Chan Tai-po. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2003. / Includes bibliographical references (leaves 94-101). / Abstracts in English and Chinese. / Chapter 1 --- INTRODUCTION --- p.1 / Chapter 2 --- HYPOTHESIS --- p.3 / Chapter 3 --- OBJECTIVE --- p.4 / Chapter 4 --- CLINICAL IMPLICATIONS --- p.5 / Chapter 5 --- METHODOLOGY --- p.6 / Chapter 5.1 --- Materials --- p.8 / Chapter 5.2 --- Study method --- p.13 / Chapter 5.3 --- Venues of the research --- p.22 / Chapter 5.4 --- Data acquisition --- p.23 / Chapter 5.5 --- Data management and analysis --- p.24 / Chapter 5.6 --- Ethical considerations --- p.25 / Chapter 5.7 --- Participations of persons in the research --- p.28 / Chapter 6 --- RESULTS --- p.34 / Chapter 6.1 --- Problems and fate of rats in the model development group --- p.34 / Chapter 6.2 --- Morbidity and mortality after LEM administration --- p.38 / Chapter 6.3 --- Results of radiological findings --- p.39 / Chapter 6.4 --- Results of liver function tests --- p.48 / Chapter 6.5 --- Results of liver morphology --- p.52 / Chapter 6.6 --- Histological results --- p.53 / Chapter 7 --- DISCUSSION --- p.69 / Chapter 7.1 --- Problems encountered in the development group --- p.69 / Chapter 7.2 --- The pilot study group --- p.71 / Chapter 7.3 --- The need for the present study --- p.74 / Chapter 7.4 --- LEM in cirrhotic rat compared with the normal liver rat --- p.75 / Chapter 7.5 --- Liver function markers in cirrhotic liver --- p.76 / Chapter 7.6 --- Discussion on the assumptions of the research --- p.80 / Chapter 7.7 --- Assessment on measurement error --- p.82 / Chapter 7.8 --- Errors in the pilot study --- p.83 / Chapter 8 --- CONCLUSIONS --- p.84 / Chapter 9 --- Future experiments that may be performed using this model --- p.85 / Chapter 10 --- APPENDICES --- p.86 / Chapter 10.1 --- Appendix 1: Copy on the letter of ethics approval from the Animal Research Ethics Committee of the Chinese University of Hong Kong --- p.86 / Chapter 10.2 --- Appendix 2: Copy on the licences issued by the Department of Health of Hong Kong --- p.88 / Chapter 11 --- REFERENCES --- p.94

Both SM and ST reduced ALT elevation in rats in the prevention study. In the treatment study, ALT of all rats was resolved. Only ST reduced the fibrosis in both prevention and treatment studies. Maximum reduction of fibrosis compared to control was 44.12% in the prevention group and 56.83% in the treatment group. Activated HSC was decreased and apoptosis increased in rats with improved fibrosis. / Conclusion. ST prevented formation of liver fibrosis and promoted resolution of established fibrosis in the rat model. These effects were mediated through induction of HSC apoptosis in the liver. (Abstract shortened by UMI.) / Hepatic fibrosis results from the wound healing response to prolonged liver insult such as chronic hepatitis. It represents an imbalance of fibrogenesis and fibrolysis, causing formation of scars. Activation and proliferation of hepatic stellate cells (HSC) is a key to fibrogenesis while apoptosis of HSC is associated with resolution of fibrosis. / Intense efforts are currently underway to evaluate potential anti-fibrotic agents in herbal medicine. The study hypothesized that herbs may resolve hepatic fibrosis through induction of apoptosis of HSC. In this study, the anti-fibrotic potentials of fourteen commonly used herbs were examined. The anti-fibrotic effect and the underlying mechanism of two herbs were further investigated in an animal model. / Method. Fourteen herbs including Angelica sinensis(AS), Astragalus membranaceus(AM), Cordyceps sinensis(CS), Curcuma wenyujin(CW), Carthamus tinctorius(CT), Curcuma kwangsinensis(CK), Bupleurum chinensis(BC), Ligusticum chuanxiong(LC), Paeconia lactiflora(PL), Prunus persiea(PP), Poria cocos(PC), Salvia miltorrhiza(SM), Schisandra chinensis(SC) and Stephania tetrandra(ST) were selected for screening based on documented safety and effectiveness, and availability in commercial extracts. These two herbs were also authenticated by chemical profiling using HPLC. / Result. For in vitro bioassay, five herbs, namely Angelica sinensis (AS), Carthamus tinctorius (CT), Ligusticum chuanxiong(LC), Salvia miltiorrhiza(SM) and Stephania tetrandra(ST) demonstrated both anti-proliferative and pro-apoptotic activities in T6. SM and ST showed highest potencies with 51.63% and 44.52% of T6 cells showing apoptotsis respectively. Fas and Bax expression was up-regulated and BclxL expression decreased in HSC after incubation with SM and ST. Fas ligand and Bcl2 expression remained unchanged. / Treatment of chronic liver disease with herbal medicine has been documented in ancient China. Nowadays, practitioners of traditional Chinese medicine (TCM) also use herbs to treat chronic liver disease and it is conceivable that such herbs redress the imbalance between fibrogenesis and fibrolysis. / Chor Sin Yee. / "July 2005." / Adviser: Joseph J. Y. Sung. / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0172. / Thesis (Ph.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 196-217). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in English and Chinese. / School code: 1307.

