that race/ethnicity needs to be taken into account in the modelling of associations between protective factors and adolescent drinking behaviors in order to understand family effects and promote positive youth development. The current study examined racial/ethnic variation in the prospective effects of family cohesion on adolescent alcohol-related problems using a nationally representative sample. Data were drawn from the first two waves of the National Longitudinal Study of Adolescent to Adult Health and included 10,992 (50% female) non-Hispanic Asian, non-Hispanic Black, Latino, and non-Hispanic White 7th-12th graders. Consistent with Hirschi's social control theory of youth delinquency, higher levels of family cohesion predicted lower levels of future adolescent alcohol-related problems, independent of race/ethnicity, sex, age, baseline alcohol-related problems, and family socioeconomic status. Findings from moderation analyses indicated that the magnitude of associations differed across groups such that the protective effect of family cohesion was strongest among White adolescents. For Latino adolescents, family cohesion was not associated with alcohol-related problems. Future longitudinal cross-racial/ethnic research is needed on common and unique mechanisms underlying differential associations between family processes and adolescent high-risk drinking. Understanding these processes could help improve preventive interventions, identify vulnerable subgroups, and inform health policy aimed at reducing alcohol-related health disparities. PMID:25563233

  19. Effects of Ads from a Drug and Alcohol Prevention Campaign on Willingness to Engage in Alcohol-Related Risky Behaviors

    PubMed Central

    Comello, Maria Leonora G.; Slater, Michael D.

    2011-01-01

    Behavioral willingness is conceptualized as a pathway to behavior that is non-deliberative, yet traditional measures require thoughtful deliberation to complete. This study explored non-deliberative measures of alcohol-related willingness to complement recent work on marijuana-related willingness. The study also examined whether ads from a field-tested drug-and-alcohol prevention campaign may have operated by influencing alcohol-related willingness. Participants viewed campaign ads or consumer ads (control). Outcomes were reaction times to make speeded judgments about whether one would engage in risky alcohol-related behaviors. Results showed that campaign ads lowered willingness to play drinking games and (for males) to drive while intoxicated. PMID:21646292

  20. Protective behavioral strategies when drinking alcohol and their relationship to negative alcohol-related consequences in college students.

    PubMed

    Martens, Matthew P; Taylor, Kari K; Damann, Krista M; Page, Jennifer C; Mowry, Emily S; Cimini, M Dolores

    2004-12-01

    Prior research has examined a number of individual characteristics (e.g., gender, family connectedness) that protect individuals from engaging in heavy drinking and experiencing negative alcohol-related consequences, but less is known about specific behavioral strategies that might also serve as protective factors. In this study, 556 undergraduate students completed the National College Health Assessment (American College Health Association, 2000) and answered questions regarding the use of specific protective behavioral strategies (PBS), alcohol consumption, and alcohol-related consequences. Results indicated that less frequent use of PBS was related to a greater likelihood of experiencing negative alcohol-related consequences, even after accounting for the effects of gender and alcohol consumption. These results suggest that PBS may be an important component of both prevention and treatment programs for college students. PMID:15631613

  1. GWAS in Primary Biliary Cirrhosis

    PubMed Central

    Gulamhusein, Aliya F.; Juran, Brian D.

    2015-01-01

    Genome wide association studies (GWAS) have been a significant technological advance in our ability to evaluate the genetic architecture of complex diseases such as Primary Biliary Cirrhosis (PBC). To date, six large-scale studies have been performed which identified 27 non-HLA risk loci associated with PBC. The identified risk variants emphasize important disease concepts; namely, that disturbances in immunoregulatory pathways are important in the pathogenesis of PBC and that such perturbations are shared among a diverse number of autoimmune diseases – suggesting the risk architecture may confer a generalized propensity to autoimmunity not necessarily specific to PBC. Furthermore, the impact of non-HLA risk variants, particularly in genes involved with IL-12 signaling, and ethnic variation in conferring susceptibility to PBC have been highlighted. While GWAS have been a critical stepping-stone in understanding common genetic variation contributing to PBC, limitations pertaining to power, sample availability, and strong linkage disequilibrium across genes have left us with an incomplete understanding of the genetic underpinnings of disease pathogenesis. Future efforts to gain insight into this missing heritability, the genetic variation that contributes to important disease outcomes and the functional consequences of associated variants will be critical if practical clinical translation is to be realized. PMID:26676814

  2. Management of ascites in cirrhosis.

    PubMed

    Wong, Florence

    2012-01-01

    Ascites is a common complication of liver cirrhosis associated with a poor prognosis. The treatment of ascites requires dietary sodium restriction and the judicious use of distal and loop diuretics, sequential at an earlier stage of ascites, and a combination at a later stage of ascites. The diagnosis of refractory ascites requires the demonstration of diuretic non-responsiveness, despite dietary sodium restriction, or the presence of diuretic-related complications. Patients with refractory ascites require second-line treatments of repeat large-volume paracentesis (LVP) or the insertion of a transjugular intrahepatic portosystemic shunt (TIPS), and assessment for liver transplantation. Careful patient selection is paramount for TIPS to be successful as a treatment for ascites. Patients not suitable for TIPS insertion should receive LVP. The use of albumin as a volume expander is recommended for LVP of >5-6 L to prevent the development of circulatory dysfunction, although the clinical significance of post-paracentesis circulatory dysfunction is still debated. Significant mortality is still being observed in cirrhotic patients with ascites and relatively preserved liver and renal function, as indicated by a lower Model for End-Stage Liver Disease (MELD) score. It is proposed that patients with lower MELD scores and ascites should receive additional points in calculating their priority for liver transplantation. Potential new treatment options for ascites include the use of various vasoconstrictors, vasopressin V(2) receptor antagonists, or the insertion of a peritoneo-vesical shunt, all of which could possibly improve the management of ascites. PMID:21916992

  3. Effects of alcohol taxes on alcohol-related disease mortality in New York State from 1969 to 2006

    PubMed Central

    Delcher, Chris; Maldonado-Molina, Mildred M.; Wagenaar, Alexander C.

    2013-01-01

    Objective The relationship of increased alcohol taxes to reductions in alcohol-related harm is well established. Few studies, however, have examined the effects of sudden decreases in alcohol tax rates or effects of narrow tax changes limited to specific beverage types. In the current study, we: (1) examine whether tax increases on spirits have similar effects in reducing alcohol-related disease mortality as increasing taxes on all types of alcoholic beverages simultaneously, and (2) evaluate effects of beer-specific tax decreases in New York State on mortality. Method We used a time-series, quasi-experimental research design, including non-alcohol deaths within New York State and other states’ rates of alcohol-related disease mortality for comparison. The dataset included 456 monthly observations of mortality in New York State over a 38-year period (1969–2006). We used a random-effects approach and included several other important covariates. Results Alcohol-related disease mortality declined by 7.0% after a 1990 tax increase for spirits and beer. A spirits-only tax increase (in 1972) was not significantly associated with mortality but a data anomaly increased error in this effect estimate. Small tax decreases on beer between 1996 and 2006 had no measurable effect on mortality. Doubling the beer tax from $0.11 to $0.22 per gallon, a return to New York State’s 1990 levels, would decrease deaths by an estimated 250 deaths per year. Conclusions Excise tax increases on beer and spirits were associated with reductions in alcohol-related disease mortality. Modifying tax rates on a single beverage type does not appear to be as effective as doing so on multiple alcoholic beverages simultaneously. In New York, small decreases in beer taxes were not significantly associated with alcohol-related disease mortality. PMID:22436591

  4. Can screening and brief intervention lead to population-level reductions in alcohol-related harm?

    PubMed

    Heather, Nick

    2012-01-01

    A distinction is made between the clinical and public health justifications for screening and brief intervention (SBI) against hazardous and harmful alcohol consumption. Early claims for a public health benefit of SBI derived from research on general medical practitioners' (GPs') advice on smoking cessation, but these claims have not been realized, mainly because GPs have not incorporated SBI into their routine practice. A recent modeling exercise estimated that, if all GPs in England screened every patient at their next consultation, 96% of the general population would be screened over 10 years, with 70-79% of excessive drinkers receiving brief interventions (BI); assuming a 10% success rate, this would probably amount to a population-level effect of SBI. Thus, a public health benefit for SBI presupposes widespread screening; but recent government policy in England favors targeted versus universal screening, and in Scotland screening is based on new registrations and clinical presentation. A recent proposal for a national screening program was rejected by the UK National Health Service's National Screening Committee because 1) there was no good evidence that SBI led to reductions in mortality or morbidity, and 2) a safe, simple, precise, and validated screening test was not available. Even in countries like Sweden and Finland, where expensive national programs to disseminate SBI have been implemented, only a minority of the population has been asked about drinking during health-care visits, and a minority of excessive drinkers has been advised to cut down. Although there has been research on the relationship between treatment for alcohol problems and population-level effects, there has been no such research for SBI, nor have there been experimental investigations of its relationship with population-level measures of alcohol-related harm. These are strongly recommended. In this article, conditions that would allow a population-level effect of SBI to occur are

  5. Can screening and brief intervention lead to population-level reductions in alcohol-related harm?

    PubMed Central

    2012-01-01

    A distinction is made between the clinical and public health justifications for screening and brief intervention (SBI) against hazardous and harmful alcohol consumption. Early claims for a public health benefit of SBI derived from research on general medical practitioners’ (GPs’) advice on smoking cessation, but these claims have not been realized, mainly because GPs have not incorporated SBI into their routine practice. A recent modeling exercise estimated that, if all GPs in England screened every patient at their next consultation, 96% of the general population would be screened over 10 years, with 70-79% of excessive drinkers receiving brief interventions (BI); assuming a 10% success rate, this would probably amount to a population-level effect of SBI. Thus, a public health benefit for SBI presupposes widespread screening; but recent government policy in England favors targeted versus universal screening, and in Scotland screening is based on new registrations and clinical presentation. A recent proposal for a national screening program was rejected by the UK National Health Service’s National Screening Committee because 1) there was no good evidence that SBI led to reductions in mortality or morbidity, and 2) a safe, simple, precise, and validated screening test was not available. Even in countries like Sweden and Finland, where expensive national programs to disseminate SBI have been implemented, only a minority of the population has been asked about drinking during health-care visits, and a minority of excessive drinkers has been advised to cut down. Although there has been research on the relationship between treatment for alcohol problems and population-level effects, there has been no such research for SBI, nor have there been experimental investigations of its relationship with population-level measures of alcohol-related harm. These are strongly recommended. In this article, conditions that would allow a population-level effect of SBI to occur are

  6. Liver surgery in cirrhosis and portal hypertension

    PubMed Central

    Hackl, Christina; Schlitt, Hans J; Renner, Philipp; Lang, Sven A

    2016-01-01

    The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary or metastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome. The Barcelona Clinic Liver Cancer classification recommends to restrict curative liver resections for hepatocellular carcinoma in cirrhotic patients to early tumor stages in patients with Child A cirrhosis not showing portal hypertension. However, during the last two decades, relevant improvements in preoperative diagnostic, perioperative hepatologic and intensive care management as well as in surgical techniques during hepatic resections have rendered even extended liver resections in higher-degree cirrhotic patients with portal hypertension possible. However, there are few standard indications for hepatic resections in cirrhotic patients and risk stratifications have to be performed in an interdisciplinary setting for each individual patient. We here review the indications, the preoperative risk-stratifications, the morbidity and the mortality of extended resections for primary and metastatic lesions in cirrhotic livers. Furthermore, we provide a review of literature on perioperative management in cirrhotic patients needing extrahepatic abdominal surgery and an overview of surgical options in the treatment of hepatic cirrhosis. PMID:26973411

  7. Do students use contextual protective behaviors to reduce alcohol-related sexual risk? Examination of a dual-process decision-making model.

    PubMed

    Scaglione, Nichole M; Hultgren, Brittney A; Reavy, Racheal; Mallett, Kimberly A; Turrisi, Rob; Cleveland, Michael J; Sell, Nichole M

    2015-09-01

    Recent studies suggest drinking protective behaviors (DPBs) and contextual protective behaviors (CPBs) can uniquely reduce alcohol-related sexual risk in college students. Few studies have examined CPBs independently, and even fewer have utilized theory to examine modifiable psychosocial predictors of students' decisions to use CPBs. The current study used a prospective design to examine (a) rational and reactive pathways and psychosocial constructs predictive of CPB use and (b) how gender might moderate these influences in a sample of college students. Students (n = 508) completed Web-based baseline (mid-Spring semester) and 1- and 6-month follow-up assessments of CPB use; psychosocial constructs (expectancies, normative beliefs, attitudes, and self-concept); and rational and reactive pathways (intentions and willingness). Regression was used to examine rational and reactive influences as proximal predictors of CPB use at the 6-month follow-up. Subsequent path analyses examined the effects of psychosocial constructs, as distal predictors of CPB use, mediated through the rational and reactive pathways. Both rational (intentions to use CPB) and reactive (willingness to use CPB) influences were significantly associated with increased CPB use. The examined distal predictors were found to effect CPB use differentially through the rational and reactive pathways. Gender did not significantly moderate any relationships within in the model. Findings suggest potential entry points for increasing CPB use that include both rational and reactive pathways. Overall, this study demonstrates the mechanisms underlying how to increase the use of CPBs in programs designed to reduce alcohol-related sexual consequences and victimization. PMID:26415062

  8. Does increasing community and liquor licensees' awareness, police activity, and feedback reduce alcohol-related violent crime? A benefit-cost analysis.

    PubMed

    Navarro, Héctor José; Shakeshaft, Anthony; Doran, Christopher M; Petrie, Dennis J

    2013-11-01

    Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees' awareness, police activity, and feedback) on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions. PMID:24169411

  9. Does Increasing Community and Liquor Licensees’ Awareness, Police Activity, and Feedback Reduce Alcohol-Related Violent Crime? A Benefit-Cost Analysis

    PubMed Central

    Navarro, Héctor José; Shakeshaft, Anthony; Doran, Christopher M.; Petrie, Dennis J.

    2013-01-01

    Approximately half of all alcohol-related crime is violent crime associated with heavy episodic drinking. Multi-component interventions are highly acceptable to communities and may be effective in reducing alcohol-related crime generally, but their impact on alcohol-related violent crime has not been examined. This study evaluated the impact and benefit-cost of a multi-component intervention (increasing community and liquor licensees’ awareness, police activity, and feedback) on crimes typically associated with alcohol-related violence. The intervention was tailored to weekends identified as historically problematic in 10 experimental communities in NSW, Australia, relative to 10 control ones. There was no effect on alcohol-related assaults and a small, but statistically significant and cost-beneficial, effect on alcohol-related sexual assaults: a 64% reduction in in the experimental relative to control communities, equivalent to five fewer alcohol-related sexual assaults, with a net social benefit estimated as AUD$3,938,218. The positive benefit-cost ratio was primarily a function of the value that communities placed on reducing alcohol-related harm: the intervention would need to be more than twice as effective for its economic benefits to be comparable to its costs. It is most likely that greater reductions in crimes associated with alcohol-related violence would be achieved by a combination of complementary legislative and community-based interventions. PMID:24169411

  10. Preventing Fetal Alcohol Syndrome and Other Alcohol-Related Birth Defects: Teacher's Manual and Student Text. High School Edition.

    ERIC Educational Resources Information Center

    Howard, Elizabeth; And Others

    This teacher's manual presents lesson plans for a high-school instructional unit on Fetal Alcohol Syndrome and its less severe manifestations, Alcohol-Related Birth Defects. The lessons cover alcohol's effects during pregnancy, the history of concern about alcohol's effects, consequences of alcohol use in pregnancy, lifestyle risk reduction, and…

  11. Alcohol-Related Consequences among First-Year University Students: Effectiveness of a Web-Based Personalized Feedback Program

    ERIC Educational Resources Information Center

    Doumas, Diana M.; Nelson, Kinsey; DeYoung, Amanda; Renteria, Camryn Conrad

    2014-01-01

    This study evaluated the effectiveness of a web-based personalized feedback program using an objective measure of alcohol-related consequences. Participants were assigned to either the intervention group or an assessment-only control group during university orientation. Sanctions received for campus alcohol policy violations were tracked over the…

  12. Relationship of Age of First Drink to Alcohol-Related Consequences among College Students with Unhealthy Alcohol Use

    ERIC Educational Resources Information Center

    Rothman, Emily F.; Dejong, William; Palfai, Tibor; Saitz, Richard

    2008-01-01

    This study investigated the relationship between age of first drink (AFD) and a broad range of negative alcohol-related outcomes among college students exhibiting unhealthy alcohol use. We conducted an anonymous on-line survey to collect self-report data from first-year college students at a large northeastern university. Among 1,792 respondents…

  13. Assessing the Representativeness of Population-Sampled Health Surveys Through Linkage to Administrative Data on Alcohol-Related Outcomes

    PubMed Central

    Gorman, Emma; Leyland, Alastair H.; McCartney, Gerry; White, Ian R.; Katikireddi, Srinivasa Vittal; Rutherford, Lisa; Graham, Lesley; Gray, Linsay

    2014-01-01

    Health surveys are an important resource for monitoring population health, but selective nonresponse may impede valid inference. This study aimed to assess nonresponse bias in a population-sampled health survey in Scotland, with a focus on alcohol-related outcomes. Nonresponse bias was assessed by examining whether rates of alcohol-related harm (i.e., hospitalization or death) and all-cause mortality among respondents to the Scottish Health Surveys (from 1995 to 2010) were equivalent to those in the general population, and whether the extent of any bias varied according to sociodemographic attributes or over time. Data from consenting respondents (aged 20–64 years) to 6 Scottish Health Surveys were confidentially linked to death and hospitalization records and compared with general population counterparts. Directly age-standardized incidence rates of alcohol-related harm and all-cause mortality were lower among Scottish Health Survey respondents compared with the general population. For all years combined, the survey-to-population rate ratios were 0.69 (95% confidence interval: 0.61, 0.76) for the incidence of alcohol-related harm and 0.89 (95% confidence interval: 0.83, 0.96) for all-cause mortality. Bias was more pronounced among persons residing in more deprived areas; limited evidence was found for regional or temporal variation. This suggests that corresponding underestimation of population rates of alcohol consumption is likely to be socially patterned. PMID:25227767

  14. Questioning the Value of Realism: Young Adults' Processing of Messages in Alcohol-Related Public Service Announcements and Advertising.

    ERIC Educational Resources Information Center

    Andsager, Julie L.; Austin, Erica Weintraub; Pinkleton, Bruce E.

    2001-01-01

    Finds that: (1) perceived realism and themes that students could identify with are important factors in increasing the salience and persuasiveness of alcohol-related public service announcements (PSAs) among undergraduate students; (2) realistic but logic-based PSAs were not as effective as unrealistic but enjoyable ads; and (3) low production…

  15. Factors Associated with General and Sexual Alcohol-Related Consequences: An Examination of College Students Studying Abroad

    ERIC Educational Resources Information Center

    Hummer, Justin F.; Pedersen, Eric R.; Mirza, Tehniat; LaBrie, Joseph W.

    2010-01-01

    This study contributes to the scarce research on U.S. college students studying abroad by documenting general and sexual negative alcohol-related risks and factors associated with such risk. The manner of drinking (quantity vs. frequency), pre-departure expectations surrounding alcohol use while abroad, culture-related social anxiety, and…

  16. Demographic and Predeparture Factors Associated with Drinking and Alcohol-Related Consequences for College Students Completing Study Abroad Experiences

    ERIC Educational Resources Information Center

    Pedersen, Eric R.; Skidmore, Jessica R.; Aresi, Giovanni

    2014-01-01

    Objective: Study abroad students are at risk for increased and problematic drinking behavior. As few efforts have been made to examine this at-risk population, the authors predicted drinking and alcohol-related consequences abroad from predeparture and site-specific factors. Participants: The sample consisted of 339 students completing study…

  17. The Hispanic Americans Baseline Alcohol Survey (HABLAS): Acculturation, Birthplace and Alcohol-Related Social Problems across Hispanic National Groups

    ERIC Educational Resources Information Center

    Caetano, Raul; Vaeth, Patrice A. C.; Rodriguez, Lori A.

    2012-01-01

    The purpose of this study was to examine the association between acculturation, birthplace, and alcohol-related social problems across Hispanic national groups. A total of 5,224 Hispanic adults (18+ years) were interviewed using a multistage cluster sample design in Miami, New York, Philadelphia, Houston, and Los Angeles. Multivariate analysis…

  18. Alcohol Expectancies and Evaluations of Aggression in Alcohol-Related Intimate-Partner Verbal and Physical Aggression

    PubMed Central

    Kachadourian, Lorig K; Quigley, Brian M; Leonard, Kenneth E

    2014-01-01

    Objective: Alcohol aggression expectancies have been found to be associated with increases in aggressive behavior. However, research has not consistently examined evaluations of such behavior. This is unfortunate as both expectancies and evaluations may play a role in whether such behavior will occur. Given this, the current study cross-sectionally examined the associations between alcohol aggression expectancies, evaluations of alcohol-related aggression, indicators of excessive drinking, and alcohol-related verbal and physical aggression. Method: The sample consisted of 280 married and cohabiting couples. These couples reported on excessive drinking indicators, alcohol expectancies and evaluations, and alcohol-related verbal and physical aggression during the past year. Results: Findings showed that verbal aggression was positively associated with indicators of excessive drinking among females and with alcohol aggression expectancies for females who evaluated such aggression positively. For males, aggression expectancies and indicators of excessive drinking were positively associated with verbal aggression. For physical aggression, results showed that indicators of excessive drinking and aggression expectancies were associated with physical aggression for females. For males, aggression expectancies were positively associated and evaluations were negatively associated with physical aggression. Conclusions: These findings add to previous research on alcohol aggression expectancies in close relationships and emphasize the importance of considering evaluations of alcohol-related behavior and how they may play a role in intimate-partner violence and aggression. PMID:25208191

  19. Exploring the Relationship between Experiential Avoidance, Alcohol Use Disorders, and Alcohol-Related Problems among First-Year College Students

    ERIC Educational Resources Information Center

    Levin, Michael E.; Lillis, Jason; Seeley, John; Hayes, Steven C.; Pistorello, Jacqueline; Biglan, Anthony

    2012-01-01

    Objective: This study explored the relationship of experiential avoidance (eg, the tendency to avoid, suppress, or otherwise control internal experiences even when doing so causes behavioral harm) to alcohol use disorders and alcohol-related problems. Participants: Cross-sectional data were collected from 240 undergraduate college students in…

  20. The influence of alcohol-specific communication on adolescent alcohol use and alcohol-related consequences.

    PubMed

    Reimuller, Alison; Hussong, Andrea; Ennett, Susan T

    2011-12-01

    Alcohol-specific communication, a direct conversation between an adult and an adolescent regarding alcohol use, contains messages about alcohol relayed from the adult to the child. The current study examined the construct of alcohol-specific communication and the effect of messages on adolescent alcohol use and alcohol-related consequences. Parent-adolescent dyads were assessed biannually for 3 years (grades 9-11 at wave 6) to examine these relations in a large longitudinal study of adolescents initially in grades 6 through 8. An exploratory factor analysis identified two factors among alcohol-specific communication items, permissive messages and negative alcohol messages. Results showed previous level of adolescent alcohol use moderated the relation between permissive messages and alcohol use outcomes. Plotting of these interactions showed greater alcohol use and consequences with increasing permissive messages in adolescents with higher versus lower levels of previous alcohol use. Results suggest that parental messages regarding alcohol use may impact adolescent alcohol use beyond the effect of general parenting style and parental alcohol use. PMID:21667141

  1. Study Protocol: Screening and Treatment of Alcohol-Related Trauma (START) – a randomised controlled trial

    PubMed Central

    2012-01-01

    Background The incidence of mandibular fractures in the Northern Territory of Australia is very high, especially among Indigenous people. Alcohol intoxication is implicated in the majority of facial injuries, and substance use is therefore an important target for secondary prevention. The current study tests the efficacy of a brief therapy, Motivational Care Planning, in improving wellbeing and substance misuse in youth and adults hospitalised with alcohol-related facial trauma. Methods and design The study is a randomised controlled trial with 6 months of follow-up, to examine the effectiveness of a brief and culturally adapted intervention in improving outcomes for trauma patients with at-risk drinking admitted to the Royal Darwin Hospital maxillofacial surgery unit. Potential participants are identified using AUDIT-C questionnaire. Eligible participants are randomised to either Motivational Care Planning (MCP) or Treatment as Usual (TAU). The outcome measures will include quantity and frequency of alcohol and other substance use by Timeline Followback. The recruitment target is 154 participants, which with 20% dropout, is hoped to provide 124 people receiving treatment and follow-up. Discussion This project introduces screening and brief interventions for high-risk drinkers admitted to the hospital with facial trauma. It introduces a practical approach to integrating brief interventions in the hospital setting, and has potential to demonstrate significant benefits for at-risk drinkers with facial trauma. Trial Registration The trial has been registered in Australian New Zealand Clinical Trials Registry (ANZCTR) and Trial Registration: ACTRN12611000135910. PMID:23106916

  2. Alcohol-related problems: a critical review of the literature and directions in nurse education.

    PubMed

    Arthur, D

    1998-08-01

    It is generally accepted the around 2-5% of the adult population show major signs of alcohol dependence, that alcohol-related harm is experienced by up to 20% of the population, and that approximately 60% drink at risk-free levels. Further prevalence studies show that there are high numbers of problem drinkers who attend general hospital services for reasons other than their alcohol consumption. Nurses are in constant contact with patients who may have an early problem with alcohol but who are admitted for other reasons, and they are in a prime position to comprehensively assess patients (including alcohol screening), develop rapport and provide 'counselling'. Also, university nursing education is propelling nurses toward adoption of independent discipline focused models of care which are increasingly becoming independent of the medical model. Recent trends in the management of problem drinkers suggest that controlled drinking approaches may well offer treatment options to nurses that the traditional abstinence approaches did not. This paper presents a brief overview of the notion of controlled drinking, then critically reviews the nursing research studies and the descriptive literature providing direction for nursing education. Some recent clinical initiatives are discussed which highlight the flaws existing in nursing education, including lack of sufficient curriculum hours and the need for better designed education models and strategies. PMID:9847741

  3. Chemosensory Dysfunction in Alcohol-Related Disorders: A Joint Exploration of Olfaction and Taste.

    PubMed

    Brion, Mélanie; de Timary, Philippe; Vander Stappen, Caroline; Guettat, Lamia; Lecomte, Benoît; Rombaux, Philippe; Maurage, Pierre

    2015-11-01

    Chemosensory (olfaction-taste) dysfunctions are considered as reliable biomarkers in many neurological and psychiatric states. However, experimental measures of chemosensory abilities are lacking in alcohol-dependence (AD) and Korsakoff Syndrome (KS, a neurological complication of AD), despite the role played by alcohol-related odors and taste in the emergence and maintenance of AD. This study thus investigated chemosensory impairments in AD and KS. Olfactory-gustatory measures were taken among 20 KS, 20 AD, and 20 control participants. Olfaction (odor detection-discrimination-identification) was assessed using the "Sniffin Sticks" battery and taste was measured using the "Taste Strips" task. Impairments were found for high-level olfaction in AD (odor discrimination) and KS (odor discrimination-identification), even after controlling for psychopathological comorbidities. Gustatory deficits were also observed in both groups, indexing a global deficit for chemosensory perception. Finally, the gradient of impairment between the successive disease stages for odor identification suggests that the hypothesis of a continuum between AD and KS regarding cognitive deficits can be generalized to chemosensory perception. AD and KS are thus characterized by deficits in chemosensory abilities, which could constitute a marker of the AD-KS transition. In view of its deleterious influence on everyday life, chemosensory dysfunction should also be taken into account in clinical settings. PMID:26354933

  4. Infant Symbolic Play as an Early Indicator of Fetal Alcohol-Related Deficit

    PubMed Central

    Molteno, Christopher D.; Jacobson, Joseph L.; Carter, R. Colin; Jacobson, Sandra W.

    2010-01-01

    Infant symbolic play was examined in relation to prenatal alcohol exposure and socioenvironmental background and to predict which infants met criteria for fetal alcohol syndrome (FAS) at 5 years. 107 Cape Coloured, South African infants born to heavy drinking mothers and abstainers/light drinkers were recruited prenatally. Complexity of play, socio-demographic and psychological correlates of maternal alcohol use, and quality of parenting were assessed at 13 months, and IQ and FAS diagnosis at 5 years. The effect of drinking on spontaneous play was not significant after control for social environment. By contrast, prenatal alcohol and quality of parenting related independently to elicited play. Elicited play predicted 5-year Digit Span and was poorer in infants subsequently diagnosed with FAS/partial FAS and in nonsyndromal heavily exposed infants, compared with abstainers/light drinkers. Thus, symbolic play may provide an early indicator of risk for alcohol-related deficits. The independent effects of prenatal alcohol and quality of parenting suggest that infants whose symbolic play is adversely affected by alcohol exposure may benefit from stimulation from a responsive caregiver. PMID:20953338

  5. Genetic influences in emotional dysfunction and alcoholism-related brain damage

    PubMed Central

    Oscar-Berman, Marlene; Bowirrat, Abdalla

    2005-01-01

    Alcoholism is a complex, multifactorial disorder involving problematic ethanol ingestion; it results from the interplay between genetic and environmental factors. Personality, likewise, is formed from a combination of inherited and acquired influences. Because selected dimensions of emotional temperament are associated with distinct neurochemical substrates contributing to specific personality phenotypes, certain aspects of abnormal emotional traits in alcoholics may be inherited. Emotions involve complex subjective experiences engaging multiple brain regions, most notably the cortex, limbic system, and cerebellum. Results of in vivo magnetic resonance imaging and post-mortem neuropathological studies of alcoholics indicate that the greatest cortical loss occurs in the frontal lobes, with concurrent thinning of the corpus callosum. Additional damage has been documented for the amygdala and hippocampus, as well as in the white matter of the cerebellum. All of the critical areas of alcoholism-related brain damage are important for normal emotional functioning. When changes occur in these brain regions, either as a consequence of chronic ethanol abuse or from a genetic anomaly affecting temperament and/or a vulnerability to alcoholism, corresponding changes in emotional functions are to be expected. In alcoholics, such changes have been observed in their perception and evaluation of emotional facial expressions, interpretation of emotional intonations in vocal utterances, and appreciation of the meaning of emotional materials. PMID:18568071

  6. Amelioration of carbon tetrachloride-induced cirrhosis and portal hypertension in rat using adenoviral gene transfer of Akt

    PubMed Central

    Deng, Gang; Huang, Xiang-Jun; Luo, Hong-Wu; Huang, Fei-Zhou; Liu, Xun-Yang; Wang, Yong-Heng

    2013-01-01

    AIM: To investigate whether a virus constitutively expressing active Akt is useful to prevent cirrhosis induced by carbon tetrachloride (CCl4). METHODS: Using cre-loxp technique, we created an Ad-myr-HA-Akt virus, in which Akt is labeled by a HA tag and its expression is driven by myr promoter. Further, through measuring enzyme levels and histological structure, we determined the efficacy of this Ad-myr-HA-Akt virus in inhibiting the development of cirrhosis induced by CCl4 in rats. Lastly, using western blotting, we examined the expression levels and/or phosphorylation status of Akt, apoptotic mediators, endothelial nitric oxide synthase (eNOS), and markers for hepatic stellate cells activation to understand the underlying mechanisms of protective role of this virus. RESULTS: The Ad-myr-HA-Akt virus was confirmed using polymerase chain reaction amplification of inserted Akt gene and sequencing for full length of inserted fragment, which was consistent with the sequence reported in the GenBank. The concentrations of Ad-myr-HA-Akt and adenoviral enhanced green fluorescent protein (Ad-EGFP) virus used in the current study were 5.5 × 1011 vp/mL. The portal vein diameter, peak velocity of blood flow, portal blood flow and congestion index were significantly increased in untreated, saline and Ad-EGFP cirrhosis groups when compared to normal control after the virus was introduced to animal through tail veil injection. In contrast, these parameters in the Akt cirrhosis group were comparable to normal control group. Compared to the normal control, the liver function (Alanine aminotransferase, Aspartate aminotransferase and Albumin) was significantly impaired in the untreated, saline and Ad-EGFP cirrhosis groups. The Akt cirrhosis group showed significant improvement of liver function when compared to the untreated, saline and Ad-EGFP cirrhosis groups. The Hyp level and portal vein pressure in Akt cirrhosis groups were also significantly lower than other cirrhosis groups

  7. The Factors Affecting Bone Density in Cirrhosis

    PubMed Central

    Hajiabbasi, Asghar; Shafaghi, Afshin; Fayazi, Haniyeh Sadat; Shenavar Masooleh, Irandokht; Hedayati Emami, Mohammad Hassan; Ghavidel Parsa, Pooneh; Amir Maafi, Alireza

    2015-01-01

    Background: Bone loss is common in cirrhosis. However, the prevalence of osteopenia and osteoporosis has been heterogeneous in different reports. Reduction in bone formation with or without increase in bone resorption appears to be responsible for bone loss in these patients. Objectives: We aimed to investigate bone loss in patients with cirrhosis at different anatomical sites and key factors that might affect it. Patients and Methods: In this cross-sectional study, 97 patients with cirrhosis who were referred to Razi Hospital, Rasht, Iran, from 2008 to 2010, were studied. Cirrhosis was diagnosed using biopsy and/or clinical and paraclinical findings. Bone mineral densitometry was done in L2 through L4 lumbar spine (LS) and femoral neck (FN), using dual-energy X-ray absorptiometry (DEXA) (QDR 1000, Hologic DEXA Inc, Waltham, Massachusetts, the United States). Statistical analysis was performed using SPSS 18. A P value < 0.05 was considered statistically significant. Results: A total of 97 patients with cirrhosis (55.7% male) and the mean age of 51 ± 13 years and median body mass index (BMI) of 22.7 kg/m2 were recruited over a two-year period. Etiologies of cirrhosis were hepatitis C (40.2%), hepatitis B (26.8%), cryptogenic (21.6%), and other causes (11.4%). Child A, B, and C, were seen in 16.5%, 47.4%, and 36.1% of patients, respectively. The DEXA results were abnormal in 78.4% of our participants (osteopenia, 45.4%; osteoporosis, 33%). BMI and calculated glomerular filtration rate (GFRc) had moderate positive and Child score had moderate negative significant correlation with T score in both anatomical sites. There was no significant association between abnormal DEXA and the causes of cirrhosis. The univariate analysis showed that the risk of abnormal results in DEXA was significantly higher in those with low BMI, current smoking, higher Child score, and low GFRc; however, in multivariate analysis, the abnormal results were more frequent in those with lower

  8. Renal failure in cirrhosis: Emerging concepts

    PubMed Central

    Bittencourt, Paulo Lisboa; Farias, Alberto Queiroz; Terra, Carlos

    2015-01-01

    Acute renal failure, now termed acute kidney injury (AKI), is frequently found in patients with cirrhosis. The occurrence of AKI, irrespective of the underlying cause, is associated with reduced in-hospital, 3-mo and 1-year survival. Hepatorenal syndrome is associated with the worst outcome among AKI patients with cirrhosis. Several definitions for AKI that have been proposed are outlined and evaluated in this paper. Among these, the International Club for Ascites-AKI criteria substantially strengthen the quality of early diagnosis and intervention according to underlying cause of AKI. PMID:26413223

  9. Under-Researched Demographics: Heavy Episodic Drinking and Alcohol-Related Problems Among Asian Americans.

    PubMed

    Iwamoto, Derek Kenji; Kaya, Aylin; Grivel, Margaux; Clinton, Lauren

    2016-01-01

    , traditional norms that may directly pertain to hyperfemininzed Asian-American women, including modesty and sexual fidelity, may protect against heavy episodic drinking (Young et al. 2005). Conversely, the risk for heavy episodic drinking may be enhanced in men who strive to demonstrate traditional notions of masculinity through risk-taking and endorsement of playboy norms (Iwamoto et al. 2010). Although this review has illustrated the contemporary state of research on alcohol use among Asian Americans, it also highlights the significant limitations in this literature. Many of the studies reviewed here have used cross-sectional data, which do not allow researchers to infer causality between the various sociocultural factors and problematic alcohol use. One way of addressing this gap in the existing literature may be to implement longitudinal designs to further understand how the temporal relationship between sociocultural factors, including acculturation and gender norms, may impact alcohol use and alcohol-related problem trajectories. There also is a pressing need to develop greater understanding of within-group differences among U.S.-born and foreign-born Asian Americans as well as among as specific ethnic groups. To date, epidemiological research has largely neglected to examine these significant discrepancies. Given the growing prevalence of alcohol use and alcohol-related problems among Asian-American women (Grant et al. 2004; Iwamoto et al. 2010), studies also should focus on this group and explore how the intersection of gender and culture may influence alcohol use. Finally, the majority of research on this population has been conducted in college samples; therefore, it is important to also examine community samples, including U.S.-born young adults who are not attending college and older adult Asian-American populations. PMID:27159808

  10. Alcohol, drinking pattern and all-cause, cardiovascular and alcohol-related mortality in Eastern Europe.

    PubMed

    Bobak, Martin; Malyutina, Sofia; Horvat, Pia; Pajak, Andrzej; Tamosiunas, Abdonas; Kubinova, Ruzena; Simonova, Galina; Topor-Madry, Roman; Peasey, Anne; Pikhart, Hynek; Marmot, Michael G

    2016-01-01

    Alcohol has been implicated in the high mortality in Central and Eastern Europe but the magnitude of its effect, and whether it is due to regular high intake or episodic binge drinking remain unclear. The aim of this paper was to estimate the contribution of alcohol to mortality in four Central and Eastern European countries. We used data from the Health, Alcohol and Psychosocial factors in Eastern Europe is a prospective multi-centre cohort study in Novosibirsk (Russia), Krakow (Poland), Kaunas (Lithuania) and six Czech towns. Random population samples of 34,304 men and women aged 45-69 years in 2002-2005 were followed up for a median 7 years. Drinking volume, frequency and pattern were estimated from the graduated frequency questionnaire. Deaths were ascertained using mortality registers. In 230,246 person-years of follow-up, 2895 participants died from all causes, 1222 from cardiovascular diseases (CVD), 672 from coronary heart disease (CHD) and 489 from pre-defined alcohol-related causes (ARD). In fully-adjusted models, abstainers had 30-50% increased mortality risk compared to light-to-moderate drinkers. Adjusted hazard ratios (HR) in men drinking on average ≥60 g of ethanol/day (3% of men) were 1.23 (95% CI 0.95-1.59) for all-cause, 1.38 (0.95-2.02) for CVD, 1.64 (1.02-2.64) for CHD and 2.03 (1.28-3.23) for ARD mortality. Corresponding HRs in women drinking on average ≥20 g/day (2% of women) were 1.92 (1.25-2.93), 1.74 (0.76-3.99), 1.39 (0.34-5.76) and 3.00 (1.26-7.10). Binge drinking increased ARD mortality in men only. Mortality was associated with high average alcohol intake but not binge drinking, except for ARD in men. PMID:26467937

  11. Relative Mortality among Criminals in Norway and the Relation to Drug and Alcohol Related Offenses

    PubMed Central

    Skardhamar, Torbjørn; Skirbekk, Vegard

    2013-01-01

    Background Registered offenders are known to have a higher mortality rate, but given the high proportion of offenders with drug-addiction, particularly among offenders with a custodial sentence, higher mortality is expected. While the level of overall mortality compared to the non-criminal population is of interest in itself, we also estimate the risk of death by criminal records related to substance abuse and other types of criminal acts, and separate between those who receive a prison sentence or not. Methods Age-adjusted relative risks of death for 2000–2008 were studied in a population based dataset. Our dataset comprise the total Norwegian population of 2.9 million individuals aged 15–69 years old in 1999, of whom 10% had a criminal record in the 1992–1999 period. Results Individuals with a criminal record have twice the relative risk (RR) of death of the control group (non-offenders). Males with a record of use/possession of drugs and a prison record have an 11.9 RR (females, 15.6); males with a drug record but no prison record have a 6.9 RR (females 10.5). Males imprisoned for driving under the influence of substances have a 4.4 RR (females 5.6); males with a record of driving under the influence but no prison sentence have a 3.2 RR (females 6.5). Other male offenders with a prison record have a 2.8 RR (females 3.7); other male offenders with no prison record have a 1.7 RR (females 2.3). Conclusion Significantly higher mortality was found for people with a criminal record, also for those without any record of drug use. Mortality is much higher for those convicted of substance-related crimes: more so for drug- than for alcohol-related crimes and for women. PMID:24223171

  12. Predictors of risky alcohol consumption in schoolchildren and their implications for preventing alcohol-related harm

    PubMed Central

    Bellis, Mark A; Hughes, Karen; Morleo, Michela; Tocque, Karen; Hughes, Sara; Allen, Tony; Harrison, Dominic; Fe-Rodriguez, Eduardo

    2007-01-01

    Background While alcohol-related health and social problems amongst youths are increasing internationally, both consumption and associated harms are particularly high in British youth. Youth drinking patterns, including bingeing, frequent drinking and drinking in public spaces, are associated with increased risks of acute (e.g. violence) and long-term (e.g. alcohol-dependence) health problems. Here we examine economic, behavioural and demographic factors that predict these risky drinking behaviours among 15–16 year old schoolchildren who consume alcohol. A cross-sectional survey was conducted among schoolchildren in North West England (n = 10,271) using an anonymous questionnaire delivered in school settings. Analysis utilised logistic regression to identify independent predictors of risky drinking behaviour. Results Of all respondents, 87.9% drank alcohol. Of drinkers, 38.0% usually binged when drinking, 24.4% were frequent drinkers and 49.8% drank in public spaces. Binge, frequent and public drinking were strongly related to expendable income and to individuals buying their own alcohol. Obtaining alcohol from friends, older siblings and adults outside shops were also predictors of risky drinking amongst drinkers. However, being bought alcohol by parents was associated with both lower bingeing and drinking in public places. Membership of youth groups/teams was in general protective despite some association with bingeing. Conclusion Although previous studies have examined predictors of risky drinking, our analyses of access to alcohol and youth income have highlighted eradicating underage alcohol sales and increased understanding of children's spending as key considerations in reducing risky alcohol use. Parental provision of alcohol to children in a family environment may also be important in establishing child-parent dialogues on alcohol and moderating youth consumption. However, this will require supporting parents to ensure they develop only moderate drinking

  13. A Qualitative Study of Service Provision for Alcohol Related Health Issues in Mid to Later Life

    PubMed Central

    Haighton, Catherine; Wilson, Graeme; Ling, Jonathan; McCabe, Karen; Crosland, Ann; Kaner, Eileen

    2016-01-01

    Aims Epidemiological surveys over the last 20 years show a steady increase in the amount of alcohol consumed by older age groups. Physiological changes and an increased likelihood of health problems and medication use make older people more likely than younger age groups to suffer negative consequences of alcohol consumption, often at lower levels. However, health services targeting excessive drinking tend to be aimed at younger age groups. The aim of this study was to gain an in-depth understanding of experiences of, and attitudes towards, support for alcohol related health issues in people aged 50 and over. Methods Qualitative interviews (n = 24, 12 male/12 female, ages 51–90 years) and focus groups (n = 27, 6 male/21 female, ages 50–95 years) were carried out with a purposive sample of participants who consumed alcohol or had been dependent. Findings Participants’ alcohol misuse was often covert, isolated and carefully regulated. Participants tended to look first to their General Practitioner for help with alcohol. Detoxification courses had been found effective for dependent participants but only in the short term; rehabilitation facilities were appreciated but seen as difficult to access. Activities, informal groups and drop-in centres were endorsed. It was seen as difficult to secure treatment for alcohol and mental health problems together. Barriers to seeking help included functioning at a high level, concern about losing positive aspects of drinking, perceived stigma, service orientation to younger people, and fatalistic attitudes to help-seeking. Facilitators included concern about risk of fatal illness or pressure from significant people. Conclusion Primary care professionals need training on improving the detection and treatment of alcohol problems among older people. There is also a compelling need to ensure that aftercare is in place to prevent relapse. Strong preferences were expressed for support to be provided by those who had experienced

  14. Alcohol-related emergency department admissions among adolescents in the Ghent and Sint-Niklaas areas.

    PubMed

    Calle, P; Hautekiet, A; François, H; Sundahl, N; Cornelis, C; Calle, S; Damen, J; Vanbrabant, P; De Turck, B; De Graeve, K; Mpotos, N; De Paepe, P

    2015-10-01

    Alcohol abuse is a major health concern. The aim of this retrospective study was to analyse the alcohol-related emergency department (ED) admissions among adolescents in all hospitals of distinct areas during a 1-year period. In each hospital, all ED patients with a blood alcohol concentration (BAC) of at least 0.5 g/l were surveyed in a standardised way. Of the 3918 included patients, only 146 (3.7%) were < 18  years. The male-to-female ratio was 1.5:1. There was a strong preponderance of weekend and night time admissions. Most of the patients were transported by ambulance (77% of 138 patients with information on this item). The main reason for ED admittance was depressed level of consciousness (64%), trauma (12%), vomiting and/or abdominal pain (12%), agitation or aggression (4%), syncope (4%) and psychological problems (4%). The context of the alcohol intoxication was related to some kind of festivity in 85%, mental problems in 14% and chronic abuse in 1%. Median BAC values (and range) were 2.08 g/l (0.73-3.70 g/l) for boys and 1.51 g/l (0.73-2.90 g/l) for girls. Most patients (87%) could be discharged home within 24  hours. Our study confirms that problematic alcohol use leading to ED admissions starts in adolescence. Although the numbers of cases below 18 years are low when compared to adults, the phenomenon is alarming as it is associated with substantial health problems. Therefore, Belgium urgently needs a global national alcohol plan, with youngsters being one of the target groups. PMID:25984783

  15. Primary Biliary Cirrhosis Is a Generalized Autoimmune Epithelitis

    PubMed Central

    Gao, Jun; Qiao, Liang; Wang, Bingyuan

    2015-01-01

    Primary biliary cirrhosis (PBC) is a chronic progressive autoimmune cholestatic liver disease characterized by highly specific antimitochondrial antibodies (AMAs) and the specific immune-mediated injury of small intrahepatic bile ducts. Unique apoptotic feature of biliary epithelial cells (BECs) may contribute to apotope presentation to the immune system, causing unique tissue damage in PBC. Perpetuation of inflammation may result in senescence of BECs, contributing to irreversible loss of bile duct. In addition to the classic liver manifestations, focal inflammation and tissue damage are also seen in salivary glands and urinary tract in a significant proportion of PBC patients. These findings provide potent support to the idea that molecular mimicry may be involved in the breakdown of autoimmune tolerance and mucosal immunity may lead to a systematic epithelitis in PBC patients. Thus, PBC is considered a generalized epithelitis in clinical practice. PMID:25803105

  16. 10 Projects for Preventing Fetal Alcohol Syndrome and Other Alcohol-Related Birth Defects and Have You Heard about Alcohol and Pregnancy.

