Artificial and bioartificial liver support systems for acute and acute-on-chronic hepatic failure: A meta-analysis and meta-regression

Zheng, Zhen; Li, Xu; Li, Zhiliang; Ma, Xiaochun

doi:10.3892/etm.2013.1241

Cited by 53 publications

(39 citation statements)

References 35 publications

(32 reference statements)

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“…Although both studies used similar methodologies, the previous meta-analysis included nonrandomized trials. 6 In contrast to our study, another recently published metaanalysis 29 found a mortality benefit of artificial liver support systems over standard medical therapy in patients with acute-on-chronic liver failure. The study did not focus on albumin dialysis and included studies that compared albumin dialysis, hemoperfusion, hemofiltration, and the BioLogic-DT sorbent suspension dialyzer to standard medical therapy.…”

Section: Discussioncontrasting

confidence: 66%

Albumin Dialysis for Liver Failure: A Systematic Review

Tsipotis

Shuja

Jaber

2015

Advances in Chronic Kidney Disease

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Section: Discussioncontrasting

confidence: 66%

Albumin Dialysis for Liver Failure: A Systematic Review

Tsipotis

Shuja

Jaber

2015

Advances in Chronic Kidney Disease

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“…Finally, the number of studies included in this meta-analysis was relatively small; however, in a previous systematic review (29) investigating the characteristics of meta-analyses and their included studies in the Cochrane Database, it was revealed that, irrespective of the medical field, relatively few studies are typically eligible for meta-analysis for all outcomes and interventions covered by the Cochrane reviews. Furthermore, the methodological quality of the studies included in a meta-analysis has a greater impact on the estimated effects than the numbers of included studies (30,31). QUADAS assessment revealed a high overall quality of the studies included in the present meta-analysis.…”

Section: Per-patientmentioning

confidence: 84%

Subtraction CT angiography for the detection of intracranial aneurysms: A meta-analysis

Feng

Han

Lang

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. The aim of this meta-analysis was to investigate the accuracy of subtraction computed tomography angiography (CTA) for diagnosing intracranial aneurysms. A systematic literature search up to January 1, 2013 was performed in PubMed. Two independent reviewers selected 8 studies that compared subtraction CTA with digital subtraction angiography. Data from the studies were used to construct a 2x2 contingency table on a per-patient basis in ≥5 diseased and 5 non-diseased patients, with additional data on a per-aneurysm basis. Overall, subtraction CTA had a pooled sensitivity of 99% [95% confidence interval (CI), 95-100%] and specificity of 94% (95% CI, 86-97%) for detecting and ruling out cerebral aneurysms, respectively, on a per-patient basis. On a per-aneurysm basis, the pooled sensitivity was 96% (95% CI, 90-99%), and the specificity was 91% (95% CI, 85-95%).In conclusion, subtraction CTA is a highly sensitive, specific and non-inva sive method for the diagnosis and evaluation of intracranial aneurysms. IntroductionThe prevalence of cerebral aneurysm in the general population is estimated to be 1-5% (1). Ruptured intracranial aneurysms are the most important cause of non-traumatic subarachnoid hemorrhage, which is a medical emergency and can result in severe disability or mortality (2). Thus, the prompt diagnosis and treatment of intracranial aneurysm are of considerable importance for the outcome of the patient.Conventional digital subtraction angiography (DSA) has been considered the gold standard for the detection and characterization of intracranial aneurysms due to its high spatial resolution and large field of view (3,4); however, it also has several disadvantages, including the relatively high cost and the high skill level required to perform the procedure. Furthermore, DSA is an invasive procedure associated with a small but definite risk of neurological morbidity (5). There is a requirement, therefore, to find an accurate, minimally invasive imaging method that is free from these complications. Computed tomography angiography (CTA), as a relatively non-invasive imaging method, has been widely used in the screening of patients with suspected intracranial aneurysms (6). As a result of the rapid improvement in multi-detector CTA technology, the diagnostic performance of multi-detector CTA for the detection of intracranial aneurysms is now approaching that of DSA (7); however, it exhibits a disadvantage in the detection of small-sized aneurysms that are located near the skull base due to the influence of overprojecting bone structures (8).As CT technology has evolved and various subtraction and post-processing techniques have been developed, subtraction CTA, allowing bone-free visualization of aneurysms, has become possible for the diagnosis of intracranial aneurysms. There have been several reports on the potential usefulness of subtraction CTA in evaluating intracranial aneurysms; however, the results of these studies have been varied (6-8). The purpose of this meta-analysis was to calculate the ...