Submitted by Natalia Vieira (natalia.vieira@famerp.br) on 2016-05-19T19:34:50Z No. of bitstreams: 1 odetemauadcavenaghi_dissert.pdf: 773214 bytes, checksum: f8ee778371ec5f6b55320dbef17115cb (MD5) / Made available in DSpace on 2016-05-19T19:34:50Z (GMT). No. of bitstreams: 1 odetemauadcavenaghi_dissert.pdf: 773214 bytes, checksum: f8ee778371ec5f6b55320dbef17115cb (MD5) Previous issue date: 2015-12-04 / Introduction: Liver transplantation (TxF) is a complex procedure and considered standard treatment for patients with terminal chronic liver disease, many of them suffering from severe organic deterioration. The CTP Pugh scores (CTP) and Model for End-stage Liver Disease (MELD) have been used to assess the severity of liver disease and the risk of death, respectively. The st Six Minutes Walk Test (6MWT) assesses the functional capacity of these patients. Objective: Our goal was to determine whether there is a correlation between the 6MWT and the CTP and MELD scores in candidates for TxF. Methods: Cross-sectional study of cirrhotic patients undergoing pre-transplant evaluation in a follow-up at the Liver Transplantation United of Hospital de Base, São José do Rio Preto SP, from May 2012 to may 2014 All of them submitted to 6MWT consecutively. The results of the 6MWT and CTP and MELD scores were analyzed by the Student’s t tests and Spearman. Results: We studied 45 men and 11 women with a mean age 54.50 ± 11 years, who walked mean distance of 461.35 ± 87,31m in the 6MWT. It has been found that patients with CTP B and C walked distance significantly shorter when compared with the predicted value (p <0.0001) and with patients presenting CTP score A (p <0.016). There was significant inverse correlation between the 6MWT and the scores CTP (p = 0.01) and native Meld (p value = 0.05). Conclusion: There was inverse correlation between the 6MWT test and the Child and MELD scores. The 6MWT lower values identified patients on the waiting list for liver transplantation, higher Chid carriers (uncompensated) and highest MELD (worse prognosis). This data have strenghthened the potential usefulness of the 6MWT to evaluate the severity and prognosis of these patients. / Introdução: O transplante de fígado, é um procedimento complexo, considerado tratamento padrão para pacientes com doença hepática crônica terminal, muitos deles portadores de grave deterioração orgânica. Os escores Child-Turcotte Pugh (CTP) e o Model for End-Stage Liver Disease (MELD) são utilizados para avaliar a gravidade da doença hepática e o risco de morte, respectivamente. O Teste de Caminhada de Seis Minutos (TC6) avalia a capacidade funcional destes pacientes. Objetivo: O presente estudo teve como objetivo verificar se há correlação entre o teste de caminhada de seis minutos e os escores Child e MELD, em candidatos ao transplante de fígado. Métodos: Estudo transversal de pacientes cirróticos em avaliação pré-transplante na Unidade de Transplante de Fígado do Hospital de Base de São José do Rio Preto, no período de maio de 2012 a maio de 2014. Todos foram submetidos ao TC6, consecutivamente. Os valores do TC6 e dos escores CTP e MELD foram analisados por testes t e Spearman. Resultados: Foram estudados 45 homens e 11 mulheres com idade média 54,50 ± 11 anos, que percorreram distância média no TC6 de 461,35 ± 87,31m. Verificou-se que os pacientes com escore CTP B e C percorreram distância significantemente menor quando comparados com o valor predito (p < 0,0001) e com os portadores de escore CTP A (valor p<0,016). Houve correlação significante entre o TC6 e os escores CTP (valor p=0,01) e MELD real (valor p=0,05). Conclusões: Houve correlação inversa entre o teste TC6 e os escores Child e MELD. Valores mais baixos do TC6 identificaram pacientes em lista de espera para transplante de fígado, portadores de Child mais alto (descompensados) e MELD mais elevado (piores prognósticos). Este dado reforça a utilidade potencial do TC6 na avaliação da gravidade e do prognóstico destes pacientes.