    ERIC Educational Resources Information Center

    Adams, Jerry; And Others

    A set of two pamphlets is presented on the topic of Fetal Alcohol Syndrome and Alcohol-Related Birth Defects. "Ten Projects for Preventing Fetal Alcohol Syndrome and Other Alcohol-Related Birth Defects" provides ideas and materials for students and others to use in educating the public about the dangers of alcohol use during pregnancy. It offers…

  17. Evidence of Active Pro-Fibrotic Response in Blood of Patients with Cirrhosis

    PubMed Central

    Iglesias, Verónica; Rico, Lucia; Ortega, Alicia; Muñoz-Conejero, Eva; García-Pajares, Felix; Bermejo-Martin, Jesus F.

    2015-01-01

    The role of systemic immunity in the pathogenesis of cirrhosis is not fully understood. Analysis of transcriptomic profiles in blood is an easy approach to obtain a wide picture of immune response at the systemic level. We studied gene expression profiles in blood from thirty cirrhotic patients and compared them against those of eight healthy volunteers. Most of our patients were male [n = 21, 70%] in their middle ages [57.4 ± 6.8 yr]. Alcohol abuse was the most frequent cause of cirrhosis (n = 22, 73%). Eleven patients had hepatocellular carcinoma (36.7%). Eight patients suffered from hepatitis C virus infection (26.7%). We found a signature constituted by 3402 genes which were differentially expressed in patients compared to controls (2802 over-expressed and 600 under-expressed). Evaluation of this signature evidenced the existence of an active pro-fibrotic transcriptomic program in the cirrhotic patients, involving the [extra-cellular matrix (ECM)-receptor interaction] & [TGF-beta signaling] pathways along with the [Cell adhesion molecules] pathway. This program coexists with alterations in pathways participating in [Glycine, serine and threonine metabolism], [Phenylalanine metabolism], [Tyrosine metabolism], [ABC transporters], [Purine metabolism], [Arachidonic acid metabolism]. In consequence, our results evidence the co-existence in blood of a genomic program mediating pro-fibrotic mechanisms and metabolic alterations in advanced cirrhosis. Monitoring expression levels of the genes involved in these programs could be of interest for predicting / monitoring cirrhosis evolution. These genes could constitute therapeutic targets in this disease. PMID:26317806

  18. Relationship of age of first drink to alcohol-related consequences among college students with unhealthy alcohol use.

    PubMed

    Rothman, Emily F; DeJong, William; Palfai, Tibor; Saitz, Richard

    2008-01-01

    This study investigated the relationship between age of first drink (AFD) and a broad range of negative alcohol-related outcomes among college students exhibiting unhealthy alcohol use. We conducted an anonymous on-line survey to collect self-report data from first-year college students at a large northeastern university. Among 1,792 respondents who reported ever drinking, 14% reported an AFD before age 14. These early onset drinkers were more likely than later onset drinkers to report frequent drinking, heavy drinking, and other unhealthy alcohol use behaviors. Among the subset of drinkers with unhealthy alcohol use (36%), early drinkers were more likely than later onset drinkers to report experiencing five out of 13 alcohol-related consequences, including driving while intoxicated, missing work or school due to drinking, getting into trouble at work or school due to drinking, receiving lower grades than they should have due to drinking, and developing a tolerance to alcohol. PMID:19042317

  19. Applying the Attention-Allocation Model to the Explanation of Alcohol-Related Aggression: Implications for Prevention

    PubMed Central

    Giancola, Peter R.; Josephs, Robert A.; DeWall, C. Nathan; Gunn, Rachel L.

    2009-01-01

    The primary purpose of this article is to apply the attention allocation model (AAM; Steele & Josephs, 1990) to the explanation, as well as the prevention, of alcohol-related violence. The AAM contends that alcohol has a “myopic” effect on attentional capacity that presumably facilitates aggression by narrowing attentional focus on the most salient provocative cues, that are naturally present in hostile situations, rather than less salient inhibitory cues. Data are presented to demonstrate support for the AAM with regard to alcohol-related aggression. The model has also been expanded to suggest some intermediary mechanisms that may account for how distracting attention away from provocative cues might be involved in the reduction of aggression. Finally, a number of practical suggestions are put forth regarding how the AAM can be applied to the prevention of intoxicated aggression. PMID:19938917

  20. Childhood Household Dysfunction, Social Inequality and Alcohol Related Illness in Young Adulthood. A Swedish National Cohort Study

    PubMed Central

    Gauffin, Karl; Hjern, Anders; Vinnerljung, Bo; Björkenstam, Emma

    2016-01-01

    The aim of this paper is to estimate the cumulative effect of childhood household dysfunction (CHD) on alcohol related illness and death later in life and to test the interaction between CHD and socioeconomic background. The study utilised Swedish national registers including data of a Swedish national cohort born 1973–82 (n = 872 912), which was followed from age 18 to 29–40 years. Cox regression analyses were used to calculate hazard ratios (HR) for alcohol related illness or death in young adulthood. The CHD measure consisted of seven indicators: parental alcohol/drug misuse, mental health problems, criminality, death, divorce, social assistance, and child welfare interventions. Childhood socioeconomic position (SEP) was indicated by parental occupational status. Outcomes were alcohol related inpatient hospital care, specialised outpatient care or deaths. Using the highest socioeconomic group without CHD experience as a reference, those in the same socioeconomic group with one indicator of CHD had HRs of 2.1 [95% CI: 1.7–2.5], two CHD indicators 5.6 [4.4–7.1], three or more indicators 9.4 [7.1–12.4] for retrieving inpatient care. Socioeconomic disadvantage further increased the risks–those with low socioeconomic background and three CHD indicators or more had a HR of 12.5 [10.9–14.3]. Testing for interaction suggests that the combined HRs deviates from additivity [Synergy index: 1.6, 95% CI: 1.4–1.9]. The results for outpatient care were similar, but not as pronounced. In conclusion, this Swedish national cohort study shows that childhood household dysfunction is strongly and cumulatively associated to alcohol related illness later in life and that it interacts with socioeconomic disadvantage. PMID:26991657

  1. Examining the relationship between parenting types and patterns of student alcohol-related behavior during the transition to college

    PubMed Central

    Abar, Caitlin C.

    2011-01-01

    Objective The present study sought to examine parenting influences on student alcohol use through the use of a holistic, person-centered approach in order to accomplish three distinct research aims: (1) identify groups of college students with unique profiles of perceived parenting characteristics; (2) identify groups of college students with unique profiles of alcohol-related correlates; and (3) examine the extent to which profiles of perceived parenting characteristics are associated with profiles of college alcohol-related risk. Method A sample of 1,153 first-year university students (17 – 20 years-of-age) was assessed on a host of perceived parenting and self-reported alcohol-related items. Results Four profiles of perceived parenting (High Quality, High Monitoring, Anti-Alcohol, Pro-Alcohol) were found using latent profile analysis (LPA). Five profiles of student alcohol-related characteristics (Abstainers, Past Drinkers, Light Drinkers, High Risk Drinkers, Extreme Risk Drinkers) were also found using LPA. Latent transition analysis illustrated that students who perceived their parents as belonging to the Pro-Alcohol profile had much higher probabilities of belonging in the High Risk Drinker or Extreme Risk Drinker profiles than students in all other perceived parenting profiles. Conclusions In addition to alcohol-specific parenting characteristics, aspects of parent-teen relationship quality may also be integral in the prevention of college alcohol misuse. Finally, this study observed complex patterns of parenting and alcohol behaviors, such that the profiles could be interpreted as qualitatively distinct types of individuals. These unique profiles suggest that a targeted approach reflecting the profiles found in the current study might greatly enhance prevention program efficacy. PMID:21842968

  2. Childhood Household Dysfunction, Social Inequality and Alcohol Related Illness in Young Adulthood. A Swedish National Cohort Study.

    PubMed

    Gauffin, Karl; Hjern, Anders; Vinnerljung, Bo; Björkenstam, Emma

    2016-01-01

    The aim of this paper is to estimate the cumulative effect of childhood household dysfunction (CHD) on alcohol related illness and death later in life and to test the interaction between CHD and socioeconomic background. The study utilised Swedish national registers including data of a Swedish national cohort born 1973-82 (n = 872,912), which was followed from age 18 to 29-40 years. Cox regression analyses were used to calculate hazard ratios (HR) for alcohol related illness or death in young adulthood. The CHD measure consisted of seven indicators: parental alcohol/drug misuse, mental health problems, criminality, death, divorce, social assistance, and child welfare interventions. Childhood socioeconomic position (SEP) was indicated by parental occupational status. Outcomes were alcohol related inpatient hospital care, specialised outpatient care or deaths. Using the highest socioeconomic group without CHD experience as a reference, those in the same socioeconomic group with one indicator of CHD had HRs of 2.1 [95% CI: 1.7-2.5], two CHD indicators 5.6 [4.4-7.1], three or more indicators 9.4 [7.1-12.4] for retrieving inpatient care. Socioeconomic disadvantage further increased the risks-those with low socioeconomic background and three CHD indicators or more had a HR of 12.5 [10.9-14.3]. Testing for interaction suggests that the combined HRs deviates from additivity [Synergy index: 1.6, 95% CI: 1.4-1.9]. The results for outpatient care were similar, but not as pronounced. In conclusion, this Swedish national cohort study shows that childhood household dysfunction is strongly and cumulatively associated to alcohol related illness later in life and that it interacts with socioeconomic disadvantage. PMID:26991657

  3. The Alcohol Improvement Programme: Evaluation of an Initiative to Address Alcohol-Related Health Harm in England

    PubMed Central

    Thom, Betsy; MacGregor, Susanne; Godfrey, Christine; Herring, Rachel; Lloyd, Charlie; Tchilingirian, Jordan; Toner, Paul

    2013-01-01

    Aims: The evaluation aimed to assess the impact of The Alcohol Improvement Programme (AIP). This was a UK Department of Health initiative (April 2008–March 2011) aiming to contribute to the reduction of alcohol-related harm as measured by a reduction in the rate of increase in alcohol-related hospital admissions (ARHAs). Methods: The evaluation (March 2010–September 2011) used a mix of qualitative and quantitative methods to assess the impact of the AIP on ARHAs, to describe and assess the process of implementation, and to identify elements of the programme which might serve as a ‘legacy’ for the future. Results: There was no evidence that the AIP had an impact on reducing the rise in the rate of ARHAs. The AIP was successfully delivered, increased the priority given to alcohol-related harm on local policy agendas and strengthened the infrastructure for the delivery of interventions. Conclusion: Although there was no measurable short-term impact on the rise in the rate of ARHAs, the AIP helped to set up a strategic response and a delivery infrastructure as a first, necessary step in working towards that goal. There are a number of valuable elements in the AIP which should be retained and repackaged to fit into new policy contexts. PMID:23729674

  4. Associations between depression, distress tolerance, delay discounting, and alcohol-related problems in European American and African American college students.

    PubMed

    Dennhardt, Ashley A; Murphy, James G

    2011-12-01

    Although levels of heavy drinking and alcohol-related problems are high in college students, there is significant variability in the number and type of problems experienced, even among students who drink heavily. African American students drink less and experience fewer alcohol-related problems than European American students, but are still at risk, and little research has investigated the potentially unique patterns and predictors of problems among these students. Depression, distress tolerance, and delay discounting have been implicated in adult substance abuse and may be important predictors of alcohol problem severity among college students. We examined the relationship between these variables and alcohol-related problems among African American and European American students (N = 206; 53% female; 68% European American; 28% African American) who reported recent heavy drinking. In regression models that controlled for drinking level, depression, distress tolerance, and delay discounting were associated with alcohol problems among African American students, but only depression was associated with alcohol problems among European American students. These results suggest that negative affect is a key risk factor for alcohol problems among college student drinkers. For African American students, the inability to tolerate negative emotions and to organize their behavior around future outcomes may also be especially relevant risk factors. PMID:21988480

  5. Telomere shortening as genetic risk factor of liver cirrhosis.

    PubMed

    Carulli, Lucia

    2015-01-14

    Cirrhosis is the main complication of chronic liver disease, leads to progressive liver function impairment and is the main risk factor for the development of liver cancer. Liver failure at endstage cirrhosis is associated with increased mortality with liver transplantation as the only possible treatment at this stage. The pathogenesis of liver cirrhosis is not completely elucidated. Although the common factors leading to liver injury, such as viral hepatitis, alcohol consume or fatty liver disease can be identified in the majority of patients a small percentage of patients have no apparent risk factors. Moreover given the same risk factors, some patients progress to cirrhosis whereas others have a benign course, the reason remains unclear. In order to develop new diagnostic and therapeutic tools, it is s essential to understand the pathogenesis of cirrhosis. The identification of genetic risk factors associated with cirrhosis is one of the possible approach to achieve these goal. In the past years several studies have supported the role of telomere shortening and cirrhosis. In the recent year several studies on the relation between several single nucleotide polymorphism (SNPs) and cirrhosis have been published; it has been proposed also a cirrhosis risk score based on seven SNPs. Also epidemiological studies on identical twins and in different ethnic groups have been supporting the importance of the role of genetic risk factors. Finally in the very recent years it has been suggested that telomere shortening may represent a genetic risk factor for the development of cirrhosis. PMID:25593453

  6. Hepatic metabolism in patients with alcoholic cirrhosis.

    PubMed

    Reichle, F A; Owen, O E; Golsorkhi, M; Kreulen, T

    1978-07-01

    Fuel homeostasis was studied in 15 patients with hepatic cirrhosis who previously had sustained upper gastrointestinal hemorrhage secondary to portal hypertension. By combining substrate arteriovenous concentration differences with measured hepatic blood flow rates, the exchange rates of metabolites across the liver was calculated. Hepatic extraction of acetoacetate, beta-hydroxybutyrate, lactate, pyruvate, analine, and glycerol was studied. After an overnight fast, splanchnic glucose production in 15 cirrhotic patients was diminished markedly. Despite reduced total glucose production, there was no decrease in hepatic gluconeogenesis; instead, there was increased glucose formation from amino acids, glycerol, lactate, and pyruvate. In patients with hepatic cirrhosis, the liver does not produce as much glucose as does a normal liver; the failing cirrhotic liver is capable of maintaining fuel homeostasis by increased ketone-body production. PMID:663824

  7. Radionuclide demonstration of intrapulmonary shunting in cirrhosis

    SciTech Connect

    Bank, E.R.; Thrall, J.H.; Dantzker, D.R.

    1983-05-01

    The association of hepatic cirrhosis and severe arterial hypoxemia has been well described. Although alterations in ventilatory function may partially account for the hypoxemia, the principal mechanism is thought to be a microangiopathic change in the pulmonary vasculature resulting in intrapulmonary arteriovenous shunting with resultant systemic desaturation. Whole-body radionuclide scans with technetium-99m macroaggregated albumin labeling have been diagnostic of right-to-left shunting by their demonstration of tracer accumulation within the extrapulmonary circulation. A case of severe pulmonary arteriovenous shunting in an alcoholic patient in whom hepatic disease had not been of apparent clinical significance before radionuclide scanning is reported. He did not have cuntaeous angiomata as have all other patients with alcoholic cirrhosis and hypoxemia.

  8. Radionuclide demonstration of intrapulmonary shunting in cirrhosis

    SciTech Connect

    Bank, E.R.; Thrall, J.H.; Dantzker, D.R.

    1983-05-01

    The association of hepatic cirrhosis and severe arterial hypoxemia has been well described. Although alterations in ventilatory function may partially account for the hypoxemia, the principal mechanism is thought to be a microangiopathic change in the pulmonary arteriovenous shunting with resultant systemic desaturation. Whole-body radionuclide scans with technetium-99m macroaggrregated albumin (/sup 99m/Tc MAA) labeling have been diagnostic of right-to-left shunting by their demonstration of tracer accumulation within the extrapulmonary circulation. A case of severe pulmonary arteriovenous shunting in an alcoholic patient in whom hepatic disease had not been of apparent clinical significance before radionuclide scanning is reported. He did not have cutaneous angiomata as have all other patients with alcoholic cirrhosis and hypoxemia.

  9. Primary Biliary Cirrhosis: Environmental Risk Factors

    PubMed Central

    Dronamraju, Deepti; Odin, Joseph; Bach, Nancy

    2010-01-01

    Primary biliary cirrhosis (PBC) is an autoimmune disease of unclear etiology. It is a chronic, progressive condition that causes intrahepatic ductal destruction ultimately leading to symptoms of cholestasis, cirrhosis and liver failure. The disease predominantly affects middle aged Caucasian women. It has a predilection to certain regions and is found in higher incidences in North America and Northern Europe. It also has a genetic predisposition with a concordance rate of 60% among monozygotic twins. Combinations of genetic and environmental factors are proposed in the pathogenesis of this disease with a compelling body of evidence that suggests a role for both these factors. This review will elucidate data on the proposed environmental agents involved the disease's pathogenesis including xenobiotic and microbial exposure and present some of the supporting epidemiologic data. PMID:21297251

  10. Acute Kidney Injury in Patients with Cirrhosis

    PubMed Central

    Russ, Kirk B.; Stevens, Todd M; Singal, Ashwani K.

    2015-01-01

    Acute kidney injury (AKI) occurs commonly in patients with advanced cirrhosis and negatively impacts pre- and post-transplant outcomes. Physiologic changes that occur in patients with decompensated cirrhosis with ascites, place these patients at high risk of AKI. The most common causes of AKI in cirrhosis include prerenal injury, acute tubular necrosis (ATN), and the hepatorenal syndrome (HRS), accounting for more than 80% of AKI in this population. Distinguishing between these causes is particularly important for prognostication and treatment. Treatment of Type 1 HRS with vasoconstrictors and albumin improves short term survival and renal function in some patients while awaiting liver transplantation. Patients with HRS who fail to respond to medical therapy or those with severe renal failure of other etiology may require renal replacement therapy. Simultaneous liver kidney transplant (SLK) is needed in many of these patients to improve their post-transplant outcomes. However, the criteria to select patients who would benefit from SLK transplantation are based on consensus and lack strong evidence to support them. In this regard, novel serum and/or urinary biomarkers such as neutrophil gelatinase-associated lipocalin, interleukins-6 and 18, kidney injury molecule-1, fatty acid binding protein, and endothelin-1 are emerging with a potential for accurately differentiating common causes of AKI. Prospective studies are needed on the use of these biomarkers to predict accurately renal function recovery after liver transplantation alone in order to optimize personalized use of SLK. PMID:26623266

  11. The role of zinc in liver cirrhosis.

    PubMed

    Grüngreiff, Kurt; Reinhold, Dirk; Wedemeyer, Heiner

    2016-01-01

    Zinc is an essential trace element playing fundamental roles in cellular metabolism. It acts mostly by binding a wide range of proteins, thus affecting a broad spectrum of biological processes, which include cell division, growth and differentiation. Zinc is critical to a large number of structural proteins, enzymatic processes, and transcription factors. Zinc deficiency can result in a spectrum of clinical manifestations, such as poor of appetite, loss of body hair, altered taste and smell, testicular atrophy, cerebral and immune dysfunction, and diminished drug elimination capacity. These are common symptoms in patients with chronic liver diseases, especially liver cirrhosis. The liver is the main organ responsible for the zinc metabolism which can be affected by liver diseases. On the other hand, zinc deficiency may alter hepatocyte functions and also immune responses in inflammatory liver diseases. Liver cirrhosis represents the most advanced stage of chronic liver diseases and is the common outcome of chronic liver injury. It is associated with energy malnutrition, with numerous metabolic disorders, such as hypoalbuminemia, with imbalance between branched-chain amino acids and aromatic amino acids, and with reduced zinc serum concentrations. All these processes can influence the clinical outcome of patients, such ascites, hepatic encephalopathy and hepatocellular carcinoma. In the present review, we summarize the emerging evidence on the pitoval role of zinc in the pathogenesis of liver cirrhosis. PMID:26626635

  12. Bacterial infections in cirrhosis: A critical review and practical guidance

    PubMed Central

    Bunchorntavakul, Chalermrat; Chamroonkul, Naichaya; Chavalitdhamrong, Disaya

    2016-01-01

    Bacterial infection is common and accounts for major morbidity and mortality in cirrhosis. Patients with cirrhosis are immunocompromised and increased susceptibility to develop spontaneous bacterial infections, hospital-acquired infections, and a variety of infections from uncommon pathogens. Once infection develops, the excessive response of pro-inflammatory cytokines on a pre-existing hemodynamic dysfunction in cirrhosis further predispose the development of serious complications such as shock, acute-on-chronic liver failure, renal failure, and death. Spontaneous bacterial peritonitis and bacteremia are common in patients with advanced cirrhosis, and are important prognostic landmarks in the natural history of cirrhosis. Notably, the incidence of infections from resistant bacteria has increased significantly in healthcare-associated settings. Serum biomarkers such as procalcitonin may help to improve the diagnosis of bacterial infection. Preventive measures (e.g., avoidance, antibiotic prophylaxis, and vaccination), early recognition, and proper management are required in order to minimize morbidity and mortality of infections in cirrhosis. PMID:26962397

  13. Challenges and Management of Liver Cirrhosis: Pathophysiology of Renal Dysfunction in Cirrhosis.

    PubMed

    Solà, Elsa; Ginès, Pere

    2015-01-01

    Kidney dysfunction is a common complication of patients with advanced cirrhosis and is associated with poor prognosis. Patients with advanced cirrhosis show circulatory dysfunction characterized by reduced systemic vascular resistance due to splanchnic arterial vasodilation, which is caused by portal hypertension. The progressive reduction in systemic vascular resistance leads to effective arterial hypovolemia. In order to maintain arterial pressure within normal limits in this setting, there is activation of systemic vasoconstrictor systems, including the renin-angiotensin-aldosterone system, sympathetic nervous system and, in late stages, nonosmotic hypersecretion of vasopressin. Although these systems have positive effects in maintaining arterial pressure, they have a negative influence on kidney function, leading to the retention of sodium and solute-free water, and in late stages of the disease an intense kidney vasoconstriction develops, leading to decrease of the glomerular filtration rate and the development of hepatorenal syndrome (HRS). Moreover, bacterial translocation and the existence of a systemic inflammatory state in patients with advanced cirrhosis may play a role in the impairment of circulatory function. HRS is a unique cause of kidney failure of functional origin that develops in patients with cirrhosis. However, besides HRS, patients with cirrhosis may develop kidney failure due to other causes, including bacterial infections, prerenal kidney failure, shock, use of nephrotoxic drugs or intrinsic kidney diseases. Considering the existence of circulatory dysfunction and some degree of kidney vasoconstriction, patients with advanced cirrhosis have fragile kidney function and are susceptible to easily developing kidney failure associated with other complications of the disease, particularly bacterial infections and gastrointestinal bleeding. PMID:26159270

  14. Women with Cirrhosis: Prevalence, Natural History, and Management.

    PubMed

    Giard, Jeanne-Marie; Terrault, Norah A

    2016-06-01

    Cirrhosis is less frequent in women than in men, in large part due to the lower prevalence of hepatitis B, hepatitis C, and alcohol use in women. The most common causes of cirrhosis among women are hepatitis C, autoimmune etiologies, nonalcoholic steatohepatitis, and alcoholic liver disease. For most chronic liver diseases, the risk of progression to cirrhosis and rates of liver failure and hepatocellular carcinoma are lower in women than in men. Pregnancy is very infrequent in women with cirrhosis due to reduced fertility, but when it occurs, requires specialized management. PMID:27261903

  15. Role of systemic inflammation in cirrhosis: From pathogenesis to prognosis.

    PubMed

    Dirchwolf, Melisa; Ruf, Andrés Eduardo

    2015-08-01

    The natural history of cirrhosis can be divided into an initial stage, known as compensated cirrhosis, and an advanced stage which encompasses both decompensated cirrhosis and acute-on-chronic liver failure (ACLF). The latter syndrome has been recently described as an acute deterioration of liver function in patients with cirrhosis, which is usually triggered by a precipitating event and results in the failure of one or more organs and high short-term mortality rates. Each stage is characterized by distinctive clinical manifestations and prognoses. One of the key elements involved in cirrhosis physiopathology is systemic inflammation, recently described as one of the components in the cirrhosis-associated immune dysfunction syndrome. This syndrome refers to the combination of immune deficiency and exacerbated inflammation that coexist during the course of cirrhosis and relates to the appearance of clinical complications. Since systemic inflammation is often difficult to assess in cirrhosis patients, new objective, reproducible and readily-available markers are needed in order to optimize prognosis and lengthen survival. Thus, surrogate serum markers and clinical parameters of systemic inflammation have been sought to improve disease follow-up and management, especially in decompensated cirrhosis and ACLF. Leukocyte counts (evaluated as total leukocytes, total eosinophils or neutrophil:lymphocyte ratio) and plasma levels of procalcitonin or C-reactive protein have been proposed as prognostic markers, each with advantages and shortcomings. Research and prospective randomized studies that validate these and other markers are clearly warranted. PMID:26261687

  16. Role of systemic inflammation in cirrhosis: From pathogenesis to prognosis

    PubMed Central

    Dirchwolf, Melisa; Ruf, Andrés Eduardo

    2015-01-01

    The natural history of cirrhosis can be divided into an initial stage, known as compensated cirrhosis, and an advanced stage which encompasses both decompensated cirrhosis and acute-on-chronic liver failure (ACLF). The latter syndrome has been recently described as an acute deterioration of liver function in patients with cirrhosis, which is usually triggered by a precipitating event and results in the failure of one or more organs and high short-term mortality rates. Each stage is characterized by distinctive clinical manifestations and prognoses. One of the key elements involved in cirrhosis physiopathology is systemic inflammation, recently described as one of the components in the cirrhosis-associated immune dysfunction syndrome. This syndrome refers to the combination of immune deficiency and exacerbated inflammation that coexist during the course of cirrhosis and relates to the appearance of clinical complications. Since systemic inflammation is often difficult to assess in cirrhosis patients, new objective, reproducible and readily-available markers are needed in order to optimize prognosis and lengthen survival. Thus, surrogate serum markers and clinical parameters of systemic inflammation have been sought to improve disease follow-up and management, especially in decompensated cirrhosis and ACLF. Leukocyte counts (evaluated as total leukocytes, total eosinophils or neutrophil:lymphocyte ratio) and plasma levels of procalcitonin or C-reactive protein have been proposed as prognostic markers, each with advantages and shortcomings. Research and prospective randomized studies that validate these and other markers are clearly warranted. PMID:26261687

  17. Diabetes mellitus in patients with cirrhosis: clinical implications and management.

    PubMed

    Elkrief, Laure; Rautou, Pierre-Emmanuel; Sarin, Shiv; Valla, Dominique; Paradis, Valérie; Moreau, Richard

    2016-07-01

    Disorders of glucose metabolism, namely glucose intolerance and diabetes, are frequent in patients with chronic liver diseases. In patients with cirrhosis, diabetes can be either a classical type 2 diabetes mellitus or the so-called hepatogenous diabetes, i.e. a consequence of liver insufficiency and portal hypertension. This review article provides an overview of the possible pathophysiological mechanisms explaining diabetes in patients with cirrhosis. Cirrhosis is associated with portosystemic shunts as well as reduced hepatic mass, which can both impair insulin clearance by the liver, contributing to peripheral insulin resistance through insulin receptors down-regulation. Moreover, cirrhosis is associated with increased levels of advanced-glycation-end products and hypoxia-inducible-factors, which may play a role in the development of diabetes. This review also focuses on the clinical implications of diabetes in patients with cirrhosis. First, diabetes is an independent factor for poor prognosis in patients with cirrhosis. Specifically, diabetes is associated with the occurrence of major complications of cirrhosis, including ascites and renal dysfunction, hepatic encephalopathy and bacterial infections. Diabetes is also associated with an increased risk of hepatocellular carcinoma in patients with chronic liver diseases. Last, the management of patients with concurrent diabetes and liver disease is also addressed. Recent findings suggest a beneficial impact of metformin in patients with chronic liver diseases. Insulin is often required in patients with advanced cirrhosis. However, the favourable impact of controlling diabetes in patients with cirrhosis has not been demonstrated yet. PMID:26972930

  18. Non-invasive diagnosis of advanced fibrosis and cirrhosis.

    PubMed

    Sharma, Suraj; Khalili, Korosh; Nguyen, Geoffrey Christopher

    2014-12-01

    Liver cirrhosis is a common and growing public health problem globally. The diagnosis of cirrhosis portends an increased risk of morbidity and mortality. Liver biopsy is considered the gold standard for diagnosis of cirrhosis and staging of fibrosis. However, despite its universal use, liver biopsy is an invasive and inaccurate gold standard with numerous drawbacks. In order to overcome the limitations of liver biopsy, a number of non-invasive techniques have been investigated for the assessment of cirrhosis. This review will focus on currently available non-invasive markers of cirrhosis. The evidence behind the use of these markers will be highlighted, along with an assessment of diagnostic accuracy and performance characteristics of each test. Non-invasive markers of cirrhosis can be radiologic or serum-based. Radiologic techniques based on ultrasound, magnetic resonance imaging and elastography have been used to assess liver fibrosis. Serum-based biomarkers of cirrhosis have also been developed. These are broadly classified into indirect and direct markers. Indirect biomarkers reflect liver function, which may decline with the onset of cirrhosis. Direct biomarkers, reflect extracellular matrix turnover, and include molecules involved in hepatic fibrogenesis. On the whole, radiologic and serum markers of fibrosis correlate well with biopsy scores, especially when excluding cirrhosis or excluding fibrosis. This feature is certainly clinically useful, and avoids liver biopsy in many cases. PMID:25492996

  19. Effectiveness of ignition interlocks for preventing alcohol-impaired driving and alcohol-related crashes: a Community Guide systematic review.

    PubMed

    Elder, Randy W; Voas, Robert; Beirness, Doug; Shults, Ruth A; Sleet, David A; Nichols, James L; Compton, Richard

    2011-03-01

    A systematic review of the literature to assess the effectiveness of ignition interlocks for reducing alcohol-impaired driving and alcohol-related crashes was conducted for the Guide to Community Preventive Services (Community Guide). Because one of the primary research issues of interest--the degree to which the installation of interlocks in offenders' vehicles reduces alcohol-impaired driving in comparison to alternative sanctions (primarily license suspension)--was addressed by a 2004 systematic review conducted for the Cochrane Collaboration, the current review incorporates that previous work and extends it to include more recent literature and crash outcomes. The body of evidence evaluated includes the 11 studies from the prior review, plus four more recent studies published through December 2007. The installation of ignition interlocks was associated consistently with large reductions in re-arrest rates for alcohol-impaired driving within both the earlier and later bodies of evidence. Following removal of interlocks, re-arrest rates reverted to levels similar to those for comparison groups. The limited available evidence from three studies that evaluated crash rates suggests that alcohol-related crashes decrease while interlocks are installed in vehicles. According to Community Guide rules of evidence, these findings provide strong evidence that interlocks, while they are in use in offenders' vehicles, are effective in reducing re-arrest rates. However, the potential for interlock programs to reduce alcohol-related crashes is currently limited by the small proportion of offenders who participate in the programs and the lack of a persistent beneficial effect once the interlock is removed. Suggestions for facilitating more widespread and sustained use of ignition interlocks are provided. PMID:21335270

  20. All-Wales licensed premises intervention (AWLPI): a randomised controlled trial to reduce alcohol-related violence

    PubMed Central

    2014-01-01

    Background Alcohol-related violence in and in the vicinity of licensed premises continues to place a considerable burden on the United Kingdom’s (UK) health services. Robust interventions targeted at licensed premises are therefore required to reduce the costs of alcohol-related harm. Previous evaluations of interventions in licensed premises have a number of methodological limitations and none have been conducted in the UK. The aim of the trial was to determine the effectiveness of the Safety Management in Licensed Environments intervention designed to reduce alcohol-related violence in licensed premises, delivered by Environmental Health Officers, under their statutory authority to intervene in cases of violence in the workplace. Methods/Design A national randomised controlled trial, with licensed premises as the unit of allocation. Premises were identified from all 22 Local Authorities in Wales. Eligible premises were those with identifiable violent incidents on premises, using police recorded violence data. Premises were allocated to intervention or control by optimally balancing by Environmental Health Officer capacity in each Local Authority, number of violent incidents in the 12 months leading up to the start of the project and opening hours. The primary outcome measure is the difference in frequency of violence between intervention and control premises over a 12 month follow-up period, based on a recurrent event model. The trial incorporates an embedded process evaluation to assess intervention implementation, fidelity, reach and reception, and to interpret outcome effects, as well as investigate its economic impact. Discussion The results of the trial will be applicable to all statutory authorities directly involved with managing violence in the night time economy and will provide the first formal test of Health and Safety policy in this environment. If successful, opportunities for replication and generalisation will be considered. Trial registration

  1. Protective behavioral strategies, alcohol consumption, and negative alcohol-related consequences: do race and gender moderate these associations?

    PubMed

    Madson, Michael B; Zeigler-Hill, Virgil

    2013-01-01

    White, non-Hispanic college students tend to drink more alcohol and experience more negative consequences than African American college students. However, racial differences have not been examined for protective behavioral strategies. This study examined whether race and gender moderated the associations that protective behavioral strategies had with alcohol consumption and negative alcohol-related consequences. In general, the use of protective behavioral strategies were associated with greater deceases in consumption, harmful drinking, and negative consequences for White, non-Hispanic students than African American students, which suggests important racial differences related to protective strategy use. Research and clinical implications are provided. PMID:23967885

  2. Alcohol-related injury among Greek-letter college students: Defining a target population for secondary prevention

    PubMed Central

    O’Brien, Mary Claire; McNamara, Robert S; McCoy, Thomas P; Sutfin, Erin L; Wolfson, Mark; Rhodes, Scott D

    2013-01-01

    Members of Greek-letter societies are the heaviest drinkers on college campuses, and experience more alcohol-related problems than their peers. This study reports the results of a web-based survey administered to stratified random samples of college students from ten North Carolina universities. Greek-letter status was a significant independent risk factor for increased injury (both experienced and caused to others), even after adjusting for drinking behaviors. Prevention, screening, and intervention strategies are discussed in the context of these results. PMID:22689586

  3. Factors Associated With General and Sexual Alcohol-Related Consequences: An Examination of College Students Studying Abroad.

    PubMed

    Hummer, Justin F; Pedersen, Eric R; Mirza, Tehniat; Labrie, Joseph W

    2010-12-01

    This study contributes to the scarce research on U.S. college students studying abroad by documenting general and sexual negative alcohol-related risks and factors associated with such risk. The manner of drinking (quantity vs. frequency), predeparture expectations surrounding alcohol use while abroad, culture-related social anxiety, and perceived disparity between home and host cultures differentially predicted consequences abroad. The findings include important implications for student affairs professionals in developing study abroad-specific interventions and resources to maintain student well-being while abroad. PMID:23505594

  4. Effects of AlcoholEdu for College on Alcohol-Related Problems Among Freshmen: A Randomized Multicampus Trial*

    PubMed Central

    Paschall, Mallie J.; Antin, Tamar; Ringwalt, Christopher L.; Saltz, Robert F.

    2011-01-01

    Objective: AlcoholEdu for College is a 2- to 3-hour online course for incoming college freshmen. This study was the first multicampus trial to examine effects of AlcoholEdu for College on alcohol-related problems among freshmen. Method: Thirty universi participated in the study. Fifteen were randomly assigned to receive AlcoholEdu, and the other 15 were assigned to the control condition. AlcoholEdu was implemented by intervention schools during the summer and/or fall semester. Cross-sectional surveys of freshmen were conducted at each university beginning before the intervention in spring 2008/2009; post-intervention surveys were administered in fall 2008/2009 and spring 2009/2010. The surveys included questions about the past-30-day frequency of 28 alcohol-related problems, from which we created indices for the total number of problems and problems in seven domains: physiological, academic, social, driving under the influence/riding with drinking drivers, aggression, sexual risk taking, and victimization. Multilevel Poisson regression analyses were conducted to examine intent-to-treat and dosage effects of AlcoholEdu for College on these outcomes. Results: Multilevel intent-to-treat analyses indicated significant reductions in the risk for past-30-day alcohol problems in general and problems in the physiological, social, and victimization domains during the fall semester immediately after completion of the course. However, these effects did not persist in the spring semester. Additional analyses suggested stronger AlcoholEdu effects on these outcomes at colleges with higher rates of student course completion. No AlcoholEdu effects were observed for alcohol-related problems in the other four domains. Conclusions: AlcoholEdu for College appears to have beneficial short-term effects on victimization and the most common types of alcohol-related problems among freshmen. Universities may benefit the most by mandating AlcoholEdu for College for all incoming freshmen and

  5. The relationship between collective self-esteem, acculturation, and alcohol-related consequences among Asian American young adults.

    PubMed

    Pedersen, Eric R; Hsu, Sharon Hsin; Neighbors, Clayton; Lee, Christine M; Larimer, Mary E

    2013-01-01

    We examined the relationship between collective self-esteem (i.e., the value one places on being part of a collective group), acculturation, and alcohol-related consequences in a sample of 442 Asian American young adults. We found that membership self-esteem and public collective self-esteem interacted with acculturation such that low levels of both predicted greater rates of consequences. Participants with lower acculturation and greater private collective self-esteem experienced more alcohol consequences. This study suggests that differential aspects of collective self-esteem may serve as protective or risk factors for Asian American young adults depending on degree of acculturation. PMID:23480211

  6. The Relationship Between Collective Self-Esteem, Acculturation, and Alcohol-Related Consequences Among Asian American Young Adults

    PubMed Central

    PEDERSEN, ERIC R.; HSU, SHARON HSIN; NEIGHBORS, CLAYTON; LEE, CHRISTINE M.; LARIMER, MARY E.

    2016-01-01

    We examined the relationship between collective self-esteem (i.e., the value one places on being part of a collective group), acculturation, and alcohol-related consequences in a sample of 442 Asian American young adults. We found that membership self-esteem and public collective self-esteem interacted with acculturation such that low levels of both predicted greater rates of consequences. Participants with lower acculturation and greater private collective self-esteem experienced more alcohol consequences. This study suggests that differential aspects of collective self-esteem may serve as protective or risk factors for Asian American young adults depending on degree of acculturation. PMID:23480211

  7. Trends in binge and heavy drinking, alcohol-related problems, and combat exposure in the U.S. military.

    PubMed

    Bray, Robert M; Brown, Janice M; Williams, Jason

    2013-07-01

    Population-based Department of Defense health behavior surveys were examined for binge and heavy drinking among U.S. active duty personnel. From 1998-2008, personnel showed significant increases in heavy drinking (15% to 20%) and binge drinking (35% to 47%). The rate of alcohol-related serious consequences was 4% for nonbinge drinkers, 9% for binge drinkers, and 19% for heavy drinkers. Personnel with high combat exposure had significantly higher rates of heavy (26.8%) and binge (54.8%) drinking than their counterparts (17% and 45%, respectively). Heavy and binge drinking put service members at high risk for problems that diminish force readiness and psychological fitness. PMID:23869454

  8. Self and partner alcohol-related problems among ACOAs and non-ACOAs: associations with depressive symptoms and motivations for alcohol use.

    PubMed

    Kelley, Michelle L; Linden, Ashley N; Milletich, Robert J; Lau-Barraco, Cathy; Kurtz, Erin D; D'Lima, Gabrielle M; Bodkins, Jessica A; Sheehan, Brynn E

    2014-01-01

    The present study examined whether drinking motivations and depressive symptoms would have a stronger impact on alcohol-related problems among adult children of alcoholics (ACOAs) and their dating partners as compared to non-ACOAs and their dating partners. Participants were 197 undergraduate (60 ACOAs, 137 non-ACOAs) 18 to 25year-old female drinkers in dating relationships. Participants completed measures of ACOA screening, depressive symptoms, and drinking motives, as well as alcohol-related problems for themselves and their partner. Although no differences were found between ACOA and non-ACOA women's alcohol-related problems, ACOA women and women with greater depressive symptoms were at a higher risk of having a partner with more alcohol-related problems. In addition, we found that regardless of parental history of alcoholism, higher depressive symptoms coupled with stronger motives for drinking to cope with stressors predicted participants' own alcohol-related problems. These findings demonstrate the need for future research to examine additional factors that may moderate the effects of depressive symptoms and ACOA status on female college student drinking problems. A greater understanding of the unique and interactive effects of these variables on alcohol-related problems in both young women and their dating partners can aid in the development of prevention programs more targeted to the specific vulnerabilities of this population. PMID:24182750

  9. Thioacetamide-induced cirrhosis in selenium-adequate mice displays rapid and persistent abnormity of hepatic selenoenzymes which are mute to selenium supplementation

    SciTech Connect

    Zhang Jinsong Wang Huali; Yu Hanqing

    2007-10-01

    Selenium reduction in cirrhosis is frequently reported. The known beneficial effect of selenium supplementation on cirrhosis is probably obtained from nutritionally selenium-deficient subjects. Whether selenium supplementation truly improves cirrhosis in general needs additional experimental investigation. Thioacetamide was used to induce cirrhosis in selenium-adequate and -deficient mice. Selenoenzyme activity and selenium content were measured and the influence of selenium supplementation was evaluated. In Se-adequate mice, thioacetamide-mediated rapid onset of hepatic oxidative stress resulted in an increase in thioredoxin reductase activity and a decrease in both glutathione peroxidase activity and selenium content. The inverse activity of selenoenzymes (i.e. TrxR activity goes up and GPx activity goes down) was persistent and mute to selenium supplementation during the progress of cirrhosis; accordingly, cirrhosis was not improved by selenium supplementation in any period. On the other hand, selenium supplementation to selenium-deficient mice always more efficiently increased hepatic glutathione peroxidase activity and selenium content compared with those treated with thioacetamide, indicating that thioacetamide impairs the liver bioavailability of selenium. Although thioacetamide profoundly affects hepatic selenium status in selenium-adequate mice, selenium supplementation does not modify the changes. Selenium supplementation to cirrhotic subjects with a background of nutritional selenium deficiency can improve selenium status but cannot restore hepatic glutathione peroxidase and selenium to normal levels.

  10. Reciprocal Effects of Internalizing and Oppositional Defiance Symptoms on Heavy Drinking and Alcohol-Related Harms in Young Adulthood

    PubMed Central

    Thompson, Kara D.; Leadbeater, Bonnie J.; Ames, Megan E.

    2015-01-01

    There is a need for longitudinal research to understand how psychopathology relates to the onset and maintenance of substance use from adolescence into young adulthood. Hence, we investigate the longitudinal, reciprocal influences of internalizing (anxiety and depression) and externalizing (oppositional defiance) symptoms on heavy episodic drinking (HED; ≥5 drinks per occasion) and alcohol-related harms in a community-based sample of youth aged 12–27 years. Participants were chosen from the Victoria Healthy Youth Survey, followed six times, biennially between 2003 and 2013 (N = 662). Analyses used cross-lagged panel models to examine reciprocal relations over time. Differences across age and sex were also tested. Defiance symptoms predicted increases in HED, which reciprocally predicted increases in defiance symptoms for females. Internalizing symptoms were related to HED within time for females. Alcohol-related harms had reciprocal positive associations with internalizing and defiance symptoms for both males and females. Associations were largely invariant across age groups, suggesting that the presence and strength of associations persisted across development. While psychopathology preceded the onset of HED and harms, the overall findings suggest that these risk processes are mutually reinforcing across development and that youth may become entrenched in an interdependent cycle that significantly increases their risk of comorbid disorders in adulthood. PMID:26819553

  11. Reducing alcohol-related aggression: Effects of a self-awareness manipulation and locus of control in heavy drinking males.

    PubMed

    Purvis, Danielle M; Gallagher, Kathryn E; Parrott, Dominic J

    2016-07-01

    Alcohol Myopia Theory (AMT; Steele & Josephs, 1990) purports that alcohol facilitates aggression by narrowing attentional focus onto salient and instigatory cues common to conflict situations. However, few tests of its counterintuitive prediction - that alcohol may decrease aggression when inhibitory cues are most salient - have been conducted. The present study examined whether an AMT-inspired self-awareness intervention manipulation would reduce heavy drinking men's intoxicated aggression toward women and also examined whether a relevant individual variable, locus of control, would moderate this effect. Participants were 102 intoxicated male heavy drinkers who completed a self-report measure of locus of control and completed the Taylor Aggression Paradigm (Taylor, 1967). In this task, participants administered electric shocks to, and received electric shocks from, a fictitious female opponent while exposed to an environment saturated with or devoid of self-awareness cues. Results indicated that the self-awareness manipulation was associated with less alcohol-related aggression toward the female confederate for men who reported an internal, but not an external, locus of control. Findings support AMT as a theoretical framework to inform preventative interventions for alcohol-related aggression and highlight the importance of individual differences in receptivity to such interventions. PMID:26905761

  12. Developing a guide for community-based groups to reduce alcohol-related harm among African migrants.

    PubMed

    Jaworski, Alison; Brown, Tony; Norman, Catherine; Hata, Kiri; Toohey, Mark; Vasiljevic, Dubravka; Rowe, Rachel

    2016-04-01

    Issue addressed Alcohol-related harm is an issue of concern for African migrant communities living in Australia. However, there has been little information available to guide workers in developing culturally sensitive health promotion strategies. Methods A three-step approach, comprising a literature review, community consultations and an external review, was undertaken to develop a guide to assist organisations and health promotion groups working with African migrant communities to address alcohol-related harms. Discussion There was a high level of agreement between the three steps. Addressing alcohol harms with African migrant communities requires approaches that are sensitive to the needs, structures and experiences of communities. The process should incorporate targeted approaches that enable communities to achieve their resettlement goals as well as strengthening mainstream health promotion efforts. Conclusions The resource produced guides alcohol harm prevention coalitions and workers from the first steps of understanding the influences of acculturation and resettlement on alcohol consumption, through to planning, developing and evaluating an intervention in partnership with communities. So what? This paper advances knowledge by providing a precise summary of Australian African migrant focused alcohol and other drug research to date. It also describes a three-step approach that aimed to incorporate a diversity of community views in the creation of a health promotion and community capacity-building resource. PMID:26726816

  13. The Influence of Gender and Sexual Orientation on Alcohol Use and Alcohol-Related Problems: Toward a Global Perspective.

