was read the article
array:24 [ "pii" => "S1665268119303680" "issn" => "16652681" "doi" => "10.5604/16652681.1226822" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "70190" "copyright" => "Fundación Clínica Médica Sur, A.C." "copyrightAnyo" => "2017" "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2017;16:115-22" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 144 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 82 "PDF" => 51 ] ] "itemSiguiente" => array:19 [ "pii" => "S1665268119303692" "issn" => "16652681" "doi" => "10.5604/16652681.1226823" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "70191" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2017;16:123-32" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 105 "formatos" => array:3 [ "EPUB" => 11 "HTML" => 50 "PDF" => 44 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Utility and Safety of Tolvaptan in Cirrhotic Patients with Hyponatremia: a Prospective Cohort Study" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "123" "paginaFinal" => "132" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2222 "Ancho" => 2074 "Tamanyo" => 261319 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Kaplan-Meier curve of 30-day survival in (<span class="elsevierStyleBold">A</span>) the tolvaptan and control groups (p = 0.36), (<span class="elsevierStyleBold">B</span>) patients with and without normalization of serum sodium level (135-145 mmol/L) on day 7 (p = 0.0019), and (<span class="elsevierStyleBold">C</span>) patients with and without improvement of serum sodium level on day 7 (p = 0.013). Footnote: Improved serum sodium was defined as an increase of serum sodium from < 125 mmol/L to ≥ 125 mmol/L in patients with baseline serum sodium < 125 mmol/L, or from < 135 mmol/L to ≥ 135 mmol/L in patients with baseline serum sodium 125-134 mmol/L.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Ji-Dong Jia, Wen Xie, Hui-Guo Ding, Hua Mao, Hui Guo, Yonggang Li, Xiaojin Wang, Jie-Fei Wang, Wei Lu, Cheng-Zhong Li, Yimin Mao, Gui-Qiang Wang, Yue-qiu Gao, Bangmao Wang, Qin Zhang, Yan Ge, Vincent Wai-Sun Wong" "autores" => array:17 [ 0 => array:2 [ "nombre" => "Ji-Dong" "apellidos" => "Jia" ] 1 => array:2 [ "nombre" => "Wen" "apellidos" => "Xie" ] 2 => array:2 [ "nombre" => "Hui-Guo" "apellidos" => "Ding" ] 3 => array:2 [ "nombre" => "Hua" "apellidos" => "Mao" ] 4 => array:2 [ "nombre" => "Hui" "apellidos" => "Guo" ] 5 => array:2 [ "nombre" => "Yonggang" "apellidos" => "Li" ] 6 => array:2 [ "nombre" => "Xiaojin" "apellidos" => "Wang" ] 7 => array:2 [ "nombre" => "Jie-Fei" "apellidos" => "Wang" ] 8 => array:2 [ "nombre" => "Wei" "apellidos" => "Lu" ] 9 => array:2 [ "nombre" => "Cheng-Zhong" "apellidos" => "Li" ] 10 => array:2 [ "nombre" => "Yimin" "apellidos" => "Mao" ] 11 => array:2 [ "nombre" => "Gui-Qiang" "apellidos" => "Wang" ] 12 => array:2 [ "nombre" => "Yue-qiu" "apellidos" => "Gao" ] 13 => array:2 [ "nombre" => "Bangmao" "apellidos" => "Wang" ] 14 => array:2 [ "nombre" => "Qin" "apellidos" => "Zhang" ] 15 => array:2 [ "nombre" => "Yan" "apellidos" => "Ge" ] 16 => array:2 [ "nombre" => "Vincent" "apellidos" => "Wai-Sun Wong" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119303692?idApp=UINPBA00004N" "url" => "/16652681/0000001600000001/v1_201905311015/S1665268119303692/v1_201905311015/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S1665268119303679" "issn" => "16652681" "doi" => "10.5604/16652681.1226821" "estado" => "S300" "fechaPublicacion" => "2017-01-01" "aid" => "70189" "copyright" => "Fundación Clínica Médica Sur, A.C." "documento" => "article" "crossmark" => 0 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "fla" "cita" => "Ann Hepatol. 2017;16:107-14" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:2 [ "total" => 154 "formatos" => array:3 [ "EPUB" => 12 "HTML" => 82 "PDF" => 60 ] ] "en" => array:11 [ "idiomaDefecto" => true "titulo" => "Sarcopenia Predicts Reduced Survival in Patients with Hepatocellular Carcinoma at First Diagnosis" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "107" "paginaFinal" => "114" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 818 "Ancho" => 986 "Tamanyo" => 54175 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Kaplan Meier Survival Curve. In blue, non sarcopenic patients survival curve. In red, sarcopenic patients survival curve.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Paola Begini, Elia Gigante, Giulio Antonelli, Francesco Carbonetti, Elsa Iannicelli, Giulia Anania, Barbara Imperatrice, Adriano Maria Pellicelli, Gianfranco Delle Fave, Massimo Marignani" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Paola" "apellidos" => "Begini" ] 1 => array:2 [ "nombre" => "Elia" "apellidos" => "Gigante" ] 2 => array:2 [ "nombre" => "Giulio" "apellidos" => "Antonelli" ] 3 => array:2 [ "nombre" => "Francesco" "apellidos" => "Carbonetti" ] 4 => array:2 [ "nombre" => "Elsa" "apellidos" => "Iannicelli" ] 5 => array:2 [ "nombre" => "Giulia" "apellidos" => "Anania" ] 6 => array:2 [ "nombre" => "Barbara" "apellidos" => "Imperatrice" ] 7 => array:2 [ "nombre" => "Adriano" "apellidos" => "Maria Pellicelli" ] 8 => array:2 [ "nombre" => "Gianfranco" "apellidos" => "Delle Fave" ] 9 => array:2 [ "nombre" => "Massimo" "apellidos" => "Marignani" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119303679?idApp=UINPBA00004N" "url" => "/16652681/0000001600000001/v1_201905311015/S1665268119303679/v1_201905311015/en/main.assets" ] "en" => array:17 [ "idiomaDefecto" => true "titulo" => "Minimal Hepatic Encephalopathy in Cirrhosis- How Long to Treat?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "115" "paginaFinal" => "122" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Omesh Goyal, Sandeep S. Sidhu, Harsh Kishore" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Omesh" "apellidos" => "Goyal" "email" => array:1 [ 0 => "goyalomesh@yahoo.co.in" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:4 [ "nombre" => "Sandeep S." "apellidos" => "Sidhu" "email" => array:1 [ 0 => "sandeepsidhu1963@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 2 => array:2 [ "nombre" => "Harsh" "apellidos" => "Kishore" ] ] "afiliaciones" => array:1 [ 0 => array:3 [ "entidad" => "Dayanand Medical College and Hospital, Ludhiana, Punjab, India" "etiqueta" => "*" "identificador" => "aff1" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence and reprint request:" ] ] ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1209 "Ancho" => 1534 "Tamanyo" => 160492 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Flow of participants in the study. MHE: minimal hepatic encephalopathy. OHE: overt hepatic encephalopathy. * P value = 0.677. ** P value = 0.274.