Os processos fibrogênicos, ativados por mecanismos como estresse oxidativo, podem levar a um quadro de cirrose hepática, que representa uma das principais causas de morte no ocidente. Entretanto, em alguns estudos, substâncias fenólicas, como o Ácido Gálico (AG), demonstraram inibir e até regredir esses processos. O objetivo do presente estudo foi investigar os efeitos do composto fenólico AG no processo fibrogênico hepático murino. Os mesmos foram avaliados tanto na fase de progressão da fibrose, como na cirrose hepática estabelecida pela administração crônica de tetracloreto de carbono em camundongos C57. Para isso foram realizadas análises histológicas, imuno-histoquímicas, PCR e Western-bloting, estimando-se fatores relacionados à fibrogênese e mediadores inflamatórios associados. Observou-se uma diminuição importante na percentagem de áreas coradas pelo Sirius red, ou seja, redução na percentagem de fibrose nos grupos tratados com AG, tanto durante a prevenção (p<0,05), quanto na regressão da cirrose (p<0,05). Esta melhora foi acompanhada de redução no número de células marcadas pela SMA nos grupos tratados (p<0,05). Estes mesmos parâmetros foram confirmados através da análise genômica para colágeno, assim como pelo TIMP e pelo TGF 1; e proteômica para NFB e p38 MAPK. Os achados do presente estudo demonstraram o efeito do AG sobre a prevenção e reversão do processo fibrogênico hepático. Os principais mecanismos deste processo envolvem atividades anti-inflamatórias via TGF-1 e p38 MAPK, principalmente durante a indução de fibrose; assim como restrição da capacidade anti-apoptótica do NFB sobre as células estreladas hepáticas (CEH) na cirrose já estabelecida. / The fibrogenic processes activate by mechanisms such as oxidative stress can lead to a picture of liver cirrhosis, which represents a major cause of death in West. However, in some studies, phenolic substances, such as Gallic Acid (GA) shown to inhibit and even regress theses processes. The aim of this study was to investigate the effects of the phenolic compound GA in murine liver fibrogenic process. They were evaluated both in progression of fibrosis and in liver cirrhosis established by administration carbon tetrachloride im mice C57. For this, was performed histological, immunohistochemical, PCR and Western blotting analysis, estimating factors related to fibrogenesis and inflammatory mediators associated. There was a significant decrease of area stained by Sirius Red, which means reduction in the percentage of fibrosis in the groups treated with GA. Both for prevention (p<0,05) and for the regression of the cirrhosis (p<0,05). This improvement was accompanied by a reduction in the number of cells marked by SMA in the treated groups (p<0,05). These parameters was confirmed by genomic analysis for collagen, as well as by TIMP 1 and TGF 1, and proteomics for p38 MPK and NFkB. The findings of this study demonstrade the effect of GA in the prevention and of liver fibrogenic process. The main mechanisms of this process involves anti-inflammatory activity via TGF 1 and p38 MAPK, especially during induction of fibrosis, as well as restriction of antiapoptotic capacity of NFkB on the CEH in established cirrhosis.