    PubMed

    Hughes, Tonda L; Wilsnack, Sharon C; Kantor, Lori Wolfgang

    2016-01-01

    Although there are wide differences in alcohol use patterns among countries, men are consistently more likely than women to be drinkers and to drink heavily. Studies of alcohol use among sexual minorities (SMs), however, reflect a more complex picture. Such research has found higher rates of alcohol use and alcohol-related problems among SM persons than among heterosexuals and greater differences between SM and heterosexual women than between SM and heterosexual men. A variety of factors may contribute to differences in alcohol use and alcohol-related problems between men and women and between SM and heterosexual people. An improved understanding of these factors is important to guide prevention and treatment efforts. Although there is a dearth of literature on use of alcohol by SMs in many parts of the world, especially lower- and middle-income countries, we attempt to review and integrate the sparse data that are available from these lower-resourced countries. The global perspective presented in this article is the first attempt to go beyond a general review of literature in the Western world to document the gender paradox in alcohol use among heterosexuals and SMs in diverse countries worldwide. PMID:27159819

  14. Association between firearm ownership, firearm-related risk and risk reduction behaviours and alcohol-related risk behaviours.

    PubMed

    Wintemute, Garen J

    2011-12-01

    Alcohol use and firearm ownership are risk factors for violent injury and death. To determine whether firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours, the author conducted a cross-sectional study using Behavioral Risk Factor Surveillance System data for eight states in the USA from 1996 to 1997 (the most recent data available). Altogether, 15 474 respondents provided information on firearm exposure. After adjustment for demographics and state of residence, firearm owners were more likely than those with no firearms at home to have ≥5 drinks on one occasion (OR 1.32; 95% CI 1.16 to 1.50), to drink and drive (OR 1.79; 95% CI 1.34 to 2.39) and to have ≥60 drinks per month (OR 1.45; 95% CI 1.14 to 1.83). Heavy alcohol use was most common among firearm owners who also engaged in behaviours such as carrying a firearm for protection against other people and keeping a firearm at home that was both loaded and not locked away. The author concludes that firearm ownership and specific firearm-related behaviours are associated with alcohol-related risk behaviours. PMID:21670071

  15. Measuring illness insight in patients with alcohol-related cognitive dysfunction using the Q8 questionnaire: a validation study

    PubMed Central

    Walvoort, Serge JW; van der Heijden, Paul T; Kessels, Roy PC; Egger, Jos IM

    2016-01-01

    Aim Impaired illness insight may hamper treatment outcome in patients with alcohol-related cognitive deficits. In this study, a short questionnaire for the assessment of illness insight (eg, the Q8) was investigated in patients with Korsakoff’s syndrome (KS) and in alcohol use disorder (AUD) patients with mild neurocognitive deficits. Methods First, reliability coefficients were computed and internal structure was investigated. Then, comparisons were made between patients with KS and patients with AUD. Furthermore, correlations with the Dysexecutive Questionnaire (DEX) were investigated. Finally, Q8 total scores were correlated with neuropsychological tests for processing speed, memory, and executive function. Results Internal consistency of the Q8 was acceptable (ie, Cronbach’s α =0.73). The Q8 items represent one factor, and scores differ significantly between AUD and KS patients. The Q8 total score, related to the DEX discrepancy score and scores on neuropsychological tests as was hypothesized, indicates that a higher degree of illness insight is associated with a higher level of cognitive functioning. Conclusion The Q8 is a short, valid, and easy-to-administer questionnaire to reliably assess illness insight in patients with moderate-to-severe alcohol-related cognitive dysfunction. PMID:27445476

  16. Lysosomal Acid Lipase Activity Is Reduced Both in Cryptogenic Cirrhosis and in Cirrhosis of Known Etiology

    PubMed Central

    Vespasiani-Gentilucci, Umberto; Gallo, Paolo; Piemonte, Fiorella; Riva, Elisabetta; Porcari, Aldostefano; Vorini, Ferruccio; Tozzi, Giulia; Piccioni, Livia; Galati, Giovanni; De Vincentis, Antonio; Carotti, Simone; Morini, Sergio; D’Amico, Jessica; Angeletti, Silvia; Pedone, Claudio; Picardi, Antonio

    2016-01-01

    Lysosomal acid lipase deficiency (LAL-d) is a rare autosomal recessive disease in which LAL activity is almost absent, with consequent massive microvesicular steatosis evolving to cirrhosis and liver failure. We aimed to determine LAL-activity, and to investigate the most common single nucleotide polymorphism (SNP) affecting the LIPA gene and responsible for 50–70% of LAL-d cases (rs116928232 c.894G>A), in patients with cryptogenic cirrhosis. Sixty-three patients with cryptogenic cirrhosis, 88 cirrhotics of known etiology, and 97 healthy subjects were enrolled. LAL-activity was determined in dried-blood-spot (DBS). The c.894G>A mutation was analyzed by pyrosequencing method in SNP mode. LAL-activity was severely reduced in patients with cryptogenic cirrhosis with respect to healthy subjects [0.62 (0.44–0.86) Vs 0.96 (0.75–1.25) nmol/spot/h, p<0.001)], but it was also reduced in known-etiology cirrhotics [0.54 (0.42–0.79) nmol/spot/h, p<0.001 Vs healthy subjects; p = 0.5 Vs cryptogenic cirrhotics]. Fourteen percent of cryptogenic cirrhotics and 20% of known-etiology cirrhotics showed a LAL-activity in the range of heterozygous carriers of LIPA gene mutations (0.15–0.40 nmol/spot/h). However, none of the subjects with reduced LAL-activity carried the c.894G>A SNP except for one patient with HCV cirrhosis. By multivariate analysis, LAL-activity was not associated with age, sex, liver enzymes, liver function or lipid parameters, while it was independently associated with white blood cell (β = 0.2; p<0.01) and platelet (β = 0.4; p<0.001) counts and with the condition of cirrhosis (β = -0.2; p = 0.04). Conclusion Liver cirrhosis is characterized by a severe acquired reduction of LAL-activity, the precise causes and consequences of which need to be further addressed. DBS-determined lysosomal enzyme activities seem to be affected by white blood cell and platelet counts, and the specificity of these tests can be reduced when applied to determined populations

  17. Increased plasma homocysteine in liver cirrhosis.

    PubMed

    Bosy-Westphal, A; Petersen, S; Hinrichsen, H; Czech, N; J Müller, M

    2001-05-01

    Background: Homocysteine (Hcy), is an atherogenic and thrombogenic risk factor which has also been proposed to be involved in hepatic fibrinogenesis. Hcy metabolism, depends on the cofactors folate, vit. B12, and the vit. B6 vitamer pyridoxalphosphate (PLP). Metabolism of these vitamins is frequently disturbed in cirrhotics, but little is known about plasma Hcy levels in these patients. Methods: Plasma levels of Hcy, methionine, serine, cysteine, PLP, vit. B12 and folate, and standard clinical/biochemical parameters of liver disease were measured in 43 postabsorptive patients with biopsy proven cirrhosis of different origin. Results: 74% of the patients had elevated plasma Hcy levels defined as >13.4 µmol/l (mean+2SD of healthy age matched controls). Increased plasma Hcy concentrations were seen in alcoholic as well as in non-alcoholic cirrhosis. Excluding patients with impaired renal function (n=7), Hcy concentrations remained elevated in 69% of the patients. We found a high prevalence of pathological plasma vitamin concentrations of 33% for increased vit. B12 levels and 5% and 80% for decreased folate and vit. B6 levels, respectively. Mean plasma vitamin B12 concentrations increased, folate remained unchanged and PLP concentrations decreased with deteriorating liver function. Hcy concentrations were correlated with levels of creatinine (r=0.44, P<0.01), serine (r=-0.46, P<0.01), and cysteine (r=0.38, P<0.05), but showed no association with parameters of liver function and with plasma levels of folate, vit. B12 und vit. B6. This was contrary to data obtained in healthy individuals. In a stepwise multiple regression serine and cysteine best explained the variance in Hcy levels. Conclusions: Elevated basal Hcy-plasma levels are frequently seen cirrhotic patients. Variations of Hcy concentration in liver cirrhosis are not explained by plasma levels of cofactors of Hcy metabolism. PMID:11282484

  18. Novel Therapies on Primary Biliary Cirrhosis.

    PubMed

    Czul, Frank; Levy, Cynthia

    2016-02-01

    All patients with primary biliary cirrhosis (PBC) and abnormal liver biochemistry should be considered for specific therapy. Ursodeoxycholic acid (UDCA) is the only FDA-approved drug for treating PBC. Approximately 40% of patients with PBC respond incompletely to treatment with UDCA, thus having increased risk of death or need for liver transplantation. No second-line therapies for patients with inadequate response to UDCA therapy have been approved. This review provides a current perspective on potential new approaches to treatment in PBC, and highlights some of the challenges we face in evaluating and effectively implementing those treatments. PMID:26593294

  19. Metabolic Bone Disease in Primary Biliary Cirrhosis.

    PubMed

    Glass, Lisa M; Su, Grace Li-Chun

    2016-06-01

    Primary biliary cirrhosis (PBC) is a liver-specific autoimmune disease that primarily affects women (female-to-male ratio, 10:1) between 40 and 60 years of age. Metabolic bone disease is a common complication of PBC, affecting 14% to 52% of patients, depending on the duration and severity of liver disease. The osteoporosis seen in PBC seems mainly due to low bone formation, although increased bone resorption may contribute. Treatment of osteoporosis consists primarily of antiresorptive agents. Additional large prospective, long-term studies in patients with PBC are needed to determine efficacy in improving bone density as well as reducing fracture risk. PMID:27261902

  20. Genetics and genomics of primary biliary cirrhosis.

    PubMed

    Juran, Brian D; Lazaridis, Konstantinos N

    2008-05-01

    The etiologic and pathogenic factors contributing to primary biliary cirrhosis (PBC) development, progression, response to treatment, and outcome remain a mystery. Recognition of the genomic regions harboring risk factors is hindered by the rarity and late onset of PBC. Recent advancements in genomics hold promise for understanding, prevention, and therapy of PBC. Large registries and biospecimen repositories of patients who have PBC, their family members, and controls are needed. Haplotype mapping-based association studies are necessary for defining genetic predisposition. Experimental data will provide the means for fine mapping studies, resequencing efforts, functional experimentation, and elucidation of gene-environment and gene-gene interaction. PMID:18456185

  1. Hepatic Dimethylarginine-Dimethylaminohydrolase1 is Reduced in Cirrhosis and is a Target for Therapy in Portal Hypertension

    PubMed Central

    Mookerjee, Rajeshwar P; Mehta, Gautam; Balasubramaniyan, Vairappan; Mohamed, Fatma; Davies, Nathan; Sharma, Vikram; Iwakiri, Yasuko; Jalan, Rajiv

    2015-01-01

    Background and Aims Portal hypertension is characterized by reduced hepatic eNOS activity. Asymmetric-dimethylarginine (ADMA), an eNOS inhibitor, is elevated in cirrhosis and correlates with severity of portal hypertension. Dimethylargininedimethylaminohydrolase-1 (DDAH-1) is the key enzyme metabolizing hepatic ADMA. This study characterized DDAH-1 in cirrhosis, and explored hepatic DDAH-1 reconstitution through FXR agonism and DDAH-1 gene therapy. Methods DDAH-1 Immunohistochemistry was conducted on human cirrhosis and healthy liver tissue. Subsequently, sham-operated or bile-duct-ligated (BDL) cirrhosis rats were treated with FXR agonist Obeticholic acid (OA, 5mg/kg) or vehicle for 5 days. Further animals underwent hydrodynamic injection with DDAH-1-expressing plasmid or saline control. Groups: Sham+saline, BDL+saline, BDL+DDAH-1-plasmid. Portal pressure (PP) measurements were performed. Plasma ALT was measured by Cobas-Integra; DDAH-1 expression by qPCR and Western blot; eNOS activity by radiometric assay. Results Immunohistochemistry and Western-blotting confirmed hepatic DDAH-1 was restricted to hepatocytes, and expression decreased significantly in cirrhosis. In BDL rats, reduced DDAH-1 expression was associated with elevated hepatic ADMA, reduced eNOS activity and high PP. OA treatment significantly increased DDAH-1 expression, reduced hepatic tissue ADMA, and increased liver NO generation. PP was significantly reduced in BDL+OA vs. BDL+vehicle (8±1 vs. 13.5±0.6 mmHg; p<0.01) with no change in MAP. Similarly, DDAH-1 hydrodynamic injection significantly increased hepatic DDAH-1 gene and protein expression, and significantly reduced PP in BDL+DDAH-1 vs. BDL+ saline (p<0.01). Conclusion This study demonstrates DDAH-1 is a specific molecular target for portal pressure reduction, through actions on ADMA-mediated regulation of eNOS activity. Our data support translational studies targeting DDAH-1 in cirrhosis and portal hypertension. PMID:25152204

  2. Increased expression of 78 kD glucose-regulated protein promotes cardiomyocyte apoptosis in a rat model of liver cirrhosis

    PubMed Central

    Zhang, Lili; Zhang, Huiying; Lv, Minli; Jia, Jiantao; Fan, Yimin; Tian, Xiaoxia; Li, Xujiong; Li, Baohong; Ji, Jingquan; Wang, Limin; Zhao, Zhongfu; Han, Dewu; Ji, Cheng

    2015-01-01

    Aims: This study was to investigate the role and underlying mechanism of 78 kD glucose-regulated protein (GRP78) in cardiomyocyte apoptosis in a rat model of liver cirrhosis. Methods: A rat model of liver cirrhosis was established with multiple pathogenic factors. A total of 42 male SD rats were randomly divided into the liver cirrhosis group and control group. Cardiac structure analysis was performed to assess alterations in cardiac structure. Cardiomyocytes apoptosis was detected by TdT-mediated dUTP nick end labeling method. Expression of GRP78, CCAAT/enhancer-binding protein homologous protein (CHOP), caspase-12, nuclear factor kappa-light-chain-enhancer of activated B cells p65 subunit (NF-κB p65) and B cell lymphoma-2 (Bcl-2) was detected by immunohistochemical staining. Results: The ratios of left ventricular wall thickness to heart weight and heart weight to body weight were significantly increased with the progression of liver cirrhosis (P < 0.05). Apoptosis index of cardiomyocytes was significantly increased with the progression of liver cirrhosis (P < 0.05). The expression levels of GRP78, CHOP and caspase-12 were significantly increased in the progression of liver cirrhosis (P < 0.05). The expression levels of NF-κB p65 and Bcl-2 were highest in the 4-wk liver cirrhosis, and they were decreased in the 6-wk and 8-wk in the progression of liver cirrhosis. GRP78 expression levels were positively correlated with apoptosis index, CHOP and caspase-12 expression levels (P < 0.05). CHOP expression levels were negatively correlated with NF-κB p65 and Bcl-2 expression levels (P < 0.05). Conclusion: Increased expression of GRP78 promotes cardiomyocyte apoptosis in rats with cirrhotic cardiomyopathy. PMID:26464674

  3. Unilateral pleural effusion without ascites in liver cirrhosis

    SciTech Connect

    Faiyaz, U.; Goyal, P.C.

    1983-09-01

    The source of massive pleural effusion was not apparent in a 58-year-old man who had cirrhosis but no demonstrable ascites. Intraperitoneal injection of technetium Tc 99m sulfur colloid established the presence of peritoneopleural communication. This diagnostic technique can be helpful in evaluating patients with cirrhosis of the liver and pleural effusion with or without ascites.

  4. Vasopressin in cirrhosis and sepsis: physiology and clinical implications.

    PubMed

    Wagener, G; Bakker, J

    2015-12-01

    Arginine-vasopressin (AVP) is an important hormone in the regulation of plasma osmolality and blood volume/pressure. In clinical practice it is frequently used in the treatment of septic shock and decompensated cirrhosis. In this review the physiology of AVP and its analogues is presented. In addition the use of AVP in cirrhosis and sepsis is reviewed. PMID:25384691

  5. Treating morbid obesity in cirrhosis: A quest of holy grail.

    PubMed

    Kumar, Naveen; Choudhary, Narendra Singh

    2015-12-01

    The problem of obesity is increasing worldwide in epidemic proportions; the situation is similarly becoming more common in patients with cirrhosis which negatively affect the prognosis of disease and also makes liver transplantation difficult especially in the living donor liver transplantation setting where low graft to recipient weight ratio negatively affects survival. Treatment of obesity is difficult in cirrhosis due to difficulty in implementation of lifestyle measures, limited data on safety of anti-obesity drugs and high risk of surgery. Currently approved anti-obesity drugs have limited data in patients with cirrhosis. Bariatric surgery remains an option in selected compensated cirrhotic patients. Endoscopic interventions for obesity are emerging and are quite promising in patients with cirrhosis as these are minimally invasive. In present review, we briefly discuss various modalities of weight reduction in obese patients and their applicability in patients with cirrhosis. PMID:26668693

  6. Treating morbid obesity in cirrhosis: A quest of holy grail

    PubMed Central

    Kumar, Naveen; Choudhary, Narendra Singh

    2015-01-01

    The problem of obesity is increasing worldwide in epidemic proportions; the situation is similarly becoming more common in patients with cirrhosis which negatively affect the prognosis of disease and also makes liver transplantation difficult especially in the living donor liver transplantation setting where low graft to recipient weight ratio negatively affects survival. Treatment of obesity is difficult in cirrhosis due to difficulty in implementation of lifestyle measures, limited data on safety of anti-obesity drugs and high risk of surgery. Currently approved anti-obesity drugs have limited data in patients with cirrhosis. Bariatric surgery remains an option in selected compensated cirrhotic patients. Endoscopic interventions for obesity are emerging and are quite promising in patients with cirrhosis as these are minimally invasive. In present review, we briefly discuss various modalities of weight reduction in obese patients and their applicability in patients with cirrhosis. PMID:26668693

  7. Experiences of Individuals With Liver Cirrhosis: A Qualitative Study.

    PubMed

    Abdi, Fatemeh; Daryani, Nasser Ebrahimi; Khorvash, Farzin; Yousefi, Zahra

    2015-01-01

    Liver cirrhosis is one of the main causes of mortality and morbidity worldwide. Health-related quality of life in cirrhotic patients is affected by the disease's complications. The purpose of this article was to describe the experiences of individuals with liver cirrhosis during critical illness. The aim was to investigate the disease experiences of liver cirrhosis. The authors conducted a phenomenological qualitative study, using a Colaizzi's seven-step method. Ten participants with liver cirrhosis participated in in-depth interviews. The data from this analysis were transformed into 119 codes, 11 subthemes, and 4 main themes including (1) confronting tension, (2) needs, (3) spirituality, and (4) interaction and effective communication. Findings could be used as a basis for information and emotional and social support interventions, as these can be effective in promoting adjustment to complications of cirrhosis by suitable interventions. Adequate adjustment through adaptation leads to successful completion of treatment and improved quality of life. PMID:26226019

  8. Spinal cord involvement in patients with cirrhosis

    PubMed Central

    Nardone, Raffaele; Höller, Yvonne; Storti, Monica; Lochner, Piergiorgio; Tezzon, Frediano; Golaszewski, Stefan; Brigo, Francesco; Trinka, Eugen

    2014-01-01

    A severe spinal cord involvement may rarely occur in patients with cirrhosis and other chronic liver diseases; this complication is usually associated with overt liver failure and surgical or spontaneous porto-systemic shunt. Hepatic myelopathy (HM) is characterized by progressive weakness and spasticity of the lower extremities, while sensory and sphincter disturbances have rarely been described and are usually less important. The diagnosis is assigned in the appropriate clinical setting on clinical grounds after the exclusion of other clinical entities leading to spastic paraparesis. Magnetic resonance imaging is often unremarkable; however, also intracerebral corticospinal tract abnormalities have been reported recently. The study of motor evoked potentials may disclose central conduction abnormalities even before HM is clinically manifest. HM responds poorly to blood ammonia-lowering and other conservative medical therapy. Liver transplantation represents a potentially definitive treatment for HM in patients with decompensated cirrhosis of Child-Pugh B and C grades. Other surgical treatment options in HM include surgical ligation, shunt reduction, or occlusion by interventional procedures. PMID:24627593

  9. Sex Differences Associated with Primary Biliary Cirrhosis

    PubMed Central

    Smyk, Daniel S.; Rigopoulou, Eirini I.; Pares, Albert; Billinis, Charalambos; Burroughs, Andrew K.; Muratori, Luigi; Invernizzi, Pietro; Bogdanos, Dimitrios P.

    2012-01-01

    Primary biliary cirrhosis (PBC) is a cholestatic liver disease of autoimmune origin, characterised by the destruction of small intrahepatic bile ducts. The disease has an unpredictable clinical course but may progress to fibrosis and cirrhosis. The diagnostic hallmark of PBC is the presence of disease-specific antimitochondrial antibodies (AMA), which are pathognomonic for the development of PBC. The disease overwhelmingly affects females, with some cases of male PBC being reported. The reasons underlying the low incidence of males with PBC are largely unknown. Epidemiological studies estimate that approximately 7–11% of PBC patients are males. There does not appear to be any histological, serological, or biochemical differences between male and female PBC, although the symptomatology may differ, with males being at higher risk of life-threatening complications such as gastrointestinal bleeding and hepatoma. Studies on X chromosome and sex hormones are of interest when studying the low preponderance of PBC in males; however, these studies are far from conclusive. This paper will critically analyze the literature surrounding PBC in males. PMID:22693524

  10. Primary biliary cirrhosis: From bench to bedside

    PubMed Central

    Kouroumalis, Elias; Notas, George

    2015-01-01

    Primary biliary cirrhosis (PBC) is a chronic non-suppurative destructive intrahepatic cholangitis leading to cirrhosis after a protractive non cirrhotic stage. The etiology and pathogenesis are largely unknown and autoimmne mechanisms have been implicated to explain the pathological lesions. Many epitopes and autoantigens have been reported as crucial in the pathophysiology of the disease and T and B cells abnormalities have been described, the exact pathways leading to the destruction of small intrahepatic ductules are mostly speculative. In this review we examined the various epidemiologal and geoepidemiological data as well as the complex pathogenetic aspects of this disease, focusing on recent in vivo and in vitro studies in this field. Initiation and progression of PBC is believed to be a multifactorial process with strong infuences from the patient’s genetic background and by various environmental factors. The role of innate and adaptive immunity, including cytokines, chemokines, macrophages and the involvement of apoptosis and reactive oxygen species are outlined in detailed. The current pathogenetic aspects are presented and a novel pathogenetic theory unifying the accumulated clinical information with in vitro and in vivo data is formulated. A review of clinical manifestations and immunological and pathological diagnosis was presented. Treatment modalities, including the multiple mechanisms of action of ursodeoxycholate were finally discussed. PMID:26261733

  11. “I Will Take a Shot for Every ‘Like’ I Get on This Status”: Posting Alcohol-Related Facebook Content Is Linked to Drinking Outcomes

    PubMed Central

    Westgate, Erin C; Neighbors, Clayton; Heppner, Hannes; Jahn, Susanna; Lindgren, Kristen P

    2014-01-01

    Objective: This study investigated whether self-reports of alcohol-related postings on Facebook by oneself or one’s Facebook friends were related to common motives for drinking and were uniquely predictive of self-reported alcohol outcomes (alcohol consumption, problems, and cravings). Method: Pacific Northwest undergraduates completed a survey of alcohol outcomes, drinking motives, and alcoholrelated Facebook postings. Participants completed the survey online as part of a larger study on alcohol use and cognitive associations. Participants were randomly selected through the university registrar’s office and consisted of 1,106 undergraduates (449 men, 654 women, 2 transgender, 1 declined to answer) between the ages of 18 and 25 years (M = 20.40, SD = 1.60) at a large university in the Pacific Northwest. Seven participants were excluded from analyses because of missing or suspect data. Results: Alcohol-related postings on Facebook were significantly correlated with social, enhancement, conformity, and coping motives for drinking (all ps < .001). After drinking motives were controlled for, self–alcohol-related postings independently and positively predicted the number of drinks per week, alcohol-related problems, risk of alcohol use disorders, and alcohol cravings (all ps < .001). In contrast, friends’ alcohol-related postings only predicted the risk of alcohol use disorders (p < .05) and marginally predicted alcohol-related problems (p = .07). Conclusions: Posting alcohol-related content on social media platforms such as Facebook is associated with common motivations for drinking and is, in itself, a strong predictive indicator of drinking outcomes independent of drinking motives. Moreover, self-related posting activity appears to be more predictive than Facebook friends’ activity. These findings suggest that social media platforms may be a useful target for future preventative and intervention efforts. PMID:24766750

  12. Infectious Agents in the Pathogenesis of Primary Biliary Cirrhosis

    PubMed Central

    Ortega-Hernandez, Oscar-Danilo; Levin, Nancy-Agmon; Altman, Arie; Shoenfeld, Yehuda

    2010-01-01

    Primary biliary cirrhosis (PBC) is a chronic progressive cholestatic liver disease which is characterized by the breakdown of self-tolerance to the highly conserved pyruvate dehydrogenase complex, specially the pyruvate dehydrogenase E2 complex (PDC-E2). The breakdown of the tolerance to such antigens leads to an autoimmune process characterized by portal inflammation and immune-mediated destruction of the intrahepatic bile ducts. Epidemiological studies have suggested that infections agents can trigger or even exacerbate the disease. Among other gram negative bacteria, Escherichia Coli, and Nosphingobium aromaticivorans are the most associated agents reported hitherto. Epidemiological and molecular evidence points towards molecular mimicry between some components of these microorganisms and specific amino-acid sequences that are present in proteins on normal cells of the biliary tract. In this review, we revisit all reports suggesting that infectious agents might be associated with the autoimmune pathogenesis of PBC. We also retrieve the immune molecular mimicry mechanisms that are likely involved with the autoimmune process in PBC. PMID:21297247

  13. Evaluating the effects of six alcohol-related message frames on emotions and intentions: The neglected role of disgust.

    PubMed

    Collymore, Natalie N; McDermott, Mark R

    2016-09-01

    A total of 120 18- to 56-year-olds, divided into six groups containing equal numbers of men and women, were shown a textual message and associated photograph featuring alcohol-related behaviour. Subsequently, questions were answered about intentions to reduce consumption, to drink moderately and how positive and negative the messages made participants feel. Loss-framed messages, in particular those featuring health-related disgust, were the most effective for increasing intentions to reduce alcohol intake. In conclusion, studies have over-focused on fear-loss frames, neglecting the utility of disgust-loss frames in health messages. This study suggests that disgust-loss frames deserve equivalent attention. PMID:25673373

  14. Self-organization of alcohol-related attitudes and beliefs in a campus housing complex: an initial investigation.

    PubMed

    Bourgeois, M J; Bowen, A

    2001-11-01

    The self-organization of college students' alcohol-related attitudes and their beliefs about other students' attitudes were assessed within a campus housing complex. Pluralistic ignorance was widespread, in that, compared with their own self-ratings, students rated their friends and the "typical" student as being more in favor of alcohol and more lax in the number of drinks per hour that were acceptable and the number of drinks that were acceptable before driving. They also perceived typical students as more risky than their friends. Dynamic social impact theory was also supported, as students' dormitory building and floor of residence reliably predicted both their personal drinking attitudes and their beliefs about the drinking attitudes of other students. PMID:11714185

  15. Effects of alcohol taxes on alcohol-related mortality in Florida: Time-series analyses from 1969–2004

    PubMed Central

    Maldonado-Molina, Mildred M.; Wagenaar, Alexander C.

    2010-01-01

    Background Over a hundred studies have established the effects of beverage alcohol taxes and prices on sales and drinking behaviors. Yet, relatively few studies have examined effects of alcohol taxes on alcohol-related mortality. We evaluated effects of multiple changes in alcohol tax rates in the State of Florida from 1969–2004 on disease (not injury) mortality. Methods A time-series quasi-experimental research design was used, including non-alcohol deaths within Florida and other states’ rates of alcohol-related mortality for comparison. A total of 432 monthly observations of mortality in Florida were examined over the 36-year period. Analyses included ARIMA, fixed-effects, and random effects models, including a noise model, tax independent variables, and structural covariates. Results We found significant reductions in mortality related to chronic heavy alcohol consumption following legislatively induced increases in alcohol taxes in Florida. The frequency of deaths (t=−2.73, p=.007) and the rate per population (t=−2.06, p=.04) declined significantly. The elasticity effect estimate is −0.22 (t=−1.88, p=.06), indicating a 10% increase in tax is associated with a 2.2% decline in deaths. Conclusions Increased alcohol taxes are associated with significant and sizable reductions in alcohol-attributable mortality in Florida. Results indicate that 600–800 lives per year could be saved if real tax rates were returned to 1983 levels (when the last tax increase occurred). Findings highlight the role of tax policy as an effective means for reducing deaths associated with chronic heavy alcohol use. PMID:20659073

  16. Emerging Adult Identity Development, Alcohol Use, and Alcohol-related Problems During the Transition out of College

    PubMed Central

    Gates, Jonathan R.; Corbin, William R.; Fromme, Kim

    2016-01-01

    Alcohol use generally peaks during the early twenties and declines with age. These declines, referred to as “maturing out,” are presumed to result from the acquisition of adult roles (e.g. marriage, employment) incompatible with alcohol use. Recent empirical evidence suggests that variables other than role transitions (e.g. personality) may also be important in understanding this process. Changes in identity that occur during emerging adulthood may also be linked to the process of maturing out of heavy drinking, though no studies have yet addressed this possibility. Utilizing data from a large sample of graduating college students (N = 907) during senior year (wave 1) and the two following years (waves 2-3), the current study examined relations between aspects of emerging adult identity and drinking outcomes (alcohol use and problems). Using time varying covariate growth models, results indicated that several facets of emerging adult identity conferred risk for the failure to mature out of heavy drinking and alcohol-related problems. Experimentation/possibilities emerged as a significant risk factor for both heavy drinking and alcohol problems, but these effects diminished considerably when accounting for personality risk. In contrast, although small in magnitude, effects of self-focus on heavy drinking and negativity/instability on alcohol-related problems were relatively independent of effects of other established predictors. The effect for negativity/instability was evident only at the final wave. The findings have important implications for theories of “maturing out” and may ultimately inform tailoring or refinement of prevention/intervention approaches for emerging adults. PMID:27077443

  17. Emerging adult identity development, alcohol use, and alcohol-related problems during the transition out of college.

    PubMed

    Gates, Jonathan R; Corbin, William R; Fromme, Kim

    2016-05-01

    Alcohol use generally peaks during the early 20s and declines with age. These declines, referred to as "maturing out," are presumed to result from the acquisition of adult roles (e.g., marriage, employment) incompatible with alcohol use. Recent empirical evidence suggests that variables other than role transitions (e.g., personality) may also be important in understanding this process. Changes in identity that occur during emerging adulthood may also be linked to the process of maturing out of heavy drinking, though no studies have yet addressed this possibility. Utilizing data from a large sample of graduating college students (N = 907) during senior year (Wave 1) and the 2 following years (Waves 2-3), the current study examined relations between aspects of emerging adult identity and drinking outcomes (alcohol use and problems). Using time-varying covariate growth models, results indicated that several facets of emerging adult identity conferred risk for the failure to mature out of heavy drinking and alcohol-related problems. Experimentation/possibilities emerged as a significant risk factor for both heavy drinking and alcohol problems, but these effects diminished considerably when accounting for personality risk. In contrast, although small in magnitude, effects of self-focus on heavy drinking and negativity/instability on alcohol-related problems were relatively independent of effects of other established predictors. The effect for negativity/instability was evident only at the final wave. The findings have important implications for theories of maturing out and may ultimately inform tailoring or refinement of prevention/intervention approaches for emerging adults. (PsycINFO Database Record PMID:27077443

  18. [What are the physician's role and responsibility in the law named "Basic Act on Measures against Alcohol-related Health Harm"?].

    PubMed

    Io, Aro; Yoshimoto, Hisashi

    2015-09-01

    Japan passed the national law "Basic Act on Measures against Alcohol-related Health Harm" on December 2013. This law is expected to prevent inappropriate drinking that leads to alcohol-related problems such as physical and mental disorder, drunk driving, suicide, domestic violence, child abuse, and poor work performance. The physician's responsibilities under this law are described as follows: i) to provide high quality and appropriate medical care concerning alcohol-related health harm; ii) to reduce or eliminate the consumption of alcohol, thus preventing the progression of alcohol-related health harm; and iii) to coordinate these efforts amongst medical institutions. Based on this law, we believe that Japanese physicians will have essential roles in achieving the goals of this law and that we can fulfill our responsibilities by observing the following aspects: a) changing our message to the patients from "drink sensibly and moderately" to "low-risk drinking; but any drinking has a risk of harm and low-risk drinking is not risk-free"; b) encouraging the spread and use of Screening, Brief Intervention, and Referral to Treatment (SBIRT); and c) establishing community healthcare systems for alcohol-related problems, including dementia in the elderly and during alcohol emergencies. PMID:26394525

  19. Relationship of attention-deficit/hyperactivity disorder symptom severity with severity of alcohol-related problems in a sample of inpatients with alcohol use disorder

    PubMed Central

    Bozkurt, Muge; Evren, Cuneyt; Umut, Gokhan; Evren, Bilge

    2016-01-01

    Purpose Attention-deficit/hyperactivity disorder (ADHD) has been shown to be related to a higher risk of developing psychiatric problems such as depressive disorders, substance use disorder, and impulsivity. Adults who have comorbid ADHD and alcohol use disorder (AUD) are at greater risk of negative outcomes. Thus, it is important to evaluate the relationship of ADHD symptoms and the severity of alcohol-related problems among patients with AUD. The aim of the present study was to evaluate the effect of ADHD symptoms on severity of alcohol-related problems, while controlling the effects of depression and impulsivity in a sample of inpatients with AUD. Patients and methods Participants (n=190) were evaluated with the Beck Depression Inventory, the Short Form Barratt Impulsiveness Scale, the Michigan Alcohol Screening Test, and the Adult ADHD Self-Report Scale. Results Severity of the scale scores was positively correlated with each other. Although severity of depression and impulsivity (particularly non-planning impulsivity) predicted the severity of alcohol-related problems in a linear regression model, when severity of ADHD symptoms was included in the analysis, the inattentive subscale score, in particular, predicted the severity of alcohol-related problems together with non-planning impulsivity, whereas depression was no longer a predictor. Conclusion These findings suggest that, together with non-planning impulsivity, symptoms of ADHD (particularly inattentive factor) are an important factor that predict alcohol-related problems, while controlling the severity of depressive symptoms among inpatients with AUD. PMID:27462159

  20. Mental Health, not Social Support, Mediates the Forgiveness–Alcohol Outcome Relationship

    PubMed Central

    Webb, Jon R.; Robinson, Elizabeth A. R.; Brower, Jon R.

    2011-01-01

    Religiousness and spirituality are important to most Americans and evidence suggests that they may contribute to both addiction and recovery. Forgiveness is a specific dimension of religiousness and spirituality that may enhance recovery, but the mechanism(s) through which it operates is unknown. We hypothesized that higher levels of forgiveness would be associated with higher levels of mental health and social support, which in turn would be associated with improved alcohol-related outcomes. Baseline and 6-month longitudinal data from a sample of 149 individuals with alcohol use disorders seeking outpatient substance abuse treatment were analyzed through multiple-mediation statistical techniques. While previous research has shown direct associations among forgiveness, alcohol-related outcomes, mental health, and social support, this study found that the direct associations between forgiveness and alcohol-related outcomes were no longer significant when mental health and social support were analyzed as mediator variables. At baseline, for each alcohol-related outcome measured (alcohol-related problems, percent heavy drinking days, percent days abstinent, and drinks per drinking day), mental health individually played a role in the relationship with both forgiveness of self and forgiveness of others; fully mediating or operating through an indirect only pathway. For alcohol-related problems only, mental health fully mediated the relationship with forgiveness of self at follow-up and operated through an indirect only pathway with forgiveness of others longitudinally. Social support and feeling forgiven by God were non-significant variables at baseline, follow-up, and longitudinally. PMID:21443306

  1. Prescribing Medications in Patients with Decompensated Liver Cirrhosis

    PubMed Central

    Amarapurkar, Deepak N.

    2011-01-01

    Patients with decompensated liver cirrhosis have various serious complications which require multiple drugs for therapeutic or prophylactic use. Majority of the drugs are primarily metabolized and excreted by hepatobiliary system; hence, liver cell necrosis contributes to impaired drug handling in liver failure while portosystemic shunt can alter drug action in cirrhosis. Hence, in order to decide drug dosing in liver failure, 3 important factors need to be considered (1) pharmacokinetic alterations of drugs, (2) pharmacodynamic alteration of drugs, and (3) increased susceptibility of patients to adverse events particularly hepatotoxicity. Though there is no predictable test which can be used to determine drug dosage in patients with decompensated liver cirrhosis, drugs with first pass metabolism require reduction in oral dosages, for high clearance drugs both loading and maintenance dosages need adjustment, for low clearance drugs maintenance dose needs adjustment, whenever possible measuring drug level in the blood and monitoring of adverse events frequently should be done. No evidence-based guidelines exist for the use of medication in patients' with liver cirrhosis. There are hardly any prospective studies on the safety of drugs in cirrhotic patients. According to the experts opinion, most of the drugs can be used safely in patients with cirrhosis, but drug-induced hepatotoxicity may be poorly tolerated by patients with cirrhosis; hence, potential hepatotoxins should be avoided in patients with liver cirrhosis. Potentially hepatotoxic drugs may be used in patients with liver cirrhosis based on the clinical needs and when there are no alternatives available. Caveat for the prescribing medications in patients with cirrhosis the drug dosing should be individualized depending on a number of factors like nutritional status, renal function, adherence, and drug interaction. Monitoring of the liver function at frequent intervals is highly recommended. PMID:21994861

  2. Red blood cell sodium transport in patients with cirrhosis.

    PubMed

    Henriksen, Ulrik Lütken; Kiszka-Kanowitz, Marianne; Bendtsen, Flemming; Henriksen, Jens H

    2016-09-01

    Patients with advanced cirrhosis have abnormal sodium homoeostasis. The study was undertaken to quantify the sodium transport across the plasma membrane of red blood cells (RBC) in patients with cirrhosis. RBC efflux and influx of sodium were studied in vitro with tracer (22) Na(+) according to linear kinetics in 24 patients with cirrhosis and 14 healthy controls. The sodium efflux was modified by ouabain (O), furosemide (F) and a combination of O and F (O + F). RBC sodium was significantly decreased (4·6 versus control 6·3 mmol l(-1) , P<0·001) and directly related to serum sodium (r = 0·57, P<0·05). The RBC fractional sodium efflux was higher in patients with cirrhosis (+46%, P<0·01) compared to controls. Inhibition in both high (145 mmol l(-1) )- and low (120 mmol l(-1) )-sodium buffers showed that the F-insensitive sodium efflux was twice as high in cirrhosis as in controls (P = 0·03-0·007), especially the O-sensitive, F-insensitive efflux was increased (+ 225%, P = 0·01-0·006). Fractional F-sensitive transport was normal in cirrhosis. RBC sodium influx was largely normal in cirrhosis. In conclusion, RBC sodium content is reduced in patients with cirrhosis with a direct relation to serum sodium. Increased RBC sodium efflux is especially related to ouabain-sensitive, furosemide-insensitive transport and thus most likely due to upregulated activity of the sodium-potassium pump. The study gives no evidence to an altered intracellular/extracellular sodium ratio or to a reduced fractional furosemide-sensitive sodium transport in cirrhosis. PMID:26016736

  3. Primary Biliary Cirrhosis Beyond Ursodeoxycholic Acid.

    PubMed

    Corpechot, Christophe

    2016-02-01

    Although ursodeoxycholic acid remains the only approved pharmacotherapy for patients with primary biliary cirrhosis, the better characterization of factors responsible for the poor response to this drug and the emergence of several new putative therapeutic targets now offer significant opportunities to improve the management of patients and our capacity to treat them more efficiently. The availability of novel treatment options, such as fibrates, budesonide, and obeticholic acid, all capable of improving prognostic markers, invites us to reconsider our management and treatment strategies. Early identification of high-risk patients should remain a priority to deliver adjunctive therapies to appropriately selected populations and increase their chances of success. Given the absence of comparative trials, the choice between second-line treatments should be dictated by the biochemical, histological, and expected tolerance profiles. Here the author presents a brief overview of what should be known in this field and proposes a practical approach to facilitate decision making. PMID:26870929

  4. Environmental Factors in Primary Biliary Cirrhosis

    PubMed Central

    Juran, Brian D.; Lazaridis, Konstantinos N.

    2014-01-01

    The etiology of the autoimmune liver disease primary biliary cirrhosis (PBC) remains largely unresolved, owing in large part to the complexity of interaction between environmental and genetic contributors underlying disease development. Observations of disease clustering, differences in geographical prevalence, and seasonality of diagnosis rates suggest the environmental component to PBC is strong, and epidemiological studies have consistently found cigarette smoking and history of urinary tract infection to be associated with PBC. Current evidence implicates molecular mimicry as a primary mechanism driving loss of tolerance and subsequent autoimmunity in PBC, yet other environmentally influenced disease processes are likely to be involved in pathogenesis. In this review, the authors provide an overview of current findings and touch on potential mechanisms behind the environmental component of PBC. PMID:25057950

  5. Environmental factors in primary biliary cirrhosis.

    PubMed

    Juran, Brian D; Lazaridis, Konstantinos N

    2014-08-01

    The etiology of the autoimmune liver disease primary biliary cirrhosis (PBC) remains largely unresolved, owing in large part to the complexity of interaction between environmental and genetic contributors underlying disease development. Observations of disease clustering, differences in geographical prevalence, and seasonality of diagnosis rates suggest the environmental component to PBC is strong, and epidemiological studies have consistently found cigarette smoking and history of urinary tract infection to be associated with PBC. Current evidence implicates molecular mimicry as a primary mechanism driving loss of tolerance and subsequent autoimmunity in PBC, yet other environmentally influenced disease processes are likely to be involved in pathogenesis. In this review, the authors provide an overview of current findings and touch on potential mechanisms behind the environmental component of PBC. PMID:25057950

  6. Mitochondrial antibodies in primary biliary cirrhosis

    PubMed Central

    Berg, P. A.; Roitt, I. M.; Doniach, D.; Cooper, H. M.