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0035">Introduction</span><p id="p0005" class="elsevierStylePara elsevierViewall">Minimal hepatic encephalopathy (MHE) is the mildest form of spectrum of HE which is characterized by subtle cognitive and psychomotor deficits in the absence of recognizable clinical symptoms of HE.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Patients with MHE have increased incidence of motor-vehicle accidents, poor quality of life and increased chance of developing episodes of overt hepatic encephalopathy (OHE), which impose a formidable burden on their families and health care sys-tem.<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2-5</span></a> Overt episodes of hepatic encephalopathy can occur without warning, and render the patient incapable of self-care, and frequently require hospitalized care.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> Overall, MHE is associated with poor prognosis and is probably an independent predictor of survival.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="p0010" class="elsevierStylePara elsevierViewall">MHE is diagnosed by using neuro-psychometric (NP) tests or neurophysiological tests.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> Treatment of MHE has been mainly targeted towards ammonia lowering therapies which include lactulose,<span class="elsevierStyleSup">11-16</span> rifaximin,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> probiotics,<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19-22</span></a> L-ornithine-L- aspartate,<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23-26</span></a> L-carnitine,<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> branched-chain amino acids,<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> etc. Treatment of MHE has been shown to lead to MHE reversal, improve quality of life and also decrease the frequency of occurrence of episodes of OHE.<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11-26</span></a> Therefore, it has been proposed the MHE should be treat-ed.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29,30</span></a> However, most of the trials have focused only on short-term (8-12 weeks) treatment of MHE. What happens after the treatment of MHE is stopped? Do the patients who once become MHE negative after short-term treatment, remain negative for MHE on follow up? How frequently does MHE relapse on follow up? Does short-term treatment of MHE decrease the incidence of future episodes of OHE and improve long-term survival? These questions have not been answered by any trial till now.</p><p id="p0015" class="elsevierStylePara elsevierViewall">In this study, we aimed to evaluate the long-term (9 months) efficacy of a short-term (3 month) treatment of MHE with lactulose or rifaximin, for maintenance of remission from MHE, in out-patient cirrhotics diagnosed to have MHE.</p></span><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Material and Methods</span><p id="p0020" class="elsevierStylePara elsevierViewall">This prospective study was conducted at the Gastroen-terology out-patient department of a tertiary care institute in northern India. The study consisted of 2 phases:<ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="u0005"><span class="elsevierStyleLabel">•</span><p id="p0025" class="elsevierStylePara elsevierViewall">A 3-month treatment phase, and</p></li><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">•</span><p id="p0030" class="elsevierStylePara elsevierViewall">6 months follow–up phase.</p></li></ul></p><p id="p0035" class="elsevierStylePara elsevierViewall">Consecutive patients with cirrhosis visiting the out-patient department were screened for the presence of MHE. MHE was diagnosed if any two of the five neuro-psycho-metric tests were positive (details below).</p><p id="p0040" class="elsevierStylePara elsevierViewall">Inclusion criteria were- liver cirrhosis, age 18-65 years and presence of MHE.</p><p id="p0045" class="elsevierStylePara elsevierViewall">Exclusion criteria were- current or recent (< 6 weeks) use of alcohol; use of Lactulose/Lactitol, Probiotics, Met-ronidazole, Rifaximin within last six weeks; use of inter-feron therapy, psychoactive drugs, anti-epileptics within last six weeks; infection or gastrointestinal hemorrhage within last six weeks; opium addiction; presence of hepa-tocellular carcinoma (HCC); history of portosystemic shunt surgery and past history of OHE.</p><p id="p0050" class="elsevierStylePara elsevierViewall">Laboratory assessment was carried out at baseline, after 3 months of treatment and at 6 months of post-treatment follow up. This included hemogram, liver and renal function tests, prothrombin time index, and fasting blood sugar. Child-Turcotte-Pugh (CTP) score and Model for End Stage Liver disease (MELD) score for stage of cirrhosis were calculated.</p><p id="p0055" class="elsevierStylePara elsevierViewall">Written informed consent was taken from each patient. The Institutional ethics committee approved the study protocol, and it conformed to ethical guidelines of the 1975 Declaration of Helsinki.</p><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Diagnosis of minimal hepatic encephalopathy</span><p id="p0060" class="elsevierStylePara elsevierViewall">Patients with a Mini Mental State Examination score > 25 were considered for neuropsychometric testing using number connection test A (NCT-A), figure connection test-A (FCT-A), digit symbol test (DST), picture completion test (PCT), and block design test (BDT).<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,31,32</span></a> Diagnosis of MHE was made if two or more neuropsy-chometric tests were impaired beyond two standard deviations of known control values.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Neuropsychometric test results were expressed as Z-scores, indicating differences (in standard deviation) between observed and expected scores. A Z-score of < -2 indicated that the result was impaired beyond 2 standard deviations of the known control value. The mean Z-score was calculated for each patient in order to avoid bias related to multiple comparisons. Mean Z-score (Δ mZS) after three months of treatment served as a quantitative measure of psychometric change.</p></span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Treatment phase (3 months)</span><p id="p0065" class="elsevierStylePara elsevierViewall">Patients with MHE were randomized into two groups (group A and B) using computer-generated randomization (1:1) and sealed opaque envelope method. Group A patients to receive Lactulose (Duphalac; Abbott India Limited, Mumbai, India) per orally, 30-120 mL/day and group B patients to receive Rifaximin tablets (Rifagut; Sun Pharmaceutical Industries Ltd, Mumbai, India) per orally, 400mg three times/day, for three months. Dosage of lactulose was adjusted to make the patient pass 2 to 3 semi-formed stools. Patients were followed up at regular intervals for assessment of compliance and for the development of any new symptoms/treatment related adverse events. At the end of 3 months, repeat neuropsychometric testing was done; specific therapy for MHE (Lactulose/ Rifaximin) was stopped while standard medical therapy for cirrhosis was continued.