A cirrose hepática é a consequência de todas as doenças crônicas, de longo prazo, que acometem o fígado e é caracterizada a insuficiência hepática (IH) e a hipertensão portal (HP). As coagulopatias vistas em pacientes cirróticos são dependentes de diversos mecanismos, que envolvem tanto a IH como a HP, e que comprometem as funções fisiológicas rotineiras do fígado, entre elas a síntese de todos os fatores de coagulação, com exceção do fator de von Willebrand. Todos os trabalhos publicados até hoje em odontologia não puderam associar os dois testes geralmente utilizados no pré-operatório desses pacientes, o INR e a contagem de plaquetas, com a presença de eventos hemorrágicos. O objetivo deste trabalho foi avaliar a presença de sangramento intra e pós-operatório de pacientes cirróticos, submetidos a exodontias, e verificar se existe associação entre parâmetros laboratoriais (plaquetas, hemoglobina, INR, TTPa, ureia, creatinina) e clínicos (complicações da cirrose, estágio da doença, MELD, tipo de exodontia, tempo de cirurgia, número de dentes extraídos). Foi realizado um estudo observacional retrospectivo analítico, de corte transversal de pacientes cirróticos em fila de transplante do Centro de Atendimento a Pacientes Especiais (CAPE) da Faculdade de Odontologia da Universidade de São Paulo (FOUSP). Foram transferidos para o EpiInfo, originando um banco de dados, as informações constantes do prontuário de 224 pacientes. Em 99 pacientes foram executados 190 atendimentos que resultaram em 333 dentes extraídos. A maioria dos pacientes era do sexo masculino (75,44%), com idade média de 51,27 anos e escolaridade de nível fundamental (23,56%). A maior causa de cirrose foi a hepatite C (40,18%), e as complicações da cirrose mais comuns foram a circulação colateral (66,80%), encefalopatia hepática (56,30%) e ascite (64,20%). Em 190 hemogramas foi identificada plaquetopenia (95,80%); anemia, em 129 (67,90%) e alterações da série branca em 110 (57,80%). A média do INR foi de 1,45 (mínimo 1,03 e máximo 2,71) e a de plaquetas 76.380 (mínimo 16.000 e máximo de 216.000). Apenas 12 pacientes apresentaram eventos hemorrágicos no intra-operatório e 12 no pós-operatório. A única associação positiva foi entre a contagem de plaquetas e os eventos hemorrágicos intra-operatórios (p=0,26; teste de Mann Whitney, confirmada a associação através de análise de regressão linear). Todos os eventos foram controlados com medidas locais. Pacientes cirróticos em fila de transplante de fígado apresentam poucos eventos relacionados com sangramento e todos de pouca severidade. Existe uma chance maior de sangramento intra-operatório à medida que a contagem de plaquetas diminui, mas o sangramento é controlado com medidas locais simples. Os eventos hemorrágicos pós-operatórios não puderam ser associados com nenhuma das variáveis, mas nenhum paciente necessitou de transfusão e a resolução do quadro foi espontânea. / Hepatic cirrhosis is the result of all long-term chronic diseases, which can compromise the liver, and is characterised by hepatic insufficiency (HI) and portal hypertension (PH). The coagulopathies seen in cirrhotic patients depend on several mechanisms involving both HI and PH, which impairs the routine physiological functions of the liver, such as synthesis of all coagulation factors, except the von Willebrand factor. All dental studies published until today could not associate the two tests commonly used prior to tooth extraction in these patients, namely, INR and platelets count, for presence of haemorrhagic events. The objective of this work was to assess the presence of intra- and post-operative bleeding in cirrhotic patients undergoing tooth extraction and to verify whether there exists an association between laboratory (i.e. platelets, haemoglobins, INR, TTPa, urea, creatinine) and clinical parameters (i.e. cirrhosis complications, disease stage, MELD score, type of tooth extraction, surgery time, number of teeth extracted). This is a cross-sectional, retrospective, observational study of cirrhotic patients who were on the liver transplant waiting list at the Healthcare Centre for Special Patients (CAPE) of the University of São Paulo Faculty of Dentistry (FOUSP). Data were obtained from the medical records of 224 patients and the Epi Info software was used to generate a database. A total