    1969-01-01

    The effect on the mitochondrial antigen of different agents known to influence the integrity and structure of membranes has been studied using quantitative complement fixation with autoantibodies from the serum of a patient with primary biliary cirrhosis. The susceptibility to proteolytic enzymes suggests that the antigen is a protein. Activity depends upon an association with phospholipids. Addition of phospholipids prevents loss of antigen during artificial ageing of mitochondria at 37°. Activity is lost after treatment with phospholipases or solvents which extract phospholipids. Antigen is also destroyed by surface active agents which dissociate the link with phospholipid but those which weaken bonds between phospholipids and hydrophobic molecules yield fragments of antigen-containing membrane structures which, nonetheless, still react with the mitochondrial autoantibody. ImagesFIG. 2FIG. 4 PMID:5804537

  7. Prevalence of alcohol related attendance at an inner city emergency department and its impact: a dual prospective and retrospective cohort study

    PubMed Central

    Parkinson, Kathryn; Newbury-Birch, Dorothy; Phillipson, Angela; Hindmarch, Paul; Kaner, Eileen; Stamp, Elaine; Vale, Luke; Wright, John; Connolly, Jim

    2016-01-01

    Background Alcohol related hospital attendances are a potentially avoidable burden on emergency departments (EDs). Understanding the number and type of patients attending EDs with alcohol intoxication is important in estimating the workload and cost implications. We used best practice from previous studies to establish the prevalence of adult alcohol related ED attendances and estimate the costs of clinical management and subsequent health service use. Methods The setting was a large inner city ED in northeast England, UK. Data were collected via (i) retrospective review of hospital records for all ED attendances for four pre-specified weeks in 2010/2011 to identify alcohol related cases along with 12 months of follow-up of the care episode and (ii) prospective 24/7 assessment via breath alcohol concentration testing of patients presenting to the ED in the corresponding weeks in 2012/2013. Results The prevalence rates of alcohol related attendances were 12% and 15% for the retrospective and prospective cohorts, respectively. Prospectively, the rates ranged widely from 4% to 60% across week days, rising to over 70% at weekends. Younger males attending in the early morning hours at weekends made up the largest proportion of alcohol related attendances. The mean cost per attendance was £249 (SD £1064); the mean total cost for those admitted was £851 (SD £2549). The most common reasons for attending were trauma related injuries followed by psychiatric problems. Conclusions Alcohol related attendances are a major and avoidable burden on emergency care. However, targeted interventions at weekends and early morning hours could capture the majority of cases and help prevent future re-attendance. PMID:26698364

  8. Endoscopic management of choledocholithiasis and cholelithiasis in patients with cirrhosis.

    PubMed

    Khan, Ali S; Eloubeidi, Mohamad A; Khashab, Mouen A

    2016-07-01

    Treatment of choledocholithiasis and cholelithiasis in patients with cirrhosis often requires diagnostic and therapeutic endoscopy such as endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP). Patients with underlying cirrhosis may have coagulopathy, hepatic encephalopathy, ascites and other comorbidities associated with cirrhosis that can make endoscopic therapy challenging and can be associated with a higher risk of adverse events. Given the unique derangements of physiologic parameters associated with cirrhosis this population requires a truly multifaceted and multidisciplinary understanding between therapeutic endoscopists, hepatologists and anesthesiologists. For therapeutic endoscopists, it is critical to be aware of the specific issues unique to this population of patients to optimize outcomes and avoid adverse events. The epidemiology of gallstone disease, the diagnostic and therapeutic approach to patients with varying degree of hepatic dysfunction, and a review of the available literature in this area are presented. PMID:26799755

  9. Understanding and treating patients with alcoholic cirrhosis: an update.

    PubMed

    Addolorato, Giovanni; Russell, Marcia; Albano, Emanuele; Haber, Paul S; Wands, Jack R; Leggio, Lorenzo

    2009-07-01

    Alcoholic cirrhosis represents the terminal stage of alcoholic liver disease (ALD) and one of the main causes of death among alcohol abusers. The aim of this review was to provide an update on alcoholic cirrhosis, with an emphasis on recent findings. Increased alcohol consumption in developing countries is expected to increase cirrhosis mortality. There is a need, therefore, to develop new approaches to the prevention of ALD, including more attention to co-factors that may increase risk of ALD (i.e., obesity and diabetes, chronic HCV infection, and smoking). Furthermore, a better understanding of the pathological mechanisms on the basis of alcohol cirrhosis represents a cornerstone in order to develop new pharmacological treatments. Inflammatory and immune responses along with oxidative stress and alterations in adipokine secretion might contribute in different ways to the evolution of alcohol-induced fibrosis/cirrhosis. As of this date, patients with severe alcoholic hepatitis with a Maddrey Discriminant Factor (MDF) 32 should be offered pentoxifylline and/or corticosteroids unless contraindications exist. For ambulatory patients, S-adenosylmethionine (SAMe) may be considered in a motivated patient with nutritional support. Current studies do not support use of anti-tumor necrosis factor (TNF)-alpha antibody. Finally, achieving total alcohol abstinence should represent the main aim in the management of patients affected by any stage of cirrhosis. In the last decades, several drugs able to increase abstinence and prevent alcohol relapse have been evaluated and some of them have obtained approval for alcohol dependence. Patients with alcoholic cirrhosis; however, are usually excluded from such treatments. A recent study demonstrated the efficacy and safety of baclofen in inducing and maintaining alcohol abstinence in cirrhotic alcohol-dependent patients with cirrhosis. All together the information available suggests the need of a multimodal approach in the clinical

  10. EDTA-dependent pseudothrombocytopenia in a case of liver cirrhosis.

    PubMed

    Matarazzo, M; Conturso, V; Di Martino, M; Chiurazzi, F; Guida, G; Morante, R

    2000-06-01

    Pseudothrombocytopenia (PTCP) is the consequence of an EDTA-activated platelet agglutination, resulting in a spuriously low platelet count. We report the case of a 54-year-old man with EDTA-dependent PTCP associated with liver cirrhosis. He couldn't undergo endoscopic examination and dental care for two years because of a previous diagnosis of severe thrombocytopenia secondary to liver cirrhosis. Lack of PTCP recognition may lead the physician to misdiagnosis and mismanagement of the patient. PMID:10965778

  11. Periodontal disease and liver cirrhosis: A systematic review

    PubMed Central

    2015-01-01

    Objectives: Studies suggest that periodontal disease, a source of subclinical and persistent infection, may be associated with various systemic conditions, including liver cirrhosis. The aim of this study was to examine the literature and determine the relationship between periodontal disease and liver cirrhosis and to identify opportunities and directions for future research in this area. Methods: A systematic review of English articles in the PubMed, EMBASE, and Scopus databases was conducted using search terms including ‘liver cirrhosis’, ‘end-stage liver disease’, ‘liver diseases’, ‘oral health’, ‘periodontal disease’, ‘mouth disease’, ‘gingivitis’, and ‘periodontitis’. Results: Thirteen studies published between 1981 and 2014 were found to include data on oral health and periodontal disease in cirrhotic patients. Studies indicated an increased incidence of periodontal disease in patients with liver cirrhosis, measured with several different periodontal indices. The reported prevalence of periodontal disease in cirrhosis patients ranged from 25.0% to 68.75% in four studies and apical periodontitis was found in 49%–79% of the patients. One study found that mortality was lower among patients who underwent dental treatment versus non-treated patients. Another study suggested an association between periodontal disease and the progression of liver cirrhosis, but data are sparse and conflicting as to whether periodontal disease is correlated to cirrhosis aetiology and severity. Conclusion: Despite the clinical reality of periodontal disease in liver cirrhosis patients, there are few published studies. Before clinical implications can be addressed, more data on the prevalence of and correlation between periodontal disease and liver cirrhosis aetiology, duration, and progression are needed. PMID:26770799

  12. Portal vein thrombosis in cirrhosis: Controversies and latest developments

    PubMed Central

    Harding, Damian J; Perera, M Thamara PR; Chen, Frederick; Olliff, Simon; Tripathi, Dhiraj

    2015-01-01

    Portal vein thrombosis (PVT) is encountered in liver cirrhosis, particularly in advanced disease. It has been a feared complication of cirrhosis, attributed to significant worsening of liver disease, poorer clinical outcomes and potential inoperability at liver transplantation; also catastrophic events such as acute intestinal ischaemia. Optimal management of PVT has not yet been addressed in any consensus publication. We review current literature on PVT in cirrhosis; its prevalence, pathophysiology, diagnosis, impact on the natural history of cirrhosis and liver transplantation, and management. Studies were identified by a search strategy using MEDLINE and Google Scholar. The incidence of PVT increases with increasing severity of liver disease: less than 1% in well-compensated cirrhosis, 7.4%-16% in advanced cirrhosis. Prevalence in patients undergoing liver transplantation is 5%-16%. PVT frequently regresses instead of uniform thrombus progression. PVT is not associated with increased risk of mortality. Optimal management has not been addressed in any consensus publication. We propose areas for future research to address unresolved clinical questions. PMID:26078553

  13. Reciprocal Relations of Protective Behavioral Strategies and Risk-Amplifying Behaviors with Alcohol-Related Consequences: Targets for Intervention with Female College Students

    ERIC Educational Resources Information Center

    Luebbe, Aaron M.; Varvel, Shiloh; Dude, Kim

    2009-01-01

    Transactional associations of protective behavioral strategies (PBS) and risk-amplifying behaviors (RAB) to alcohol-related negative consequences were tested. A sample of 138 undergraduate women was assessed with self-report measures at two time points four months apart. Over and above quantity and frequency of alcohol consumption, engagement in…

  14. Alcohol-Related Problems among Younger Drinkers Who Misuse Prescription Drugs: Results from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC)

    ERIC Educational Resources Information Center

    Hermos, J.; Winter, M.; Heeren, T.; Hingson, R.

    2009-01-01

    The authors determined whether lifetime prescription drug misuse (PDM) associated with increased risks for alcohol-related problems among 18- to 34-year-old, NESARC respondents. Among 8222 "ever-drinkers," 15.4% reported ever "misusing sedatives, tranquilizers, painkillers or stimulants ... as prescriptions or from indirect sources." Outcomes were…

  15. Socioeconomic Status and Alcohol-Related Behaviors in Mid- to Late Adolescence in the Avon Longitudinal Study of Parents and Children

    PubMed Central

    Kendler, Kenneth S; Gardner, Charles O; Hickman, Matt; Heron, Jon; Macleod, John; Lewis, Glyn; Dick, Danielle M

    2014-01-01

    Objective: Prior studies of the relationship between socioeconomic status (SES) and alcohol consumption and problems in adolescence have been inconclusive. Few studies have examined all three major SES indicators and a broad range of alcohol-related outcomes at different ages. Method: In the Avon Longitudinal Study of Parents and Children cohort, we examined (by logistic regression, with differential weighting to control for attrition) the relationship between family income and parental education and occupational status, and five alcohol outcomes assessed at ages 16 and 18 years. Results: At age 16, high SES—as indexed by income and education—significantly predicted frequent alcohol consumption. Low SES—as measured by education and occupational status—predicted alcohol-related problems. At age 18, high SES—particularly income and education—significantly predicted frequent alcohol consumption and heavy episodic drinking and, more weakly, symptoms of alcohol dependence. All three measures of SES were inversely related to high-quantity consumption and alcohol behavioral problems. Conclusions: In adolescents in the United Kingdom, the relationship between SES and alcohol-related behaviors is complex and varies as a function of age, SES measure, and specific outcome. High SES tends to predict increased consumption and, in later adolescence, heavy episodic drinking and perhaps symptoms of alcohol dependence. Low SES predicts alcohol-related behavioral problems and, in later adolescence, high-quantity alcohol consumption. PMID:24988252

  16. Preventing Alcohol-Related Problems on Campus: Methods for Assessing Student Use of Alcohol and Other Drugs. A Guide for Program Coordinators.

    ERIC Educational Resources Information Center

    DeJong, William; Wechsler, Henry

    Under the Drug-Free Schools and Campuses Act, institutions of higher education are required to review the effectiveness of their alcohol and drug prevention programs biannually. This guide offers a method for gathering and interpreting student survey data on alcohol-related problems based on the methodology of the College Alcohol Survey developed…

  17. Effects of Alcohol Tax Increases on Alcohol-Related Disease Mortality in Alaska: Time-Series Analyses From 1976 to 2004

    PubMed Central

    Maldonado-Molina, Mildred M.; Wagenaar, Bradley H.

    2009-01-01

    Objective. We evaluated the effects of tax increases on alcoholic beverages in 1983 and 2002 on alcohol-related disease mortality in Alaska. Methods. We used a quasi-experimental design with quarterly measures of mortality from 1976 though 2004, and we included other states for comparison. Our statistical approach combined an autoregressive integrated moving average model with structural parameters in interrupted time-series models. Results. We observed statistically significant reductions in the numbers and rates of deaths caused by alcohol-related disease beginning immediately after the 1983 and 2002 alcohol tax increases in Alaska. In terms of effect size, the reductions were –29% (Cohen's d = –0.57) and –11% (Cohen's d = –0.52) for the 2 tax increases. Statistical tests of temporary-effect models versus long-term-effect models showed little dissipation of the effect over time. Conclusions. Increases in alcohol excise tax rates were associated with immediate and sustained reductions in alcohol-related disease mortality in Alaska. Reductions in mortality occurred after 2 tax increases almost 20 years apart. Taxing alcoholic beverages is an effective public health strategy for reducing the burden of alcohol-related disease. PMID:19008507

  18. "Man-ing" up and getting drunk: the role of masculine norms, alcohol intoxication and alcohol-related problems among college men.

    PubMed

    Iwamoto, Derek Kenji; Cheng, Alice; Lee, Christina S; Takamatsu, Stephanie; Gordon, Derrick

    2011-09-01

    Compared to college women, college men face elevated risks for problematic drinking and negative alcohol-related consequences. These risks highlight the critical need to investigate gender issues and risk factors contributing to intoxication and related problems among men. Theoretical models suggest that conforming to masculine norms or the beliefs and expectations of what it means to be a man, may help explain patterns of problematic drinking among men. The current study advances the literature by investigating the association between masculine norms, drinking to intoxication, and alcohol-related consequences among 776 undergraduate males after taking into account the importance of fraternity status and perceived peer norms. Results indicate that fraternity status and higher perceived peer norms regarding drinking increased the risks of getting drunk and experiencing alcohol-related consequences. Specifically, the masculine norms of being a "playboy", risk-taking, and winning were risk factors of drinking to intoxication; while, being a "playboy", risk-taking, and self-reliance increased the risks of alcohol-related problems. Primacy of work and heterosexual presentation were two masculine norms that were protective of drinking to intoxication. Our findings contribute to important future considerations for prevention, clinical interventions, and public-health implications in college settings. PMID:21620570

  19. “Man-ing” up and Getting Drunk: The Role of Masculine Norms, Alcohol Intoxication and Alcohol-Related Problems among College Men

    PubMed Central

    Iwamoto, Derek Kenji; Cheng, Alice; Lee, Christina S.; Takamatsu, Stephanie; Gordon, Derrick

    2011-01-01

    Compared to college women, college men face elevated risks for problematic drinking and negative alcohol-related consequences. These risks highlight the critical need to investigate gender issues and risk factors contributing to intoxication and related problems among men. Theoretical models suggest that conforming to masculine norms or the beliefs and expectations of what it means to be a man, may help explain patterns of problematic drinking among men. The current study advances the literature by investigating the association between masculine norms, drinking to intoxication, and alcohol-related consequences among 776 undergraduate males after taking into account the importance of fraternity status and perceived peer norms. Results indicate that fraternity status and higher perceived peer norms regarding drinking increased the risks of getting drunk and experiencing alcohol-related consequences. Specifically, the masculine norms of being a “playboy”, risk-taking, and winning were risk factors of drinking to intoxication; while, being a “playboy”, risk-taking, and self-reliance increased the risks of alcohol-related problems. Primacy of work and heterosexual presentation were two masculine norms that were protective of drinking to intoxication. Our findings contribute to important future considerations for prevention, clinical interventions, and public-health implications in college settings. PMID:21620570

  20. Prevalence of excessive or problem drinkers among patients attending somatic outpatient clinics: a study of alcohol related medical care.

    PubMed Central

    Persson, J; Magnusson, P H

    1987-01-01

    The prevalence of alcohol related morbidity was studied among 2038 patients attending somatic outpatient clinics. A further 76 patients had refused the study, giving an overall drop out rate of 3.6%. Several methods were combined so as to detect as many patients with problem drinking as possible. According to the criteria and definitions employed 17% of men (confidence interval 15% to 19%) and 4% of women (confidence interval 3% to 5%) were excessive consumers of alcohol or problem drinkers. The highest proportion of such patients--that is, 17%--was noted in the emergency rooms (27% of men, 8% of women). At other clinics the proportions varied from 11% to 17% of men and from 2% to 4% of women. The strongest relations between overconsumption of alcohol and consultation at the clinic were among patients attending the medical outpatient clinic and the emergency rooms; in 86% (confidence interval 75% to 97%) and 88% (confidence interval 81% to 95%) of problem drinkers attending these clinics, respectively, alcohol was related to the consultation. Consultations were related to alcohol in 82% of women with excessive or problem drinking and 73% of men defined in this way. There was a tendency to a higher proportion of men with excessive or problem drinking in the age group 40-49 years. These findings show that among patients classified as excessive or problem drinkers attending somatic outpatient clinics there was a close relation between alcohol consumption and utilisation of medical resources, especially in women. PMID:3117173

  1. Effects of Acute Alcohol Consumption on the Processing of Emotion in Faces: Implications for Understanding Alcohol-Related Aggression

    PubMed Central

    Attwood, Angela S.; Munafò, Marcus R.

    2016-01-01

    The negative consequences of chronic alcohol abuse are well known, but heavy episodic consumption ("binge drinking") is also associated with significant personal and societal harms. Aggressive tendencies are increased after alcohol but the mechanisms underlying these changes are not fully understood. While effects on behavioural control are likely to be important, other effects may be involved given the widespread action of alcohol. Altered processing of social signals is associated with changes in social behaviours, including aggression, but until recently there has been little research investigating the effects of acute alcohol consumption on these outcomes. Recent work investigating the effects of acute alcohol on emotional face processing has suggested reduced sensitivity to submissive signals (sad faces) and increased perceptual bias towards provocative signals (angry faces) after alcohol consumption, which may play a role in alcohol-related aggression. Here we discuss a putative mechanism that may explain how alcohol consumption influences emotional processing and subsequent aggressive responding, via disruption of OFC-amygdala connectivity. While the importance of emotional processing on social behaviours is well established, research into acute alcohol consumption and emotional processing is still in its infancy. Further research is needed and we outline a research agenda to address gaps in the literature. PMID:24920135

  2. Procollagen III peptide and fibronectin in alcohol-related chronic liver disease: correlations with morphological features and biochemical tests.

    PubMed

    Gabrielli, G B; Faccioli, G; Casaril, M; Capra, F; Bonazzi, L; Falezza, G; Tomba, A; Baracchino, F; Corrocher, R

    1989-02-22

    In order to clarify the significance of procollagen III peptide (PIIIP) and fibronectin (FN) blood concentration in alcohol related chronic liver disease (ALD), we have investigated their relationships with histological liver features and biochemical liver tests in 44 ALD patients. PIIIP was measured in serum by radioimmunoassay whereas FN was determined in plasma using an immunonephelometric method. In each liver biopsy, steatosis, portal infiltrate, lobular necro-inflammation, portal fibrosis and lobular fibrosis were semiquantitatively assessed by scoring from 0 to 3. A close correlation of PIIIP was found with morphological features of fibrosis (both of lobular and portal type), but not with necro-inflammation or steatosis. PIIIP was also positively correlated with ALP and GGT and exhibited a good diagnostic value in liver fibrosis. On the contrary, FN did not distinguish between normals and patients and was not correlated with any morphological liver feature or biochemical liver test. We also conclude that serum NP3P effectively reflects liver fibrosis, whereas plasma FN seems not related to any of the main histological aspects of liver damage in ALD. PMID:2714004

  3. Alcohol Drinking Patterns and Differences in Alcohol-Related Harm: A Population-Based Study of the United States

    PubMed Central

    Antai, D.; Lopez, G. B.; Antai, J.; Anthony, D. S.

    2014-01-01

    Alcohol use and associated alcohol-related harm (ARH) are a prevalent and important public health problem, with alcohol representing about 4% of the global burden of disease. A discussion of ARH secondary to alcohol consumption necessitates a consideration of the amount of alcohol consumed and the drinking pattern. This study examined the association between alcohol drinking patterns and self-reported ARH. Pearson chi-square test (χ2) and logistic regression analyses were used on data from the National Comorbidity Survey Replication (NCS-R). The NCS-R is a cross-sectional nationally representative sample. Data was obtained by face-to-face interviews from 9282 adults aged ≥18 years in the full sample, and 5,692 respondents in a subsample of the full sample. Results presented as odds ratio (OR) and 95% confidence intervals (95% CI). Alcohol drinking patterns (frequency of drinking, and drinks per occasion) were associated with increased risks of self-reported ARH; binge or “risky” drinking was strongly predictive of ARH than other categories of drinks per occasion or frequency of drinking; and men had significantly higher likelihood of ARH in relation to frequency of drinking and drinks per occasion. Findings provide evidence for public health practitioners to target alcohol prevention strategies at the entire population of drinkers. PMID:25057502

  4. Demographic and Predeparture Factors Associated With Drinking and Alcohol-Related Consequences for College Students Completing Study Abroad Experiences

    PubMed Central

    Pedersen, Eric R.; Skidmore, Jessica R.; Aresi, Giovanni

    2014-01-01

    Objective: Study abroad students are at-risk for increased and problematic drinking behavior. As few efforts have been made to examine this at-risk population, we predicted drinking and alcohol-related consequences abroad from predeparture and site-specific factors. Participants: The sample consisted of 339 students completing study abroad programs. Method: Participants filled out online measures at predeparture, abroad, and at post-return. Results: We found drinking and consequences abroad were predicted by a number of factors including demographics (e.g., younger age, male sex, Greek affiliation, White ethnicity), student factors (e.g. low GPA, major area of study), study abroad site factors (e.g., apartment living abroad, study in Europe), predeparture levels of drinking and consequences, sensation seeking, and goals related to social gathering. Conclusions: Findings can be used to inform campus policies for admission to study abroad programs as well as assist in the development of interventions targeted toward preventing risk for students during abroad experiences. PMID:24499190

  5. Role of albumin in diseases associated with severe systemic inflammation: Pathophysiologic and clinical evidence in sepsis and in decompensated cirrhosis.

    PubMed

    Artigas, Antonio; Wernerman, Jan; Arroyo, Vicente; Vincent, Jean-Louis; Levy, Mitchell

    2016-06-01

    The metabolism of albumin in inflammatory states such as sepsis or major surgery is complex and still not well characterized. Nevertheless, in inflammatory states, albumin synthesis has been observed to increase. By contrast, in decompensated cirrhosis, a disease characterized by systemic inflammation, albumin synthesis by the liver may decrease to 30% to 50% of normal values. Furthermore, in these conditions, there are high capillary leakage and altered albumin kinetics. The discussion regarding the effect of exogenous albumin administration on intravascular volume in inflammatory states should therefore address albumin turnover. To add complexity to our understanding of the effects of albumin, there are many data indicating that the therapeutic action of albumin is mediated not only through the impact on plasma volume expansion but also through a modulatory effect on inflammation and oxidative stress. All these characteristics are relevant to diseases associated with systemic inflammation including sepsis and decompensated cirrhosis. PMID:26831575

  6. Liver Cirrhosis: Evaluation, Nutritional Status, and Prognosis.

    PubMed

    Nishikawa, Hiroki; Osaki, Yukio

    2015-01-01

    The liver is the major organ for the metabolism of three major nutrients: protein, fat, and carbohydrate. Chronic hepatitis C virus infection is the major cause of chronic liver disease. Liver cirrhosis (LC) results from different mechanisms of liver injury that lead to necroinflammation and fibrosis. LC has been seen to be not a single disease entity but one that can be graded into distinct clinical stages related to clinical outcome. Several noninvasive methods have been developed for assessing liver fibrosis and these methods have been used for predicting prognosis in patients with LC. On the other hand, subjects with LC often have protein-energy malnutrition (PEM) and poor physical activity. These conditions often result in sarcopenia, which is the loss of skeletal muscle volume and increased muscle weakness. Recent studies have demonstrated that PEM and sarcopenia are predictive factors for poorer survival in patients with LC. Based on these backgrounds, several methods for evaluating nutritional status in patients with chronic liver disease have been developed and they have been preferably used in the clinical field practice. In this review, we will summarize the current knowledge in the field of LC from the viewpoints of diagnostic method, nutritional status, and clinical outcomes. PMID:26494949

  7. [Pain management in patients with liver cirrhosis].

    PubMed

    Ojeda, Antonio; Moreno, Luis A

    2014-01-01

    Pain management in patients with liver cirrhosis is a real challenge and is often inadequate due to a lack of therapeutic efficacy or the high incidence of adverse effects. The focus of treatment differs depending on whether the pain is acute or chronic and involves understanding the causative pathophysiological mechanism. Analgesics should be started with the minimum effective dose and should be titrated slowly with avoidance of polypharmacy. Adverse effects must be monitored, especially sedation and constipation, which predispose the patient to the development of hepatic encephalopathy. The first-line drug is paracetamol, which is safe at doses of 2-3g/day. Non-steroidal anti-inflammatory agents are contraindicated because they can cause acute renal failure and/or gastrointestinal bleeding. Tramadol is a safe option for moderate-severe pain. The opioids with the best safety profile are fentanyl and hydromorphone, with methadone as an alternative. Topical treatment can reduce oral drug consumption. In neuropathic pain the first-line therapeutic option is gabapentin. The use of antidepressants such as amitriptyline can be considered in some patients. Interventional techniques are a valuable tool in moderate to severe pain, since they allow a reduction in drug therapy and consequently its adverse effects. Psychological treatment, physical therapy and rehabilitation should be considered as part of multimodality therapy in the management of chronic pain. PMID:24309482

  8. Liver Cirrhosis: Evaluation, Nutritional Status, and Prognosis

    PubMed Central

    Nishikawa, Hiroki; Osaki, Yukio

    2015-01-01

    The liver is the major organ for the metabolism of three major nutrients: protein, fat, and carbohydrate. Chronic hepatitis C virus infection is the major cause of chronic liver disease. Liver cirrhosis (LC) results from different mechanisms of liver injury that lead to necroinflammation and fibrosis. LC has been seen to be not a single disease entity but one that can be graded into distinct clinical stages related to clinical outcome. Several noninvasive methods have been developed for assessing liver fibrosis and these methods have been used for predicting prognosis in patients with LC. On the other hand, subjects with LC often have protein-energy malnutrition (PEM) and poor physical activity. These conditions often result in sarcopenia, which is the loss of skeletal muscle volume and increased muscle weakness. Recent studies have demonstrated that PEM and sarcopenia are predictive factors for poorer survival in patients with LC. Based on these backgrounds, several methods for evaluating nutritional status in patients with chronic liver disease have been developed and they have been preferably used in the clinical field practice. In this review, we will summarize the current knowledge in the field of LC from the viewpoints of diagnostic method, nutritional status, and clinical outcomes. PMID:26494949

  9. Management of varices in patients with cirrhosis.

    PubMed

    O'Brien, Julia; Triantos, Christos; Burroughs, Andrew K

    2013-07-01

    Variceal bleeding remains a life-threatening condition with a 6-week mortality rate of ∼20%. Prevention of variceal bleeding can be achieved using nonselective β-blockers (NSBBs) or endoscopic band ligation (EBL), with NSBBs as the first-line treatment. EBL should be reserved for cases of intolerance or contraindications to NSBBs. Although NSBBs cannot be used to prevent varices, if the hepatic venous pressure gradient (HVPG) is ≤10 mmHg, prognosis is excellent. Survival after acute variceal bleeding has improved over the past three decades, but patients with Child-Pugh grade C cirrhosis remain at greatest risk. Vasoactive drugs combined with endoscopic therapy and antibiotics are the best therapeutic strategy for these patients. Transjugular intrahepatic portosystemic shunts (TIPS) should be used in patients with uncontrolled bleeding or those who are likely to have difficult-to-control bleeding. Rebleeding from varices occurs in ∼60% of patients 1-2 years after the initial bleeding episode, with a mortality rate of 30%. Secondary prophylaxis should start at day 6 after initial bleeding using a combination of NSBBs and EBL. TIPS with polytetrafluoroethylene-covered stents are the preferred option in patients who fail combined treatment with NSBBs and EBL. Despite the improvement in patient survival, further studies are needed to direct the management of patients with gastro-oesophageal varices and variceal bleeding. PMID:23545523

  10. Plasma cysteine, cystine, and glutathione in cirrhosis.

    PubMed

    Chawla, R K; Lewis, F W; Kutner, M H; Bate, D M; Roy, R G; Rudman, D

    1984-10-01

    Plasma contains three forms of cyst(e)ine: cysteine, cystine, and protein-bound cysteine. The former is a thiol and the latter two are disulfides. The levels of all three types of cyst(e)ine, as well as the cysteinyl tripeptide glutathione, were measured in the plasma of 14 normal and 10 cirrhotic individuals. All subjects ate mixed foods. Some cirrhotic patients were studied during nasogastric hyperalimentation with Vivonex (Norwich Eaton Pharmaceuticals, Norwich, N.Y.) as well as during total parenteral nutrition with FreAmine III (American McGaw, Irvine, Calif.); neither formula contains cyst(e)ine. Regardless of the nature of the diet, cirrhotic patients had significantly subnormal values for cysteine, glutathione, and albumin. In addition, the following significant changes were found to be diet-dependent: (a) elevated methionine during Vivonex, (b) subnormal taurine during mixed foods and total parenteral nutrition, (c) depressed protein-bound cysteine during total parenteral nutrition, (d) depressed cyst(e)ine thiol/disulfide ratio during mixed foods, and (e) depressed total thiol during Vivonex and total parenteral nutrition. The data indicate multiple abnormalities in sulfur metabolism in cirrhosis. PMID:6468868

  11. “Let’s get Wasted!” and Other Apps: Characteristics, Acceptability, and Use of Alcohol-Related Smartphone Applications

    PubMed Central

    Weaver, Emma R; Horyniak, Danielle R; Jenkinson, Rebecca; Dietze, Paul

    2013-01-01

    Background Smartphone applications (“apps”) offer a number of possibilities for health promotion activities. However, young people may also be exposed to apps with incorrect or poor quality information, since, like the Internet, apps are mostly unregulated. Little is known about the quality of alcohol-related apps or what influence they may have on young people’s behavior. Objective To critically review popular alcohol-related smartphone apps and to explore young people’s opinions of these apps, their acceptability, and use for alcohol-related health promotion. Methods First, a content analysis of 500 smartphone apps available via Apple iTunes and Android Google Play stores was conducted. Second, all available blood alcohol concentration (BAC) apps were tested against four individual case profiles of known BAC from a previous study. Third, two focus group discussions explored how young people use alcohol-related apps, particularly BAC apps. Results 384 apps were included; 50% (192) were entertainment apps, 39% (148) were BAC apps, and 11% (44) were health promotion and/or stop drinking–related apps. When testing the BAC apps, there was wide variation in results, with apps tending to overestimate BAC scores compared with recorded scores. Participants were skeptical of the accuracy of BAC apps, and there was an overall concern that these apps would be used as a form of entertainment, further encouraging young people to drink, rather than reduce their drinking and risk taking. Conclusions The majority of popular alcohol-related apps encouraged alcohol consumption. Apps estimating blood alcohol concentration were widely available but were highly unreliable. Health departments and prominent health organizations need to endorse alcohol smartphone apps that are accurate and evidence-based to give specific apps credibility in the ever-expanding market of unregulated apps. PMID:25100681

  12. Gut microbiota and host metabolism in liver cirrhosis

    PubMed Central

    Usami, Makoto; Miyoshi, Makoto; Yamashita, Hayato

    2015-01-01

    The gut microbiota has the capacity to produce a diverse range of compounds that play a major role in regulating the activity of distal organs and the liver is strategically positioned downstream of the gut. Gut microbiota linked compounds such as short chain fatty acids, bile acids, choline metabolites, indole derivatives, vitamins, polyamines, lipids, neurotransmitters and neuroactive compounds, and hypothalamic-pituitary-adrenal axis hormones have many biological functions. This review focuses on the gut microbiota and host metabolism in liver cirrhosis. Dysbiosis in liver cirrhosis causes serious complications, such as bacteremia and hepatic encephalopathy, accompanied by small intestinal bacterial overgrowth and increased intestinal permeability. Gut dysbiosis in cirrhosis and intervention with probiotics and synbiotics in a clinical setting is reviewed and evaluated. Recent studies have revealed the relationship between gut microbiota and host metabolism in chronic metabolic liver disease, especially, non-alcoholic fatty liver disease, alcoholic liver disease, and with the gut microbiota metabolic interactions in dysbiosis related metabolic diseases such as diabetes and obesity. Recently, our understanding of the relationship between the gut and liver and how this regulates systemic metabolic changes in liver cirrhosis has increased. The serum lipid levels of phospholipids, free fatty acids, polyunsaturated fatty acids, especially, eicosapentaenoic acid, arachidonic acid, and docosahexaenoic acid have significant correlations with specific fecal flora in liver cirrhosis. Many clinical and experimental reports support the relationship between fatty acid metabolism and gut-microbiota. Various blood metabolome such as cytokines, amino acids, and vitamins are correlated with gut microbiota in probiotics-treated liver cirrhosis patients. The future evaluation of the gut-microbiota-liver metabolic network and the intervention of these relationships using probiotics

  13. Gut microbiota and host metabolism in liver cirrhosis.

    PubMed

    Usami, Makoto; Miyoshi, Makoto; Yamashita, Hayato

    2015-11-01

    The gut microbiota has the capacity to produce a diverse range of compounds that play a major role in regulating the activity of distal organs and the liver is strategically positioned downstream of the gut. Gut microbiota linked compounds such as short chain fatty acids, bile acids, choline metabolites, indole derivatives, vitamins, polyamines, lipids, neurotransmitters and neuroactive compounds, and hypothalamic-pituitary-adrenal axis hormones have many biological functions. This review focuses on the gut microbiota and host metabolism in liver cirrhosis. Dysbiosis in liver cirrhosis causes serious complications, such as bacteremia and hepatic encephalopathy, accompanied by small intestinal bacterial overgrowth and increased intestinal permeability. Gut dysbiosis in cirrhosis and intervention with probiotics and synbiotics in a clinical setting is reviewed and evaluated. Recent studies have revealed the relationship between gut microbiota and host metabolism in chronic metabolic liver disease, especially, non-alcoholic fatty liver disease, alcoholic liver disease, and with the gut microbiota metabolic interactions in dysbiosis related metabolic diseases such as diabetes and obesity. Recently, our understanding of the relationship between the gut and liver and how this regulates systemic metabolic changes in liver cirrhosis has increased. The serum lipid levels of phospholipids, free fatty acids, polyunsaturated fatty acids, especially, eicosapentaenoic acid, arachidonic acid, and docosahexaenoic acid have significant correlations with specific fecal flora in liver cirrhosis. Many clinical and experimental reports support the relationship between fatty acid metabolism and gut-microbiota. Various blood metabolome such as cytokines, amino acids, and vitamins are correlated with gut microbiota in probiotics-treated liver cirrhosis patients. The future evaluation of the gut-microbiota-liver metabolic network and the intervention of these relationships using probiotics

  14. Proteomic evidence of bacterial peptide translocation in afebrile patients with cirrhosis and ascites.

    PubMed

    Caño, Rocío; Llanos, Lucía; Zapater, Pedro; Pascual, Sonia; Bellot, Pablo; Barquero, Claudia; Pérez-Mateo, Miguel; Such, José; Francés, Rubén

    2010-05-01

    Bacterial translocation in patients with cirrhosis induces a marked proinflammatory activity that may be different against viable bacteria or bacterial products. The aim of this study is to identify new markers of bacterial translocation by investigating bacterial-driven peptides and correlate their presence with the inflammatory response. Patients with cirrhosis and ascites were included. An analysis by two-dimensional polyacrylamide gel electrophoresis of ascitic fluid total protein from patients (n = 47) and from frequently detected bacterial strains was performed. Two-dimensional maps were digitally compared. The identification of possible markers was performed by mass spectrometry. TNF-alpha, IFN-gamma, IL-12, nitric oxide, and proteins of the complement and lipopolysaccharide-binding protein levels were measured in ascitic fluid samples of patients by enzyme-linked immunosorbent assay. Patients were distributed according to the presence (group I, n = 16) and absence (group II, n = 31) of serum and ascitic fluid bacterial DNA. Among clinical and analytical differences between groups, only mean arterial pressure was significantly higher in patients from group II. Identified bacterial peptides were associated with bacterial protection against immune defenses and included glyceraldehyde-3-phosphate dehydrogenase A, Porin OmpC, and HSP60. Eight patients from group I also showed bacterial peptides, whereas none from group II did. All studied mediators of immune activation were significantly higher in patients with bacterial DNA than in patients without bacterial DNA. TNF-alpha, IFN-gamma, and proteins of the complement were significantly increased in patients with bacterial peptides versus those without bacterial peptides. Bacterial peptide translocation is present in the ascitic fluid of a subgroup of patients with advanced cirrhosis and is associated with an increased immune response. PMID:20087563

  15. Genome-wide polygenic scores for age at onset of alcohol dependence and association with alcohol-related measures.

    PubMed

    Kapoor, M; Chou, Y-L; Edenberg, H J; Foroud, T; Martin, N G; Madden, P A F; Wang, J C; Bertelsen, S; Wetherill, L; Brooks, A; Chan, G; Hesselbrock, V; Kuperman, S; Medland, S E; Montgomery, G; Tischfield, J; Whitfield, J B; Bierut, L J; Heath, A C; Bucholz, K K; Goate, A M; Agrawal, A

    2016-01-01

    Age at onset of alcohol dependence (AO-AD) is a defining feature of multiple drinking typologies. AO-AD is heritable and likely shares genetic liability with other aspects of alcohol consumption. We examine whether polygenic variation in AO-AD, based on a genome-wide association study (GWAS), was associated with AO-AD and other aspects of alcohol consumption in two independent samples. Genetic risk scores (GRS) were created based on AO-AD GWAS results from a discovery sample of 1788 regular drinkers from extended pedigrees from the Collaborative Study of the Genetics of Alcoholism (COGA). GRS were used to predict AO-AD, AD and Alcohol dependence symptom count (AD-SX), age at onset of intoxication (AO-I), as well as maxdrinks in regular drinking participants from two independent samples-the Study of Addictions: Genes and Environment (SAGE; n=2336) and an Australian sample (OZ-ALC; n=5816). GRS for AO-AD from COGA explained a modest but significant proportion of the variance in all alcohol-related phenotypes in SAGE. Despite including effect sizes associated with large numbers of single nucleotide polymorphisms (SNPs; >110 000), GRS explained, at most, 0.7% of the variance in these alcohol measures in this independent sample. In OZ-ALC, significant but even more modest associations were noted with variance estimates ranging from 0.03 to 0.16%. In conclusion, there is modest evidence that genetic variation in AO-AD is associated with liability to other aspects of alcohol involvement. PMID:27003187

  16. Childhood adversity moderates the effect of ADH1B on risk for alcohol-related phenotypes in Jewish Israeli drinkers.

    PubMed

    Meyers, Jacquelyn L; Shmulewitz, Dvora; Wall, Melanie M; Keyes, Katherine M; Aharonovich, Efrat; Spivak, Baruch; Weizman, Abraham; Frisch, Amos; Edenberg, Howard J; Gelernter, Joel; Grant, Bridget F; Hasin, Deborah

    2015-01-01

    Childhood adversity and genetic variant ADH1B-rs1229984 have each been shown to influence heavy alcohol consumption and disorders. However, little is known about how these factors jointly influence these outcomes. We assessed the main and additive interactive effects of childhood adversity (abuse, neglect and parental divorce) and the ADH1B-rs1229984 on the quantitative phenotypes 'maximum drinks in a day' (Maxdrinks) and DSM-Alcohol Use Disorder (AUD) severity, adjusting for demographic variables, in an Israeli sample of adult household residents (n = 1143) evaluated between 2007 and 2009. Childhood adversity and absence of the protective ADH1B-rs1229984 A allele were associated with greater mean Maxdrinks (mean differences: 1.50; 1.13, respectively) and AUD severity (mean ratios: 0.71; 0.27, respectively). In addition, childhood adversity moderated the ADH1B-rs1229984 effect on Maxdrinks (P < 0.01) and AUD severity (P < 0.05), in that there was a stronger effect of ADH1B-rs1229984 genotype on Maxdrinks and AUD severity among those who had experienced childhood adversity compared with those who had not. ADH1B-rs1229984 impacts alcohol metabolism. Therefore, among those at risk for greater consumption, e.g. those who experienced childhood adversity, ADH1B-rs1229984 appears to have a stronger effect on alcohol consumption and consequently on risk for AUD symptom severity. Evidence for the interaction of genetic vulnerability and early life adversity on alcohol-related phenotypes provides further insight into the complex relationships between genetic and environmental risk factors. PMID:24164917

  17. Genome-wide polygenic scores for age at onset of alcohol dependence and association with alcohol-related measures

    PubMed Central

    Kapoor, M; Chou, Y-L; Edenberg, H J; Foroud, T; Martin, N G; Madden, P A F; Wang, J C; Bertelsen, S; Wetherill, L; Brooks, A; Chan, G; Hesselbrock, V; Kuperman, S; Medland, S E; Montgomery, G; Tischfield, J; Whitfield, J B; Bierut, L J; Heath, A C; Bucholz, K K; Goate, A M; Agrawal, A

    2016-01-01

    Age at onset of alcohol dependence (AO-AD) is a defining feature of multiple drinking typologies. AO-AD is heritable and likely shares genetic liability with other aspects of alcohol consumption. We examine whether polygenic variation in AO-AD, based on a genome-wide association study (GWAS), was associated with AO-AD and other aspects of alcohol consumption in two independent samples. Genetic risk scores (GRS) were created based on AO-AD GWAS results from a discovery sample of 1788 regular drinkers from extended pedigrees from the Collaborative Study of the Genetics of Alcoholism (COGA). GRS were used to predict AO-AD, AD and Alcohol dependence symptom count (AD-SX), age at onset of intoxication (AO-I), as well as maxdrinks in regular drinking participants from two independent samples—the Study of Addictions: Genes and Environment (SAGE; n=2336) and an Australian sample (OZ-ALC; n=5816). GRS for AO-AD from COGA explained a modest but significant proportion of the variance in all alcohol-related phenotypes in SAGE. Despite including effect sizes associated with large numbers of single nucleotide polymorphisms (SNPs; >110 000), GRS explained, at most, 0.7% of the variance in these alcohol measures in this independent sample. In OZ-ALC, significant but even more modest associations were noted with variance estimates ranging from 0.03 to 0.16%. In conclusion, there is modest evidence that genetic variation in AO-AD is associated with liability to other aspects of alcohol involvement. PMID:27003187

  18. Childhood adversity moderates the effect of ADH1B on risk for alcohol-related phenotypes in Jewish Israeli drinkers

    PubMed Central

    Meyers, Jacquelyn L.; Shmulewitz, Dvora; Wall, Melanie M.; Keyes, Katherine M.; Aharonovich, Efrat; Spivak, Baruch; Weizman, Abraham; Frisch, Amos; Edenberg, Howard J.; Gelernter, Joel; Grant, Bridget F.; Hasin, Deborah

    2013-01-01

    Childhood adversity and genetic variant ADH1B-rs1229984 have each been shown to influence heavy alcohol consumption and disorders. However, little is known about how these factors jointly influence these outcomes. We assessed the main and additive interactive effects of childhood adversity (abuse, neglect, parental divorce) and the ADH1B-rs1229984 on the quantitative phenotypes “maximum drinks in a day” (Maxdrinks) and DSM-Alcohol Use Disorder (AUD) severity, adjusting for demographic variables, in an Israeli sample of adult household residents (n=1,143) evaluated between 2007–2009. Childhood adversity and absence of the protective ADH1B-rs1229984 A allele were associated with greater mean Maxdrinks [Mean Differences: 1.50; 1.13 respectively] and AUD severity [Mean Ratios: 0.71; 0.27 respectively]). In addition, childhood adversity moderated the ADH1B-rs1229984 effect on Maxdrinks (p<0.01) and AUD severity (p<0.05), in that there was a stronger effect of ADH1B-rs1229984 genotype on Maxdrinks and AUD severity among those who had experienced childhood adversity compared to those who had not. ADH1B-rs1229984 impacts alcohol metabolism. Therefore, among those at risk for greater consumption, e.g., those who experienced childhood adversity, ADH1B-rs1229984 appears to have a stronger effect on alcohol consumption and consequently on risk for AUD symptom severity. Evidence for the interaction of genetic vulnerability and early life adversity on alcohol-related phenotypes provides further insight into the complex relationships between genetic and environmental risk factors. PMID:24164917

  19. Utility of urinary ethyl glucuronide analysis in post-mortem toxicology when investigating alcohol-related deaths.

    PubMed

    Sundström, M; Jones, A W; Ojanperä, I

    2014-08-01

    Use and abuse of alcohol are common findings when unnatural deaths are investigated as evidenced by high blood- and urine- alcohol concentrations (BAC and UAC) at autopsy. Because ethanol is metabolized in the liver until the time of death, the autopsy BAC or UAC might be negative even though the deceased had consumed alcohol in the immediate ante-mortem period. Analysis of the non-oxidative metabolite of ethanol [ethyl glucuronide (EtG)] offers a more sensitive test of recent drinking. In this paper, we determined the concentrations of ethanol and EtG in urine samples from 972 consecutive forensic autopsies. In 425 cases (44%) both EtG and ethanol were positive, which supports ante-mortem drinking. In 342 cases (35%), both EtG and ethanol was negative, which speaks against any consumption of alcohol just before death. In 181 cases, ethanol was negative in urine (<0.2 g/kg), whereas EtG was positive (>0.5 mg/L), which points towards ingestion of alcohol some time before death. In these cases, mean and median concentrations of EtG were 53.2 mg/L and 23.7 mg/L, respectively, although there was no mention of alcohol on 131 of the death certificates. Alcohol was mentioned on death certificates as an underlying or immediate cause of death or a contributing factor in 435 (45%) cases, which rose to 566 (58%) cases when positive EtG results were included. This article demonstrates the usefulness of EtG analysis in routine post-mortem toxicology when ante-mortem drinking and alcohol-related deaths are investigated. PMID:24954799

  20. Depression in patients with chronic hepatitis B and cirrhosis is closely associated with the severity of liver cirrhosis

    PubMed Central

    ZHU, HAI-PENG; GU, YU-RONG; ZHANG, GENG-LIN; SU, YU-JIE; WANG, KE; ZHENG, YU-BAO; GAO, ZHI-LIANG

    2016-01-01

    Depression in patients with chronic hepatitis B (CHB) can affect the quality of life, disease diagnosis and case fatality rate. The aim of this study was to explore depression in patients with CHB and cirrhosis, and the effect of the severity of liver cirrhosis on the depressive emotional state. The depressive emotional state was investigated using the Hamilton Depression Scale (HAMD) and Hamilton Anxiety Scale (HAMA) in 114 patients with CHB and cirrhosis, comprising 42 cases classified as Child-Pugh grade (CPG)-A, 38 cases classified as CPG-B and 34 cases classified as CPG-C at a single hepatology center. Patients with mood disorders accounted for 33.33% of the 114 cases with CHB and liver cirrhosis and comprised 10 cases of CPG-A, 12 cases of CPG-B and 16 cases of CPG-C classification. The results shows that HAMA and HAMD scores of patients in the CPG-C group were significantly higher than those in the CPG-A group (P<0.01), but not significantly higher than those in the CPG-B group (P>0.05). The incidence rate of mood disorders in the CPG-C group was significantly higher than that in the CPG-B group (P=0.0336), and the incidence rate of mood disorders was higher in the CPG-B group compared with the CPG-A group, but the difference was not statistically significant (P=0.4370). The incidence rate of mood disorders in patients in the CPG-A group was significantly lower than that in the CPG-C group (P=0.0078). The study shows that a considerable proportion of patients with liver cirrhosis have mood disorders, and the depression rates of CHB-infected patients with liver cirrhosis are closely associated with the severity of the cirrhosis. PMID:27347069

  1. Management of HCV in cirrhosis-a rapidly evolving landscape.

    PubMed

    Sharma, Suraj A; Feld, Jordan J

    2015-05-01

    Despite the rapid progress in treatment, chronic hepatitis C virus (HCV) infection remains a growing cause of liver-related mortality globally. Patients who have been infected for decades are now presenting with advanced liver disease with the complications of cirrhosis and liver cancer. Early attempts at treatment with peginterferon and ribavirin were limited by toxicity, long treatment duration, and limited efficacy. This was especially relevant for patients with cirrhosis, where exposure to peginterferon-based therapy was relatively ineffective and led to high rates of toxicity. However, the recent development of multiple novel direct-acting antivirals (DAAs) has revolutionized the treatment of HCV. The majority of patients can now be cured with short courses of extremely well-tolerated all-oral regimens. However, the real test of these regimens comes in patients with more advanced liver disease, both in terms of safety and efficacy. Patients with cirrhosis have the greatest need for therapy and have traditionally been the most difficult to cure. The new therapies are rapidly changing this paradigm. Accumulating data suggest that high cure rates are achievable in patients with compensated cirrhosis and may even be possible in patients with signs of liver failure. This review will focus on the treatment of HCV in patients with cirrhosis, with an emphasis on the challenges that remain and strategies to deal with this important population. PMID:25896437

  2. The ischemic liver cirrhosis theory and its clinical implications.

    PubMed

    Mancuso, Andrea

    2016-09-01

    The canonical pathway theory of cirrhosis addresses inflammation as the main driver of hepatic fibrogenesis in hepatitis, so needing a further hypothesis for etiologies missing inflammation, for which parenchymal extinction is postulated. The present paper reports an alternative hypothesis suggesting a central role of micro-vascular ischemia in fibrogenesis and cirrhosis development, whatever is the aetiology of liver chronic injury. In fact, since chronic liver injury could finally result in endothelial damage and micro-vascular thrombosis, leading to a trigger of inappropriate hepatocyte proliferation and fibrosis, finally cirrhosis development could arise from chronic micro-vascular ischemia. Recently, some important confirmation of this hypothesis has been reported. In fact, in a murine experimental model of congestive hepatopathy, it was found that chronic hepatic congestion leads to sinusoidal thrombosis and strain, which in turn promote hepatic fibrosis. Furthermore, a study on a murine model of cirrhosis reported enoxaparin to reduce hepatic vascular resistance and portal pressure by having a protective role against fibrogenesis. In conclusion, the hypothesis giving a central role of micro-vascular ischemia in fibrogenesis and cirrhosis development could change the clinical scenario of chronic liver disease and have several main implications on management of various liver disease. PMID:27515188

  3. Itch in primary biliary cirrhosis: a patients' perspective.

    PubMed

    Rishe, Eric; Azarm, Ali; Bergasa, Nora V

    2008-01-01

    The perception of itch in primary biliary cirrhosis (PBC) is not characterized. Patients with primary biliary cirrhosis who were members of the PBCers Organization were invited to participate in an on-line survey addressing certain characteristics of their itch. Patients used their own words in the questions that asked for descriptions. A total of 238 subjects responded to the survey; of these, 231 were women, and 165 (69%) reported itch. One hundred and twenty-four patients from the 165 (75%) reported that itch preceded the diagnosis of primary biliary cirrhosis. A total of 58 from 164 (35%) respondents described their itch as "bugs crawling". Fifty-seven of 88 (64.7%) subjects reported that something cool relieved their itch, and 69 of 112 (61.6%) reported that heat worsened it. One hundred and seven of 164 (65.2%) respondents reported that the itch was worse at night. The most commonly prescribed medications were antihistamines and cholestyramine, and the most common type of medication reported as being associated with relief was antihistamine drugs. There was no systematic approach to the evaluation and treatment of itch in patients with primary biliary cirrhosis. Education on the subject of itch in primary biliary cirrhosis is warranted. PMID:18176748

  4. Frequency of gastroesophageal reflux in patients with liver cirrhosis.

    PubMed

    Ahmed, A M; al Karawi, M A; Shariq, S; Mohamed, A E

    1993-10-01

    Twenty-five adult patients with liver cirrhosis, and another 30 patients with no liver disease but referred with symptoms suggestive of gastroesophageal reflux disease were selected at random. Twenty-four hour ambulatory intra-esophageal pH measurement and upper gastrointestinal endoscopy were carried out on all patients recruited. Applying the former test, 16 (64%) of the patients with liver cirrhosis have gastroesophageal reflux disease. This figure is comparable with the 70% (21/30) rate recorded in the group of dyspeptic patients clinically thought to have the disorder. A positive endoscopic diagnosis was much lower at 12% and 23%, respectively. No significant differences were observed among liver disease patients when they were subdivided in accordance with the etiology of liver cirrhosis and the grade of esophageal varices. We conclude that gastroesophageal reflux disease occurs at a high frequency (64%) in patients with liver cirrhosis and portal hypertension, irrespective of the etiology of cirrhosis and the grade of esophageal varices. It is therefore considered to be the main cause of esophagitis in these patients, and that it might play a role in initiating a variceal bleeding episode. The latter hypothesis needs further evaluation. PMID:8270239

  5. Prediction of liver cirrhosis, using diagnostic imaging tools

    PubMed Central

    Yeom, Suk Keu; Lee, Chang Hee; Cha, Sang Hoon; Park, Cheol Min

    2015-01-01

    Early diagnosis of liver cirrhosis is important. Ultrasound-guided liver biopsy is the gold standard for diagnosis of liver cirrhosis. However, its invasiveness and sampling bias limit the applicability of the method. Basic imaging for the diagnosis of liver cirrhosis has developed over the last few decades, enabling early detection of morphological changes of the liver by ultrasonography (US), computed tomography, and magnetic resonance imaging (MRI). They are also accurate diagnostic methods for advanced liver cirrhosis, for which early diagnosis is difficult. There are a number of ways to compensate for this difficulty, including texture analysis to more closely identify the homogeneity of hepatic parenchyma, elastography to measure the stiffness and elasticity of the liver, and perfusion studies to determine the blood flow volume, transit time, and velocity. Amongst these methods, elastography using US and MRI was found to be slightly easier, faster, and able to provide an accurate diagnosis. Early diagnosis of liver cirrhosis using MRI or US elastography is therefore a realistic alternative, but further research is still needed. PMID:26301049

  6. Cirrhosis Classification Based on Texture Classification of Random Features

    PubMed Central

    Shao, Ying; Guo, Dongmei; Zheng, Yuanjie; Zhao, Zuowei; Qiu, Tianshuang

    2014-01-01

    Accurate staging of hepatic cirrhosis is important in investigating the cause and slowing down the effects of cirrhosis. Computer-aided diagnosis (CAD) can provide doctors with an alternative second opinion and assist them to make a specific treatment with accurate cirrhosis stage. MRI has many advantages, including high resolution for soft tissue, no radiation, and multiparameters imaging modalities. So in this paper, multisequences MRIs, including T1-weighted, T2-weighted, arterial, portal venous, and equilibrium phase, are applied. However, CAD does not meet the clinical needs of cirrhosis and few researchers are concerned with it at present. Cirrhosis is characterized by the presence of widespread fibrosis and regenerative nodules in the hepatic, leading to different texture patterns of different stages. So, extracting texture feature is the primary task. Compared with typical gray level cooccurrence matrix (GLCM) features, texture classification from random features provides an effective way, and we adopt it and propose CCTCRF for triple classification (normal, early, and middle and advanced stage). CCTCRF does not need strong assumptions except the sparse character of image, contains sufficient texture information, includes concise and effective process, and makes case decision with high accuracy. Experimental results also illustrate the satisfying performance and they are also compared with typical NN with GLCM. PMID:24707317

  7. Bone Marrow–Derived Stromal Cell Therapy in Cirrhosis: Clinical Evidence, Cellular Mechanisms, and Implications for the Treatment of Hepatocellular Carcinoma

    SciTech Connect

    Vainshtein, Jeffrey M.; Kabarriti, Rafi; Mehta, Keyur J.; Roy-Chowdhury, Jayanta; Guha, Chandan

    2014-07-15

    Current treatment options for hepatocellular carcinoma (HCC) are often limited by the presence of underlying liver disease. In patients with liver cirrhosis, surgery, chemotherapy, and radiation therapy all carry a high risk of hepatic complications, ranging from ascites to fulminant liver failure. For patients receiving radiation therapy, cirrhosis dramatically reduces the already limited radiation tolerance of the liver and represents the most important clinical risk factor for the development of radiation-induced liver disease. Although improvements in conformal radiation delivery techniques have improved our ability to safely irradiate confined areas of the liver to increasingly higher doses with excellent local disease control, patients with moderate-to-severe liver cirrhosis continue to face a shortage of treatment options for HCC. In recent years, evidence has emerged supporting the use of bone marrow–derived stromal cells (BMSCs) as a promising treatment for liver cirrhosis, with several clinical studies demonstrating sustained improvement in clinical parameters of liver function after autologous BMSC infusion. Three predominant populations of BMSCs, namely hematopoietic stem cells, mesenchymal stem cells, and endothelial progenitor cells, seem to have therapeutic potential in liver injury and cirrhosis. Preclinical studies of BMSC transplantation have identified a range of mechanisms through which these cells mediate their therapeutic effects, including hepatocyte transdifferentiation and fusion, paracrine stimulation of hepatocyte proliferation, inhibition of activated hepatic stellate cells, enhancement of fibrolytic matrix metalloproteinase activity, and neovascularization of regenerating liver. By bolstering liver function in patients with underlying Child's B or C cirrhosis, autologous BMSC infusion holds great promise as a therapy to improve the safety, efficacy, and utility of surgery, chemotherapy, and hepatic radiation therapy in the treatment

  8. Factors predicting early postoperative liver cirrhosis-related complications after lung cancer surgery in patients with liver cirrhosis.