</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Follow-up phase (6 months)</span><p id="p0070" class="elsevierStylePara elsevierViewall">All patients were followed up after six months of stopping treatment (i.e., 9 months post-randomization), the general condition of each patient was enquired telephoni-cally. Patients who could not be contacted were labeled as ‘lost to follow-up’. Patients who had not suffered from any adverse events like OHE or death in the 6 month follow-up period were called to the hospital for repeat evaluation. Routine investigations and testing for MHE was performed in these patients.</p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Diet and concurrent therapy</span><p id="p0075" class="elsevierStylePara elsevierViewall">During the entire study period, patients were allowed to take a normal protein diet (~1 g/kg body weight, predominantly vegetable/casein based). Salt restriction was advised to those who had ascites. Standard treatment for cirrhosis including diuretics and β -blockers were given, if indicated.</p></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Statistical analysis</span><p id="p0080" class="elsevierStylePara elsevierViewall">Data are presented as means with 95% confidence intervals (CI) for quantitative variables and as proportions with 95% CI for qualitative variables. The changes in NP test results and within and between the groups were assessed by analysis of variance. Multiple logistic regression analysis was performed to assess the factors associated with MHE relapse, and results expressed as odds ratio (OR) with 95% CI. Fisher’s exact test was performed to assess improvement in MHE on an intention-to-treat basis. A P-value of < 0.05 was considered statistically significant. Statistical analysis was carried out with SPSS software, version 11.5 (SPSS, Chicago, IL).</p></span></span><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Results</span><p id="p0085" class="elsevierStylePara elsevierViewall">A total of 527 patients with liver cirrhosis were screened. Out of these, 176 (33.4%) patients were excluded due to various reasons (127 patients had history of recent OHE and were using Lactulose, L-ornithine-L-aspartate or Rifax-imin, 44 had history of opium addiction, 27 had history of current/recent (< 6 weeks) use of alcohol, 11 had advanced cardiopulmonary disease, nine had used antibiotics within last six weeks, seven had hepatocellular carcinoma, five were using psychoactive drugs/anti-epileptics, seven had history of gastrointestinal hemorrhage within last six weeks, four had renal insufficiency, and four were on Interferon therapy). A total of 69 patients were excluded due to multiple reasons. The remaining 351 patients were found eligible and tested for MHE. Out of these, 112 (31.9%) patients were diagnosed to have MHE (mean age 55.3 years; 75% males). They were randomized to receive Rifaximin (n = 57; 1200 mg/day) or Lactulose (n = 55; 30-120 ml/day) for three months. Later, these patients were followed up to 9 months (<a class="elsevierStyleCrossRef" href="#f0005">Figure 1</a>). Baseline characteristics of the 2 groups were similar (<a class="elsevierStyleCrossRef" href="#t0005">Table 1</a>).</p><elsevierMultimedia ident="f0005"></elsevierMultimedia><elsevierMultimedia ident="t0005"></elsevierMultimedia><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Treatment phase (3 months)</span><p id="p0090" class="elsevierStylePara elsevierViewall">The detailed results of treatment phase are available elsewhere.<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> In brief, at two weeks, 30/57 patients (52.6%) in the Rifaximin group experienced MHE reversal compared to 22/55 (40.0%) in the Lactulose group (based on the intention-to-treat population). The absolute difference in percentages with MHE reversal was calculated to be 12.6% (95% C.I. -2.8% to 27.2%).</p><p id="p0095" class="elsevierStylePara elsevierViewall">At 3 months, forty-two out of 57 patients (73.7%) in the Rifaximin group experienced MHE reversal compared to 38 out of 55 (69.1%) in the Lactulose group (based on the intention-to-treat population) (p = 0.677). The absolute difference in percentages with reversal (Rifaximin-Lactu-lose) was calculated to be 4.6% (95% C.I.-9.3% to 18.4%). This corresponds to an odds ratio of 1.25 (95% C.I. 0.63 to 2.50) for Rifaximin relative to Lactulose.</p><p id="p0100" class="elsevierStylePara elsevierViewall">In the Rifaximin group, two patients developed OHE, one patient went for liver transplant and eight were lost to follow up. In the Lactulose group, one patient developed OHE, two patients developed hepato-cellular carcinoma, two patients died, and 4 were lost to follow up.</p></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Follow-up phase (6 months)</span><p id="p0105" class="elsevierStylePara elsevierViewall">In the Rifaximin group, at 6 months follow-up, 18 (42.8%) out of 42 patients (who had become MHE negative with treatment) were still MHE negative. Out of the rest, 20 patients (47.6%) had relapse of MHE, while 3 (7.1%) developed OHE and one (0.23%) expired. Out of the 4 patients who had persisted to be MHE positive at 3 months despite treatment, 2 expired (50%), one (25%) developed OHE and one was lost to follow up.</p><p id="p0110" class="elsevierStylePara elsevierViewall">In the lactulose group, at 6 months follow-up, 19 (50%) out of 38 patients (who had become MHE negative with treatment) were still MHE negative. Out of the rest, 16 patients (42.1%) had relapse of MHE and 3 (7.9%) developed OHE. Out of the 8 patients who had persisted to be MHE positive at 3 months despite treatment, 3 (37.5%) developed OHE, 3 expired (37.5%) and 2 were lost to follow up.</p><p id="p0115" class="elsevierStylePara elsevierViewall">Results of individual NP test scores, CTP score and MELD score in the two groups are shown in <a class="elsevierStyleCrossRef" href="#t0010">table 2</a>. Comparison between the 2 groups revealed that the incidence of MHE relapse at 6 months was not significantly different between the Rifaximin and lactulose groups (47.6% <span class="elsevierStyleItalic">vs.</span> 42.1% respectively, p = 0.274). The mean CTP score (8.2 ± 2.3 <span class="elsevierStyleItalic">vs.