of 190 visits were performed for 99 patients, resulting in 333 teeth extracted. The majority of the patients were male (75.44%) with mean age of 51.27 years old and elementary education level (23.56%). The greatest cause was hepatitis C (40.18%) and the most common cirrhosis complications were collateral circulation (66.80%), hepatic encephalopathy (56.30%) and ascite (64.20%). Plateletopenia (95.80%) was identified in 190 blood counts, anaemia (67.90%) in 129, and white blood cell changes in 110 (57.80%). The mean scores for INR was 1.45 (minimum 1.03 and maximum 2.71) and for platelets was 76,380 (minimum 16,000 and maximum 216,000). Only 12 patients presented haemorrhagic events during surgery and 12 after it. The only positive association was found between platelet counts and intra-operative haemorrhagic events (P = 0.26; Mann Whitney\'s test, confirmed with linear regression analysis). All the bleeding events were controlled with local measures. Cirrhotic patients who were on the liver transplant waiting list had a few bleeding events, all with little severity. Intra-operative haemorrhagic events are more likely to occur when the platelet count is low, but bleeding can be handled with simple local measures. Post-operative haemorrhagic events could not be associated with any variable, but no patient needed blood transfusion as the clinical picture improved spontaneously.

Introdução: A cirrose é uma hepatopatia crônica e progressiva que constitui um estágio irreversível ou lentamente reversível de disfunção hepática, caracterizada pela formação de nódulos de fibrose no tecido hepático. Investigações devem ser realizadas para avaliar essa população a fim de que se tenha um diagnóstico mais preciso dos efeitos da doença sobre a função cardiopulmonar, a funcionalidade e a qualidade de vida desses indivíduos. Objetivo: Investigar a influência da cirrose hepática pelo vírus da hepatite C (VHC) no consumo máximo de oxigênio (VO2max.), a capacidade funcional e a qualidade de vida em indivíduos cirróticos. Materiais e métodos: Foram avaliados 36 indivíduos(18 cirróticos e 18 controles) de ambos os sexos, maiores de 18 anos. Foram avaliados e comparados entre os grupos, o consumo máximo de oxigênio através da ergoespirometria em bicicleta, a capacidade funcional pelo teste de caminhada de seis minutos e pelo time up and go test, a força do aperto de mão, a antropometria e a qualidade de vida. Foram feitas correlações em pacientes cirróticos, entre a força do aperto de mão e o VO2max e o TC6, o VO2max e o teste de caminhada de 6 minutos e a qualidade de vida e o TC6. Resultados: Os grupos doença e controle foram pareados pelo sexo e pela idade, não havendo diferença significativa entre os grupos quanto à idade e o sexo. Não foram encontradas diferenças significativas entre cirróticos e controles quanto ao Time Up And Go Test. Quanto ao Teste de Caminhada de Seis Minutos a distância percorrida foi significativamente menor nos cirróticos em comparação aos controles. Não houve diferença entre os grupos para a distância percorrida predita para cirróticos e controles. Não foi encontrada diferença para a força do aperto de mão (HGS) entre cirróticos e controles. Não foram encontradas diferenças significativas entre os grupos para avaliação antropométrica em nenhum dos itens que a contemplam. Na avaliação da qualidade de vida foram encontradas diferenças significativas entre os grupos para todos os seus domínios. O consumo máximo de oxigênio VO2max apresentou valores inferiores no grupo doença. Houveram correlações em pacientes cirróticos entre a capacidade funcional e o VO2max. e a qualidade de vida. Conclusão: Foram encontradas diferenças entre cirróticos e controles quanto ao VO2max., a capacidade funcional e a qualidade de vida. As correlações encontradas nesse estudo devem ser exploradas em novas pesquisas envolvendo esses pacientes. / Introduction: Cirrhosis is a chronic progressive liver disease is a slowly reversible or irreversible stage of liver dysfunction, characterized by the formation of nodules of fibrosis in liver tissue. investigations should be performed to evaluate this population so that it has a more accurate diagnosis of disease effects on cardiopulmonary function, functionality, and quality of life of these individuals. Objective: To investigate the influence