    PubMed

    Iwata, Takashi; Inoue, Kiyotoshi; Nishiyama, Noritoshi; Nagano, Koshi; Izumi, Nobuhiro; Tsukioka, Takuma; Hanada, Shoji; Suehiro, Shigefumi

    2007-12-01

    We aimed to determine the factors predicting liver cirrhosis-related complications in the early postoperative period after lung cancer surgery in patients with liver cirrhosis. We retrospectively reviewed the medical records of patients who underwent curative surgery for primary lung cancer in our institute from January 1990 to March 2007, finding 37 cases with comorbid liver cirrhosis. These patients were divided into two groups, according to whether liver failure, bleeding, and critical infection had occurred postoperatively. Various clinical parameters were analyzed statistically between the bigeminal groups. Liver cirrhosis-related complications occurred in seven of the 37 patients (18.9%). Transient liver failure occurred in two patients (5.4%) after pulmonary resection. Acute intrathoracic bleeding occurred in four cases (10.8%). Two patients died (5.4%) in both cases due to sepsis. Preoperative total bilirubin (P<0.05), and indocyanine green retention rate at 15 min (P<0.05) were significantly higher in patients with liver failure. Only serum value of total bilirubin was an independent risk factor (P<0.05) by multivariate analysis. In predicting death from infection, only preoperative nutritional status was a significant risk factor (P<0.05). To avoid postoperative cirrhosis-related complications, preoperative preparation to improve their liver function and nutrition status is essential. PMID:17766277

  9. Variations of pharmacokinetics of drugs in patients with cirrhosis.

    PubMed

    Pena, M A; Horga, J F; Zapater, P

    2016-01-01

    Liver cirrhosis is the end stage of many different chronic liver diseases and is becoming an important cause of mortality and morbidity across the world. In theory, the numerous physiopathological changes suffered by these patients warrant relevant pharmacokinetic changes in most drugs. However, the influence of these changes on the efficacy and toxicity responses of patients with cirrhosis have been evaluated by few clinical trials and observational studies. As a consequence, therapeutic decisions in these patients are usually complex and subject to uncertainties. In this article, we review the regulatory guidelines to study responses to drugs according to pharmacokinetic variability and the published information that is useful for guiding the dosage adjustment of frequently used drugs in patients with cirrhosis (antivirals, antibiotics, analgesics, etc.) to obtain the best risk-benefit ratio. PMID:26696448

  10. Prekallikein and kallikrein inhibitor in liver cirrhosis and hepatitis.

    PubMed

    Faciullacci, M; Galli, P; Monetti, M G; Pela, I; Del Bianco, P L

    1976-01-01

    Plasma prekallikrein (kallikreinogen) and kallikrein inhibitor, assayed with the kaolin activable esterase method, have been evaluated in 20 patients with hepatic cirrhosis, in 12 cases with jaundice from acute viral hepatitis, and in 9 normal. A significant reduction of the plasma prekallikrein in cirrhosis has been found. A lowering of plasma prekallikrein has also been observed in viral hepatitis; in this condition, however, the modifications were less important than those obtained in cirrhosis. In three cases of hepatitis, the behaviour of the plasma prekallikrein and kallikrein inhibitor have been controlled during the period of the disease and compared with the behaviour of some conventional parameters, such as serum transaminases and bilirubin. An important increase of the prekallikrein level has been observed during the improvement of hepatitis. These data confirm the implication of the prekallikrein-kallikrein system in severe liver diseases, and indirectly points out the role of the liver in maintaining the physiological balance of the kallikrein system. PMID:1084679

  11. Alcohol availability and cirrhosis mortality rates by gender and race.

    PubMed Central

    Colón, I

    1981-01-01

    This study test whether the availability of alcoholic beverages is a simple integrated dimension as implied by certain policy models and in its treatment by researchers. Factor analysis reveals two independent availability factors: on-premise and retail availability. A correlation analysis found that on-premise availability was related to cirrhosis mortality rates for the total population, White males, non-White males, and White females. It was not related to non-White female cirrhosis mortality. In contrast, retail availability was not related to any of cirrhosis mortality rates. Examination of the states with extremes of high and low on-premise availability indicates that this type of availability is not a manipulable control variable but an index of extant norms toward drinking. It is recommended that differential prevention strategies be adopted rather than a uniform policy prevention model. PMID:7315996

  12. [Management of decompensated liver cirrhosis in the intensive care unit].

    PubMed

    Lerschmacher, O; Koch, A; Streetz, K; Trautwein, C; Tacke, F

    2013-11-01

    Liver cirrhosis is the end-stage of long-standing chronic liver diseases. The occurrence of complications from liver cirrhosis increases the mortality risk, but the prognosis can be improved by optimal management in the intensive care unit (ICU). Defined diagnostic algorithms allow the etiology and presence of typical complications upon presentation to the ICU to be identified. Acute variceal bleeding requires endoscopic intervention, vasoactive drugs, antibiotics, supportive intensive care measures and, where necessary, urgent transjugular intrahepatic portosystemic shunt (TIPS) procedure. Spontaneous bacterial peritonitis needs to be diagnosed and immediately treated in patients with ascites. Hepatorenal syndrome should be treated by albumin and terlipressin. In case of respiratory failure, differential diagnosis should not only consider pneumonia, pulmonary embolism and cardiac failure, but also hepatic hydrothorax, portopulmonary hypertension and hepatopulmonary syndrome. The feasibility of liver transplantation should be always discussed in patients with decompensated cirrhosis. Artificial liver support devices may only serve as a bridging procedure until transplant. PMID:24030843

  13. Management before hepatectomy for hepatocellular carcinoma with cirrhosis

    PubMed Central

    Nakayama, Hisashi; Takayama, Tadatoshi

    2015-01-01

    The global distribution of hepatocellular carcinoma (HCC) varies markedly among regions, and patients in East Asia and Central Africa account for about 80% of all cases. The risk factors are hepatitis B, hepatitis C, alcohol, and etc. The risk of carcinogenesis further increases with progression to hepatic cirrhosis in all liver disorders. Radical treatment of HCC by liver resection without causing liver failure has been established as a safe approach through selection of an appropriate range of resection of the damaged liver. This background indicates that both evaluation of hepatic functional reserve and measures against concomitant diseases such as thrombocytopenia accompanying portal hypertension, prevention of rupture of esophageal varices, reliable control of ascites, and improvement of hypoalbuminemia are important issues in liver resection in patients with hepatic cirrhosis. We review the latest information on perioperative management of liver resection in HCC patients with hepatic cirrhosis. PMID:26380653

  14. Urine Monocyte Chemoattractant Protein-1 Is an Independent Predictive Factor of Hospital Readmission and Survival in Cirrhosis

    PubMed Central

    Graupera, Isabel; Solà, Elsa; Fabrellas, Núria; Moreira, Rebeca; Solé, Cristina; Huelin, Patricia; de la Prada, Gloria; Pose, Elisa; Ariza, Xavier; Risso, Alessandro; Albertos, Sonia; Morales-Ruiz, Manuel; Jiménez, Wladimiro; Ginès, Pere

    2016-01-01

    MCP-1 (monocyte chemoattractant protein-1) is a proinflammatory cytokine involved in chemotaxis of monocytes. In several diseases, such as acute coronary syndromes and heart failure, elevated MCP-1 levels have been associated with poor outcomes. Little is known about MCP-1 in cirrhosis. AIM: To investigate the relationship between MCP-1 and outcome in decompensated cirrhosis. METHODS: Prospective study of 218 patients discharged from hospital after an admission for complications of cirrhosis. Urine and plasma levels of MCP-1 and other urine proinflammatroy biomarkers: osteopontin(OPN), trefoil-factor3 and liver-fatty-acid-binding protein were measured at admission. Urine non-inflammatory mediators cystatin-C, β2microglobulin and albumin were measured as control biomarkers. The relationship between these biomarkers and the 3-month hospital readmission, complications of cirrhosis, and mortality were assessed. RESULTS: 69 patients(32%) had at least one readmission during the 3-month period of follow-up and 30 patients died(14%). Urine MCP-1 and OPN levels, were associated with 3-month probability of readmission (0.85 (0.27–2.1) and 2003 (705–4586) ug/g creat vs 0.47 (0.2–1.1) and 1188 (512–2958) ug/g creat, in patients with and without readmission, respectively; p<0.05; median (IQR)). Furthermore, urine levels of MCP-1 were significantly associated with mortality (1.01 (1–3.6) vs 0.5 (0.2–1.1) μg/g creat, in dead and alive patients at 3 months; p<0.05). Patients with higher levels of urine MCP-1 (above percentile 75th) had higher probability of development of hepatic encephalopathy, bacterial infections or AKI. Urine MCP-1 was an independent predictive factor of hospital readmission and combined end-point of readmission or dead at 3 months. Plasma levels of MCP-1 did not correlated with outcomes. CONCLUSION: Urine, but not plasma, MCP-1 levels are associated with hospital readmission, development of complications of cirrhosis, and mortality. These

  15. Clinical relevance of sarcopenia in patients with cirrhosis

    PubMed Central

    Montano-Loza, Aldo J

    2014-01-01

    The most commonly recognized complications in cirrhotic patients include ascites, hepatic encephalopathy, variceal bleeding, susceptibility for infections, kidney dysfunction, and hepatocellular carcinoma; however, severe muscle wasting or sarcopenia are the most common and frequently unseen complications which negatively impact survival, quality of life, and response to stressor, such as infections and surgeries. At present, D’Amico stage classification, Child-Pugh, and MELD scores constitute the best tools to predict mortality in patients with cirrhosis; however, one of their main limitations is the lack of assessing the nutritional and functional status. Currently, numerous methods are available to evaluate the nutrition status of the cirrhotic patient; nevertheless, most of these techniques have limitations primarily because lack of objectivity, reproducibility, and prognosis discrimination. In this regard, an objective and reproducible technique, such as muscle mass quantification with cross-sectional imaging studies (computed tomography scan or magnetic resonance imaging) constitute an attractive index of nutritional status in cirrhosis. Sarcopenia is part of the frailty complex present in cirrhotic patients, resulting from cumulative declines across multiple physiologic systems and characterized by impaired functional capacity, decreased reserve, resistance to stressors, and predisposition to poor outcomes. In this review, we discuss the current accepted and new methods to evaluate prognosis in cirrhosis. Also, we analyze the current knowledge regarding incidence and clinical impact of malnutrition and sarcopenia in patients with cirrhosis and their impact after liver transplantation. Finally, we discuss existing and potential novel therapeutic approaches for malnutrition in cirrhosis, emphasizing the recognition of sarcopenia in an effort to reduced morbidity related and improved survival in cirrhosis. PMID:25009378

  16. Evidence-based clinical practice guidelines for liver cirrhosis 2015.

    PubMed

    Fukui, Hiroshi; Saito, Hidetsugu; Ueno, Yoshiyuki; Uto, Hirofumi; Obara, Katsutoshi; Sakaida, Isao; Shibuya, Akitaka; Seike, Masataka; Nagoshi, Sumiko; Segawa, Makoto; Tsubouchi, Hirohito; Moriwaki, Hisataka; Kato, Akinobu; Hashimoto, Etsuko; Michitaka, Kojiro; Murawaki, Toshikazu; Sugano, Kentaro; Watanabe, Mamoru; Shimosegawa, Tooru

    2016-07-01

    The Japanese Society of Gastroenterology revised the evidence-based clinical practice guidelines for liver cirrhosis in 2015. Eighty-three clinical questions were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. Manual searching of the latest important literature was added until August 2015. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This digest version in English introduces selected clinical questions and statements related to the management of liver cirrhosis and its complications. Branched-chain amino acids relieve hypoalbuminemia and hepatic encephalopathy and improve quality of life. Nucleoside analogues and peginterferon plus ribavirin combination therapy improve the prognosis of patients with hepatitis B virus related liver cirrhosis and hepatitis C related compensated liver cirrhosis, respectively, although the latter therapy may be replaced by direct-acting antivirals. For liver cirrhosis caused by primary biliary cirrhosis and active autoimmune hepatitis, urosodeoxycholic acid and steroid are recommended, respectively. The most adequate modalities for the management of variceal bleeding are the endoscopic injection sclerotherapy for esophageal varices and the balloon-occluded retrograde transvenous obliteration following endoscopic obturation with cyanoacrylate for gastric varices. Beta-blockers are useful for primary prophylaxis of esophageal variceal bleeding. The V2 receptor antagonist tolvaptan is a useful add-on therapy in careful diuretic therapy for ascites. Albumin infusion is useful for the prevention of paracentesis-induced circulatory disturbance and renal failure. In addition to disaccharides, the nonabsorbable antibiotic rifaximin is useful for the management of encephalopathy. Anticoagulation therapy is proposed for

  17. [Critically ill patients with decompensated liver cirrhosis - New aspects and intensive care management].

    PubMed

    Maschmeier, Miriam; Hüsing, Anna; Schmidt, Hartmut; Kabar, Iyad

    2015-10-01

    The prevalence of liver cirrhosis in the German population is about 1 %. Clinically, compensated liver cirrhosis should be distinguished from decompensated cirrhosis with poor prognosis. Decompensated cirrhosis is defined by the occurrence of complications and consequences of portal hypertension (such as ascites, variceal bleeding, hepatic encephalopathy and hepatorenal syndrome) and progressive liver failure. Optimizing the management of these patients in the intensive care unit could essentially improve their outcome. PMID:26445254

  18. Vibrio vulnificus infection and liver cirrhosis: a potentially lethal combination.

    PubMed

    Nazir, Salik; Brown, Krysta; Shin, Ann Kyungwohn; Donato, Anthony A

    2016-01-01

    We present a case of a 40-year-old man with decompensated alcoholic liver cirrhosis presenting with atraumatic cellulitis of one extremity and severe sepsis that rapidly progressed to compartment syndrome despite broad-spectrum antibiotics. Local cultures following debridement revealed Vibrio vulnificus, and subsequent history revealed consumption of raw oysters 48 h before presentation. Our case points out the unique susceptibility of those with cirrhosis and elevated iron saturation to Vibrio septicaemia, as well as the rapidity and severity of the disease progression. PMID:27151052

  19. Noninvasive diagnosis of cirrhosis: A review of different imaging modalities

    PubMed Central

    De Robertis, Riccardo; D’Onofrio, Mirko; Demozzi, Emanuele; Crosara, Stefano; Canestrini, Stefano; Pozzi Mucelli, Roberto

    2014-01-01

    Progressive hepatic fibrosis can lead to cirrhosis, so its early detection is fundamental. Staging fibrosis is also critical for prognosis and management. The gold standard for these aims is liver biopsy, but it has several drawbacks, as it is invasive, expensive, has poor acceptance, is prone to inter observer variability and sampling errors, has poor repeatability, and has a risk of complications and mortality. Therefore, non-invasive imaging tests have been developed. This review mainly focuses on the role of transient elastography, acoustic radiation force impulse imaging, and magnetic resonance-based methods for the noninvasive diagnosis of cirrhosis. PMID:24966594

  20. Dealing with Alcohol-related problems in the Night-Time Economy: A Study Protocol for Mapping trends in harm and stakeholder views surrounding local community level interventions

    PubMed Central

    2011-01-01

    Background This project will provide a comprehensive investigation into the prevalence of alcohol-related harms and community attitudes in the context of community-based interventions being implemented to reduce harm in two regional centres of Australia. While considerable experimentation and innovation to address these harms has occurred in both Geelong and Newcastle, only limited ad-hoc documentation and analysis has been conducted on changes in the prevalence of harm as a consequence, leaving a considerable gap in terms of a systematic, evidence-based analysis of changes in harm over time and the need for further intervention. Similarly, little evidence has been reported regarding the views of key stakeholder groups, industry, government agencies, patrons or community regarding the need for, and the acceptability of, interventions to reduce harms. This project will aim to provide evidence regarding the impact and acceptability of local initiatives aimed at reducing alcohol-related harms. Methods/Design This study will gather existing police data (assault, property damage and drink driving offences), Emergency Department presentations and Ambulance attendance data. Further, the research team will conduct interviews with licensed venue patrons and collect observational data of licensed venues. Key informant interviews will assess expert knowledge from key industry and government stakeholders, and a community survey will assess community experiences and attitudes towards alcohol-related harm and harm-reduction strategies. Overall, the project will assess: the extent of alcohol-related harm in the context of harm-reduction interventions, and the need for and acceptability of further intervention. Discussion These findings will be used to improve evidence-based practice both nationally and internationally. Ethical Approval This project has been approved by Deakin University HREC. PMID:21682908

  1. Receptivity to and Recall of Alcohol Brand Appearances in U.S. Popular Music and Alcohol-Related Behaviors

    PubMed Central

    Primack, Brian A.; McClure, Auden; Li, Zhigang; Sargent, James D.

    2014-01-01

    Background The average U.S. adolescent is exposed to about 2.5 hours of popular music per day and 8 mentions of alcohol brands every day. Alcohol brand mentions may function as advertising whether or not they are sanctioned by the alcohol industry. Our study aimed to determine associations between adolescents' involvement with music containing alcohol brand mentions and alcohol-related behaviors. Methods In 2010–2011 we conducted a random-digit-dial survey using national U.S. land line and cell phone frames. Through screening interviews, we identified 6,466 eligible households with subjects between 15 to 23 years of age, of whom 3422 (52%) completed the telephone survey. Of these, 2541 opted to participate in a subsequent Web-based component. Independent variables included a composite score indicating owning and liking popular songs with alcohol brand mentions and correct recall of alcohol brands in songs. Outcome measures included ever having consumed a complete drink, ever bingeing, bingeing at least monthly, and having experienced problems from alcohol use. Results Among the 2541 participants, compared with those in the lowest tertile on the receptivity scale, those in the highest tertile had higher odds of having had a complete drink (OR=3.4; 95% CI=2.2, 5.2) after adjusting for age, sex, race/ethnicity, socioeconomic status, sensation seeking, friend alcohol use, and parent alcohol use. Compared with those who did not identify at least one alcohol brand correctly, those who did had over twice the odds of having had a complete drink (OR=2.1; 95% CI=1.2, 3.8) after adjusting for all covariates. Results were also significant for the outcome of ever bingeing but not for bingeing at least monthly or having had problems due to drinking. Conclusions In a national sample of U.S. adolescents and young adults, there were independent associations between involvement with popular music containing alcohol brand mentions and both having ever had a complete drink and

  2. Sleep Disturbances in Individuals with Alcohol-Related Disorders: A Review of Cognitive-Behavioral Therapy for Insomnia (CBT-I) and Associated Non-Pharmacological Therapies

    PubMed Central

    Brooks, Alyssa T; Wallen, Gwenyth R

    2014-01-01

    Sleep disturbances are common among alcohol-dependent individuals and are often associated with relapse. The utility of behavioral therapies for sleep disturbances, including cognitive-behavioral therapy for insomnia (CBT-I), among those with alcohol-related disorders is not well understood. This review systematically evaluates the evidence of CBT-I and related behavioral therapies applied to those with alcohol-related disorders and accompanying sleep disturbances. A search of four research databases (PubMed, PsycINFO, Embase, and CINAHL Plus) yielded six studies that met selection criteria. Articles were reviewed using Cochrane’s Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) scoring system. A majority of the studies demonstrated significant improvements in sleep efficiency among behavioral therapy treatment group(s), including but not limited to CBT-I. While behavioral sleep interventions have been successful in varied populations, they may not be utilized to their full potential among those with alcohol-related disorders as evidenced by the low number of studies found. These findings suggest a need for mixed-methods research on individuals’ sleep experience to inform interventions that are acceptable to the target population. PMID:25288884

  3. Health professionals' alcohol-related professional practices and the relationship between their personal alcohol attitudes and behavior and professional practices: a systematic review.

    PubMed

    Bakhshi, Savita; While, Alison E

    2014-01-01

    Health professionals' personal health behaviors have been found to be associated with their practices with patients in areas such as smoking, physical activity and weight management, but little is known in relation to alcohol use. This review has two related strands and aims to: (1) examine health professionals' alcohol-related health promotion practices; and (2) explore the relationship between health professionals' personal alcohol attitudes and behaviors, and their professional alcohol-related health promotion practices. A comprehensive literature search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, British Nursing Index, Web of Science, Scopus and Science Direct (2007-2013) identified 26 studies that met the inclusion criteria for Strand 1, out of which six were analyzed for Strand 2. The findings indicate that health professionals use a range of methods to aid patients who are high-risk alcohol users. Positive associations were reported between health professionals' alcohol-related health promotion activities and their personal attitudes towards alcohol (n = 2), and their personal alcohol use (n = 2). The findings have some important implications for professional education. Future research should focus on conducting well-designed studies with larger samples to enable us to draw firm conclusions and develop the evidence base. PMID:24366045

  4. Health Professionals’ Alcohol-Related Professional Practices and the Relationship between Their Personal Alcohol Attitudes and Behavior and Professional Practices: A Systematic Review

    PubMed Central

    Bakhshi, Savita; While, Alison E.

    2013-01-01

    Health professionals’ personal health behaviors have been found to be associated with their practices with patients in areas such as smoking, physical activity and weight management, but little is known in relation to alcohol use. This review has two related strands and aims to: (1) examine health professionals’ alcohol-related health promotion practices; and (2) explore the relationship between health professionals’ personal alcohol attitudes and behaviors, and their professional alcohol-related health promotion practices. A comprehensive literature search of the Cochrane Library, MEDLINE, EMBASE, PsycINFO, CINAHL, British Nursing Index, Web of Science, Scopus and Science Direct (2007–2013) identified 26 studies that met the inclusion criteria for Strand 1, out of which six were analyzed for Strand 2. The findings indicate that health professionals use a range of methods to aid patients who are high-risk alcohol users. Positive associations were reported between health professionals’ alcohol-related health promotion activities and their personal attitudes towards alcohol (n = 2), and their personal alcohol use (n = 2). The findings have some important implications for professional education. Future research should focus on conducting well-designed studies with larger samples to enable us to draw firm conclusions and develop the evidence base. PMID:24366045

  5. The Roles of Negative Affect and Coping Motives in the Relationship Between Alcohol Use and Alcohol-Related Problems Among College Students

    PubMed Central

    Neighbors, Clayton; Lewis, Melissa A.; Lee, Christine M.; Oster-Aaland, Laura; Larimer, Mary E.

    2016-01-01

    Objective Although studies have consistently indicated that among college students alcohol use and the likelihood of experiencing alcohol-related problems are related it is possible that additional factors strengthen the magnitude of this relationship. The purpose of the present study was to assess the moderating effect of two such factors: negative affect and coping drinking motives. Method Data were collected on 316 college students at a midsized public university in the upper Midwest who reported using alcohol. Results Findings indicated that both negative affect and coping drinking motives moderated the alcohol use–alcohol problems relationship. The three-way interaction indicated that the strongest relationship between alcohol use and alcohol-related problems existed for individuals high in both negative affect and coping drinking motives. Conclusions This study suggests that college students high in negative affect and coping drinking motives are particularly at risk for experiencing problems as a result of their alcohol use, indicating that clinicians should consider screening for these factors when conducting alcohol-related prevention and intervention efforts. PMID:18432384

  6. Challenges and Management of Liver Cirrhosis: Practical Issues in the Therapy of Patients with Cirrhosis due to NAFLD and NASH.

    PubMed

    Traussnigg, Stefan; Kienbacher, Christian; Halilbasic, Emina; Rechling, Christian; Kazemi-Shirazi, Lili; Hofer, Harald; Munda, Petra; Trauner, Michael

    2015-01-01

    Nonalcoholic fatty liver disease (NAFLD) is the hepatic manifestation of the metabolic syndrome and comprises a liver disease spectrum ranging from steatosis to nonalcoholic steatohepatitis (NASH) with risk of progression to liver cirrhosis and hepatocellular carcinoma (HCC). Associated metabolic conditions and comorbidities such as obesity, diabetes and cardiovascular diseases are common and require concerted management. Adiponutrin (PNPLA3) variants may help to identify NAFLD patients at higher risk for liver disease progression towards advanced fibrosis and HCC. The therapeutic options in NAFLD/NASH include lifestyle modification, pharmacological treatment, bariatric surgery for patients with morbid obesity and treatment of complications of liver cirrhosis and HCC, including liver transplantation. Insulin sensitizers and antioxidative treatment strategies with vitamin E are among the best-established pharmacological approaches, but both drugs have long-term safety issues and there is limited evidence in cirrhotic patients. Treatment of concomitant/underlying metabolic conditions with statins or metformin may also have beneficial effects on portal hypertension, complications of liver cirrhosis and HCC prevention. The bile acid receptor FXR may be a promising novel therapeutic target for the treatment of NAFLD/NASH, fibrosis and portal hypertension, but the prognostic implications of associated changes in low- and high-density lipoprotein cholesterol require further studies. Morbidly obese NASH patients can benefit from bariatric surgery which may reduce liver fibrosis but carries a risk of decompensation in patients with advanced liver cirrhosis. When carefully selected, patients with NASH cirrhosis undergoing liver transplantation have a good outcome. This review summarizes recent progress in the management of patients with liver cirrhosis due to NASH. PMID:26159280

  7. Opportunities for prevention of alcohol-related death in primary care: results from a population-based cross-sectional study.

    PubMed

    Morris, Margaret; Johnson, David; Morrison, David S

    2012-11-01

    The mortality rate from alcohol-related conditions has risen sharply in the United Kingdom and it is not known whether opportunities for preventive interventions could be improved. The purpose of our study was to identify opportunities to detect, assess, and manage alcohol problems in primary care according to evidence-based guidelines. We carried out a cross-sectional study on patients who died from alcohol-related conditions in the calendar year 2003 within National Health Service Greater Glasgow Health Board area, Scotland (population 920,000). We described patient characteristics and care recorded in health service records, comparing it with best evidence-based practice in Scottish Intercollegiate Guidelines Network and Health Technology Board for Scotland recommendations on the management of harmful drinking and alcohol dependence. 501 deaths occurred from an alcohol-related cause. The mean age at death was 57.5 years and 72% were male. The most common causes of death, recorded by the International Classification of Diseases, revision 10, excluding accidents, were alcoholic liver disease (290, 57.9%) and mental and behavioural disorders due to alcohol (70, 14.0%). Lifetime mean consultations at primary care general practitioner and hospital outpatient departments were 24 in males and 5 in females. All individuals who died from an alcohol-related cause had at least one biochemical or physical indicator suggestive of alcohol misuse. 21% (95% CI 13-33%) had no record of having been advised to abstain from alcohol and 23% (95% CI 15-35%) had received brief interventions. 58% (95% CI 46-70%) had been referred to specialist alcohol services but a third of them did not attend. The majority of patients (83%, 95% CI 72-90%) had no evidence of shared health service and social work care. We concluded that individuals who died from alcohol-related conditions were usually in contact with statutory and voluntary services but further efforts were required to use these

  8. Guillain-Barré syndrome mimics primary biliary cirrhosis-related myopathy.

    PubMed

    Munday, William R; DiCapua, Daniel; Vortmeyer, Alexander; Gomez, Jose Luis

    2015-04-01

    Guillain-Barré syndrome (GBS) is an immune-mediated disorder characterized by acute polyneuropathy, ascending paralysis and post infectious polyneuritis. Two-thirds of patients present with a history of recent upper respiratory tract or gastrointestinal infection. The clinical history, neurologic examination and laboratory assessment allow for a straightforward diagnosis in the majority of cases. However, primary biliary cirrhosis (PBC) is known to cause clinically detectable muscular weakness. It is therefore critical to differentiate between PBC-associated muscular weakness and GBS-induced paralysis. Here, we report a patient with a longstanding history of PBC who developed progressive weakness and respiratory failure due to GBS, which clinically mimicked PBC myopathy. This is the first reported association between GBS and PBC. PMID:26634144

  9. The peritoneal macrophage inflammatory profile in cirrhosis depends on the alcoholic or hepatitis C viral etiology and is related to ERK phosphorylation

    PubMed Central

    2012-01-01

    macrophage inflammatory status is higher in ascites of alcohol-related cirrhotic patients than in HCV-related patients, which could be related with differences in bacterial translocation episodes or regulatory T cell populations. These findings should contribute to identifying potential prognostic and/or therapeutic targets for chronic liver diseases of different etiology. PMID:22866973

  10. Antitubercular therapy in patients with cirrhosis: Challenges and options

    PubMed Central

    Kumar, Naveen; Kedarisetty, Chandan Kumar; Kumar, Sachin; Khillan, Vikas; Sarin, Shiv Kumar

    2014-01-01

    Tuberculosis (TB) has been a human disease for centuries. Its frequency is increased manyfold in patients with liver cirrhosis. The gold standard of TB management is a 6-mo course of isoniazid, rifampicin, pyrazinamide and ethambutol. Although good results are seen with this treatment in general, the management of patients with underlying cirrhosis is a challenge. The underlying depressed immune response results in alterations in many diagnostic tests. The tests used for latent TB have many flaws in this group of patients. Three of four first-line antitubercular drugs are hepatotoxic and baseline liver function is often disrupted in patients with underlying cirrhosis. Frequency of hepatotoxicity is increased in patients with liver cirrhosis, frequently leading to severe liver failure. There are no established guidelines for the treatment of TB in relation to the severity of liver disease. There is no consensus on the frequency of liver function tests required or the cut-off used to define hepatotoxicity. No specific treatment exists for prevention or treatment of hepatotoxicity, making monitoring even more important. A high risk of multidrug-resistant TB is another major worry due to prolonged and interrupted treatment. PMID:24914337

  11. Mesenchymal stem cell therapy for cirrhosis: Present and future perspectives.

    PubMed

    Eom, Young Woo; Kim, Gaeun; Baik, Soon Koo

    2015-09-28

    Cirrhosis occurs as a result of various chronic liver injuries, which may be caused by viral infections, alcohol abuse and the administration of drugs and chemicals. Recently, bone marrow cells (BMCs), hematopoietic stem cells (HSCs) and mesenchymal stem cells (MSCs) have been used for developing treatments for cirrhosis. Clinical trials have investigated the therapeutic potential of BMCs, HSCs and MSCs for the treatment of cirrhosis based on their potential to differentiate into hepatocytes. Although the therapeutic mechanisms of BMC, HSC and MSC treatments are still not fully characterized, the evidence thus far has indicated that the potential therapeutic mechanisms of MSCs are clearer than those of BMCs or HSCs with respect to liver regenerative medicine. MSCs suppress inflammatory responses, reduce hepatocyte apoptosis, increase hepatocyte regeneration, reverse liver fibrosis and enhance liver functionality. This paper summarizes the clinical studies that have used BMCs, HSCs and MSCs in patients with liver failure or cirrhosis. We also present the potential therapeutic mechanisms of BMCs, HSCs and MSCs for the improvement of liver function. PMID:26420953

  12. Malnutrition in alcoholic and virus-related cirrhosis.

    PubMed

    Caregaro, L; Alberino, F; Amodio, P; Merkel, C; Bolognesi, M; Angeli, P; Gatta, A

    1996-04-01

    The study aimed to define the prevalence, characteristics, and clinical importance of nutritional disorders in patients with liver cirrhosis. Nutritional status was evaluated in 120 hospitalized patients--77 with alcoholic and 43 with virus-related cirrhosis--by anthropometric, visceral, and immunologic measurements. Energy malnutrition, defined as triceps skinfold thickness (TSF) and/or midarm muscle circumference (MAMC) below the 5th percentile of standard values, was found in 34% of the study population. Patients below the 5th percentile for MAMC and/or TSF showed significantly lower survival rates at e, 6, 12, and 24 mo compared with patients above the 5th percentile. Protein malnutrition (low albumin, transthyretin, transferrin, and retinol-binding-protein concentrations) and immunoincompetence (abnormal response to skin tests) were much more frequent (81% and 59%) than energy malnutrition (34%). Serum proteins correlated with the degree of liver function impairment, but not with immunologic tests. The prevalence, characteristics, and severity of protein-energy malnutrition were comparable in alcoholic and viral cirrhosis. Malnutrition was correlated with the clinical severity of the liver disease. The study shows that protein-energy malnutrition is a common complication of liver cirrhosis. Nutritional disorders appear to be related to the degree of liver injury rather than to its etiology. Compared with other methods, which have important limitations in liver disease, anthropometry is currently the most reliable method for nutritional assessment in clinical practice and may be valuable for predicting survival in cirrhotic patients. PMID:8599326

  13. The prognosis of liver cirrhosis in recent years in Korea.

    PubMed

    Kim, Young Sun; Um, Soon Ho; Ryu, Ho Sang; Lee, Jung Bok; Lee, Jae Won; Park, Dong Kyu; Kim, Yong Sik; Jin, Yoon Tae; Chun, Hoon Jai; Lee, Hong Sik; Lee, Sang Woo; Choi, Jai Hyun; Kim, Chang Duck; Hyun, Jin Hai

    2003-12-01

    The survival of a recent series of 823 cirrhosis patients who were followed up for a mean of 48 months was analyzed. Cirrhosis was ascribed to alcohol (26%), hepatitis virus B (58%), hepatitis virus C (11%) or both (2%), or was cryptogenic (3%). Features of decompensation were observed in 51% of the patients at entry, and newly developed in 44% of compensated patients within 5 yr. The 5-yr survival after decompensation was 25%. The leading causes of death were liver failure (53%), hepatocellular carcinoma (HCC, 23%), and variceal bleeding (10%). Early detection of HCC significantly improved the survival of cirrhosis patients. Biannual ultrasonography increased the detection rate of small HCC. Mortality of variceal hemorrhage was much lower in patients with Child-Pugh scores from 5 to 8 than in those with scores above 8 (5% vs. 52%). Endoscopic prophylaxis significantly decreased the incidence of first variceal hemorrhage, but the effect was insufficient to improve the rate of survival. Mortality of first spontaneous bacterial peritonitis was 18%. These data suggest that the mortality of major complications of liver cirrhosis has considerably decreased during the last two decades, while there was no remarkable improvement in long-term survival. More efficient management of etiologic factors would be required. PMID:14676440

  14. The Burden of Rehospitalization for Patients With Liver Cirrhosis.

    PubMed

    Desai, Archita P; Reau, Nancy

    2016-01-01

    Advanced liver disease is becoming more prevalent in the United States. This increase has been attributed largely to the growing epidemic of nonalcoholic fatty liver disease and an aging population infected with hepatitis C. Complications of cirrhosis are a major cause of hospital admissions and readmissions. It is important to target efforts for preventing rehospitalization toward patients with cirrhosis who are at the highest risk for readmission, such as those who have high Model for End-Stage Liver Disease scores, are at risk for fluid/electrolyte abnormalities or overt hepatic encephalopathy recurrence, and those who have comorbid conditions (e.g. diabetes). The heart failure management paradigm may provide valuable insights for managing patients with cirrhosis, given the extensive research on preventing hospital readmission and improving health care utilization in this subpopulation. As quality measures related to hospital readmissions for cirrhosis and its complications are adopted by the Centers for Medicare & Medicaid Services and private payers in the future, understanding drivers of hospital readmissions and health care utilization in this vulnerable population are key to improving quality measure performance. PMID:26782133

  15. Vitamin D deficiency in patients with liver cirrhosis.

    PubMed

    Konstantakis, Christos; Tselekouni, Paraskevi; Kalafateli, Maria; Triantos, Christos

    2016-01-01

    There is ongoing evidence that vitamin D is related to the pathophysiology of cirrhosis. Although the incidence of vitamin D deficiency in chronic liver diseases and cirrhosis is strongly documented, its pathogenic association with advanced liver fibrosis remains controversial. There is evidence of a significant relation of 25(OH)D levels with the degree of liver dysfunction, considering that an inverse correlation of 25(OH)D levels with both Child-Pugh score and Model for End-Stage Liver Disease has been reported. In addition, vitamin D deficiency has been shown to increase the risk for overall mortality and infections in patients with cirrhosis. Vitamin D deficiency has been also associated with advanced stages of hepatocellular carcinoma and poor prognosis. Finally, there are studies suggesting that patients with chronic hepatitis C and normal vitamin D levels have higher virological response to treatment. However, there are not enough studies conducted in cirrhotic-only populations. The association between vitamin D and cirrhosis demonstrates a great potential for clinical application. The relation between vitamin D deficiency and the degree of liver function, degree of fibrosis and infectious complications could support its use as a prognostic index and a diagnostic tool. PMID:27366029

  16. Pathogenesis of primary biliary cirrhosis: A unifying model

    PubMed Central

    Kouroumalis, Elias; Notas, George

    2006-01-01

    Primary biliary cirrhosis (PBC) is a disease of unknown etiology leading to progressive destruction of small intrahepatic bile ducts and eventually to liver cirrhosis and failure. It is characterised by female predominance and serum auto-antibodies to mitochondrial antigens targeting the E2 components of the 2-oxoacid dehydrogenase complex. Although they are associated with disease pathogenesis, no concrete evidence has been presented so far. Epidemiological data indicate that a geographical clustering of cases and possible environmental factors are implicated in pathogenesis. A number of genetic factors play a role in determining disease susceptibility or progression, although no definitive conclusion has been reached so far. A key factor to immune pathogenesis is considered to be the breakdown of immune tolerance, either through molecular mimicry or through the so called determinant density model. In this review, the available data regarding the pathogenesis of primary biliary cirrhosis are described and discussed. A new unifying hypothesis based on early endothelin overproduction in primary biliary cirrhosis (PBC) is presented and discussed. PMID:16688819

  17. Hyponatremia in Patients with Cirrhosis of the Liver

    PubMed Central

    Bernardi, Mauro; Ricci, Carmen Serena; Santi, Luca

    2014-01-01

    Hyponatremia is common in cirrhosis. It mostly occurs in an advanced stage of the disease and is associated with complications and increased mortality. Either hypovolemic or, more commonly, hypervolemic hyponatremia can be seen in cirrhosis. Impaired renal sodium handling due to renal hypoperfusion and increased arginine-vasopressin secretion secondary to reduced effective volemia due to peripheral arterial vasodilation represent the main mechanisms leading to dilutional hyponatremia in this setting. Patients with cirrhosis usually develop slowly progressing hyponatremia. In different clinical contexts, it is associated with neurological manifestations due to increased brain water content, where the intensity is often magnified by concomitant hyperammonemia leading to hepatic encephalopathy. Severe hyponatremia requiring hypertonic saline infusion is rare in cirrhosis. The management of asymptomatic or mildly symptomatic hyponatremia mainly rely on the identification and treatment of precipitating factors. However, sustained resolution of hyponatremia is often difficult to achieve. V2 receptor blockade by Vaptans is certainly effective, but their long-term safety, especially when associated to diuretics given to control ascites, has not been established as yet. As in other conditions, a rapid correction of long-standing hyponatremia can lead to irreversible brain damage. The liver transplant setting represents a condition at high risk for the occurrence of such complications. PMID:26237020

  18. [Aspects of pathogenetc pharmacotherapy for portal hypertension in liver cirrhosis].