</span> 6.3 ± 1.9; p = 0.0001) and MELD scores (11.8 ± 4.5 <span class="elsevierStyleItalic">vs.</span> 8.7 ± 3.9; p = 0.0016) of patients who had MHE relapse were higher compared to those who didn’t have a relapse of MHE.</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><p id="p0120" class="elsevierStylePara elsevierViewall">The 6-month incidence of development of OHE among patients who became MHE negative at 3 months was not significantly different between the 2 groups (7.1% <span class="elsevierStyleItalic">vs</span>. 7.9% respectively; p = 0.924). However, the incidence of OHE among those who had persisted to be MHE positive at 3 months was significantly higher (25% and 37.5% in the two groups respectively; p = 0.011).</p><p id="p0125" class="elsevierStylePara elsevierViewall">The mortality rate at 6-month follow-up among patients who became MHE negative at 3 months was not significantly different in the 2 groups (0.23% <span class="elsevierStyleItalic">vs.</span> 0% respectively). The 6-month mortality rate among patients who persisted to be MHE positive at 3 months was much higher (50% and 37.5% in the two groups respectively; p = 0.014).</p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Factors affecting MHE relapse</span><p id="p0130" class="elsevierStylePara elsevierViewall">Various factors like age, sex, CTP score, MELD score, serum bilirubin, platelet count and baseline NP test score (Z-score) were evaluated for association with MHE relapse (<a class="elsevierStyleCrossRef" href="#t0015">Table 3</a>). On univariate analysis, CTP, score, MELD score and Z-score were associated with MHE relapse. On multivariate regression analysis, MELD score was an independent predictor of MHE relapse.</p><elsevierMultimedia ident="t0015"></elsevierMultimedia></span></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">Discussion</span><p id="p0135" class="elsevierStylePara elsevierViewall">The prevalence of MHE in patients with cirrhosis varies between 30% and 84%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,9,10,34</span></a> With treatment, MHE reversal has been reported to occur in about 54-75% of the patients.<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12,13,17,33</span></a> In addition, treatment has been shown to improve health related quality of life, decrease road-traffic accidents, improve daily performance and also decrease the occurrence of episodes of OHE, during the treatment period.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,13,17,18,23</span></a> The present study is the first study that followed up patients of MHE after short-term treatment with lactulose or Rifaximin, and found that although about 65% of patients had MHE reversal after treatment for 3 months, almost half of these patients had relapse of MHE at 6 months follow-up. The frequency of MHE relapse, OHE development and mortality were similar in the lactulose or Rifaximin groups. However, the incidence of OHE and mortality were higher among patients who didn’t experience MHE reversal at 3 months compared to those who had initial MHE reversal.</p><p id="p0140" class="elsevierStylePara elsevierViewall">MHE, although common, is not routinely tested in clinical practice, as there are no clinical guidelines recommending the universal screening of MHE.<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">35-37</span></a> However, testing of MHE in cirrhotic patients has gained importance in the recent years as it can provide useful and meaningful information at the individual level and help to plan a tailored therapy.<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> Some subgroups of patients would benefit the most from testing for MHE as specific recommendations can be made if they have MHE.<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10,30</span></a> For example, active drivers should be cautioned regarding the increased probability of road traffic accidents due to their increased reaction time, and workers engaged in high risk jobs should be counseled against handling of complex/dangerous machinery. In addition, patients who have cognitive impairment and decline in work performance perceived by themselves, relatives or by colleagues should be assessed and, if possible, changes in daily/ working activities should be carried out.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30,35</span></a> The importance of testing MHE has further been strengthened by a recent study by Ampuero, <span class="elsevierStyleItalic">et al</span>., which showed that MHE is associated with a reduced 5-year survival rate of patients with cirrhosis. Evaluation of MHE could help predict survival times and outcomes of patients with specific MELD scores.<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a></p><p id="p0145" class="elsevierStylePara elsevierViewall">The decision to initiate medical therapy for MHE ought to be individualized, based on the estimation of the extent of patient’s daily life impairment that can ameliorate with therapy.<a class="elsevierStyleCrossRefs" href="#bib0150"><span class="elsevierStyleSup">30,35</span></a> In the recent years, various medical therapies that have been found effective for treating MHE patients include lactulose,<span class="elsevierStyleSup">11-16</span> rifaximin,<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17,18</span></a> probiotics,<span class="elsevierStyleSup">19-22</span> L-orni-thine-L- aspartate<span class="elsevierStyleSup">23-26</span> and improved nutritional status.<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a> However, none of these studies have reported the follow up data of the patients after withdrawal of specific therapy for MHE. Thus, the long-term benefit of these therapeutic options for MHE had remained questionable till now. The present study attempted to fill this lacuna in the knowledge regarding the long-term efficacy of treatment of MHE. This study differs from previous studies in that it evaluated the long-term beneficial effect of a short-term therapy with Ri-faximin and lactulose, rather than their short-term benefits only. In our study, after treatment with lactulose or Rifax-imin for 3 months, about 65% of patients had MHE reversal. These results are similar to the previously reported data on MHE reversal after short-term treatment with lactulose or Rifaximin.<span class="elsevierStyleSup">13,14,17,18</span> However, after 6 months of post-treatment follow up, only about 50% of these patients in our study remained negative for MHE, while the rest suffered from adverse outcomes (MHE, OHE or mortality). In a study by Das, <span class="elsevierStyleItalic">et al.