of liver cirrhosis due to hepatitis C virus (HCV) on maximal oxygen consumption (VO2máx.), functional capacity and quality of life in individuals with cirrhosis. Materials and methods: We evaluated 36 patients (18 cirrhotic patients and 18 controls) of both sexes, aged 18 years. Were evaluated and compared between groups, the maximal oxygen uptake by cardiopulmonary exercise test on bicycle, on functional capacity by testing six-minute walk and the time up and go test, the strength of the handgrip, anthropometry and quality of life. Correlations were in cirrhotic patients, between the strength of the handshake and VO2max and 6MWT, VO2max test and 6-minute walk and the quality of life and 6MWT. Results: The disease and control groups were matched by sex and age, no significant difference between groups with respect to age and sex. No significant differences were found between cirrhotic patients and controls regarding Time Up And Go Test. How to Walk Test Six Minutes distance traveled was significantly lower in cirrhotic patients compared to controls. There was no difference between groups for the distance predicted for cirrhotic patients and controls. No difference was found for the strength of the handgrip (HGS) between cirrhotic patients and controls. No significant differences were found between groups in anthropometric assessment in any of the items that come. In assessing the quality of life were significant differences between groups for all domains. The maximal oxygen consumption VO2max values were lower in the disease group. There were correlations in cirrhotic patients between functional capacity and VO2max. and quality of life. Conclusion: We found differences between cirrhotic patients and controls regarding VO2max., Functional capacity and quality of life. The correlations found in this study should be explored in further studies involving these patients.

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 165-195).

Diss. (sammanfattning) Umeå : Univ., 2009. / Härtill 4 uppsatser.

Orientador: Fernando Gomes Romeiro / Banca: Giovanni Faria Silva / Banca: Ana Cláudia de Oliveira / Resumo: Pacientes com cirrose hepática são comumente acometidos por deficiências nutricionais e perda de massa óssea, por mecanismos como baixa ingestão de nutrientes e falta de atividade física. O objetivo deste estudo foi aferir a prevalência de doença óssea na cirrose e avaliar se alterações nutricionais e hepáticas estariam correlacionadas à perda de massa óssea (osteopenia ou osteoporose) em pacientes ambulatoriais atendidos na Faculdade de Medicina de Botucatu (FMB) - UNESP. Avaliações nutricionais e da massa óssea foram feitas por meio de antropometria, medidas de força muscular (pelo handgrip), absorciometria de raios X de dupla energia (dual-energy X-ray absorptiometry - DXA) e exames bioquímicos. A amostra foi de 129 indivíduos (77 homens e 52 mulheres), classificados em Child A (69%), Child B (24,8%) e Child C (6,2%). A média do escore Model for End-Stage Liver Disease (MELD) foi de 10,60 ± 3,99. A prevalência de osteoporose foi de 31,01% e a de osteopenia foi de 32,56%. Os resultados foram avaliados pelo modelo de regressão linear de Backward, mostrando que baixos valores de força muscular pelo handgrip, níveis elevados de paratormônio (PTH) e baixo índice de massa corporal (IMC) foram preditores de baixo t-escore da coluna, enquanto a idade e o IMC foram fatores preditores de baixo t-escore de quadril. A gravidade da doença hepática não influenciou a presença da doença óssea. Como a cirrose acomete mais os ossos da coluna, sugerimos que exames de PTH, handgrip e o IMC sejam utilizados rotineiramente na avaliação de portadores de cirrose, e se esses exames estiverem alterados a densidade óssea seja medida com mais frequência, mesmo na cirrose compensada / Abstract: Cirrhotic patients are often compromised by nutritional deficiencies and loss of bone density through mechanisms as low ingestion of nutrients and lack of physical activity. The aim of this study was evaluate the prevalence of bone alterations and investigate if nutritional and hepatic tests would be related to the bone loss (osteoporosis or osteopenia) in cirrhotic outpatients from the Botucatu medical school (FMB-UNESP). Nutritional, hepatic and bone assessments were performed through anthropometric