    PubMed

    Garbuzenko, D V

    2016-01-01

    The review of literature considers the principles of medical treatment for portal hypertension in liver cirrhosis, which are based on the current views of its development mechanisms. It describes both current pharmacotherapy methods for portal hypertension and drugs, the efficacy of which is being investigated. PMID:27135108

  19. Vitamin D deficiency in patients with liver cirrhosis

    PubMed Central

    Konstantakis, Christos; Tselekouni, Paraskevi; Kalafateli, Maria; Triantos, Christos

    2016-01-01

    There is ongoing evidence that vitamin D is related to the pathophysiology of cirrhosis. Although the incidence of vitamin D deficiency in chronic liver diseases and cirrhosis is strongly documented, its pathogenic association with advanced liver fibrosis remains controversial. There is evidence of a significant relation of 25(OH)D levels with the degree of liver dysfunction, considering that an inverse correlation of 25(OH)D levels with both Child-Pugh score and Model for End-Stage Liver Disease has been reported. In addition, vitamin D deficiency has been shown to increase the risk for overall mortality and infections in patients with cirrhosis. Vitamin D deficiency has been also associated with advanced stages of hepatocellular carcinoma and poor prognosis. Finally, there are studies suggesting that patients with chronic hepatitis C and normal vitamin D levels have higher virological response to treatment. However, there are not enough studies conducted in cirrhotic-only populations. The association between vitamin D and cirrhosis demonstrates a great potential for clinical application. The relation between vitamin D deficiency and the degree of liver function, degree of fibrosis and infectious complications could support its use as a prognostic index and a diagnostic tool. PMID:27366029

  20. Mononuclear cell complement receptor blockade in primary biliary cirrhosis.

    PubMed Central

    Al-Aghbar, M N; Neuberger, J; Williams, R; Eddleston, A L

    1985-01-01

    Peripheral blood monocyte and lymphocyte receptors for Fc and C3b fragments were examined in vitro in patients with primary biliary cirrhosis and other chronic liver diseases using sheep red blood cells coated with anti-SRBC IgG1 (to detect Fc receptors) and with anti-SRBC IgM and complement (to detect C3b receptors). The number of C3b receptors detected on 100 monocytes was significantly lower in patients with primary biliary cirrhosis (23.0 +/- 12.0, mean +/- 1 SD) compared with normal controls (57.4 +/- 16.9) and other chronic liver disease (HBsAg negative chronic active hepatitis 62.0 +/- 17.0, alcoholic cirrhosis 50.9 +/- 4.0), while the number of Fc receptors detected on 100 monocytes was not significantly different in all the groups (primary biliary cirrhosis 72.8 +/- 28.6, chronic active hepatitis 74.7 +/- 14.0, alcoholic cirrhosis 58.0 +/- 13.5 and normal controls 69.6 +/- 19.9). When mononuclear cells isolated from normal individuals were pre-incubated with serum from patients with primary biliary cirrhosis before testing their receptor function there was a significant reduction in the number of C3b receptors detected per 100 monocytes (27.6 +/- 10.8) compared with pre-incubation with normal serum (72.0 +/- 18.0). This reduction in C3b-receptor function was again observed when the serum used for pre-incubation was depleted of circulating immune complexes; but when complement was further depleted from these sera, the number of C3b-receptors detected after pre-incubation was similar to normal values (64.0 +/- 11.8). Lymphocyte receptors showed a similar pattern of results. This implies a specific C3b receptor blockade on monocytes and lymphocytes from patients with primary biliary cirrhosis which appears to be because of blocking by serum factor(s) including complement fragments. PMID:3155513

  1. Alcohol-related road traffic accidents before and after the passing of the Road Traffic Safety Act in Croatia.

    PubMed

    Missoni, Eduard; Bozić, Boris; Missoni, Ivan

    2012-12-01

    The aim of this study was to gather enough data in order to formulate theory- and research-based recommendations to policy makers with the intention of decreasing the number of alcohol-related accidents and victims on Croatian roads. The data on the injured traffic participants and the share of participants under the influence of alcohol were collected from the police reports of the Traffic Police Department, Ministry of the Interior, written at the scene of the respective accidents. This documentation was then processed by descriptive epidemiology and analysed through a four-year period, before and after the passing of the New Road Traffic Safety Act in the Republic of Croatia, on 20 August 2004. In the first six months of 2005, after the passing of the Act, there were 3,275 accidents caused by the motorists under the influence of alcohol (12.5% of all the accidents), with 64 persons killed. Only 5 fatalities (8%) were caused by the drivers with measured blood alcohol concentration of up to 0.5 per thousand. As much as 27 fatalities (42%) were caused by the drivers with measured more than 1.5 per thousand, while half of the fatalities, 32 (50%), were caused by drivers with 0.5-1.5 per thousand. In this period, more than 451,000 violations were recorded, whereas in the same period of the previous year, the number of violations was about 519,000. A reduction of the total number of accidents is the result of the new regulation provision, according to which the incidents without human victims do not have to be reported to the police. The number of traffic accidents caused by drivers under the influence of alcohol had increased by some dozen per cents, namely: 2005 - 6,219 persons, 2006- 6,590 persons, noting that in 2006 one less person was killed (123) compared to 2005. In 2005, drivers with alcohol concentration of 0-0.5 per thousand caused 1,096 accidents, with 14 fatalities, whereas in 2006 there were 1,164 accidents with 9 fatalities. A total of 2,314 accidents

  2. The Influence of Alcohol-Related Cognitions on Personality-Based Risk for Alcohol Use during Adolescence

    ERIC Educational Resources Information Center

    Bekman, Nicole M.; Cummins, Kevin; Brown, Sandra A.

    2011-01-01

    This study examines whether expectancies about the impact of not drinking or reducing alcohol use and perceptions of peer alcohol use partially mediated risk incurred by sensation seeking for adolescent alcohol involvement. High school drinkers (N = 3,153) completed a survey assessing substance use, sensation seeking, perceived peer alcohol use,…

  3. Increased Salivary Nitrite and Nitrate Excretion in Rats with Cirrhosis.

    PubMed

    Mahmoodi, Somayeh; Rahmatollahi, Mahdieh; Shahsavari, Fatemeh; Shafaroodi, Hamed; Grayesh-Nejad, Siyavash; Dehpour, Ahmad R

    2015-11-01

    Increased nitric oxide (NO) formation is mechanistically linked to pathophysiology of the extrahepatic complications of cirrhosis. NO is formed by either enzymatic or non-enzymatic pathways. Enzymatic production is catalyzed by NO synthase (NOS) while entero-salivary circulation of nitrate and nitrite is linked to non-enzymatic formation of NO under acidic pH in the stomach. There is no data on salivary excretion of nitrate and nitrite in cirrhosis. This study was aimed to investigate salivary levels of nitrate and nitrite in a rat model of biliary cirrhosis. Cirrhosis was induced by bile duct ligation (BDL). Four weeks after the operation, submandibular ducts of anesthetized BDL and control rats were cannulated with polyethylene microtube for saliva collection. Assessment of pH, nitrite and nitrate levels was performed in our research. We also investigated NOS expression by real time RT-PCR to estimate eNOS, nNOS and iNOS mRNA levels in the submandibular glands. Salivary pH was significantly lower in BDL rats in comparison to control animals. We also observed a statistically significant increase in salivary levels of nitrite as well as nitrate in BDL rats while there was no elevation in the mRNA expression of nNOS, eNOS, and iNOS in submandibular glands of cirrhotic groups. This indicates that an increased salivary level of nitrite/nitrate is less likely to be linked to increased enzymatic production of NO in the salivary epithelium. It appears that nitrate/nitrite can be transported from the blood stream by submandibular glands and excreted into saliva as entero-salivary circulation, and this mechanism may have been exaggerated during cirrhosis. PMID:26786986

  4. Alcohol Policies and Alcoholic Cirrhosis Mortality in the United States

    PubMed Central

    Xuan, Ziming; Blanchette, Jason G.; Heeren, Timothy C.; Swahn, Monica H.; Naimi, Timothy S.

    2015-01-01

    Introduction Stronger alcohol policies predict decreased alcohol consumption and binge drinking in the United States. We examined the relationship between the strength of states’ alcohol policies and alcoholic cirrhosis mortality rates. Methods We used the Alcohol Policy Scale (APS), a validated assessment of policies of the 50 US states and Washington DC, to quantify the efficacy and implementation of 29 policies. State APS scores (theoretical range, 0–100) for each year from 1999 through 2008 were compared with age-adjusted alcoholic cirrhosis death rates that occurred 3 years later. We used Poisson regression accounting for state-level clustering and adjusting for race/ethnicity, college education, insurance status, household income, religiosity, policing rates, and urbanization. Results Age-adjusted alcoholic cirrhosis mortality rates varied significantly across states; they were highest among males, among residents in states in the West census region, and in states with a high proportion of American Indians/Alaska Natives (AI/ANs). Higher APS scores were associated with lower mortality rates among females (adjusted incidence rate ratio [IRR], 0.91 per 10-point increase in APS score; 95% confidence interval [95% CI], 0.84–0.99) but not among males (adjusted IRR, 0.97; 95% CI, 0.90–1.04). Among non-AI/AN decedents, higher APS scores were also associated with lower alcoholic cirrhosis mortality rates among both sexes combined (adjusted IRR, 0.89; 95% CI, 0.82–0.97). Policies were more strongly associated with lower mortality rates among those living in the Northeast and West census regions than in other regions. Conclusions Stronger alcohol policy environments are associated with lower alcoholic cirrhosis mortality rates. Future studies should identify underlying reasons for racial/ethnic and regional differences in this relationship. PMID:26469950

  5. Primary hyperoxaluria complicated with liver cirrhosis: A case report.

    PubMed

    Kogiso, Tomomi; Tokushige, Katsutoshi; Hashimoto, Etsuko; Miyakata, Chiharu; Taniai, Makiko; Torii, Nobuyuki; Omori, Akiko; Kotera, Yoshihito; Egawa, Hiroto; Yamamoto, Masakazu; Nagata, Masao; Shiratori, Keiko

    2015-12-01

    Primary hyperoxaluria (PH) is a rare, autosomal recessive disorder characterized by overproduction of oxalate caused by a deficiency in a hepatic enzyme. The excess oxalate combines with calcium in the kidneys to form deposits of calcium oxalate, which can lead to nephrocalcinosis and renal failure. PH type 1 (PH1), the most common form of this disease, is caused by a deficiency of the liver-specific enzyme alanine/glyoxylate aminotransferase (AGT). Liver transplantation is performed as a definitive therapy for PH to correct the enzyme defect. Usually, liver depositions are limited and liver function is normal without fibrosis. Here, we report an adult case of liver cirrhosis caused by PH1. A 28-year-old woman was admitted to our hospital under suspicion of PH1 and the presence of nephrocalcinosis. The patient had suffered from kidney stone recurrences from 17 years of age, and was initiated on hemodialysis due to renal failure at the age of 27 years. The serum level of oxalic acid was high, whereas the AGT level in the liver tissue was decreased. Thus, the patient was definitively diagnosed with PH1. Although she had normal liver function, surface nodularity and splenomegaly were detected by computed tomography, suggesting liver cirrhosis. The native liver showed micronodular cirrhosis and portal fibrosis. Several arterioles were filled with rhomboid and polyhedral refractile oxalate crystals and various portal tracts showed these crystals. Our case suggests that long-term oxalosis can lead to liver cirrhosis; thus, PH should be considered one of the causes of liver cirrhosis. PMID:25594663

  6. An Internet-Based Intervention to Promote Alcohol-Related Attitudinal and Behavioral Change Among Adolescents: Protocol of a Cluster Randomized Controlled Trial

    PubMed Central

    Chan, Ko-Ling; Chow, Chun-Bong; Lam, Tai-Hing; Ho, Sai-Yin; Wong, Wilfred Hing-Sang; Wong, Margaret Fung-Yee

    2016-01-01

    Background Underage drinking is a prevalent risk behavior and common public health problem. Research shows that alcohol abuse not only affects the quality of life of drinkers themselves. The problems resulting from underage drinking pose substantial costs to society as well. The proposed study will address underage drinking with the use of an Internet campaign, which is a cost-effective way of tackling the problem. Objective The aims of this study are to test the effectiveness of an online quiz competition in changing adolescents’ alcohol-related attitudes and behavior and to explore the feasibility of using Internet viral marketing to reach a significant number of adolescents. Methods The study will constitute a cluster randomized controlled trial for 20 secondary schools (6720 Grade 7-9 students). Schools will be randomized to intervention or control arm with equal likelihood. Students in intervention schools will be invited to take part in the Internet campaign, whereas those in control schools will receive relevant promotional leaflets. Results Alcohol-related attitude and behavior will be the primary outcome measures. The results of the proposed study will provide evidence on the efficacy of an Internet intervention in modifying adolescents’ attitudes and behavior and guide further investigation into the prevention of and intervention in such risk behaviors as underage drinking. The project was funded July 2015, enrollment started September 2015, and results are expected July 2017. Conclusions With the Internet increasingly being recognized as a practical and cost-effective platform for health information delivery, the proposed Internet-based intervention is expected to be more effective in altering adolescents’ alcohol-related attitudes and behaviors than traditional health promotion. ClinicalTrial ClinicalTrials.gov NCT02450344; https://clinicaltrials.gov/ct2/show/NCT02450344 (Archived by WebCite at http://www.webcitation.org/6heB2zMBD) PMID:27252072

  7. Do college drinkers learn from their mistakes? Effects of recent alcohol-related consequences on planned protective drinking strategies among college freshmen.

    PubMed

    Nguyen, Norma; Walters, Scott T; Wyatt, Todd M; DeJong, William

    2013-12-01

    This study examined whether recent alcohol-related consequences affect intentions to use protective drinking strategies. Responses were collected from incoming college freshmen (N = 84,367) at 279 U.S. colleges and universities. Plans to limit future drinking were significantly lower among students who were male, younger, White, or were in or intending to join a fraternity or sorority. For heavy drinkers, having recently experienced a higher level of external harms predicted increased plans to limit drinking. For all drinkers, a lower level of recent impaired driving predicted increased plans to limit drinking. Limitations and implications are discussed. PMID:23750616

  8. Alcohol Use, Alcohol-Related Outcome Expectancies, and Partner Aggression Among Males Court-Mandated to Batterer Intervention Programs: A Brief Report.

    PubMed

    Brasfield, Hope; Morean, Meghan E; Febres, Jeniimarie; Shorey, Ryan C; Moore, Todd M; Zuckosky Zapor, Heather; Elmquist, JoAnna; Wolford-Clevenger, Caitlin; Labrecque, Lindsay; Plasencia, Maribel; Stuart, Gregory L

    2016-01-01

    Additional work is needed to determine how and/or why the relationship between alcohol use and increased risk of partner aggression (PA) exists. Researchers have begun to examine whether alcohol-related outcome expectancies (i.e., beliefs about the cognitive and behavioral effects of alcohol) are associated with PA irrespective of alcohol use. We examined the relationship between alcohol use, alcohol expectancies, and PA among 360 males arrested for a domestic violence offense and court-mandated to treatment. Results indicate that certain alcohol expectancies do play a role in the relationship between alcohol use and some forms of PA. PMID:25519237

  9. Teenage drinking, alcohol availability and pricing: a cross-sectional study of risk and protective factors for alcohol-related harms in school children

    PubMed Central

    Bellis, Mark A; Phillips-Howard, Penelope A; Hughes, Karen; Hughes, Sara; Cook, Penny A; Morleo, Michela; Hannon, Kerin; Smallthwaite, Linda; Jones, Lisa

    2009-01-01

    Background There is a lack of empirical analyses examining how alcohol consumption patterns in children relate to harms. Such intelligence is required to inform parents, children and policy relating to the provision and use of alcohol during childhood. Here, we examine drinking habits and associated harms in 15-16 year olds and explore how this can inform public health advice on child drinking. Methods An opportunistic survey of 15-16 year olds (n = 9,833) in North West England was undertaken to determine alcohol consumption patterns, drink types consumed, drinking locations, methods of access and harms encountered. Cost per unit of alcohol was estimated based on a second survey of 29 retail outlets. Associations between demographics, drinking behaviours, alcohol pricing and negative outcomes (public drinking, forgetting things after drinking, violence when drunk and alcohol-related regretted sex) were examined. Results Proportions of drinkers having experienced violence when drunk (28.8%), alcohol-related regretted sex (12.5%) and forgetting things (45.3%), or reporting drinking in public places (35.8%), increased with drinking frequency, binge frequency and units consumed per week. At similar levels of consumption, experiencing any negative alcohol-related outcome was lower in those whose parents provided alcohol. Drunken violence was disproportionately associated with being male and greater deprivation while regretted sex and forgetting things after drinking were associated with being female. Independent of drinking behaviours, consuming cheaper alcohol was related to experiencing violence when drunk, forgetting things after drinking and drinking in public places. Conclusion There is no safe level of alcohol consumption for 15-16 year olds. However, while abstinence removes risk of harms from personal alcohol consumption, its promotion may also push children into accessing drink outside family environments and contribute to higher risks of harm. Strategies to

  10. The association between protective behavioral strategies and alcohol-related problems: An examination of race and gender differences among college drinkers.

    PubMed

    Clarke, Nickeisha; Kim, Su-Young; Ray, Anne E; White, Helene R; Jiao, Yang; Mun, Eun-Young

    2016-01-01

    This study examined race and gender differences in use of specific types of protective behavioral strategies (PBS) and the moderating effects of race and gender on the relationship between PBS use and alcohol problems, controlling for alcohol use, among a large sample of Asian, Black, and White college drinkers. There were significant racial and gender differences in the types of PBS used. Moderation analyses indicated that PBS were more protective for women than men against experiencing alcohol-related problems. There were no significant race effects or race-by-gender interaction effects on alcohol problems. Implementing PBS may be beneficial for all college students. PMID:26114577

  11. Does drinking refusal self-efficacy mediate the impulsivity-problematic alcohol use relation?

    PubMed

    Stevens, Angela K; Littlefield, Andrew K; Blanchard, Brittany E; Talley, Amelia E; Brown, Jennifer L

    2016-02-01

    There is consistent evidence that impulsivity-like traits relate to problematic alcohol involvement; however, identifying mechanisms that account for this relation remains an important area of research. Drinking refusal self-efficacy (or a person's ability to resist alcohol; DRSE) has been shown to predict alcohol use among college students and may be a relevant mediator of the impulsivity-alcohol relation. The current study examined the indirect effect of various constructs related to impulsivity (i.e., urgency, sensation seeking, and deficits in conscientiousness) via several facets of DRSE (i.e., social pressure, opportunistic, and emotional relief) on alcohol-related problems among a large sample of college students (N=891). Overall, results indicated that certain DRSE facets were significant mediators of the relation between impulsivity-related constructs and alcohol problems. More specifically, emotional-relief DRSE was a mediator for the respective relations between urgency and deficits in conscientiousness and alcohol problems, whereas social-DRSE was a significant mediator of the respective relations between urgency and sensation seeking with alcohol problems. Results from this study suggest particular types of DRSE are important mediators of the relations between specific impulsivity constructs and alcohol-related problems. These findings support prevention and intervention efforts that seek to enhance drinking refusal self-efficacy skills of college students, particularly those high in certain personality features, in order to reduce alcohol-related problems among this population. PMID:26547044

  12. Defect of Fc receptors and phenotypical changes in sinusoidal endothelial cells in human liver cirrhosis.

    PubMed Central

    Muro, H.; Shirasawa, H.; Kosugi, I.; Nakamura, S.

    1993-01-01

    To analyze the pathological changes occurring in Fc receptors (FcRs) in sinusoidal endothelial cells (SECs) in chronic liver diseases, we first characterized immunohistochemically the SEC FcRs by using monoclonal antibodies (MAbs) to FcRs and then investigated the distribution of the SEC FcRs by using peroxidase-antiperoxidase IgG complexes as a ligand on frozen sections. MAb 2E1 to FcRII reacted with SECs in a similar manner to peroxidase-antiperoxidase IgG and blocked the peroxidase-antiperoxidase IgG binding to SECs, whereas MAbs 3G8 and Leu-11b to FcRIII did not. FcRs in normal liver were found along the sinusoidal walls, except for those in the outer periportal zones, but FcRs in chronic active hepatitis and cirrhosis were intermittently or focally absent. The lengths of the FcR-positive portion of sinusoids in unit areas were respectively about 54% and 76% of the normal values in active and inactive cirrhosis. Where FcRs were absent, the MAbs CD36, CD31, and EN4 revealed the presence of sinusoids and, in active cirrhosis, frequently the thickening of liver cell plates. The FcR-negative SECs in the outer periportal zones of normal livers were different from the SECs of other sites in the presence of PAL-E antigen and a rich amount of EN4 antigen, though these sinusoids possessed Kupffer cells and no perisinusoidal deposition of laminin. The FcR-negative SECs in liver diseases occasionally presented the character of ordinary blood vessels, viz., PAL-E antigen, CD34 antigen, and a deficiency of Kupffer cells, regardless of perisinusoidal laminin deposition. However, they preserved the character of normally FcR-possessing SECs, viz., CD36 antigen, and a small amount of EN4 and CD31 antigens. These findings indicate that the outer-periportal SECs in normal livers are phenotypically different from other SECs and that the SECs in diseased livers frequently undergo phenotypical changes, including loss of FcRs, regardless of perisinusoidal laminin deposition, i

  13. Improving the management of gastrointestinal bleeding in patients with cirrhosis.

    PubMed

    Williams, Michael J; Hayes, Peter

    2016-04-01

    Gastrointestinal bleeding remains a major cause of mortality in patients with cirrhosis. The most common source of bleeding is from gastroesophageal varices but non-variceal bleeding from peptic ulcer disease also carries a significant risk in patients with liver disease. The prognosis is related to the severity of the underlying liver disease, and deaths often occur due to liver failure, infection or renal failure. Optimal management should therefore not only achieve haemostasis but address these complications as well. The management of gastrointestinal bleeding in patients with cirrhosis includes a range of medical, endoscopic and radiological interventions. This article updates the recent developments in this area and highlights topics where further research is still required. PMID:26581713

  14. [Diagnosis and treatment of portal thrombosis in liver cirrhosis].

    PubMed

    Seijo, Susana; García-Criado, Angeles; Darnell, Anna; García-Pagán, Juan Carlos

    2012-11-01

    Improved imaging techniques and the routine use of color Doppler ultrasound in the follow-up of patients with liver cirrhosis has increased diagnosis of portal vein thrombosis (PVT) in these patients. The extension of PVT should be evaluated with computed tomography angiography or magnetic resonance angiography. The natural history of PVT in cirrhosis and its impact on liver disease is unknown but it seems clear that PVT could increase the morbidity and mortality associated with liver transplantation and can even be a contraindication to this procedure when the thrombus extends to the superior mesenteric vein. Anticoagulation is a relatively safe and effective treatment in achieving recanalization of the splenoportal axis or in preventing progression of thrombosis and is therefore frequently used. The use of transjugular intrahepatic portosystemic shunts (TIPS) is reserved for patients unresponsive to anticoagulation or in those with severe complications of portal hypertension. PMID:22534116

  15. Nursing Assessment Tool for People With Liver Cirrhosis.

    PubMed

    Gimenes, Fernanda Raphael Escobar; Reis, Renata Karina; da Silva, Patrícia Costa Dos Santos; Silva, Ana Elisa Bauer de Camargo; Atila, Elisabeth

    2016-01-01

    The aim of this study was to describe the process of developing a nursing assessment tool for hospitalized adult patients with liver cirrhosis. A descriptive study was carried out in three stages. First, we conducted a literature review to develop a data collection tool on the basis of the Conceptual Model of Wanda Horta. Second, the data collection tool was assessed through an expert panel. Third, we conducted the pilot testing in hospitalized patients. Most of the comments offered by the panel members were accepted to improve the tool. The final version was in the form of a questionnaire with open-closed questions. The panel members concluded that the tool was useful for accurate nursing diagnosis. Horta's Conceptual Model assisted with the development of this data collection tool to help nurses identify accurate nursing diagnosis in hospitalized patients with liver cirrhosis. We hope that the tool can be used by all nurses in clinical practice. PMID:26425862

  16. Proton pump inhibitor prescription abuse and sepsis in cirrhosis

    PubMed Central

    Picardi, Antonio; Vespasiani-Gentilucci, Umberto

    2016-01-01

    Proton pump inhibitors (PPIs) represent one of the most extensively prescribed classes of drugs in general and in patients with liver cirrhosis. Many prescriptions are made without a clear adherence to standard indications. As a class of ordinarily well tolerated drug, PPIs are not free of side-effects and concerns have been raised about a possible role for PPIs in predisposing patients to an increased risk of bacterial infections and sepsis. As evidences of different power are accumulating on this topic, prospective studies are needed to reach a more universal agreement, but definitely more attention is needed by prescribers in being more adherent to the few recognized indications for the use of PPIs, particularly in patients with liver cirrhosis. Otherwise, doctors could run the risk of being accused of “abused” prescription. PMID:26855807

  17. Nursing Assessment Tool for People With Liver Cirrhosis

    PubMed Central

    Reis, Renata Karina; da Silva, Patrícia Costa dos Santos; Silva, Ana Elisa Bauer de Camargo; Atila, Elisabeth

    2016-01-01

    The aim of this study was to describe the process of developing a nursing assessment tool for hospitalized adult patients with liver cirrhosis. A descriptive study was carried out in three stages. First, we conducted a literature review to develop a data collection tool on the basis of the Conceptual Model of Wanda Horta. Second, the data collection tool was assessed through an expert panel. Third, we conducted the pilot testing in hospitalized patients. Most of the comments offered by the panel members were accepted to improve the tool. The final version was in the form of a questionnaire with open-closed questions. The panel members concluded that the tool was useful for accurate nursing diagnosis. Horta's Conceptual Model assisted with the development of this data collection tool to help nurses identify accurate nursing diagnosis in hospitalized patients with liver cirrhosis. We hope that the tool can be used by all nurses in clinical practice. PMID:26425862

  18. Impact of hepatic cirrhosis on outcome in adult cardiac surgery.

    PubMed

    Dimarakis, Ioannis; Grant, Stuart; Corless, Rebecca; Velissaris, Theodore; Prince, Martin; Bridgewater, Ben; Asimakopoulos, George

    2015-02-01

    Increasing prevalence of hepatic disease is likely to translate in a growing number of patients with significant hepatic disease requiring cardiac surgery. Available cardiac risk stratification models do not address the risk associated with hepatic disease. However, weighted mean mortality rates based on previous studies of cardiac surgery in patients with hepatic disease demonstrate operative mortality rates that range from 9.88% (standard deviation [SD] 9.69) for patients in Child-Turcotte-Pugh (CTP) class A cirrhosis to 69.23% (SD 28.55) for patients with CTP class C cirrhosis. This review comprehensively appraises the pathophysiology of hepatic disease, reported clinical outcomes and considerations for risk stratification. PMID:25291160

  19. Radiofrequency Ablation of Hepatocellular Cancer in 110 Patients With Cirrhosis

    PubMed Central

    Curley, Steven A.; Izzo, Francesco; Ellis, Lee M.; Nicolas Vauthey, J.; Vallone, Paolo

    2000-01-01

    Objective To determine the treatment efficacy, safety, local tumor control, and complications related to radiofrequency ablation (RFA) in patients with cirrhosis and unresectable hepatocellular carcinoma (HCC). Summary Background Data Most patients with HCC are not candidates for resection because of tumor size, location, or hepatic dysfunction related to cirrhosis. RFA is a technique that permits in situ destruction of tumors by means of local tissue heating. Methods One hundred ten patients with cirrhosis and HCC (Child class A, 50; B, 31; C, 29) were treated during a prospective study using RFA. Patients were treated with RFA using an open laparotomy, laparoscopic, or percutaneous approach with ultrasound guidance to place the RF needle electrode into the hepatic tumors. All patients were followed up at regular intervals to detect treatment-related complications or recurrence of disease. Results All 110 patients were followed up for at least 12 months after RFA (median follow-up 19 months). Percutaneous or intraoperative RFA was performed in 76 (69%) and 34 patients (31%), respectively. A total of 149 discrete HCC tumor nodules were treated with RFA. The median diameter of tumors treated percutaneously (2.8 cm) was smaller than that of lesions treated during laparotomy (4.6 cm). Local tumor recurrence at the RFA site developed in four patients (3.6%); recurrent HCC subsequently developed in other areas of the liver in all four. New liver tumors or extrahepatic metastases developed in 50 patients (45.5%), but 56 patients (50.9%) had no evidence of recurrence. There were no treatment-related deaths, but complications developed in 14 patients (12.7%) after RFA. Conclusions In patients with cirrhosis and HCC, RFA produces effective local control of disease in a significant proportion of patients and can be performed safely with minimal complications. PMID:10973388

  20. [Concentration and reinfusion of ascitic fluid in liver cirrhosis].

    PubMed

    Mian, G; Triolo, L; Magris, D; de Savorgnani, M N; G'Agnolo, B

    1979-09-29

    46 concentration-reinfusion treatments were performed on 36 patients, suffering from refractory ascites for liver cirrhosis. The procedure was well tolerated, improved the status of the patients and enabled diuretic to be effective again, in some cases for as long as two years. The usefulness of infusing autologous, non-denatured proteins in high dosage is stressed. The Authors belive that hepatorenal syndrome, severe hypokaliemia or hyposodemia and encephalopathy are the elective indications for the treatment. PMID:492554

  1. Prognostic indicators in primary biliary cirrhosis: significance of revised IAHG (International Autoimmune Hepatitis Group) score

    PubMed Central

    Jung, Ho Eun; Jeong, Soung Won; Kim, Jin Nyoung; Jang, Hee Yoon; Cho, Yun Ju; Woo, Sung Ae; Lee, Sae Hwan; Kim, Sang Gyune; Cha, Sang-Woo; Kim, Young Seok; Cho, Young Deok; Kim, Hong Soo; Kim, Boo Sung

    2012-01-01

    Background/Aims Primary biliary cirrhosis (PBC) is a slowly progressing autoimmune disease of the liver that is characterized by portal inflammation and immune-mediated destruction of the intrahepatic bile ducts. Serum total bilirubin is one of the various prognostic factors that have been proposed. A recent study found that PBC with accompanying autoimmune hepatitis (AIH) carries a negative prognosis. This study examined the clinical characteristics of PBC and analyzed the factors that affect its prognosis. Methods Patients diagnosed with PBC between January 1998 and December 2010 based on clinical and histopathological findings were compiled and analyzed retrospectively. Results Among 27 patients, 24 (1 male and 23 females, ages 50.0±9.3 years) were followed up. The follow-up period was 8.6±0.9 years. Of the 24 patients, 9 patients progressed to liver cirrhosis (LC). Comparison between patients who did and did not progress to LC revealed statistically significant differences in the patients' serum total bilirubin (2.7±1.8 vs. 0.8±0.4, P=0.012), the Mayo risk score (5.1±0.7 vs. 3.9±0.6, P=0.001), the revised IAHG (International Autoimmune Hepatitis Group) score (9.2±2.3 vs. 5.4±3.0, P=0.004) and frequency of AIH overlap (5/9 [55.6%] vs. 0/15 [0%], P=0.001) at the time of diagnosis. Conclusions We propose that serum total bilirubin, the Mayo risk score, and the revised IAHG score at the time of diagnosis are helpful for predicting PBC prognosis. In particular, since all of the patients with accompanying AIH progressed to LC, the presence of overlap syndrome at the time of diagnosis is helpful for predicting PBC prognosis and providing an adequate treatment. PMID:23323253

  2. I drink for my liver, Doc: emerging evidence that coffee prevents cirrhosis.

    PubMed

    Feld, Jordan J; Lavoie, Élise G; Fausther, Michel; Dranoff, Jonathan A

    2015-01-01

    Evidence demonstrating that regular ingestion of coffee has salutary effects on patients with chronic liver disease is accumulating rapidly. Specifically, it appears that coffee ingestion can slow the progression of liver fibrosis, preventing cirrhosis and hepatocellular carcinoma (HCC). This should excite clinicians and scientists alike, since these observations, if true, would create effective, testable hypotheses that should lead to improved understanding on fibrosis pathogenesis and thus may generate novel pharmacologic treatments of patients with chronic liver disease. This review is designed to examine the relevant clinical and epidemiological data in critical fashion and to examine the putative pharmacological effects of coffee relevant to the pathogenesis of liver fibrosis and cirrhosis. We hope that this will inspire relevant critical analyses, especially among "coffee skeptics". Of note, one major assumption made by this review is that the bulk of the effects of coffee consumption are mediated by caffeine, rather than by other chemical constituents of coffee. Our rationales for this assumption are threefold: first, caffeine's effects on adenosinergic signaling provide testable hypotheses; second, although there are  myriad chemical constituents of coffee, they are present in very low concentrations, and perhaps more importantly, vary greatly between coffee products and production methods (it is important to note that we do not dismiss the "botanical" hypothesis here; rather, we do not emphasize it at present due to the limitations of the studies examined); lastly, some (but not all) observational studies have examined both coffee and non-coffee caffeine consumption and found consistent effects, and when examined, no benefit to decaffeinated coffee has been observed. Further, in the interval since we examined this phenomenon last, further evidence has accumulated supporting caffeine as the effector molecule for coffee's salutary effects. PMID:25977756

  3. I drink for my liver, Doc: emerging evidence that coffee prevents cirrhosis

    PubMed Central

    Feld, Jordan J.; Lavoie, Élise G.; Fausther, Michel; Dranoff, Jonathan A.

    2015-01-01

    Evidence demonstrating that regular ingestion of coffee has salutary effects on patients with chronic liver disease is accumulating rapidly. Specifically, it appears that coffee ingestion can slow the progression of liver fibrosis, preventing cirrhosis and hepatocellular carcinoma (HCC). This should excite clinicians and scientists alike, since these observations, if true, would create effective, testable hypotheses that should lead to improved understanding on fibrosis pathogenesis and thus may generate novel pharmacologic treatments of patients with chronic liver disease. This review is designed to examine the relevant clinical and epidemiological data in critical fashion and to examine the putative pharmacological effects of coffee relevant to the pathogenesis of liver fibrosis and cirrhosis. We hope that this will inspire relevant critical analyses, especially among “coffee skeptics”. Of note, one major assumption made by this review is that the bulk of the effects of coffee consumption are mediated by caffeine, rather than by other chemical constituents of coffee. Our rationales for this assumption are threefold: first, caffeine’s effects on adenosinergic signaling provide testable hypotheses; second, although there are  myriad chemical constituents of coffee, they are present in very low concentrations, and perhaps more importantly, vary greatly between coffee products and production methods (it is important to note that we do not dismiss the “botanical” hypothesis here; rather, we do not emphasize it at present due to the limitations of the studies examined); lastly, some (but not all) observational studies have examined both coffee and non-coffee caffeine consumption and found consistent effects, and when examined, no benefit to decaffeinated coffee has been observed. Further, in the interval since we examined this phenomenon last, further evidence has accumulated supporting caffeine as the effector molecule for coffee’s salutary effects. PMID

  4. Intravascular volume in cirrhosis. Reassessment using improved methodology

    SciTech Connect

    Rector, W.G. Jr.; Ibarra, F.

    1988-04-01

    Previous studies of blood volume (BV) in cirrhosis have either not adjusted BV properly for body size; determined plasma volume from the dilution of labeled albumin 10-20 min postinjection, when some extravascular redistribution has already occurred; and/or not used the correct whole body-peripheral hematocrit ratio (0.82) in calculating whole BV from plasma volume and the peripheral hematocrit. We measured BV with attention to these considerations in 19 patients with cirrhosis and reexamined the determinants of vascular volume and the relationship between vascular volume and sodium retention. BV was calculated as plasma volume (determined from extrapolated plasma activity of intravenously injected (/sup 131/I)+albumin at time 0) divided by (peripheral hematocrit X 0.82). The result was expressed per kilogram dry body weight, determined by subtracting the mass of ascites (measured by isotope dilution; 1 liter = 1 kg) from the actual body weight of nonedematous patients. Measured and expressed in this way, BV correlated strongly with esophageal variceal size (r = 0.87, P less than 0.05), although not with net portal, right atrial, inferior vena caval, or arterial pressure, and was significantly greater in patients with sodium retention as compared to patients without sodium retention. The principal modifier of vascular volume in cirrhosis is vascular capacity, which is probably mainly determined by the extent of the portasystemic collateral circulation. Increased vascular volume in patients with sodium retention as compared to patients without sodium retention supports the overflow theory of ascites formation.

  5. Impaired Gut-Liver-Brain Axis in Patients with Cirrhosis

    PubMed Central

    Ahluwalia, Vishwadeep; Betrapally, Naga S; Hylemon, Phillip B; White, Melanie B; Gillevet, Patrick M; Unser, Ariel B; Fagan, Andrew; Daita, Kalyani; Heuman, Douglas M; Zhou, Huiping; Sikaroodi, Masoumeh; Bajaj, Jasmohan S

    2016-01-01

    Cirrhosis is associated with brain dysfunction known as hepatic encephalopathy (HE). The mechanisms behind HE are unclear although hyperammonemia and systemic inflammation through gut dysbiosis have been proposed. We aimed to define the individual contribution of specific gut bacterial taxa towards astrocytic and neuronal changes in brain function using multi-modal MRI in patients with cirrhosis. 187 subjects (40 controls, 147 cirrhotic; 87 with HE) underwent systemic inflammatory assessment, cognitive testing, stool microbiota analysis and brain MRI analysis. MR spectroscopy (MRS) changes of increased Glutamate/glutamine, reduced myo-inositol and choline are hyperammonemia-associated astrocytic changes, while diffusion tensor imaging (DTI) demonstrates changes in neuronal integrity and edema. Linkages between cognition, MRI parameters and gut microbiota were compared between groups. We found that HE patients had a significantly worse cognitive performance, systemic inflammation, dysbiosis and hyperammonemia compared to controls and cirrhotics without HE. Specific microbial families (autochthonous taxa negatively and Enterobacteriaceae positively) correlated with MR spectroscopy and hyperammonemia-associated astrocytic changes. On the other hand Porphyromonadaceae, were only correlated with neuronal changes on DTI without linkages with ammonia. We conclude that specific gut microbial taxa are related to neuronal and astrocytic consequences of cirrhosis-associated brain dysfunction. PMID:27225869

  6. [Bacterial overgrowth in small intestine in patients with liver cirrhosis].

    PubMed

    Chesta, J; Silva, M; Thompson, L; del Canto, E; Defilippi, C

    1991-06-01

    Hepatic encephalopathy, bacterial infections and endotoxemia in cirrhotic patients have been related to colonic flora. However, an abnormal small bowel bacterial content could also be implied. We investigated small bowel bacterial overgrowth (SIBO) by jejunal cultures in 14 cirrhotic patients and 5 control subjects, and indirectly by the lactulose H2 breath test in 22 patients with cirrhosis and 12 controls. SIBO was demonstrated by cultures in 64% of cirrhotic patients and 1 of 5 controls. The breath test was positive for SIBO in 45% of patients with cirrhosis and 8% of controls. No differences were noted between patients with alcoholic and non-alcoholic liver disease. According to fasting H2 breath levels, SIBO was significantly correlated with the Child-Pugh score for hepatic function (r = 0.45; p < 0.05). Also, patients with positive criteria for SIBO in jejunal cultures had worse hepatic function in comparison to cirrhotics with normal jejunal bacterial counts (p < 0.05). Thus SIBO is frequent in patients with hepatic cirrhosis and is associated with impairment in hepatic function. PMID:1844365

  7. Khat chewing and cirrhosis in Somaliland: Case series

    PubMed Central

    Mahamoud, Hawa D.; Muse, Sabah Mohammed; Roberts, Lewis R.; Torbenson, Michael S.; Fader, Tim

    2016-01-01

    Background Khat chewing is common especially among men in East Africa and Yemen. It is generally viewed by the populace as a benign social custom. Several studies of ethnic Somali immigrants to Western countries suggest an association between khat chewing and hepatotoxicity, but the risk of hepatotoxicity related to khat chewing within African settings is not documented. Aim To identify and describe liver disease without evidence of alcohol exposure or infectious etiology in khat chewers. Settings A university-affiliated teaching hospital in Somaliland. Methods Cases of cirrhosis of unknown cause were identified from the clinical practice of Al Hayatt Hospital in Borama, Somaliland, during 14 months beginning December 2012. Results Eight Somali men aged 27–70 years living in Somaliland were identified with cirrhosis of otherwise unknown cause. All chewed khat habitually for many years (15–128 bundles per day times years of use). A liver biopsy of one man was consistent with khat hepatotoxicity. Four of the eight men died during the study period. Conclusion Khat chewing may be associated with health consequences including severe hepatotoxicity with cirrhosis. PMID:27543281

  8. Metabolic Bone Disease in Viral Cirrhosis: A Prospective Study

    PubMed Central

    Goubraim, Rabia; Kabbaj, Nawal; Salihoun, Mouna; Chaoui, Zakia; Nya, M'Hamed; Amrani, Naima

    2013-01-01

    Background/Aim. Metabolic Bone disorders are well-recognized extrahepatic complications of cirrhosis. The aim was to report their prevalence and the associated factors to their development in patients with viral cirrhosis. Patients and Methods. All consecutive patients with viral cirrhosis were prospectively enrolled. Parathyroid hormone, 25-hydroxyvitamin D, liver function, and phosphocalcic tests were measured in all patients. Bone mineral density was measured at the lumbar spine and total hip by dual-energy X-ray absorptiometry. Data were analyzed using SPSS software. Results. Forty-six cirrhotic patients were included with hepatitis C (87%) and hepatitis B (13%). The Child-Pugh score was grade A in 87% of cases and grade B in 13%. Thirty-seven patients had decreased bone mineral density with osteopenia in 24 patients and osteoporosis in 13 patients. Decreased 25-hydroxyvitamin D was found in 95.6% of cases. Bone disorders were significantly more frequent in old patients with low body mass index, long duration of liver disease, and low 25-hydroxyvitamin D level. None of these factors was an independent factor associated with bone disorders. Conclusion. Our study revealed a high prevalence of metabolic bone disorders among viral cirrhotic patients. Consequently, bone mineral density assessment should be performed systematically in all cirrhotic patients.

  9. Neurosurgical procedures in patients with liver cirrhosis: A review

    PubMed Central

    Chen, Ching-Chang; Huang, Yin-Cheng; Yeh, Chun-Nan

    2015-01-01

    Liver cirrhosis, a devastating liver fibrosis caused by hepatitis/inflammation or tumors, is a major comorbid factor in known surgery fields, such as cardiovascular and abdominal surgeries. It is important to review possible comorbid results in neurosurgical procedures in cirrhotic patients. In the reviewed literature, Child-Pugh and model for end-stage liver disease scores are commonly used in the assessment of surgical risks for cirrhotic patients undergoing abdominal, cardiovascular or neurosurgical procedures. The major categories of neurosurgery are traumatic brain injury (TBI), spontaneous intracranial hemorrhage (SICH), brain tumors, and spinal instrumentation procedures. TBI was reported with surgical mortality as high as 34.5% and a complication rate of 87.2%. For SICH, mortality ranged from 22.7% to 47.0%, while complications were reported to be 43.2%. Less is discussed in brain tumor patients; still the postoperative hemorrhage rate approached 26.7%. In spinal fusion instrumentation procedures, the complication rate was as high as 41.0%. Preoperative assessment and correction could possibly decrease complications such as hemorrhage, wound infection and other cirrhosis-related complications (renal, pulmonary, ascites and encephalopathy). In this study, we reviewed the neurosurgical-related literature with regard to liver cirrhosis as a prognostic factor influencing neurosurgical outcomes. PMID:26413225

  10. Impaired Gut-Liver-Brain Axis in Patients with Cirrhosis.

    PubMed

    Ahluwalia, Vishwadeep; Betrapally, Naga S; Hylemon, Phillip B; White, Melanie B; Gillevet, Patrick M; Unser, Ariel B; Fagan, Andrew; Daita, Kalyani; Heuman, Douglas M; Zhou, Huiping; Sikaroodi, Masoumeh; Bajaj, Jasmohan S

    2016-01-01

    Cirrhosis is associated with brain dysfunction known as hepatic encephalopathy (HE). The mechanisms behind HE are unclear although hyperammonemia and systemic inflammation through gut dysbiosis have been proposed. We aimed to define the individual contribution of specific gut bacterial taxa towards astrocytic and neuronal changes in brain function using multi-modal MRI in patients with cirrhosis. 187 subjects (40 controls, 147 cirrhotic; 87 with HE) underwent systemic inflammatory assessment, cognitive testing, stool microbiota analysis and brain MRI analysis. MR spectroscopy (MRS) changes of increased Glutamate/glutamine, reduced myo-inositol and choline are hyperammonemia-associated astrocytic changes, while diffusion tensor imaging (DTI) demonstrates changes in neuronal integrity and edema. Linkages between cognition, MRI parameters and gut microbiota were compared between groups. We found that HE patients had a significantly worse cognitive performance, systemic inflammation, dysbiosis and hyperammonemia compared to controls and cirrhotics without HE. Specific microbial families (autochthonous taxa negatively and Enterobacteriaceae positively) correlated with MR spectroscopy and hyperammonemia-associated astrocytic changes. On the other hand Porphyromonadaceae, were only correlated with neuronal changes on DTI without linkages with ammonia. We conclude that specific gut microbial taxa are related to neuronal and astrocytic consequences of cirrhosis-associated brain dysfunction. PMID:27225869

  11. Protein-protein interaction network analysis of cirrhosis liver disease

    PubMed Central

    Safaei, Akram; Rezaei Tavirani, Mostafa; Arefi Oskouei, Afsaneh; Zamanian Azodi, Mona; Mohebbi, Seyed Reza; Nikzamir, Abdol Rahim

    2016-01-01

    Aim: Evaluation of biological characteristics of 13 identified proteins of patients with cirrhotic liver disease is the main aim of this research. Background: In clinical usage, liver biopsy remains the gold standard for diagnosis of hepatic fibrosis. Evaluation and confirmation of liver fibrosis stages and severity of chronic diseases require a precise and noninvasive biomarkers. Since the early detection of cirrhosis is a clinical problem, achieving a sensitive, specific and predictive novel method based on biomarkers is an important task. Methods: Essential analysis, such as gene ontology (GO) enrichment and protein-protein interactions (PPI) was undergone EXPASy, STRING Database and DAVID Bioinformatics Resources query. Results: Based on GO analysis, most of proteins are located in the endoplasmic reticulum lumen, intracellular organelle lumen, membrane-enclosed lumen, and extracellular region. The relevant molecular functions are actin binding, metal ion binding, cation binding and ion binding. Cell adhesion, biological adhesion, cellular amino acid derivative, metabolic process and homeostatic process are the related processes. Protein-protein interaction network analysis introduced five proteins (fibroblast growth factor receptor 4, tropomyosin 4, tropomyosin 2 (beta), lectin, Lectin galactoside-binding soluble 3 binding protein and apolipoprotein A-I) as hub and bottleneck proteins. Conclusion: Our result indicates that regulation of lipid metabolism and cell survival are important biological processes involved in cirrhosis disease. More investigation of above mentioned proteins will provide a better understanding of cirrhosis disease. PMID:27099671

  12. Reductions in drinking and alcohol-related harms reported by first-year college students taking an online alcohol education course: a randomized trial.

    PubMed

    Lovecchio, Catherine P; Wyatt, Todd M; DeJong, William

    2010-10-01

    A randomized control trial was conducted at a midsized private university in the Northeast to evaluate the short-term impact of AlcoholEdu for College 8.0, an online alcohol course for first-year students. In September 2007, 1,620 matriculated first-year students were randomly assigned to either a treatment group or an assessment-only control group. Both groups of students completed a baseline survey and knowledge test. Treatment group students finished the course, took a second knowledge test, and 30 days later completed a postintervention survey. Control group students completed the postintervention survey and knowledge test during the same time period. Compared with the control group, treatment group students reported a significantly lower level of alcohol use, fewer negative drinking consequences, and less positive alcohol-related attitudes. AlcoholEdu 8.0 had a positive impact on the first-year students' alcohol-related attitudes, behaviors, and consequences. Additional investigations of online alcohol education courses are warranted. PMID:21104507

  13. The Inability of Self-Affirmations to Decrease Defensive Bias toward an Alcohol-Related Risk Message among High-Risk College Students

    PubMed Central

    Meier, Ellen; Miller, Mary Beth; Lechner, William V.; Lombardi, Nate; Claborn, Kasey R.; Leffingwell, Thad R.