</span><a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> describing the natural history of MHE, 32 patients who were negative for MHE were followed up for a mean of 5.4 months. At the end of follow up, 68.8% patients were still negative for MHE while the rest had adverse outcomes (MHE in 18.7%, OHE in 6.2% and mortality in 6.2%). These data indicate that the natural history of MHE in patients who become MHE negative with short-term treatment is worse than those who are MHE negative at the baseline. This is because of the high relapse rate of MHE after as short-term treatment. This suggests that the therapy of MHE may need to be given for a longer period for secondary prevention of MHE.</p><p id="p0150" class="elsevierStylePara elsevierViewall">The prognostic significance of MHE has been reported in another study by Dhiman, <span class="elsevierStyleItalic">et al.</span><a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> In this study, the 2-year mortality rate among untreated MHE positive patients was significantly higher compared to MHE negative patients (39.1% <span class="elsevierStyleItalic">vs</span>. 22.9% respectively). Similar results were observed in our study, where the 6 month mortality among patients who persisted to be MHE positive at 3 months despite treatment was significantly higher compared to those who became MHE negative (37.5% <span class="elsevierStyleItalic">vs</span>. 0.23% respectively). Also, in concordance with the Dhiman, <span class="elsevierStyleItalic">et al.</span> study, the incidence of OHE was significantly higher among MHE positive patients compared to MHE negative patients in our study (37.5% <span class="elsevierStyleItalic">vs.</span> 8%). MHE with poor psychometric hepatic encephalop-athy score was an independent predictor of survival in their study. In a recent study, Patidar, <span class="elsevierStyleItalic">et al</span>.<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">41</span></a> have shown that covert HE was associated with worsened survival, increased risk of hospitalization and overt HE development after controlling for the MELD score. These data highlight the need to treat MHE to reduce long-term morbidity and mortality.</p><p id="p0155" class="elsevierStylePara elsevierViewall">The next question arises: How long should patients be treated for secondary prevention of MHE? Although the long-term data for secondary prevention of MHE is not available, similar data for secondary prevention of OHE with ammonia lowering therapies for after treatment of acute episode has been addressed by various studies. In a single-center, open-label study of 120 patients, lactulose therapy was found to be more effective than no active treatment in the prevention of overt hepatic encephalopa-thy.<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> Later, Bass, <span class="elsevierStyleItalic">et al.</span> showed that the addition of Rifax-imin to lactulose reduced the risk of a breakthrough episode of OHE during a 6-month period among patients in remission who had a recent history of recurrent overt hepatic encephalopathy (≥ 2 episodes within the previous 6 months) before enrollment.<a class="elsevierStyleCrossRef" href="#bib0215"><span class="elsevierStyleSup">43</span></a> Recently, Neff, <span class="elsevierStyleItalic">et al.</span> has reported that Rifaximin use for greater than 6 months proved to be effective in the management of HE, especially in patients with MELD less than equal to 20.<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">44</span></a> As the underlying pathophysiology of MHE and OHE are same, it is understandable that both of these conditions need long term treatment for their secondary prevention. As discussed earlier, specific sub-groups of MHE patients are likely to benefit the most from treatment. Hence, the decision to treat MHE for short-term or long term needs to be individualized.</p><p id="p0160" class="elsevierStylePara elsevierViewall">To conclude, this is the first study to provide the follow-up data of MHE patients after short-term treatment. Of the patients who became MHE negative after short-term (3 months) treatment with rifaximin/lactulose, almost 50% had a relapse of MHE at 6 months follow-up.</p><p id="p0165" class="elsevierStylePara elsevierViewall">Future multi-centric placebo-controlled studies must address questions regarding the efficacy, safety and cost-effectiveness of long-term treatment of MHE with lactu-lose or rifaximin.</p></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0095">Abbreviations</span><p id="p0170" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0015"><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">•</span><p id="p0175" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">BDT:</span> block design test.</p></li><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">•</span><p id="p0180" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">CTP:</span> Child Turcotte Pugh score.</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">•</span><p id="p0185" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">DST:</span> digit symbol test.</p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">•</span><p id="p0190" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">FCT-A:</span> figure connection test-A.</p></li><li class="elsevierStyleListItem" id="u0035"><span class="elsevierStyleLabel">•</span><p id="p0195" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HCC:</span> hepatocellular carcinoma.</p></li><li class="elsevierStyleListItem" id="u0040"><span class="elsevierStyleLabel">•</span><p id="p0200" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">MELD:</span> Model for End Stage Liver Disease.</p></li><li class="elsevierStyleListItem" id="u0045"><span class="elsevierStyleLabel">•</span><p id="p0205" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">MHE:</span> minimal hepatic encephalopathy.</p></li><li class="elsevierStyleListItem" id="u0050"><span class="elsevierStyleLabel">•</span><p id="p0210" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">NCT A:</span> number connection test A.</p></li><li class="elsevierStyleListItem" id="u0055"><span class="elsevierStyleLabel">•</span><p id="p0215" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">NP:</span> neuro-psychometric.</p></li><li class="elsevierStyleListItem" id="u0060"><span class="elsevierStyleLabel">•</span><p id="p0220" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">OHE:</span> overt hepatic encephalopathy.</p></li><li class="elsevierStyleListItem" id="u0065"><span class="elsevierStyleLabel">•</span><p id="p0225" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PCT:</span> picture completion test.