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“…Commonly used methods to counteract HE may be divided into several types according to treatment access: Administration via the oral, rectal or intravenous routes; artificial liver transplantation; and full liver transplantation (9)(10)(11)(12)(13). Oral drugs mainly act by reducing the production and absorption of ammonia.…”

Section: Introductionmentioning

confidence: 99%

pH-sensitive microemulsion-based gels for removal of colonic ammonia: A novel preventative oral preparation for hepatic encephalopathy in rats

Zhang

Duan

Tian

et al. 2015

Molecular Medicine Reports

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Abstract.Microemulsions with limited stability in mimetic gastrointestinal environments have previously demonstrated potential for the effective removal of ammonia from artificial colonic fluid. Specialized pH-sensitive microemulsion-based gels for the removal of colonic ammonia (MBG-RCA), however, possess relative stability in the gastrointestinal (GI) tract of normal rats, indicating potential use in in vivo applications. An investigation of the effects of oral MBG-RCA was conducted in order to evaluate the reduction of intestinal ammonia and the prevention of hepatic encephalopathy (HE) in rat models. Eighty rats were allocated into eight 4-day treatment groups: The HE model (intraperitoneal injection of thioacetamide) group; the high-, medium-and low-dose MBG-RCA therapeutic groups (15, 10 and 5 ml/kg MBG-RCA, respectively); and the normal, blank, lactulose and acetic acid control groups, each of which received daily treatment administration. Oral MBG-RCA effects were identified using behavioral monitoring observed by an infrared night vision supervisory control system, electroencephalograms, blood ammonia levels, intestinal ammonia levels, liver functionality and pathological observation. High-and medium-dose oral administrations of MBG-RCA significantly decreased the blood and intestinal ammonia levels (P<0.05), improved liver functionality and reduced the clinical manifestations of HE in rats. MBG-RCA demonstrated high clearance of rat colonic ammonia while maintaining sufficient stability in the GI tract, indicating the potential for the development of new clinically relevant oral preparations for the prevention of HE. Additionally, such preparations are advantageous in that ammonia is eliminated without the production of potentially harmful metabolic byproducts. IntroductionElimination of excess ammonia is the primary method of prevention and treatment of hepatic encephalopathy (HE), a progressive condition in which neurological function is impaired as the liver fails to remove toxic metabolites, particularly ammonia, from the bloodstream. The majority of intestinal ammonia is produced in the colon; however, no clinically viable oral treatment exists for the elimination of this excess ammonia, resulting in continuous low clearance levels due to poor ammonia elimination in the body.HE is a syndrome caused by serious hepatic diseases as a result of metabolic disturbance and dysfunction of the central nervous system. Its clinical manifestation includes deposition changes, ethological abnormalities and mental retardation. In severe cases, it may develop into a coma or even be life-threatening. A number of researchers have divided HE into three categories: Type A is associated with acute liver failure; type B is caused by severe portosystemic shunting without liver disease; and type C is associated with chronic liver disease and hepatic cirrhosis (1). Acute liver failure models are well recognized as a representative model of type A HE. These models may be used to examine the pathological response of HE to v...

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Artificial and bioartificial liver support systems for acute and acute-on-chronic hepatic failure: A meta-analysis and meta-regression

Cited by 53 publications

References 35 publications

Albumin Dialysis for Liver Failure: A Systematic Review

Albumin Dialysis for Liver Failure: A Systematic Review

Subtraction CT angiography for the detection of intracranial aneurysms: A meta-analysis

pH-sensitive microemulsion-based gels for removal of colonic ammonia: A novel preventative oral preparation for hepatic encephalopathy in rats

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