    2016-01-01

    Objective To examine the efficacy of a self-affirmation task in deterring college alcohol misuse and the importance of pre-existing beliefs in predicting subsequent behavior change. Participants Heavy drinking undergraduates (N=110) participated during the 2011–2012 academic year. Methods Participants were randomized to complete an affirmation or control task before reading an alcohol risk message. Alcohol-related beliefs and behaviors were assessed. Participants completed a two-week online follow-up assessing alcohol-related behaviors. Results Both groups reported increased perceived problem importance, but neither group displayed changes in personal risk. Follow-up assessment revealed similar, significant declines in peak consumption in both groups, with no significant between-group differences. Pre-existing beliefs accounted for 5 to 10 percent of variance in drinking outcomes. Conclusions An affirmation task does not seem to decrease defensive processing or alter high-risk drinking behaviors among college students and should not be utilized in lieu of more effective strategies. PMID:25580717

  14. Association and ancestry analysis of sequence variants in ADH and ALDH using alcohol-related phenotypes in a Native American community sample

    PubMed Central

    Peng, Qian; Gizer, Ian R.; Libiger, Ondrej; Bizon, Chris; Wilhelmsen, Kirk C.; Schork, Nicholas J.; Ehlers, Cindy L.

    2015-01-01

    Higher rates of alcohol use and other drug-dependence have been observed in some Native American populations relative to other ethnic groups in the U.S. Previous studies have shown that alcohol dehydrogenase (ADH) genes and aldehyde dehydrogenase (ALDH) genes may affect the risk of development of alcohol dependence, and that polymorphisms within these genes may differentially affect risk for the disorder depending on the ethnic group evaluated. We evaluated variations in the ADH and ALDH genes in a large study investigating risk factors for substance use in a Native American population. We assessed ancestry admixture and tested for associations between alcohol-related phenotypes in the genomic regions around the ADH1-7 and ALDH2 and ALDH1A1 genes. Seventy-two (72) ADH variants showed significant evidence of association with a severity level of alcohol drinking-related dependence symptoms phenotype. These significant variants spanned across the entire 7 ADH gene cluster regions. Two significant associations, one in ADH and one in ALDH2, were observed with alcohol dependence diagnosis. Seventeen (17) variants showed significant association with the largest number of alcohol drinks ingested during any 24-hour period. Variants in or near ADH7 were significantly negatively associated with alcohol-related phenotypes, suggesting a potential protective effect of this gene. In addition, our results suggested that a higher degree of Native American ancestry is associated with higher frequencies of potential risk variants and lower frequencies of potential protective variants for alcohol dependence phenotypes. PMID:25270064

  15. Effects of Obstructive Sleep Apnea on Sleep Quality, Cognition, and Driving Performance in Patients with Cirrhosis

    PubMed Central

    Bajaj, Jasmohan S; Thacker, Leroy R; Leszczyszyn, David; Taylor, Samuel A; Heuman, Douglas M; Raman, Shekar; Sterling, Richard K; Siddiqui, Muhammad S; Stravitz, R Todd; Sanyal, Arun J; Puri, Puneet; Luketic, Velimir; Matherly, Scott; Fuchs, Michael; White, Melanie B; Noble, Nicole A; Unser, Ariel B; Wade, James B

    2014-01-01

    Background & Aims: In patients with cirrhosis, sleep disturbances are assumed to result from hepatic encephalopathy (HE). The effects of obstructive sleep apnea (OSA) on cognition, sleep parameters, or driving in patients with cirrhosis are unclear. Methods: We performed a cross-sectional, prospective study of 118 subjects. Subjects were assigned to 1 of 4 groups: those with OSA and cirrhosis (without HE or ascites, n=34), those with only cirrhosis (n=30), those with only OSA only (n=29), and those without OSA or cirrhosis (controls, n=25). None of OSA patients were receiving continuous positive airway pressure (CPAP) therapy. Subjects underwent cognitive testing (paper–pencil tests for psychomotor speed and attention, as well as executive function tests), sleep assessment (daytime sleepiness and night-time sleep quality) and a monotonous driving simulation (worsening lane deviations over time indicate poor performance). We also tested patients with OSA, with cirrhosis (n=10) and without cirrhosis (n=7), before and after CPAP therapy. Results: Daytime sleepiness and sleep quality were worse in subjects in the OSA groups (with or without cirrhosis) than subjects with cirrhosis alone or controls. Of subjects with only OSA, 36% had impaired psychomotor speed and attention, compared to >60% of subjects in both cirrhosis groups. In contrast, executive function was uniformly worse in subjects with OSA, with or without cirrhosis, than groups without OSA. Simulator performance (lane deviations) worsened over time in both OSA groups. CPAP therapy significantly increased executive function and sleep quality, and reduced simulator lane deviations and sleepiness, in subjects with and without cirrhosis. After CPAP therapy, performance on the paper–pencil test performance improved significantly only in subjects with OSA without cirrhosis. Conclusion: OSA should be considered in evaluating sleep impairment in patients with cirrhosis. In patients with cirrhosis and OSA

  16. Incipient primary biliary cirrhosis/autoimmune hepatitis overlap or hepatitic form of primary biliary cirrhosis: a case report.

    PubMed

    Minz, Ranjana W; Chhabra, Seema; Aggarwal, Ritu; Das, Ashim; Saikia, Biman; Chawla, Yogesh K

    2009-01-01

    A 42 year old asymptomatic female detected as incipient Primary Biliary Cirrhosis/Autoimmune Hepatitis overlap during routine checkup. The biochemical profile showed evolution from a mildly deranged liver function test in 2004 along with increased erythrocyte sedimentation rate to a 4 times elevation of alkaline phosphatase in 2006 with mildly deranged alanine transaminase. Autoimmune markers demonstrable were Anti mitochondrial antibody M(2) and sp100. Histopathology showed dual features, dominant findings were of autoimmune heptatitis. Features consistent with Primary Biliary Cirrhosis were minimal with an occasional portal tract showing paucity of bile ducts and occasional bile duct proliferation. Human leucocyte antigen DR/DQ genotype was as follows: DRB1*03, DRB1*07, DQB1*02, DQB1*04. PMID:19829977

  17. Incipient primary biliary cirrhosis/autoimmune hepatitis overlap or hepatitic form of primary biliary cirrhosis: a case report

    PubMed Central

    Minz, Ranjana W; Aggarwal, Ritu; Das, Ashim; Saikia, Biman; Chawla, Yogesh K

    2009-01-01

    A 42 year old asymptomatic female detected as incipient Primary Biliary Cirrhosis/Autoimmune Hepatitis overlap during routine checkup. The biochemical profile showed evolution from a mildly deranged liver function test in 2004 along with increased erythrocyte sedimentation rate to a 4 times elevation of alkaline phosphatase in 2006 with mildly deranged alanine transaminase. Autoimmune markers demonstrable were Anti mitochondrial antibody M2 and sp100. Histopathology showed dual features, dominant findings were of autoimmune heptatitis. Features consistent with Primary Biliary Cirrhosis were minimal with an occasional portal tract showing paucity of bile ducts and occasional bile duct proliferation. Human leucocyte antigen DR/DQ genotype was as follows: DRB1*03, DRB1*07, DQB1*02, DQB1*04. PMID:19829977

  18. [Current problems in the prevention and treatment of infections in patients with cirrhosis].

    PubMed

    Bellot, Pablo; Jara Pérez López, Neftalí; Martínez Moreno, Belén; Such, José

    2010-12-01

    Infections in patients with cirrhosis are a common complication causing substantial morbidity and mortality. Bacterial translocation plays an important role in the pathogenesis of many infections in cirrhosis. In turn, infections are involved in the pathogenesis of many episodes of decompensated cirrhosis, such as esophageal variceal bleeding, renal insufficiency, the hemodynamic alterations of cirrhosis, and hepatic encephalopathy. Spontaneous bacterial peritonitis is currently the most frequent infection in cirrhosis. Mortality from this entity has recently decreased due to early diagnosis, the use of appropriate antibiotic therapy, and albumin administration. However, infections due to multiresistant microorganisms have recently increased, leading to greater mortality. Primary prophylaxis with quinolones is effective in preventing infections and is associated with lower mortality in a selected population of patients with liver cirrhosis. PMID:20444525

  19. Impact of obesity and insulin-resistance on cirrhosis and portal hypertension.

    PubMed

    Berzigotti, Annalisa; Abraldes, Juan G

    2013-10-01

    Obesity is sharply rising worldwide and is increasingly recognized in patients with cirrhosis. This review summarizes the available data documenting a detrimental role of obesity and insulin-resistance on the risk of appearance of clinical events in patients with cirrhosis. Molecular pathways explaining the harmful effect of obesity and insulin resistance in the natural history of cirrhosis are largely unknown. Increasing knowledge of mechanisms leading to white adipose tissue dysfunction on one side, and to portal hypertension on the other side, allow hypothesizing that a link between the pathophysiology of obesity, insulin resistance and portal hypertension in cirrhosis exists. Mechanisms likely involved in this interplay are discussed in this article. PMID:23731977

  20. Vaccinating Adult Patients with Cirrhosis: Trends over a Decade in the United States

    PubMed Central

    Waghray, Nisheet; Menon, K. V. Narayanan

    2016-01-01

    Introduction. The progression of chronic liver disease to cirrhosis involves both innate and adaptive immune system dysfunction resulting in increased risk of infectious complications. Vaccinations against pneumococcus, hepatitis A virus (HAV), and hepatitis B virus (HBV) are well tolerated and effective in disease prevention and reduction in morbidity and mortality. Prior studies assessing vaccination rates in patients with cirrhosis have specific limitations and to date no study has provided a comprehensive evaluation of vaccination rates in patients with cirrhosis in the United States. Aim. This study assessed vaccination rates for pneumococcus, HAV, and HBV in patients with cirrhosis. Results. Overall 59.7% of patients with cirrhosis received at least 1 vaccination during the study period. Vaccination rates within the same or following year of cirrhosis diagnosis were 19.9%, 7.7%, and 11.0% against pneumococcus, HAV, and HBV, respectively. Trend analysis revealed significant increases in vaccination rates for pneumococcus in all patients with cirrhosis and within subgroups based on age, gender, and presence of concomitant diabetes. Conclusion. The study demonstrated that vaccination rates in patients with cirrhosis remain suboptimal. Ultimately, the use of electronic medical record (EMR) reminders improved communication between healthcare professionals and public health programs to increase awareness are fundamental to reducing morbidity, mortality, and health-care related costs of vaccine preventable diseases in patients with cirrhosis. PMID:27239192

  1. The endocrinology and pathophysiology of alcoholic cirrhosis and functional renal failure--a review.

    PubMed Central

    Domurat, E. S.; Elias, A. N.

    1992-01-01

    The pathophysiology and characteristics of decompensated alcoholic cirrhosis and functional renal failure are reviewed. The review will be restricted to alcoholic cirrhosis, because most cases of functional renal failure in the United States occur in the setting of alcoholic cirrhosis, which is also the most common cause of ascites in North America and Europe. Moreover, hepatorenal syndrome may complicate other forms of liver disease besides alcoholic cirrhosis, but the pathogenesis in such circumstances may not be the same as in the cirrhotic state. PMID:1602514

  2. Conscientiousness, Protective Behavioral Strategies, and Alcohol Use: Testing for Mediated Effects

    ERIC Educational Resources Information Center

    Martens, Matthew P.; Karakashian, Michael A.; Fleming, Kristie M.; Fowler, Roneferiti M.; Hatchett, E. Suzanne; Cimini, M. Dolores

    2009-01-01

    The purpose of this study was to determine if use of protective behavioral strategies mediated the relationship between conscientiousness and alcohol use and alcohol-related problems. Participants were 186 college students at a state university campus in the Northeastern United States participating in a study examining the effectiveness of a brief…

  3. The Quik Fix study: a randomised controlled trial of brief interventions for young people with alcohol-related injuries and illnesses accessing emergency department and crisis support care

    PubMed Central

    2014-01-01

    Background Alcohol is a major preventable cause of injury, disability and death in young people. Large numbers of young people with alcohol-related injuries and medical conditions present to hospital emergency departments (EDs). Access to brief, efficacious, accessible and cost effective treatment is an international health priority within this age group. While there is growing evidence for the efficacy of brief motivational interviewing (MI) for reducing alcohol use in young people, there is significant scope to increase its impact, and determine if it is the most efficacious and cost effective type of brief intervention available. The efficacy of personality-targeted interventions (PIs) for alcohol misuse delivered individually to young people is yet to be determined or compared to MI, despite growing evidence for school-based PIs. This study protocol describes a randomized controlled trial comparing the efficacy and cost-effectiveness of telephone-delivered MI, PI and an Assessment Feedback/Information (AF/I) only control for reducing alcohol use and related harm in young people. Methods/design Participants will be 390 young people aged 16 to 25 years presenting to a crisis support service or ED with alcohol-related injuries and illnesses (including severe alcohol intoxication). This single blinded superiority trial randomized young people to (i) 2 sessions of MI; (ii) 2 sessions of a new PI or (iii) a 1 session AF/I only control. Participants are reassessed at 1, 3, 6 and 12 months on the primary outcomes of alcohol use and related problems and secondary outcomes of mental health symptoms, functioning, severity of problematic alcohol use, alcohol injuries, alcohol-related knowledge, coping self-efficacy to resist using alcohol, and cost effectiveness. Discussion This study will identify the most efficacious and cost-effective telephone-delivered brief intervention for reducing alcohol misuse and related problems in young people presenting to crisis support

  4. Does Drinking Location Matter? Profiles of Risky Single-Occasion Drinking by Location and Alcohol-Related Harm among Young Men

    PubMed Central

    Bähler, Caroline; Dey, Michelle; Dermota, Petra; Foster, Simon; Gmel, Gerhard; Mohler-Kuo, Meichun

    2014-01-01

    In adolescents and young adults, acute consequences like injuries account for a substantial proportion of alcohol-related harm, especially in risky single-occasion (RSO) drinkers. The primary aim of the study was to characterize different drinking profiles in RSO drinkers according to drinking locations and their relationship to negative, alcohol-related consequences. The sample consisted of 2746 young men from the Cohort Study on Substance Use Risk Factors who had reported drinking six or more drinks on a single-occasion at least monthly over the preceding 12 months. Principal component analysis on the frequency and amount of drinking at 11 different locations was conducted, and 2 distinguishable components emerged: a non-party-dimension (loading high on theater/cinema, sport clubs, other clubs/societies, restaurants, and sport events) and a party-dimension (loading high on someone else’s home, pubs/bars, discos/nightclubs, outdoor public places, special events, and home). Differential impacts of drinking location profiles were observed on severe negative alcohol-related consequences (SAC). Relative to those classified as low or intermediate in both dimensions, no significant difference experiencing SAC was found among those who were classified as high in the non-party-dimension only. However, those who were classified as high in the party-dimension alone or in both dimensions were more likely to experience SAC. These differential effects remained after adjusting for alcohol consumption (volume and risky single-occasion drinking), personality traits, and peer-influence [adjusted OR = 0.83 (0.68–1.02), 1.57 (1.27–1.96), and 1.72 (1.23–2.41), respectively], indicating independent effects of drinking location on SAC. The inclusion of sociodemographic factors did not alter this association. The fact that this cluster of party-dimension locations seems to predispose young men to experiencing SAC has important implications for alcohol control policies

  5. Clinical use of meconium fatty acid ethyl esters for identifying children at risk for alcohol-related disabilities: the first reported case.

    PubMed

    Zelner, Irene; Shor, Sarit; Lynn, Hazel; Roukema, Henry; Lum, Lisa; Eisinga, Kirsten; Koren, Gideon

    2012-01-01

    Fatty acid ethyl esters (FAEEs) in meconium are validated biomarkers of heavy fetal alcohol exposure that may potentially be used clinically for identifying children at risk for alcohol-related disabilities. However, until now, FAEEs have been largely used anonymously in epidemiological studies, and by child protection authorities in need for verification of heavy alcohol use in pregnancy. Here we describe the first case of a neonate identified as part of a research study on a pilot neonatal screening program for prenatal alcohol exposure. The neonate's meconium tested high for FAEEs (52 nmol/g; positive cut-off ≥ 2 nmol/g), which prompted active follow-up of the infant's development, identifying early neurocognitive problems and allowing initiation of a remedial program. PMID:22247425

  6. Alcohol-related amnesia and dementia: animal models have revealed the contributions of different etiological factors on neuropathology, neurochemical dysfunction and cognitive impairment.

    PubMed

    Vetreno, Ryan P; Hall, Joseph M; Savage, Lisa M

    2011-11-01

    Chronic alcoholism is associated with impaired cognitive functioning. Over 75% of autopsied chronic alcoholics have significant brain damage and over 50% of detoxified alcoholics display some degree of learning and memory impairment. However, the relative contributions of different etiological factors to the development of alcohol-related neuropathology and cognitive impairment are questioned. One reason for this quandary is that both alcohol toxicity and thiamine deficiency result in brain damage and cognitive problems. Two alcohol-related neurological disorders, alcohol-associated dementia and Wernicke-Korsakoff syndrome have been modeled in rodents. These pre-clinical models have elucidated the relative contributions of ethanol toxicity and thiamine deficiency to the development of dementia and amnesia. What is observed in these models--from repeated and chronic ethanol exposure to thiamine deficiency--is a progression of both neural and cognitive dysregulation. Repeated binge exposure to ethanol leads to changes in neural plasticity by reducing GABAergic inhibition and facilitating glutamatergic excitation, long-term chronic ethanol exposure results in hippocampal and cortical cell loss as well as reduced hippocampal neurotrophin protein content critical for neural survival, and thiamine deficiency results in gross pathological lesions in the diencephalon, reduced neurotrophic protein levels, and neurotransmitters levels in the hippocampus and cortex. Behaviorally, after recovery from repeated or chronic ethanol exposure there is impairment in working or episodic memory that can recover with prolonged abstinence. In contrast, after thiamine deficiency there is severe and persistent spatial memory impairments and increased perseverative behavior. The interaction between ethanol and thiamine deficiency does not produce more behavioral or neural pathology, with the exception of reduction of white matter, than long-term thiamine deficiency alone. PMID:21256970

  7. Alcohol-related amnesia and dementia: Animal models have revealed the contributions of different etiological factors on neuropathology, neurochemical dysfunction and cognitive impairment

    PubMed Central

    Vetreno, Ryan P.; Hall, Joseph M.; Savage, Lisa M.

    2011-01-01

    Chronic alcoholism is associated with impaired cognitive functioning. Over 75% of autopsied chronic alcoholics have significant brain damage and over 50% of detoxified alcoholics display some degree of learning and memory impairment. However, the relative contributions of different etiological factors to the development of alcohol-related neuropathology and cognitive impairment are questioned. One reason for this quandary is that both alcohol toxicity and thiamine deficiency result in brain damage and cognitive problems. Two alcohol-related neurological disorders, alcohol-associated dementia and Wernicke-Korsakoff syndrome have been modeled in rodents. These pre-clinical models have elucidated the relative contributions of ethanol toxicity and thiamine deficiency to the development of dementia and amnesia. What is observed in these models—from repeated and chronic ethanol exposure to thiamine deficiency—is a progression of both neural and cognitive dysregulation. Repeated binge exposure to ethanol leads to changes in neural plasticity by reducing GABAergic inhibition and facilitating glutamatergic excitation, long-term chronic ethanol exposure results in hippocampal and cortical cell loss as well as reduced hippocampal neurotrophin protein content critical for neural survival, and thiamine deficiency results in gross pathological lesions in the diencephalon, reduced neurotrophic protein levels, and neurotransmitters levels in the hippocampus and cortex. Behaviorally, after recovery from repeated or chronic ethanol exposure there is impairment in working or episodic memory that can recover with prolonged abstinence. In contrast, after thiamine deficiency there is severe and persistent spatial memory impairments and increased perseverative behavior. The interaction between ethanol and thiamine deficiency does not produce more behavioral or neural pathology, with the exception of reduction of white matter, than long-term thiamine deficiency alone. PMID:21256970

  8. Alcohol use, abuse, and alcohol-related disorders among ethnic groups in Hungary. Part II: Palócs from Mátraderecske.

    PubMed

    Agarwal, D P; Benkmann, H G; Goedde, H W; Püschel, K; Béres, J; Czeizel, A E; Dobos, I; Métneki, J; Szekér, E; Sahegyi, J

    1995-03-01

    An epidemiological study on alcohol drinking habits, alcohol metabolism rate, alcohol-related acute physiological symptoms, and alcohol misuse among Palócs, an ethnic minority in Hungary, was conducted. The demographic and sociocultural correlates revealed their ethnic identity: low to moderate education, relatively low number of children per family and higher percentage of skilled workers among males. Alcohol use survey revealed that frequency of alcohol consumption among Palóc male population is considerably high. While about 41% of the Palóc males reported to drink daily between 30 ml and 90 ml pure alcohol, only 5% of the females reported to consume this amount regularly. 53% of males and less than 1% of females were classified as heavy drinkers (consuming more than 60 ml absolute alcohol per day). While all kinds of alcoholic beverage was reported to be consumed by the males, Pálinka (a kind of brandy) drinking was more common among females. About 45% of the Palócs reported to experience acute reactions after drinking a moderate dose of alcohol. The physical and physiological reactions include facial flushing, higher pulse rate, tachycardia and euphoria. While there was no distinct gender difference in facial flushing response to alcohol drinking, a higher percentage of males (70%) reported symptoms such as sleepiness, euphoria and aggressiveness as compared to about only 36% females reporting such reactions. Distribution of clinical chemical markers, in particular GGT values confirmed a heavier alcohol consumption among males than among females. High GGT value also correlated with a positive alcohol-related facial flushing reaction in males. PMID:7755376

  9. Alcohol-Related Diagnoses and All-Cause Hospitalization Among HIV-Infected and Uninfected Patients: A Longitudinal Analysis of United States Veterans from 1997 to 2011.

    PubMed

    Rentsch, Christopher; Tate, Janet P; Akgün, Kathleen M; Crystal, Stephen; Wang, Karen H; Ryan Greysen, S; Wang, Emily A; Bryant, Kendall J; Fiellin, David A; Justice, Amy C; Rimland, David

    2016-03-01

    Individuals with HIV infection are living substantially longer on antiretroviral therapy, but hospitalization rates continue to be relatively high. We do not know how overall or diagnosis-specific hospitalization rates compare between HIV-infected and uninfected individuals or what conditions may drive hospitalization trends. Hospitalization rates among United States Veterans were calculated and stratified by HIV serostatus and principal diagnosis disease category. Because alcohol-related diagnoses (ARD) appeared to have a disproportional effect, we further stratified our calculations by ARD history. A multivariable Cox proportional hazards model was fitted to assess the relative risk of hospitalization controlling for demographic and other comorbidity variables. From 1997 to 2011, 46,428 HIV-infected and 93,997 uninfected patients were followed for 1,497,536 person-years. Overall hospitalization rates decreased among HIV-infected and uninfected patients. However, cardiovascular and renal insufficiency admissions increased for all groups while gastrointestinal and liver, endocrine, neurologic, and non-AIDS cancer admissions increased among those with an alcohol-related diagnosis. After multivariable adjustment, HIV-infected individuals with an ARD had the highest risk of hospitalization (hazard ratio 3.24, 95 % CI 3.00, 3.49) compared to those free of HIV infection and without an ARD. Still, HIV alone also conferred increased risk (HR 2.08, 95 % CI 2.04, 2.13). While decreasing overall, risk of all-cause hospitalization remains higher among HIV-infected than uninfected individuals and is strongly influenced by the presence of an ARD. PMID:25711299

  10. Colonic inflammation and secondary bile acids in alcoholic cirrhosis

    PubMed Central

    Kakiyama, Genta; Hylemon, Phillip B.; Zhou, Huiping; Pandak, William M.; Heuman, Douglas M.; Kang, Dae Joong; Takei, Hajime; Nittono, Hiroshi; Ridlon, Jason M.; Fuchs, Michael; Gurley, Emily C.; Wang, Yun; Liu, Runping; Sanyal, Arun J.; Gillevet, Patrick M.

    2014-01-01

    Alcohol abuse with/without cirrhosis is associated with an impaired gut barrier and inflammation. Gut microbiota can transform primary bile acids (BA) to secondary BAs, which can adversely impact the gut barrier. The purpose of this study was to define the effect of active alcohol intake on fecal BA levels and ileal and colonic inflammation in cirrhosis. Five age-matched groups {two noncirrhotic (control and drinkers) and three cirrhotic [nondrinkers/nonalcoholics (NAlc), abstinent alcoholic for >3 mo (AbsAlc), currently drinking (CurrAlc)]} were included. Fecal and serum BA analysis, serum endotoxin, and stool microbiota using pyrosequencing were performed. A subgroup of controls, NAlc, and CurrAlc underwent ileal and sigmoid colonic biopsies on which mRNA expression of TNF-α, IL-1β, IL-6, and cyclooxygenase-2 (Cox-2) were performed. One hundred three patients (19 healthy, 6 noncirrhotic drinkers, 10 CurrAlc, 38 AbsAlc, and 30 NAlc, age 56 yr, median MELD: 10.5) were included. Five each of healthy, CurrAlc, and NAlc underwent ileal/colonic biopsies. Endotoxin, serum-conjugated DCA and stool total BAs, and secondary-to-primary BA ratios were highest in current drinkers. On biopsies, a significantly higher mRNA expression of TNF-α, IL-1β, IL-6, and Cox-2 in colon but not ileum was seen in CurrAlc compared with NAlc and controls. Active alcohol use in cirrhosis is associated with a significant increase in the secondary BA formation compared with abstinent alcoholic cirrhotics and nonalcoholic cirrhotics. This increase in secondary BAs is associated with a significant increase in expression of inflammatory cytokines in colonic mucosa but not ileal mucosa, which may contribute to alcohol-induced gut barrier injury. PMID:24699327

  11. Host Genetics Predict Clinical Deterioration in HCV-Related Cirrhosis

    PubMed Central

    King, Lindsay Y.; Johnson, Kara B.; Zheng, Hui; Wei, Lan; Gudewicz, Thomas; Hoshida, Yujin; Corey, Kathleen E.; Ajayi, Tokunbo; Ufere, Nneka; Baumert, Thomas F.; Chan, Andrew T.; Tanabe, Kenneth K.; Fuchs, Bryan C.; Chung, Raymond T.

    2014-01-01

    Single nucleotide polymorphisms (SNPs) in the epidermal growth factor (EGF, rs4444903), patatin-like phospholipase domain-containing protein 3 (PNPLA3, rs738409) genes, and near the interleukin-28B (IL28B, rs12979860) gene are linked to treatment response, fibrosis, and hepatocellular carcinoma (HCC) in chronic hepatitis C. Whether these SNPs independently or in combination predict clinical deterioration in hepatitis C virus (HCV)-related cirrhosis is unknown. We genotyped SNPs in EGF, PNPLA3, and IL28B from liver tissue from 169 patients with biopsy-proven HCV cirrhosis. We estimated risk of clinical deterioration, defined as development of ascites, encephalopathy, variceal hemorrhage, HCC, or liver-related death using Cox proportional hazards modeling. During a median follow-up of 6.6 years, 66 of 169 patients experienced clinical deterioration. EGF non-AA, PNPLA3 non-CC, and IL28B non-CC genotypes were each associated with increased risk of clinical deterioration in age, sex, and race-adjusted analysis. Only EGF non-AA genotype was independently associated with increased risk of clinical deterioration (hazard ratio [HR] 2.87; 95% confidence interval [CI] 1.31–6.25) after additionally adjusting for bilirubin, albumin, and platelets. Compared to subjects who had 0–1 unfavorable genotypes, the HR for clinical deterioration was 1.79 (95%CI 0.96–3.35) for 2 unfavorable genotypes and 4.03 (95%CI 2.13–7.62) for unfavorable genotypes for all three loci (Ptrend<0.0001). In conclusion, among HCV cirrhotics, EGF non-AA genotype is independently associated with increased risk for clinical deterioration. Specific PNPLA3 and IL28B genotypes also appear to be associated with clinical deterioration. These SNPs have potential to identify patients with HCV-related cirrhosis who require more intensive monitoring for decompensation or future therapies preventing disease progression. PMID:25504078

  12. Differential Sympathetic Vasomotor Activation Induced by Liver Cirrhosis in Rats

    PubMed Central

    Bergamaschi, Cássia T.; Campos, Ruy R.

    2016-01-01

    We tested the hypothesis that there is a topographical sympathetic activation in rats submitted to experimental cirrhosis. Baseline renal (rSNA) and splanchnic (sSNA) sympathetic nerve activities were evaluated in anesthetized rats. In addition, we evaluated main arterial pressure (MAP), heart rate (HR), and baroreceptor reflex sensitivity (BRS). Cirrhotic Wistar rats were obtained by bile duct ligation (BDL). MAP and HR were measured in conscious rats, and cardiac BRS was assessed by changes in blood pressure induced by increasing doses of phenylephrine or sodium nitroprusside. The BRS and baseline for the control of sSNA and rSNA were also evaluated in urethane-anesthetized rats. Cirrhotic rats had increased baseline sSNA (BDL, 102 vs control, 58 spikes/s; p<0.05), but no baseline changes in the rSNA compared to controls. These data were accompanied by increased splanchnic BRS (p<0.05) and decreased cardiac (p<0.05) and renal BRS (p<0.05). Furthermore, BDL rats had reduced basal MAP (BDL, 93 vs control, 101 mmHg; p<0.05) accompanied by increased HR (BDL, 378 vs control, 356; p<0.05). Our data have shown topographical sympathetic activation in rats submitted to experimental cirrhosis. The BDL group had increased baseline sSNA, independent of dysfunction in the BRS and no changes in baseline rSNA. However, an impairment of rSNA and HR control by arterial baroreceptor was noted. We suggest that arterial baroreceptor impairment of rSNA and HR is an early marker of cardiovascular dysfunction related to liver cirrhosis and probably a major mechanism leading to sympathoexcitation in decompensated phase. PMID:27055088

  13. [Anemic syndrome in chronic hepatitis and liver cirrhosis].

    PubMed

    Korolko, Iu R; Sarycheva, T G; Kotelńikov, V M; Kozinets, G I; Zherebtsov, L A

    1993-01-01

    Regularities in the development of anemia in patients with chronic hepatitis or hepato-cirrhosis were studied with regard to the pattern and stage of the affection of the liver. The impact of inefficient erythropoiesis on anemia development in patients with chronic diffuse diseases of the liver was demonstrated. Reasons of the red cells imperfection that caused their rapid hemolysis were indicated. In the bone marrow of chronically ill patients there were lower levels of early precursors of erythropoiesis with their proliferative activity reduced. On the basis of the data obtained the authors gave practical recommendations for anemia treatment. PMID:8301986

  14. Sarcopenia in the prognosis of cirrhosis: Going beyond the MELD score.

    PubMed

    Kim, Hee Yeon; Jang, Jeong Won

    2015-07-01

    Estimating the prognosis of patients with cirrhosis remains challenging, because the natural history of cirrhosis varies according to the cause, presence of portal hypertension, liver synthetic function, and the reversibility of underlying disease. Conventional prognostic scoring systems, including the Child-Turcotte-Pugh score or model for end-stage liver diseases are widely used; however, revised models have been introduced to improve prognostic performance. Although sarcopenia is one of the most common complications related to survival of patients with cirrhosis, the newly proposed prognostic models lack a nutritional status evaluation of patients. This is reflected by the lack of an optimal index for sarcopenia in terms of objectivity, reproducibility, practicality, and prognostic performance, and of a consensus definition for sarcopenia in patients with cirrhosis in whom ascites and edema may interfere with body composition analysis. Quantifying skeletal muscle mass using cross-sectional abdominal imaging is a promising tool for assessing sarcopenia. As radiological imaging provides direct visualization of body composition, it is useful to evaluate sarcopenia in patients with cirrhosis whose body mass index, anthropometric measurements, or biochemical markers are inaccurate on a nutritional assessment. Sarcopenia defined by cross-sectional imaging-based muscular assessment is prevalent and predicts mortality in patients with cirrhosis. Sarcopenia alone or in combination with conventional prognostic systems shows promise for a cirrhosis prognosis. Including an objective assessment of sarcopenia with conventional scores to optimize the outcome prediction for patients with cirrhosis needs further research. PMID:26167066

  15. 28 CFR 79.27 - Indication of the presence of hepatitis B or cirrhosis.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Indication of the presence of hepatitis B... presence of hepatitis B or cirrhosis. (a)(1) If the claimant or eligible surviving beneficiary is claiming... possessed by the state cancer or tumor registries, indicates the presence of hepatitis B or cirrhosis,...

  16. 28 CFR 79.36 - Indication of the presence of hepatitis B or cirrhosis.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 28 Judicial Administration 2 2011-07-01 2011-07-01 false Indication of the presence of hepatitis B or cirrhosis. 79.36 Section 79.36 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS... § 79.36 Indication of the presence of hepatitis B or cirrhosis. Possible indication of hepatitis B...

  17. 28 CFR 79.36 - Indication of the presence of hepatitis B or cirrhosis.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Indication of the presence of hepatitis B or cirrhosis. 79.36 Section 79.36 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS... § 79.36 Indication of the presence of hepatitis B or cirrhosis. Possible indication of hepatitis B...

  18. Predictive Factors in the Incidence of Cirrhosis in Chronic Hepatitis B Virus Infections

    PubMed Central

    Alavian, Seyed Moayed; Imanieh, Mohammad Hadi; Imanieh, Mohammad Hossein

    2016-01-01

    Background Hepatitis B virus (HBV) is among the leading causes of liver cirrhosis worldwide. Predictors of cirrhosis in Iranian chronic hepatitis B (CHB) patients are yet to be clearly identified. Objectives Evaluating the predictive factors of liver cirrhosis in CHB. Patients and Methods A longitudinal study was conducted during 1995 - 2014 on all CHB patients who were referred to Tehran hepatitis center, Tehran, Iran. The patients were assessed during periodic visits through medical history and laboratory data. Logistic regression analyses were used to determine predictors of cirrhosis. Results Two hundred thirty-seven CHB patients were followed for an average duration of 10.6 years, and 41 of these patients developed cirrhosis. The incidence rate of cirrhosis was 2.82/100 person-years. Univariate analyses determined 9 out of 17 factors as significant predictors of outcome in CHB patients. Age of ≥ 45 years, positive hepatitis D virus (HDV), negative HBeAg, platelet count of < 150 (× 109)/L, and HBV DNA level of ≥ 2,000 IU/mL were identified as significant independent predictors of liver cirrhosis in multiple logistic analyses. Conclusions Five predictive factors that are simple and easy to measure may be used as parameters for the prediction of liver cirrhosis in CHB patients. PMID:27330536

  19. 28 CFR 79.27 - Indication of the presence of hepatitis B or cirrhosis.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Indication of the presence of hepatitis B... presence of hepatitis B or cirrhosis. (a)(1) If the claimant or eligible surviving beneficiary is claiming... possessed by the state cancer or tumor registries, indicates the presence of hepatitis B or cirrhosis,...

  20. 28 CFR 79.36 - Indication of the presence of hepatitis B or cirrhosis.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Indication of the presence of hepatitis B or cirrhosis. 79.36 Section 79.36 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS... § 79.36 Indication of the presence of hepatitis B or cirrhosis. Possible indication of hepatitis B...

  1. 28 CFR 79.27 - Indication of the presence of hepatitis B or cirrhosis.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Indication of the presence of hepatitis B... presence of hepatitis B or cirrhosis. (a)(1) If the claimant or eligible surviving beneficiary is claiming... possessed by the state cancer or tumor registries, indicates the presence of hepatitis B or cirrhosis,...

  2. 28 CFR 79.36 - Indication of the presence of hepatitis B or cirrhosis.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Indication of the presence of hepatitis B or cirrhosis. 79.36 Section 79.36 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS... § 79.36 Indication of the presence of hepatitis B or cirrhosis. Possible indication of hepatitis B...

  3. 28 CFR 79.36 - Indication of the presence of hepatitis B or cirrhosis.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 28 Judicial Administration 2 2013-07-01 2013-07-01 false Indication of the presence of hepatitis B or cirrhosis. 79.36 Section 79.36 Judicial Administration DEPARTMENT OF JUSTICE (CONTINUED) CLAIMS... § 79.36 Indication of the presence of hepatitis B or cirrhosis. Possible indication of hepatitis B...

  4. Life-threatening coagulopathy and hypofibrinogenaemia induced by tigecycline in a patient with advanced liver cirrhosis.

    PubMed

    Rossitto, Giacomo; Piano, Salvatore; Rosi, Silvia; Simioni, Paolo; Angeli, Paolo

    2014-06-01

    Bacterial infections because of multidrug-resistant (MDR) bacteria are spreading worldwide. In patients with advanced liver cirrhosis, healthcare-acquired and hospital-acquired infections are common and are frequently sustained by MDR bacteria. In these settings, tigecycline, a new antibiotic, has been shown to be useful in the treatment of MDR bacteria, and it has been proposed for the treatment of hospital-acquired infections in patients with cirrhosis. Nevertheless, poor data exist on the safety profile of tigecycline in patients with cirrhosis. Here, an experience is reported in a female patient with advanced liver cirrhosis, who developed sepsis by an MDR Stenotrophomonas maltophilia and was treated with tigecycline. She experienced life-threatening side effects consisting of severe coagulopathy with hypofibrinogenaemia and subsequent gastrointestinal haemorrhage. The side effect disappeared after the withdrawal of tigecycline. Therefore, a strict monitoring of coagulation parameters in patients with cirrhosis treated with tigecycline is recommended. PMID:24667348

  5. Androgen receptor roles in hepatocellular carcinoma, cirrhosis, and hepatitis

    PubMed Central

    Ma, Wen-Lung; Lai, Hsueh-Chou; Yeh, Shuyuan; Cai, Xiujun; Chang, Chawnshang

    2014-01-01

    Summary Androgen/androgen receptor (AR) signaling plays important roles in normal liver function and in progression of liver diseases. In studies of non-cancerous liver diseases, AR knockout mouse models of liver disease have revealed that androgen/AR signaling suppresses the development of steatosis, virus-related hepatitis, and cirrhosis. In addition, studies have shown that targeting AR in bone marrow-derived mesenchymal stem cells (BM-MSCs) improves their self-renewal and migration potentials, thereby increasing the efficacy of BM-MSC transplantation as a way to control the progression of cirrhosis. Androgen/AR signaling is known to be involved in the initiation of carcinogen- or Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC). However, studies have demonstrated that AR, rather than androgen, plays the dominant role in cancer initiation. Therefore, targeting AR might be an appropriate therapy for patients with early-stage HCC. In contrast, androgen/AR signaling has been shown to suppress metastasis of HCC in patients with late-stage disease. In addition, there is evidence that therapy comprising Sorafenib and agents that enhance the functional expression of AR may suppress the progression of late-stage HCC. PMID:24424503

  6. A Quick Screening Model for Symptomatic Bacterascites in Cirrhosis

    PubMed Central

    Zhu, Long-Chuan; Xu, Long; He, Wen-Hua; Wu, Wei; Zhu, Xuan

    2016-01-01

    Background: Diagnosis of spontaneous bacterial peritonitis in cirrhosis can be made when a patient has an ascites polymorphonuclear leukocyte count ≥250/mm3. However, symptomatic bacterascites, which is a variant of spontaneous bacterial peritonitis with signs of infection but an ascites polymorphonuclear leukocyte count <250/mm3, cannot be confirmed until the time-consuming ascites culture becomes positive. Currently, early indicators for symptomatic bacterascites remain undetermined. Aims: To develop a quick screening model for early detection of symptomatic bacterascites in cirrhosis. Materials and Methods: Data on patients with cirrhotic ascites from two hospitals (from 2010 to 2014) were collected retrospectively. Patients with symptomatic bacterascites were enrolled in the case group and compared with patients without any infection in the control group. Logistic regression analysis was used to build a model for screening symptomatic bacterascites, and a receiver operating characteristics curve was used to assess the model. Results: In total, 103 patients were enrolled in the case group and 204 patients were enrolled in the control group. A screening model was constructed based on body temperature, abdominal tenderness, blood neutrophil percentage, blood total bilirubin, prothrombin time, and ascites nucleated leukocyte count. The area under the receiver operating characteristic curve was 0.939; a screening score of 0.328 was the best cutoff value. Conclusion: Patients with suspected symptomatic bacterascites can be quickly screened according to the developed model, and a screening score ≥0.328 indicates symptomatic bacterascites. PMID:27488322

  7. Nutrition and survival in patients with liver cirrhosis.

    PubMed

    Alberino, F; Gatta, A; Amodio, P; Merkel, C; Di Pascoli, L; Boffo, G; Caregaro, L

    2001-06-01

    Although the effect of malnutrition on survival has been demonstrated by a number of studies, it is not clear whether malnutrition represents an independent risk factor in patients with liver disease. We studied 212 hospitalized patients with liver cirrhosis who were followed clinically for 2 y or until death. Body fat and muscle mass were evaluated by triceps skinfold thickness (TSF) and midarm muscle circumference (MAMC), respectively. Multivariate analysis according to Cox's model assessed the predictive power of nutritional parameters on survival. Thirty-four percent of patients had severe malnutrition as determined by MAMC and/or TSF below the 5th percentile and 20% had moderate malnutrition (MAMC and/or TSF < 10th percentile). Twenty-six percent of patients were overnourished (MAMC and/or TSF > 75th percentile). Severely and moderately malnourished patients had lower survival rates than normal and overnourished patients. When analyzed with Cox's regression analysis, severe depletion of muscle mass and body fat were found to be independent predictors of survival. The inclusion of MAMC and TSF in the Child-Pugh score, the prognostic score used most with liver disease, improved its prognostic accuracy. The prognostic power of MAMC was higher than that of TSF. These data demonstrate that malnutrition is an independent predictor of survival in patients with liver cirrhosis. The inclusion of anthropometric measures in the assessment of these patients might provide better prognostic information. PMID:11399401

  8. [Gastric vascular lesions in cirrhosis: gastropathy and antral vascular ectasia].