</p></li></ul></p></span><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0100">Financial Support</span><p id="p0230" class="elsevierStylePara elsevierViewall">Dayanand Medical College and Hospital. Tagore Na-gar, Civil lines. Ludhiana, Punjab, India, 141001.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:9 [ 0 => array:3 [ "identificador" => "xres1198037" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abs0010" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abs0015" "titulo" => "Material and Methods" ] 2 => array:2 [ "identificador" => "abs0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abs0025" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1116681" "titulo" => "Key words" ] 2 => array:2 [ "identificador" => "s0005" "titulo" => "Introduction" ] 3 => array:3 [ "identificador" => "s0010" "titulo" => "Material and Methods" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "s0015" "titulo" => "Diagnosis of minimal hepatic encephalopathy" ] 1 => array:2 [ "identificador" => "s0020" "titulo" => "Treatment phase (3 months)" ] 2 => array:2 [ "identificador" => "s0025" "titulo" => "Follow-up phase (6 months)" ] 3 => array:2 [ "identificador" => "s0030" "titulo" => "Diet and concurrent therapy" ] 4 => array:2 [ "identificador" => "s0035" "titulo" => "Statistical analysis" ] ] ] 4 => array:3 [ "identificador" => "s0040" "titulo" => "Results" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "s0045" "titulo" => "Treatment phase (3 months)" ] 1 => array:2 [ "identificador" => "s0050" "titulo" => "Follow-up phase (6 months)" ] 2 => array:2 [ "identificador" => "s0055" "titulo" => "Factors affecting MHE relapse" ] ] ] 5 => array:2 [ "identificador" => "s0060" "titulo" => "Discussion" ] 6 => array:2 [ "identificador" => "s0065" "titulo" => "Abbreviations" ] 7 => array:2 [ "identificador" => "s0070" "titulo" => "Financial Support" ] 8 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2016-05-09" "fechaAceptado" => "2016-06-11" "PalabrasClave" => array:1 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec1116681" "palabras" => array:4 [ 0 => "Lactulose" 1 => "Neuro-psychometric" 2 => "Relapse" 3 => "Rifaximin" ] ] ] ] "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0010">Introduction</span><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Minimal hepatic encephalopathy (MHE) can reverse after short-term treatment. However, relapse rate of MHE after stopping treatment has not been studied so far. We aimed to evaluate long-term (9 months) efficacy of a short-term (3 months) treatment of MHE with lactulose/rifaximin, for maintenance of remission from MHE.</p></span> <span id="abs0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0015">Material and Methods</span><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">In this prospective study, consecutive patients with cirrhosis and MHE were treated with lactulose/rifaximin for 3 months. After treatment, they were followed up for 6 months. Psychometric testing for diagnosis of MHE was performed at baseline, 3 months and 9 months.</p></span> <span id="abs0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0020">Results</span><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Of the 527 patients screened, 351 were found eligible and tested for MHE. Out of these, 112 (31.9%) patients had MHE (mean age 55.3 years; 75% males). They were randomized to receive Rifaximin (n = 57; 1,200 mg/day) or Lactulose (n = 55; 30-120 mL/day) for three months. At 3 months, 73.7% (42/57) patients in Rifaximin group experienced MHE reversal compared to 69.1% (38/55) in Lac-tulose group (p = 0.677). Six months after stopping treatment, 47.6% (20/42) in rifaximin group and 42.1% (16/38) patients in lactu-lose group experienced MHE relapse (p = 0.274). The overt hepatic encephalopathy development rate (7.1% <span class="elsevierStyleItalic">vs.</span> 7.9%) and mortality rate (0.23% <span class="elsevierStyleItalic">vs.</span> 0%) were similar in both groups. The Child-Turcotte-Pugh score and model for end stage liver disease (MELD) scores of patients who had MHE relapse were higher compared to those who didn’t. On multivariate regression analysis, MELD score was an independent predictor of MHE relapse.</p></span> <span id="abs0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0025">Conclusion</span><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall">Of the patients who became MHE negative after short-term (3 months) treatment with rifaximin/lactulose, almost 50% had a relapse of MHE at 6 months follow-up.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abs0010" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abs0015" "titulo" => "Material and Methods" ] 2 => array:2 [ "identificador" => "abs0020" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abs0025" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "f0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1209 "Ancho" => 1534 "Tamanyo" => 160492 ] ] "descripcion" => array:1 [ "en" => "<p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Flow of participants in the study. MHE: minimal hepatic encephalopathy. OHE: overt hepatic encephalopathy. * P value = 0.677. ** P value = 0.274.</p>" ] ] 1 => array:8 [ "identificador" => "t0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Data are expressed as mean (95% confidence interval) or number (percent). P value is non-significant for all comparison between both the arms. CTP: Child Turcotte Pugh. MELD: Model for End Stage Liver Disease. NAFLD: Non Alcoholic Fatty Liver Disease." "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Lactulose arm (n = 55) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Rifaximin arm (n = 57) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">57.5 (54.4 - 59.4) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">52.9 (49.6 - 54.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39 (71%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (79%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Urban residence \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28 (51%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (46%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Education (years) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.6 (6.3 - 9.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8.8 (7.5 - 9.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Diabetes mellitus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (15%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (21%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cirrhosis duration (months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.8 (18.9 - 36.7) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.5 (15.5 - 29.