measurement, handgrip strength, dualenergy X-Ray absorptiometry (DXA) exam and laboratory tests. The study sample was composed by 129 subjects (77 men and 52 women), who were divided according to the Child-Pugh classification as follows: Child-Pugh A (69%), Child- Pugh B (24.8%) and Child-Pugh C (6.2%). The mean of the Model for End-Stage Liver Disease (MELD) score was 10.6 ± 3.99. The rates of osteoporosis and osteopenia were 31.01% and 32.56%, respectively. The results were assessed by backward linear regression model, showing that low handgrip strength, high parathyroid hormone (PTH) and low body mass index (BMI) were predictors of low t-score values in the lumbar spine. Additionally, only age was a predictor of low t-score values in the femoral neck. The model did not select the liver disease severity as a significant predictor of bone disease. As the liver cirrhosis is more aggressive in the lumbar spine, we suggest that handgrip strength, BMI and PTH should be tested in all cirrhotic patients to select the ones with higher risk of bone disease, in order to perform specific bone exams more often when these tests are altered, even in compensated cirrhosis / Mestre

Orientador: Fernando Gomes Romeiro / Resumo: A osteoporose é uma complicação frequente da cirrose hepática (CH) que pode levar a fraturas, comprometendo a qualidade e a expectativa de vida. Bisfosfonatos são frequentemente utilizados para reduzir o risco de fraturas por osteoporose, mas podem provocar danos à mucosa gastrointestinal. O objetivo deste estudo foi avaliar a segurança do risedronato em pacientes com CH e varizes de esôfago (VE). De 354 pacientes com CH, 164 foram considerados elegíveis e alocados de acordo com a densidade mineral óssea após densitometria. No grupo intervenção, 52 indivíduos com osteoporose receberam tratamento com risedronato oral (35 mg / semana), suplementação de cálcio e vitamina D. No grupo controle, 51 indivíduos com osteopenia receberam apenas suplementação de cálcio e vitamina D. Todos foram submetidos a endoscopias de vigilância durante 1 ano e à densitometria ao final do estudo. A média etária e a proporção de mulheres foi maior no grupo intervenção. O MELD (Model of End-Stage Liver Disease) no grupo intervenção e controle foi 9,6 (5,9-15,5) e 10,3 (6,5-19), respectivamente (p= 0,047). O grupo controle teve mais casos de doença hepática alcoólica (p< 0,001). Em ambos os grupo a maioria dos indivíduos tinha classificação Child-Pugh A e VE de baixo risco de sangramento. Não houve diferença entre os grupos quanto aos achados endoscópicos observados durante a intervenção. Não houve hemorragia digestiva alta no grupo intervenção, mas em 2 casos do grupo controle. O grupo intervenção foi... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Osteoporosis is a common complication of liver cirrhosis that can lead to fractures, compromising quality of life and survival rate. Bisphosphonates are often used to reduce the risk of fractures caused by osteoporosis, but can lead to digestive mucosal damage. The aim of this study was to evaluate the safety of risedronate for patients with cirrhosis and esophageal varices. Of the 354 cirrhotic patients invited to participate, 164 were considered eligible and allocated according to the bone mineral density after densitometry. In the intervention group, 52 individuals with osteoporosis received oral risedronate 35 mg weekly plus calcium and vitamin D supplementation. In the control group, 51 individuals with osteopenia received only calcium and vitamin D supplementation. All the subjects underwent surveillance endoscopies within 1 year and another bone densitometry at the end of the trial. The mean age and the proportion of women were higher in the intervention group. The Model of End-Stage Liver Disease (MELD) scores in the intervention and control group were 9.6 (5.9-15.5) and 10.3 (6.5-19), respectively (p= 0.047). The control group had more subjects with alcoholic liver disease (p< 0.001). In both groups the majority of the individuals had Child-Pugh A classification and low-risk bleeding esophageal varices. There was no difference between the groups regarding esdoscopic findings during the intervention. There was no upper gastrointestinal bleeding in the intervention gro... (Complete abstract click electronic access below) / Doutor