    PubMed

    Casas, Meritxell; Calvet, Xavier; Vergara, Mercedes; Bella, Maria Rosa; Junquera, Félix; Martinez-Bauer, Eva; Campo, Rafael

    2015-02-01

    Portal hypertensive gastropathy (GHP) is a complication of portal hypertension usually associated with liver cirrhosis. The pathogenesis is unclear but the presence of portal hypertension is an essential factor for its development. GHP may be asymptomatic or present as gastrointestinal bleeding or iron deficiency anemia. Endoscopic lesions vary from a mosaic pattern to diffuse red spots; the most common location is the fundus. Treatment is indicated when there is acute or chronic bleeding, as secondary prophylaxis. There is insufficient evidence to recommend primary prophylaxis in patients who have never bled. Drugs that decrease portal pressure, such as non-cardioselective beta-blockers, and/or endoscopic ablative treatments, such as argon-beam coagulation, may be used. The role of transarterial intrahepatic portosystemic shunt) or bypass surgery has been insufficiently analyzed. Antral vascular ectasia (EVA) is a rare entity in liver cirrhosis, whose pathophysiology is still unknown. Clinical presentation is similar to that of GHP and endoscopy usually shows red spots in the antrum. Biopsy is often required to differentiate EVA from GHP. There is no effective medical therapy, so endoscopic ablative therapy and, in severe cases, antrectomy are recommended. PMID:25499848

  9. Multimodal treatment of hepatocellular carcinoma on cirrhosis: An update

    PubMed Central

    Vivarelli, Marco; Montalti, Roberto; Risaliti, Andrea

    2013-01-01

    Hepatocellular carcinoma (HCC) is the most frequent primary liver tumor, and overall, it is one of the most frequent cancers. The association of HCC with chronic liver disease, and cirrhosis in particular, is well known, making treatment complex and challenging. The treatment of HCC must take into account the presence and stage of chronic liver disease, with the aim of preserving hepatic function that is often already impaired, the stage of HCC and the clinical condition of the patient. The different treatment options include surgical resection, transplantation, local ablation, chemoembolization, radioembolization and molecular targeted therapies; these treatments can be combined in various ways to achieve different goals. Ideally, liver transplantation is best treatment for early stage HCC on cirrhosis because it removes both the tumor and the chronic disease that produced it; however, the application of this powerful tool is limited by the scarcity of donors. Downstaging and bridging are different strategies for the management of HCC patients who will undergo liver transplantation. Several professionals, including gastroenterologists, radiologists and surgeons, are involved in the choice of the most appropriate treatment for a single case, and a multidisciplinary approach is necessary to optimize the outcome. The purpose of this review is to provide a comprehensive description of the current treatment options for patients with HCC by analyzing the advantages, disadvantages and rationale for their use. PMID:24259963

  10. Non invasive tools for the diagnosis of liver cirrhosis

    PubMed Central

    Soresi, Maurizio; Giannitrapani, Lydia; Cervello, Melchiorre; Licata, Anna; Montalto, Giuseppe

    2014-01-01

    Liver cirrhosis (LC), the end stage of many forms of chronic hepatitis of different etiologies is a diffuse process characterized by fibrosis and the conversion of normal liver architecture into structurally abnormal nodules surrounded by annular fibrosis. This chronic progressive clinical condition, leads to liver cell failure and portal hypertension, which can favour the onset of hepatocellular carcinoma. Defining the phase of the natural history is crucial for therapeutic choice and prognosis. Liver biopsy is currently considered the best available standard of reference but it has some limits, so alternative tools have been developed to substitute liver biopsy when assessing liver fibrosis. Serum markers offer a cost-effective alternative to liver biopsy being less invasive and theoretically without complications. They can be classified into direct and indirect markers which may be used alone or in combination to produce composite scores. Diagnostic imaging includes a number of instruments and techniques to estimate liver fibrosis and cirrhosis like ultrasound (US), US Doppler, contrast enhanced US and Elastography. US could be used for the diagnosis of advanced LC while is not able to evaluate progression of fibrosis, in this case Elastography is more reliable. This review aims to revise the most recent data from the literature about non invasive methods useful in defining liver fibrosis. PMID:25561782

  11. Hepatic Encephalopathy: Early Diagnosis in Pediatric Patients With Cirrhosis

    PubMed Central

    DARA, Naghi; SAYYARI, Ali-Akbar; IMANZADEH, Farid

    2014-01-01

    Objective As acute liver failure (ALF) and chronic liver disease (cirrhosis) continue to increase in prevalence, we will see more cases of hepatic encephalopathy. Primary care physician are often the first to suspect it, since they are familiar with the patient’s usual physical and mental status. This serious complication typically occurs in patients with severe comorbidities and needs multidisciplinary evaluation and care. Hepatic encephalopathy should be considered in any patient with acute liver failure and cirrhosis who presents with neuropsychiatric manifestations, decrease level of consciousness (coma), change of personality, intellectual and behavioral deterioration, speech and motor dysfunction. Every cirrhotic patient may be at risk; potential precipitating factors should be addressed in regular clinic visits. The encephalopathy of liver disease may be prominent, or can be present in subtle forms, such as decline of school performance, emotional outbursts, or depression. “Subtle form” of hepatic encephalopathy may not be obvious on clinical examination, but can be detected by neurophysiologic and neuropsychiatric testing. PMID:24665321

  12. Diagnosis and therapy of ascites in liver cirrhosis

    PubMed Central

    Biecker, Erwin

    2011-01-01

    Ascites is one of the major complications of liver cirrhosis and is associated with a poor prognosis. It is important to distinguish noncirrhotic from cirrhotic causes of ascites to guide therapy in patients with noncirrhotic ascites. Mild to moderate ascites is treated by salt restriction and diuretic therapy. The diuretic of choice is spironolactone. A combination treatment with furosemide might be necessary in patients who do not respond to spironolactone alone. Tense ascites is treated by paracentesis, followed by albumin infusion and diuretic therapy. Treatment options for refractory ascites include repeated paracentesis and transjugular intrahepatic portosystemic shunt placement in patients with a preserved liver function. Potential complications of ascites are spontaneous bacterial peritonitis (SBP) and hepatorenal syndrome (HRS). SBP is diagnosed by an ascitic neutrophil count > 250 cells/mm3 and is treated with antibiotics. Patients who survive a first episode of SBP or with a low protein concentration in the ascitic fluid require an antibiotic prophylaxis. The prognosis of untreated HRS type 1 is grave. Treatment consists of a combination of terlipressin and albumin. Hemodialysis might serve in selected patients as a bridging therapy to liver transplantation. Liver transplantation should be considered in all patients with ascites and liver cirrhosis. PMID:21455322

  13. Nocturnal energy and BCAA supplementation in patients with liver cirrhosis.

    PubMed

    Miwa, Yoshiyuki; Moriwaki, Hisataka

    2004-12-01

    Patients with liver cirrhosis have protein-energy malnutrition (PEM) and run short of proteins and energy. Protein deficiency leads to hypoalbuminemia, which induces peritoneal effusion and edema. Energy deficiency decreases fat and muscle mass and causes muscle weakness, which decreases the QOL of these patients. A decrease in triceps skinfold thickness (TSF) and arm muscle circumference (AMC), which are indicators of hypoalbuminemia and energy deficiency, and a decrease in respiratory quotient (RQ) affect the prognosis of these patients. Therefore, appropriate nutritional assessment should be performed in order to detect PEM in these patients, and necessary proteins or energy should be supplied. TSF, AMC and RQ are improved by increasing the energy supply to correct its deficiency and by dividing daily food intake (in some cases, adding nocturnal supplementation). Serum albumin levels increase when branched-chain amino acids (BCAAs) are administered after every meal or at bedtime. Consequently, nutritional assessment on PEM, and nutritional therapy based on this assessment are essential for improving the QOL and prognosis of patients with liver cirrhosis. PMID:15607141

  14. Primary biliary cirrhosis: Clinical and laboratory criteria for its diagnosis

    PubMed Central

    Reshetnyak, Vasiliy Ivanovich

    2015-01-01

    Primary biliary cirrhosis (PBC) is a chronic progressive cholestatic granulomatous, and destructive inflammatory lesion of small intralobular and septal bile ducts, which is likely to be caused by an autoimmune mechanism with a the presence of serum antimitochondrial antibodies and a potential tendency to progress to cirrhosis. Despite the fact that the etiology of this disease has been unknown so far, there has been a considerable body of scientific evidence that can reveal the clinical and laboratory signs of PBC and the individual components of its pathogenesis and elaborate diagnostic criteria for the disease and its symptomatic therapy. Deficiencies in autoimmune tolerance are critical factors for the initiation and perpetuation of the disease. The purpose of this review is to summarize the data available in the literature and the author’s findings on clinical and laboratory criteria for the diagnosis of PBC. This review describes the major clinical manifestations of the disease and the mechanisms of its development. It presents the immunological, biochemical, and morphological signs of PBC and their significance for its diagnosis. A great deal of novel scientific evidence for the problem of PBC has been accumulated. However, the inadequate efficiency of therapy for the disease lends impetus to the quest for its etiological factors and to further investigations of its pathogenetic mechanisms and, on this basis, to searches for new methods for its early diagnosis. PMID:26167070

  15. Primary Biliary Cirrhosis and Primary Sjögren's Syndrome: Insights for the Stomatologist.

    PubMed

    Lins, Liliane; Paraná, Raymundo; Almeida Reis, Silvia Regina; Pereira Falcão, Antônio Fernando

    2014-05-01

    Primary biliary cirrhosis (PBC) is a chronic progressive autoimmune disease characterized by portal inflammation and immune-mediated destruction of the intrahepatic bile ducts. Primary Sjögren's syndrome is an autoimmune disease characterized by lymphocytic infiltration of exocrine glands, mainly the lachrymal and salivary glands, in the absence of other definitively diagnosed rheumatologic disease. We report a diagnosed case of primary Sjögren's syndrome associated with PBC. A 59-year-old Caucasian woman went to oral evaluation reporting dry mouth, difficulty in eating associated with burning mouth syndrome, dysgeusia and dysphagia. Intraoral examination revealed extensive cervical caries, gingivitis, gingival retraction, angular cheilitis and atrophic tongue. Hyposalivation was detected by salivary flow and Schirmer's test was positive. Antinuclear and antimitochondrial antibodies were both positive. Anti-Ro/SSA and anti-La/SSB antibodies were negative. A minor salivary gland biopsy of the lower lip was performed. Histopathologic analysis revealed lymphocytic infiltrate with destruction of salivary gland architecture in some areas and replacement of glandular tissues by mononuclear cells. Optimal management of PBC associated with Sjögren's syndrome requires a multidisciplinary approach as the key to optimal patient care. Dental practitioners should be able to recognize the clinical features of this associated condition. Appropriate dental care may prevent tooth decay, periodontal disease and oral infections as well as improve the patient's quality of life. PMID:25298762

  16. H-ras oncogene expression and angiogenesis in experimental liver cirrhosis.

    PubMed

    Elpek, Gülsüm Özlem; Unal, Betül; Bozova, Sevgi

    2013-01-01

    Background. Proto-oncogenes, particularly ras, may not only affect cell proliferation but also contribute to angiogenesis by influencing both proangiogenic and antiangiogenic mediators. The aim of this study was to investigate whether any relationship exists between ras expression and angiogenesis during diethylnitrosamine- (DEN-) induced experimental liver fibrosis. Materials and Methods. Liver cirrhosis was induced in rats by intraperitoneal injections of DEN. The animals were sacrificed 2 weeks after the last administrations and a hepatectomy was performed. Masson's trichrome staining was used in the evaluation of the extent of liver fibrosis. The vascular density in portal and periportal areas was assessed by determining the count of CD34 labeled vessel sections. For quantitative evaluation of H-ras expression, in each section positive and negative cells were counted. Results. In fibrotic group H-ras expression was higher than that in nonfibrotic group and was more widespread in cirrhotic livers. Friedman's test showed that there was a significant correlation between H-ras expression and VD (P < 0.01). Conclusion. The results of this descriptive study reveal that H-ras expression gradually increases according to the severity of fibrosis and strongly correlates with angiogenesis. PMID:24235967

  17. Sodium homeostasis with chronic sodium loading in preascitic cirrhosis

    PubMed Central

    Wong, F; Liu, P; Blendis, L

    2001-01-01

    BACKGROUND—Preascitic cirrhotic patients receiving 200 mmol of sodium daily for seven days remain in positive sodium balance. Thereafter, sodium handling is unknown.
AIM—To assess renal sodium handling in preascitic cirrhosis on a high sodium diet for five weeks.
METHODS—Sixteen biopsy proven preascitic cirrhotics were assessed at weekly intervals for five weeks on a diet of 200 mmol sodium/day using a daily weight diary and weekly 24 hour urinary sodium estimations. Fasting supine neurohormone levels were measured at baseline and weekly for five weeks while haemodynamics were measured at baseline and at five weeks.
RESULTS—The daily diet of 200 mmol of sodium resulted in weight gain and a positive sodium balance for three weeks, associated with significant suppression of plasma renin activity and aldosterone levels, and a significant rise in plasma atrial natriuretic peptide levels (p<0.05). Patients' weights plateaued during week 4, associated with complete sodium balance and significant suppression of plasma noradrenaline levels (p<0.05). This was followed by a negative sodium balance and weight loss, and finally complete sodium balance, again despite a mean net gain of 2.3 (0.3) kg, associated with a return of plasma renin activity and aldosterone levels to within normal ranges. The lack of increase in central blood volume in addition to the persistent increase in plasma atrial natriuretic peptide levels indicated that residual volume expansion, consequent to persistent weight gain, was distributed on the venous side of the circulation. No free fluid was seen on repeat abdominal ultrasound after five weeks.
CONCLUSION—Preascitic cirrhotics have a natriuretic "escape" after three weeks on high sodium dietary intake, associated with elevated plasma atrial natriuretic peptide levels and suppression of the renin-angiotensin-aldosterone system. With continued suppressed sympathetic activity, preascitics re-establish complete sodium balance

  18. Paracrine renal endothelin system in rats with liver cirrhosis.

    PubMed Central

    Hocher, B.; Zart, R.; Diekmann, F.; Rohmeiss, P.; Distler, A.; Neumayer, H. H.; Bauer, C.; Gross, P.

    1996-01-01

    1. Liver cirrhosis was induced in rats by CCl4 administration. We analysed the expression of endothelin receptor subtypes in the renal cortex and medulla using Scatchard analysis and receptor autoradiography, and measured plasma as well as renal-tissue endothelin-1 concentrations using a specific radioimmunoassay. Furthermore, we analysed the effects of the non-selective (A/B) endothelin receptor antagonist, bosentan (6 and 100 mg kg-1 day-1) on mean arterial blood pressure, water and sodium excretion and glomerular filtration rate. 2. Our study revealed an overexpression of the endothelin B receptor (ETB) in the renal medulla of rats with liver cirrhosis (Cir: 2775 +/- 299 fmol mg-1; Con: 1695 +/- 255 fmol mg-1; n = 8; means +/- s.d., P < 0.01), whereas the density of ETB in the cortex and the endothelin A receptor (ETA) in the cortex and medulla were similar in both cirrhotic and control rats. Receptor autoradiography showed that the upregulation of medullary ETB in cirrhotic rats was due to an upregulation of ETB in the inner medullary collecting duct cells. 3. The tissue endothelin-1 concentrations were increased in the renal medulla of cirrhotic rats (Cir: 271 +/- 68 pg g-1wet wt.; Con: 153 +/- 36 pg g-1 wet wt., n = 8; means +/- s.d., P < 0.01). 4. The glomerular filtration rate was slightly decreased in cirrhotic rats but not altered after bosentan treatment in either cirrhotic or control rats. Bosentan decreased sodium excretion to a similar extent in both cirrhotic and control rats, whereas water excretion was significantly reduced by both dosages of bosentan in cirrhotic rats only (Cir + vehicle: 12.5 +/- 0.62 m day-1, Cir + 6 mg kg-1 day-1 bosentan: 8.6 +/- 1.0 ml day-1; Cir + 100 mg kg-1 day-1 bosentan: 7.4 +/- 0.6 ml day-1; n = 10; means +/- s.e.mean). 5. We therefore suggest that the upregulation of the medullary ETB in cirrhotic rats is involved in the regulation of water excretion in rats with CCl4-induced liver cirrhosis. Images Figure 1 Figure 5

  19. Large intestine permeability is increased in patients with compensated liver cirrhosis.

    PubMed

    Pijls, Kirsten E; Koek, Ger H; Elamin, Elhaseen E; de Vries, Hanne; Masclee, Ad A M; Jonkers, Daisy M A E

    2014-01-01

    Intestinal barrier dysfunction, facilitating translocation of bacteria and bacterial products, plays an important role in the pathophysiology of liver cirrhosis and its complications. Increased intestinal permeability has been found in patients with liver cirrhosis, but data on small and large intestine permeability and tight junctions (TJs) in patients with compensated cirrhosis are scarce. We aimed to investigate both small and large intestine permeability in patients with stable compensated cirrhosis compared with healthy controls and evaluated the expression of TJ proteins in mucosal biopsies at duodenal and sigmoid level. Intestinal permeability was assessed in 26 patients with compensated cirrhosis and 27 matched controls using a multisugar test. Duodenal and sigmoid biopsies were available from a subgroup for analyses of gene transcription and expression of key TJ proteins by qRT-PCR and ELISA, respectively. Median 0-5-h urinary sucrose excretion and lactulose/rhamnose ratio were comparable between patients with compensated cirrhosis and controls, whereas 5-24-h urinary sucralose/erythritol ratio was increased in these patients. Downregulation of gene transcription was found for claudin-3 in duodenal biopsies and claudin-4 in sigmoid biopsies, and at the protein level occludin expression was significantly increased in both duodenal and sigmoid biopsies. This study shows that gastroduodenal and small intestine permeability are not altered, whereas large intestine permeability is increased in patients with stable compensated cirrhosis. Only limited alterations were found regarding the expression of TJ proteins in both the small and large intestine. PMID:24264047

  20. Ultrasound predictors of compensated liver cirrhosis in hemodialysis patients with hepatitis C.

    PubMed

    Dzekova-Vidimliski, P; Dzikova, S; Selim, Gj; Gelev, S; Trajceska, L; Pushevski, V; Sikole, A

    2013-01-01

    Ultrasound examination was performed in 80 hemodialysis (HD) patients with chronic hepatitis C in order to determine the ultrasound predictors of compensated liver cirrhosis. The ultrasound score (US) was calculated from the morphological parameters (liver size, morphology, surface, echogenicity and spleen volume) and the hemodynamic parameters (portal vein diameter and portal vein mean flow velocity). The US ranged from 0 to 200, with a cut-off value of 66, for discrimination between absence and presence of liver cirrhosis. A logistic regression model with stepwise variable selection was used to determine predictors of the progression of liver disease. According to the calculated US, patients were divided into two groups. The first group consisted of 37 (46.3%) patients with US greater than 66, indicating the presence of compensated liver cirrhosis. The second group included 43 (53.7%) patients without liver cirrhosis, with US equal to or less than 66. The value of liver morphology was significantly higher, but the portal vein flow velocity was significantly lower in patients with compensated liver cirrhosis compared with those without cirrhosis. Furthermore, rounded liver surfaces and increased liver echogenicity were significantly more frequent in patients with compensated liver cirrhosis compared with the non-compensated group. Logistic regression model with stepwise discriminant analysis identified liver morphology, liver echogenicity and portal vein mean flow velocity as independent ultrasound predictors of compensated liver cirrhosis in HD patients with chronic hepatitis C. Ultrasound examination could be used for non-invasive diagnosis of compensated liver cirrhosis, with accurate estimation of the disease severity in HD patients with chronic hepatitis C. PMID:23354188

  1. [Alcohol related problem in the workplace: trial of a screening and brief intervention program for risky drinking in the workplace, via the Internet].

    PubMed

    Kawaguchi, Kaoru; Shimizu, Yukiko; Izumi, Tomoko; Ochiai, Hiroko; Yoshimoto, Hisashi; Ino, Aro; Ochiai, Masahiro

    2014-12-01

    This report describes the effect of a screening and brief intervention via the Internet (6-month Total health Management Program: TMP, a kind of life evolution program), for improvement of alcohol related problem in the workplace. At a certain company, 2,096 employees were screened.using AUDIT-C and CAGE via the Internet (electronic screening). From those screened, 17 risky drinkers were picked up. The classification of "risky drinker" was determined based on employees scoring over six points on AUDIT-C and over two points on_ AGE. These employees were then called to one-day practical seminar program (including the program of food education, music therapy, aro-atherapy, body conditioning etc.). After which, during 6 months, they were followed up via e-mail every month. After the 6-month follow up, their results of AUDIT-C were significantly decreased. Additionally, aside from the frequency of drinking at bedtime, maximum alcohol consumption per day was also significantly decreased. The Visual Analogue Scale for anxiety captured the initial screen and then again after follow-up was reduced significantly. Moreover, quality-of-life index for sleep and dinner were both significantly improved as well..These results suggest that the SBI (screening and brief intervention: TMP) is effective for reducing drinking behavior, can be used to effectively elevate quality of life. PMID:25831951

  2. Life Course Trajectories of Labour Market Participation among Young Adults Who Experienced Severe Alcohol-Related Health Outcomes: A Retrospective Cohort Study

    PubMed Central

    Paljärvi, Tapio; Martikainen, Pekka; Pensola, Tiina; Leinonen, Taina; Herttua, Kimmo; Mäkelä, Pia

    2015-01-01

    Background Long-term employment trajectories of young problem drinkers are poorly understood. Methods We constructed retrospective labour market participation histories at ages 18–34 of 64 342 persons born in 1969–1982. Beginning from the year of each subject’s 18th birthday, we extracted information from the records of Statistics Finland on educational attainment, main type of economic activity, months in employment, and months in unemployment for a minimum of seven years (range 7–16 years). We used information on the timing of alcohol-related hospitalizations and deaths in the same period to define problem drinkers with early onset limited course, early onset persistent course, and late onset problem drinking. Results Early onset limited course problem drinkers improved their employment considerably by age, whereas early onset persistent problem drinkers experienced a constant decline in their employment by age. From the age of 18 to 34, early onset persistent problem drinkers were in employment merely 12% of the time, in comparison with 39% among the early onset limited course problem drinkers, and 58% among the general population. Conclusions These results indicate that young adults who were retrospectively defined as having early onset persistent course problem drinking were extensively marginalized from the labour market early on during their life course, and that their employment trajectory was significantly worse compared to other problem drinkers. PMID:25938764

  3. Tracking the When, Where, and With Whom of Alcohol Use: Integrating Ecological Momentary Assessment and Geospatial Data to Examine Risk for Alcohol-Related Problems.

    PubMed

    Freisthler, Bridget; Lipperman-Kreda, Sharon; Bersamin, Melina; Gruenewald, Paul J

    2014-01-01

    Prevention researchers have found that drinking in different contexts is related to different alcohol problems. Where and with whom people drink affects the types of alcohol-related problems they experience. Consequently, identifying those contexts that result in the greatest number of problems provides a novel opportunity to target new prevention efforts aimed at those contexts. However, identifying these contexts poses methodological challenges to prevention research. To overcome these challenges, researchers need tools that allow them to gather detailed information about when and where people choose to drink and how contextual factors influence drinking risks. New data collection and analysis techniques, such as activity-space analysis, which examines movement through different contexts, and ecological momentary assessment, which captures microlevel contextual changes as individuals move through their days, can advance the field of alcohol studies by providing detailed information on the use of drinking contexts, particularly when combined. Data acquired through these methods allow researchers to better identify those con-texts where and conditions under which drinking and problems related to drinking occur. Use of these methods will allow prevention practitioners to target prevention efforts to those contexts that place most drinkers at risk and tailor prevention efforts to each context for specific outcomes. PMID:26258998

  4. Reliability of a flushing questionnaire and the ethanol patch test in screening for inactive aldehyde dehydrogenase-2 and alcohol-related cancer risk.

    PubMed

    Yokoyama, A; Muramatsu, T; Ohmori, T; Kumagai, Y; Higuchi, S; Ishii, H

    1997-12-01

    Molecular epidemiology of esophageal and upper aerodigestive tract cancers revealed that alcohol is more carcinogenic in persons with inactive aldehyde dehydrogenase-2 (ALDH2) than in those with active ALDH2. A simple questionnaire has been developed to screen for the facial flushing that occurs in persons with inactive ALDH2 when they drink even a single glass of beer. In this study, 266 of 284 consecutive male Japanese clinic patients (age > or = 50 years) completed the flushing questionnaire, and 239 underwent the ethanol patch test (a cutaneous model for the flushing response). Blinded genotyping showed inactive ALDH2 for 94.4% (102 of 108) of subjects who reported always flushing (early in their drinking history or currently) and for 47.7% (21 of 44) of those who reported sometimes flushing, whereas 95.6% (109 of 114) of subjects reporting that they never exhibited facial flushing had active ALDH2. When all three categories of flushing (current always, former always, and sometimes) were collapsed into one, the questionnaire's sensitivity and specificity for identifying inactive ALDH2 were 96.1 and 79.0%, respectively, compared with 72.4 and 71.4% for the ethanol patch test. The results suggest the utility of this simple flushing questionnaire in daily practice, as well as large-scale studies to assess cancer risks associated with drinking and ALDH2 and for activities aimed at preventing alcohol-related cancer. PMID:9419411

  5. Mediterranean diet and upper aerodigestive tract cancer: the Greek segment of the Alcohol-Related Cancers and Genetic Susceptibility in Europe study.

    PubMed

    Samoli, Evangelia; Lagiou, Areti; Nikolopoulos, Elias; Lagogiannis, Georgios; Barbouni, Anastasia; Lefantzis, Dimitrios; Trichopoulos, Dimitrios; Brennan, Paul; Lagiou, Pagona

    2010-11-01

    Several dietary factors have been associated with the occurrence of cancers of the oral cavity and oropharynx, larynx and oesophagus, collectively called upper aerodigestive tract (UADT) cancers, but the evidence is considered as inconclusive. We hypothesised that the traditional Mediterranean dietary pattern may be more strongly inversely associated with UADT cancer risk than individual dietary components, and may explain the unexpectedly low incidence of these cancers in Greece. In the context of the European alcohol-related cancers and genetic susceptibility in Europe project, we have conducted a hospital-based case-control study in Athens, Greece, comparing 239 incident UADT cases and 194 hospital controls with admission diagnoses unrelated to tobacco, alcohol or diet. Adherence to Mediterranean diet was assessed through a widely used score, which ranges from 0 (minimal adherence) to 9 (maximal adherence) and increases with high consumption of plant foods and olive oil and low consumption of meat, dairy products and saturated lipids. Stricter adherence to the Mediterranean diet was associated with a substantial and significant decrease in UADT cancer risk (30 % for a two-unit increase in score), whereas after mutual adjustment, no individual dietary component of this diet was significantly associated with this risk. Adherence to the traditional Mediterranean diet is associated with reduced risk of UADT cancers, and may explain the lower incidence of UADT cancers in Greece, in spite of the smoking and drinking habits of this population. PMID:20500931

  6. Common genetic variants in the CLDN2 and PRSS1-PRSS2 loci alter risk for alcohol-related and sporadic pancreatitis

    PubMed Central

    Whitcomb, David C.; LaRusch, Jessica; Krasinskas, Alyssa M.; Klei, Lambertus; Smith, Jill P.; Brand, Randall E.; Neoptolemos, John P.; Lerch, Markus M.; Tector, Matt; Sandhu, Bimaljit S.; Guda, Nalini M.; Orlichenko, Lidiya; Alkaade, Samer; Amann, Stephen T.; Anderson, Michelle A.; Baillie, John; Banks, Peter A.; Conwell, Darwin; Coté, Gregory A.; Cotton, Peter B.; DiSario, James; Farrer, Lindsay A.; Forsmark, Chris E.; Johnstone, Marianne; Gardner, Timothy B.; Gelrud, Andres; Greenhalf, William; Haines, Jonathan L.; Hartman, Douglas J.; Hawes, Robert A.; Lawrence, Christopher; Lewis, Michele; Mayerle, Julia; Mayeux, Richard; Melhem, Nadine M.; Money, Mary E.; Muniraj, Thiruvengadam; Papachristou, Georgios I.; Pericak-Vance, Margaret A.; Romagnuolo, Joseph; Schellenberg, Gerard D.; Sherman, Stuart; Simon, Peter; Singh, Vijay K.; Slivka, Adam; Stolz, Donna; Sutton, Robert; Weiss, Frank Ulrich; Wilcox, C. Mel; Zarnescu, Narcis Octavian; Wisniewski, Stephen R.; O'Connell, Michael R.; Kienholz, Michelle L.; Roeder, Kathryn; Barmada, M. Michael; Yadav, Dhiraj; Devlin, Bernie; Albert, Marilyn S.; Albin, Roger L.; Apostolova, Liana G.; Arnold, Steven E.; Baldwin, Clinton T.; Barber, Robert; Barnes, Lisa L.; Beach, Thomas G.; Beecham, Gary W.; Beekly, Duane; Bennett, David A.; Bigio, Eileen H.; Bird, Thomas D.; Blacker, Deborah; Boxer, Adam; Burke, James R.; Buxbaum, Joseph D.; Cairns, Nigel J.; Cantwell, Laura B.; Cao, Chuanhai; Carney, Regina M.; Carroll, Steven L.; Chui, Helena C.; Clark, David G.; Cribbs, David H.; Crocco, Elizabeth A.; Cruchaga, Carlos; DeCarli, Charles; Demirci, F. Yesim; Dick, Malcolm; Dickson, Dennis W.; Duara, Ranjan; Ertekin-Taner, Nilufer; Faber, Kelley M.; Fallon, Kenneth B.; Farlow, Martin R.; Ferris, Steven; Foroud, Tatiana M.; Frosch, Matthew P.; Galasko, Douglas R.; Ganguli, Mary; Gearing, Marla; Geschwind, Daniel H.; Ghetti, Bernardino; Gilbert, John R.; Gilman, Sid; Glass, Jonathan D.; Goate, Alison M.; Graff-Radford, Neill R.; Green, Robert C.; Growdon, John H.; Hakonarson, Hakon; Hamilton-Nelson, Kara L.; Hamilton, Ronald L.; Harrell, Lindy E.; Head, Elizabeth; Honig, Lawrence S.; Hulette, Christine M.; Hyman, Bradley T.; Jicha, Gregory A.; Jin, Lee-Way; Jun, Gyungah; Kamboh, M. Ilyas; Karydas, Anna; Kaye, Jeffrey A.; Kim, Ronald; Koo, Edward H.; Kowall, Neil W.; Kramer, Joel H.; Kramer, Patricia; Kukull, Walter A.; LaFerla, Frank M.; Lah, James J.; Leverenz, James B.; Levey, Allan I.; Li, Ge; Lin, Chiao-Feng; Lieberman, Andrew P.; Lopez, Oscar L.; Lunetta, Kathryn L.; Lyketsos, Constantine G.; Mack, Wendy J.; Marson, Daniel C.; Martin, Eden R.; Martiniuk, Frank; Mash, Deborah C.; Masliah, Eliezer; McKee, Ann C.; Mesulam, Marsel; Miller, Bruce L.; Miller, Carol A.; Miller, Joshua W.; Montine, Thomas J.; Morris, John C.; Murrell, Jill R.; Naj, Adam C.; Olichney, John M.; Parisi, Joseph E.; Peskind, Elaine; Petersen, Ronald C.; Pierce, Aimee; Poon, Wayne W.; Potter, Huntington; Quinn, Joseph F.; Raj, Ashok; Raskind, Murray; Reiman, Eric M.; Reisberg, Barry; Reitz, Christiane; Ringman, John M.; Roberson, Erik D.; Rosen, Howard J.; Rosenberg, Roger N.; Sano, Mary; Saykin, Andrew J.; Schneider, Julie A.; Schneider, Lon S.; Seeley, William W.; Smith, Amanda G.; Sonnen, Joshua A.; Spina, Salvatore; Stern, Robert A.; Tanzi, Rudolph E.; Trojanowski, John Q.; Troncoso, Juan C.; Tsuang, Debby W.; Valladares, Otto; Van Deerlin, Vivianna M.; Van Eldik, Linda J.; Vardarajan, Badri N.; Vinters, Harry V.; Vonsattel, Jean Paul; Wang, Li-San; Weintraub, Sandra; Welsh-Bohmer, Kathleen A.; Williamson, Jennifer; Woltjer, Randall L.; Wright, Clinton B.; Younkin, Steven G.; Yu, Chang-En; Yu, Lei

    2012-01-01

    Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR, and SPINK1 variants were associated with pancreatitis risk. We now report two significant genome-wide associations identified and replicated at PRSS1-PRSS2 (1×10-12) and x-linked CLDN2 (p < 1×10-21) through a two-stage genome-wide study (Stage 1, 676 cases and 4507 controls; Stage 2, 910 cases and 4170 controls). The PRSS1 variant affects susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous (or hemizygous male) CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men – male hemizygous frequency is 0.26, female homozygote is 0.07. PMID:23143602

  7. Post-deployment screening and referral for risky alcohol use and subsequent alcohol-related and injury diagnoses, active component, U.S. Armed Forces, 2008-2014.

    PubMed

    Hurt, Lee

    2015-07-01

    Risky alcohol use among service members is a threat to both military readiness and the health of service members. This report describes an analysis using the Defense Medical Surveillance System (DMSS) to identify all active component service members who returned from deployment and completed the Alcohol Use Disorders Identification Test-Consumption (AUDIT-C) alcohol use screen as part of the Post Deployment Health Assessment (PDHA) and Post Deployment Health Reassessment (PDHRA) during 2008-2014. This analysis identified that 3.4% of PDHA forms and 4.8% of PDHRA forms completed indicated severe risk for alcohol abuse, defined as an AUDIT-C score of 8 or higher. Among those at severe risk on the PDHRA who were not already under care for alcohol abuse, only 37.7% received a referral for treatment: 21.7% to primary care, 13.4% to behavioral health in primary care, 7.5% to mental health specialty care, and 5.6% to a substance abuse program. Referrals for treatment for those at severe risk were lower than their respective counterparts among males, white non-Hispanics, members of the Air Force, junior officers, and pilots/air crew. There were significant trends of increasing frequencies of subsequent injury and alcohol-related conditions as alcohol use levels increased. PMID:26207410

  8. Impact of age at first drink on vulnerability to alcohol-related problems: testing the marker hypothesis in a prospective study of young adults.

    PubMed

    Buchmann, Arlette F; Schmid, Brigitte; Blomeyer, Dorothea; Becker, Katja; Treutlein, Jens; Zimmermann, Ulrich S; Jennen-Steinmetz, Christine; Schmidt, Martin H; Esser, Günter; Banaschewski, Tobias; Rietschel, Marcella; Schumann, Gunter; Laucht, Manfred

    2009-10-01

    There is ample evidence that the early initiation of alcohol use is a risk factor for the development of later alcohol-related problems. The purpose of the current study was to examine whether this association can be explained by indicators of a common underlying susceptibility or whether age at drinking onset may be considered as an independent predictor of later drinking behavior, suggesting a potential causal relationship. Participants were drawn from a prospective cohort study of the long-term outcomes of early risk factors followed up from birth onwards. Structured interviews were administered to 304 participants to assess age at first drink and current drinking behavior. Data on risk factors, including early family adversity, parental alcohol use, childhood psychopathology and stressful life events, were repeatedly collected during childhood using standardized parent interviews. In addition, information on genotype was considered. Results confirmed previous work demonstrating that hazardous alcohol consumption is related to early-adolescent drinking onset. A younger age of first drink was significantly predicted by 5-HTTLPR genotype and the degree of preceding externalizing symptoms, and both factors were related to increased consumption or harmful alcohol use at age 19. However, even after controlling for these potential explanatory factors, earlier age at drinking onset remained a strong predictor of heavy alcohol consumption in young adulthood. The present longitudinal study adds to the current literature indicating that the early onset - adult hazardous drinking association cannot solely be attributed to shared genetic and psychopathologic risk factors as examined in this study. PMID:19332346

  9. Terahertz spectroscopy of liver cirrhosis: investigating the origin of contrast

    NASA Astrophysics Data System (ADS)

    Sy, Stanley; Huang, Shengyang; Wang, Yi-Xiang J.; Yu, Jun; Ahuja, Anil T.; Zhang, Yuan-ting; Pickwell-MacPherson, Emma

    2010-12-01

    We have previously demonstrated that terahertz pulsed imaging is able to distinguish between rat tissues from different healthy organs. In this paper we report our measurements of healthy and cirrhotic liver tissues using terahertz reflection spectroscopy. The water content of the fresh tissue samples was also measured in order to investigate the correlations between the terahertz properties, water content, structural changes and cirrhosis. Finally, the samples were fixed in formalin to determine whether water was the sole source of image contrast in this study. We found that the cirrhotic tissue had a higher water content and absorption coefficient than the normal tissue and that even after formalin fixing there were significant differences between the normal and cirrhotic tissues' terahertz properties. Our results show that terahertz pulsed imaging can distinguish between healthy and diseased tissue due to differences in absorption originating from both water content and tissue structure.

  10. Prevention and Management of Bacterial Infections in Cirrhosis

    PubMed Central

    Taneja, Sunil K.; Dhiman, Radha K.

    2011-01-01

    Patients with cirrhosis of liver are at risk of developing serious bacterial infections due to altered immune defenses. Despite the widespread use of broad spectrum antibiotics, bacterial infection is responsible for up to a quarter of the deaths of patients with liver disease. Cirrhotic patients with gastrointestinal bleed have a considerably higher incidence of bacterial infections particularly spontaneous bacterial peritonitis. High index of suspicion is required to identify infections at an early stage in the absence of classical signs and symptoms. Energetic use of antibacterial treatment and supportive care has decreased the morbidity and mortality over the years; however, use of antibiotics has to be judicious, as their indiscriminate use can lead to antibiotic resistance with potentially disastrous consequences. Preventive strategies are still in evolution and involve use of antibiotic prophylaxis in patients with gastrointestinal bleeding and spontaneous bacterial infections and selective decontamination of the gut and oropharynx. PMID:22229097

  11. Clinical aspects of hepatosplenic schistosomiasis: a contrast with cirrhosis.

    PubMed Central

    Rebouças, G.

    1975-01-01

    The clinical picture of liver disease in endemic areas of Schistosomiasis mansoni differs in many ways from that observed in alcoholic and other types of cirrhosis. In hepatosplenic schistosomiasis there is predominance of the clinical manifestations of portal hypertension, e.g., bleeding esophageal varices, while ascites, jaundice, and hepatic precoma or coma are much less common. Ammonia tolerance is usually normal and helps explain the low mortality rate during bleeding. Of special interest is the observation of a high incidence of persistent hepatitis B surface antigenemia among patients with hepatosplenic schistosomiasis, suggesting increased susceptibility of such patients to the development of virus-induced chronic active hepatitis. Images FIG. 1 FIG. 2 PMID:128911

  12. Obeticholic acid for the treatment of primary biliary cirrhosis.

    PubMed

    Trivedi, Palak J; Hirschfield, Gideon M; Gershwin, M Eric

    2016-01-01

    Primary biliary cirrhosis (PBC) is characterized by progressive nonsuppurative destruction of small bile ducts, resulting in intrahepatic cholestasis, fibrosis and ultimately end-stage liver disease. Timely intervention with ursodeoxycholic acid is associated with excellent survival, although approximately one-third of all patients fail to achieve biochemical response, signifying a critical need for additional therapeutic strategies. Obeticholic acid (OCA) is a potent ligand of the nuclear hormone receptor farnesoid X receptor (FXR). Activation of FXR inhibits bile acid synthesis and protects against toxic accumulation in models of cholestasis and facilitates hepatic regeneration in preclinical studies. Data from recent Phase II and III controlled trials suggest a therapeutic impact of OCA in PBC biochemical nonresponders, as evidenced by change in proven laboratory surrogates of long-term outcome. Dose-dependent pruritus is a common adverse effect, but may be overcome through dose-titration. Longer term studies are needed with focus on safety and long-term clinical efficacy. PMID:26549695

  13. Primary biliary cirrhosis: Pathophysiology, clinical presentation and therapy

    PubMed Central

    Purohit, Treta; Cappell, Mitchell S

    2015-01-01

    Primary biliary cirrhosis (PBC) is an autoimmune, slowly progressive, cholestatic, liver disease characterized by a triad of chronic cholestasis, circulating anti-mitochondrial antibodies (AMA), and characteristic liver biopsy findings of nonsuppurative destructive cholangitis and interlobular bile duct destruction. About 10% of PBC patients, however, lack AMA. A variant, called PBC-autoimmune hepatitis (AIH) overlap, is characterized by the above findings of PBC together with findings of elevated serum alanine aminotransferase, elevated serum immunoglobulin G, and circulating anti-smooth muscle antibodies, with liver biopsy demonstrating periportal or periseptal, lymphocytic, piecemeal necrosis. PBC is hypothesized to be related to environmental exposure in genetically vulnerable individuals. It typically occurs in middle-aged females. Prominent clinical features include fatigue, pruritis, jaundice, xanthomas, osteoporosis, and dyslipidemia. The Mayo Risk score is the most widely used and best prognostic system. Ursodeoxycholic acid is the primary therapy. It works partly by reducing the concentration and injury from relatively toxic bile acids. PBC-AIH overlap syndrome is treated with ursodeoxycholic acid and corticosteroids, especially budesonide. Obeticholic acid and fibrate are promising new, but incompletely tested, therapies. Liver transplantation is the definitive therapy for advanced disease, with about 70% 10-year survival after transplantation. Management of pruritis includes local skin care, dermatologist referral, avoiding potential pruritogens, cholestyramine, and possibly opioid antagonists, sertraline, or rifaximin. Management of osteoporosis includes life-style modifications, administration of calcium and vitamin D, and alendronate. Statins are relatively safe to treat the osteopenia associated with PBC. Associated Sjogren’s syndrome is treated by artificial tears, cyclosporine ophthalmic emulsion to stimulate tear production; and saliva

  14. Analysis of mitochondrial transcription factor A SNPs in alcoholic cirrhosis

    PubMed Central

    TANG, CHUN; LIU, HONGMING; TANG, YONGLIANG; GUO, YONG; LIANG, XIANCHUN; GUO, LIPING; PI, RUXIAN; YANG, JUNTAO

    2014-01-01

    Genetic susceptibility to alcoholic cirrhosis (AC) exists. We previously demonstrated hepatic mitochondrial DNA (mtDNA) damage in patients with AC compared with chronic alcoholics without cirrhosis. Mitochondrial transcription factor A (mtTFA) is central to mtDNA expression regulation and repair; however, it is unclear whether there are specific mtTFA single nucleotide polymorphisms (SNPs) in patients with AC and whether they affect mtDNA repair. In the present study, we screened mtTFA SNPs in patients with AC and analyzed their impact on the copy number of mtDNA in AC. A total of 50 patients with AC, 50 alcoholics without AC and 50 normal subjects were enrolled in the study. SNPs of full-length mtTFA were analyzed using the polymerase chain reaction (PCR) combined with gene sequencing. The hepatic mtTFA mRNA and mtDNA copy numbers were measured using quantitative PCR (qPCR), and mtTFA protein was measured using western blot analysis. A total of 18 mtTFA SNPs specific to patients with AC with frequencies >10% were identified. Two were located in the coding region and 16 were identified in non-coding regions. Conversely, there were five SNPs that were only present in patients with AC and normal subjects and had a frequency >10%. In the AC group, the hepatic mtTFA mRNA and protein levels were significantly lower than those in the other two groups. Moreover, the hepatic mtDNA copy number was significantly lower in the AC group than in the controls and alcoholics without AC. Based on these data, we conclude that AC-specific mtTFA SNPs may be responsible for the observed reductions in mtTFA mRNA, protein levels and mtDNA copy number and they may also increase the susceptibility to AC. PMID:24348767

  15. Pulmonary and extrapulmonary contributors to hypoxemia in liver cirrhosis.

    PubMed

    Mélot, C; Naeije, R; Dechamps, P; Hallemans, R; Lejeune, P

    1989-03-01

    To determine and to quantify the pulmonary and extrapulmonary contributors to hypoxemia in liver cirrhosis, we measured in 10 cirrhotics blood gases, P50, hemodynamics, ventilation, and the distribution of ventilation-perfusion ratios (VA/Q) using the multiple inert gas elimination technique. Seven patients had an arterial hypoxemia (PaO2 = 69 +/- 6 mm Hg, mean +/- SD), and three patients were normoxemic (PaO2 = 89 +/- 6 mm Hg). In each hypoxemic patient, the VA/Q distributions were characterized by the presence of low VA/Q units. A negative logarithmic correlation was found between the dispersion of the blood flow distribution and the arterial PO2. An acute inspiratory hypoxia (FIO2, 0.125) elicited an increase in pulmonary vascular resistance by 58.5% in the hypoxemic group and by 81.6% in the normoxemic one (p = NS between the two groups). The percent change in pulmonary vascular resistance induced by hypoxia was not correlated with the percent change in the dispersion of the blood flow distribution. A theoretical analysis showed that the mean arterial PO2 of 69 mm Hg of the hypoxemic group differed from a normal reference value of 96 mm Hg as a result of the combined effects of reduced hemoglobin (-4 mm Hg), increased P50 (+4 mm Hg), increased ventilation (+10 mm Hg), low VA/Q (-35 mm Hg), and true shunt (-2 mm Hg). These results show that the "hypoxemia of liver cirrhosis" is essentially caused by VA/Q mismatching, which is not explained by an abnormal hypoxic pulmonary vasoconstriction. PMID:2923362

  16. Primary biliary cirrhosis: Pathophysiology, clinical presentation and therapy.

    PubMed

    Purohit, Treta; Cappell, Mitchell S

    2015-05-01

    Primary biliary cirrhosis (PBC) is an autoimmune, slowly progressive, cholestatic, liver disease characterized by a triad of chronic cholestasis, circulating anti-mitochondrial antibodies (AMA), and characteristic liver biopsy findings of nonsuppurative destructive cholangitis and interlobular bile duct destruction. About 10% of PBC patients, however, lack AMA. A variant, called PBC-autoimmune hepatitis (AIH) overlap, is characterized by the above findings of PBC together with findings of elevated serum alanine aminotransferase, elevated serum immunoglobulin G, and circulating anti-smooth muscle antibodies, with liver biopsy demonstrating periportal or periseptal, lymphocytic, piecemeal necrosis. PBC is hypothesized to be related to environmental exposure in genetically vulnerable individuals. It typically occurs in middle-aged females. Prominent clinical features include fatigue, pruritis, jaundice, xanthomas, osteoporosis, and dyslipidemia. The Mayo Risk score is the most widely used and best prognostic system. Ursodeoxycholic acid is the primary therapy. It works partly by reducing the concentration and injury from relatively toxic bile acids. PBC-AIH overlap syndrome is treated with ursodeoxycholic acid and corticosteroids, especially budesonide. Obeticholic acid and fibrate are promising new, but incompletely tested, therapies. Liver transplantation is the definitive therapy for advanced disease, with about 70% 10-year survival after transplantation. Management of pruritis includes local skin care, dermatologist referral, avoiding potential pruritogens, cholestyramine, and possibly opioid antagonists, sertraline, or rifaximin. Management of osteoporosis includes life-style modifications, administration of calcium and vitamin D, and alendronate. Statins are relatively safe to treat the osteopenia associated with PBC. Associated Sjogren's syndrome is treated by artificial tears, cyclosporine ophthalmic emulsion to stimulate tear production; and saliva

  17. Personalized management of cirrhosis by non-invasive tests of liver fibrosis.

    PubMed

    Wong, Grace Lai-Hung; Espinosa, Wendell Zaragoza; Wong, Vicnent Wai-Sun

    2015-09-01

    Owing to the high prevalence of various chronic liver diseases, cirrhosis is one of the leading causes of morbidity and mortality worldwide. In recent years, the development of non-invasive tests of fibrosis allows accurate diagnosis of cirrhosis and reduces the need for liver biopsy. In this review, we discuss the application of these non-invasive tests beyond the diagnosis of cirrhosis. In particular, their role in the selection of patients for hepatocellular carcinoma surveillance and varices screening is highlighted. PMID:26523265

  18. Emergency liver transplant in patient with Child-Pugh class C cirrhosis and strangulated umbilical hernia.

    PubMed

    Chaudhary, Abhideep; Daga, Sachin; Goyal, Neerav; Ramaswamy, Vasudevan Karisangal; Agarwal, Shaleen; Pareek, Shishir; Ray, Ramdip; Wadhawan, Manav; Gupta, Subash

    2013-02-01

    The authors report the case of a patient who presented with small bowel obstruction while awaiting liver transplant for Child-Pugh class C cirrhosis. He underwent emergency liver transplant with resection of the small bowel after the obstruction did not improve with conservative management. The authors believe this is the first case of successful emergency liver transplant with resection of the small bowel in a patient with decompensated Child-Pugh class C liver cirrhosis and strangulated umbilical hernia. This case suggests the possibility of improved outcomes of emergency hernia repair in patients with liver cirrhosis when small bowel resection is combined with liver transplant. PMID:23190414

  19. Short report: effect of ranitidine on duodenal ulcer healing in patients with cirrhosis of the liver.

    PubMed

    Ljubicic, W; Bilić, A; Roić, D

    1993-04-01

    The effect of ranitidine (300 mg daily) on the healing of acute duodenal ulcer was investigated in patients with and without cirrhosis of the liver. Of the 109 patients who entered the study, two patients from each group were excluded. Healing rates after 4 and 8 weeks were significantly different between patients with cirrhosis and controls (4- and 8-week healing rates in cirrhotics and non-cirrhotics: 49 and 69%, and 71 and 91%, respectively). This study demonstrates that duodenal ulcer healing is delayed in patients with cirrhosis. PMID:8485276

  20. A comparison of four serum markers of fibrosis in the diagnosis of cirrhosis.

    PubMed

    Fabris, C; Falleti, E; Federico, E; Toniutto, P; Pirisi, M

    1997-03-01

    C-terminal peptide of procollagen I, N-terminal peptide of procollagen III, collagen IV and serum prolyl hydroxylase were measured in 100 patients with cirrhosis and 71 patients with noncirrhotic chronic liver disease. Patients with cirrhosis had significantly higher mean values of prolyl hydroxylase, collagen IV, N-terminal peptide of procollagen III and C-terminal peptide of procollagen I as compared to noncirrhotic patients. This difference was maintained for collagen products even after stratification for alcohol intake, although all markers of fibrosis were higher in alcoholics. Stepwise logistic regression analysis showed that collagen IV, and N-terminal peptide of procollagen III were independently associated with cirrhosis. Receiver-operating characteristic (ROC) curves showed that collagen IV and N-terminal peptide of procollagen III perform more efficiently than C-terminal peptide of procollagen I and prolyl hydroxylase in identifying cirrhosis. PMID:9133247