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Etiology of cirrhosis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Alcohol \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (44%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 (60%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hepatitis C virus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (22%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (9%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NAFLD \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 (9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (14%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Hepatitis B virus \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 (2%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Cryptogenic \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (11%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (4%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Mixed/others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (12.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 (10.5%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Varices present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (47%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (46%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ascites duration \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.4 (6.9 - 15.9) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.9 (5.33 - 15.31) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">(months) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Ascites present \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">32 (58%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">33 (58%) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CTP score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.9 (6.6 - 7.3) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.1 (6.6 - 7.5) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MELD score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.1 (10.2 - 12.0) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.8 (10.6 - 13.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2046029.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of patients.</p>" ] ] 2 => array:8 [ "identificador" => "t0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "fuente" => "Data are expressed as mean (95% confidence interval)." "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Parameter \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Baseline (n = 112) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">3 months (n = 92) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">9 months (n = 73) \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Number Connection Test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-4.75 (-5.82 to -3.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-2.21 (-2.93 to -1.49) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-1.64 (-2.28 to -1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Figure Connection Test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-5.70 (-6.38 to -5.02) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-2.60 (-3.31 to -1.89) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-2.4 (-3.11 to -1.71) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Digit Symbol Test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-1.24 (-1.36 to -1.12) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-0.77 (-0.94 to -0.6) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.84 (0.66 to 1.02) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Picture Completion Test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-1.82 (-1.96 to -1.68) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-1.27 (-1.43 to -1.11) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-1.08 (-1.27 to -0.89) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Block Design Test \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-1.75 (-1.94 to -1.56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-1.15 (-1.35 to -0.95) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">-1.34 (-1.63 to -1.05) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Model for End Stage Liver Disease score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11.48 (10.72 to 12.24) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10.79 (10.05 to 11.53) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9.92 (9.12 to 10.72) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Child-Pugh score \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7.00 (6.72 to 7.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.72 (6.39 to 7.05) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.62 (6.29 to 6.95) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2046027.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Comparison of psychometric test performance and liver performance status of all patients at baseline, 3 months and 9 months.</p>" ] ] 3 => array:7 [ "identificador" => "t0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Univariate analysis \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Multivariate analysis</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p value \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">O.R. (95% C.I.) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col">p value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age > 40 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.757 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male Sex \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.631 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Past history of alcohol intake \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.439 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Child-Pugh score >7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.005 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.23 (0.61 - 3.56) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.06 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Model for End Stage Liver Disease > 11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.001 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6.45 (1.23 - 9.81) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.002 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Platelets < 100 x 10<span class="elsevierStyleSup">9</span>/L \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Neuropsychometric test score (z score) > -3.0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.045 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.94 (0.31 - 1.64) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.91 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2046028.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="sp0020" class="elsevierStyleSimplePara elsevierViewall">Univariate and multivariate logistic regression analysis of factors predicting relapse of minimal hepatic encephalopathy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bs0010" "bibliografiaReferencia" => array:44 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatic encephalopathy definition, nomenclature, diagnosis, and quantification: final report of the working party at the 11th World Congresses of Gastroenterology, Vienna, 1998" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Ferenci P." 1 => "Lockwood A." 2 => "Mullen K." 3 => "Tarter R." 4 => "Weissenborn K." 5 => "Blei A.T." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhep.2002.31250" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2002" "volumen" => "35" "paginaInicial" => "716" "paginaFinal" => "721" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11870389" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimal hepatic encephalopathy is associated with motor vehicle crashes: the reality beyond the driving test" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Bajaj J.S." 1 => "Saeian K." 2 => "Schubert C.M." 3 => "Muhammad H." 4 => "Jose F." 5 => "Rajiv V." 6 => "Gibson D.P." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.23128" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2009" "volumen" => "50" "paginaInicial" => "1175" "paginaFinal" => "1183" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19670416" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimal hepatic en-cephalopathy impairs quality of life" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Agrawal S." 1 => "Umapathy S." 2 => "Dhiman R.K." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jceh.2014.11.006" "Revista" => array:6 [ "tituloSerie" => "J Clin Exp Hepatol" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "S42" "paginaFinal" => "S48" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26041957" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Subclinical hepatic encephalopathy predicts the development of overt hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Romero-Gomez M." 1 => "Boza F." 2 => "García-Valdecasas M.S." 3 => "Garcia E." 4 => "Aguilar-Reina J." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2001.04130.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2001" "volumen" => "96" "paginaInicial" => "2718" "paginaFinal" => "2723" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11569701" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Prevalence and natural history of subclinical hepatic encephalopa-thy in cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Das A." 1 => "Dhiman R.K." 2 => "Saraswat V.A." 3 => "Verma M." 4 => "Naik S.R." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Gastroenterol Hepatol" "fecha" => "2001" "volumen" => "16" "paginaInicial" => "531" "paginaFinal" => "535" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11350549" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Review article: the burden of hepatic encepha-lopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Poordad F.F." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1746-6342.2006.03215.x" "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "2007" "volumen" => "25" "paginaInicial" => "3" "paginaFinal" => "9" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17295846" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hospitalizations during the use of ri-faximin versus lactulose for the treatment of hepatic en-cephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Leevy C.B." 1 => "Phillips J.A." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-006-9442-4" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2007" "volumen" => "52" "paginaInicial" => "737" "paginaFinal" => "741" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17245628" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical features and survival of cirrhotic patients with subclinical cognitive alterations detected by the number connection test and computerized psychometric tests" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Amodio P." 1 => "Del Piccolo F." 2 => "Marchetti P." 3 => "Angeli P." 4 => "Iemmolo R." 5 => "Caregaro L." 6 => "Merkel C." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.510290619" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "1999" "volumen" => "29" "paginaInicial" => "1662" "paginaFinal" => "1667" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10347105" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The prognostic significance of subclinical hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Hartmann I.J." 1 => "Groeneweg M." 2 => "Quero J.C." 3 => "Beijeman S.J." 4 => "de Man R.A." 5 => "Hop W.C." 6 => "Schalm S.W." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1572-0241.2000.02265.x" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2000" "volumen" => "95" "paginaInicial" => "2029" "paginaFinal" => "2034" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10950053" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimal hepatic encephalopa-thy: diagnosis, clinical significance and recommendations" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Ortiz M." 1 => "Jacas C." 2 => "Cordoba J." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jhep.2004.11.028" "Revista" => array:6 [ "tituloSerie" => ". J Hepatol" "fecha" => "2005" "volumen" => "42" "paginaInicial" => "S45" "paginaFinal" => "S53" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15777572" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serum endotoxin, inflammatory mediators, and magnetic resonance spectroscopy before and after treatment in patients with minimal hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Jain L." 1 => "Sharma B.C." 2 => "Srivastava S." 3 => "Puri S.K." 4 => "Sharma P." 5 => "Sarin S." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Gastroenterol Hepa-tol" "fecha" => "2013" "volumen" => "28" "paginaInicial" => "1187" "paginaFinal" => "1193" ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "An open-label randomized controlled trial of lactulose and probiotics in the treatment of minimal hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Sharma P." 1 => "Sharma B.C." 2 => "Puri V." 3 => "Sarin S.K." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eur J Gastro-enterol Hepatol" "fecha" => "2008" "volumen" => "20" "paginaInicial" => "506" "paginaFinal" => "511" ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lactulose improves cognitive functions and health related quality of life in patients with cirrhosis who have minimal hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Prasad S." 1 => "Dhiman R.K." 2 => "Duseja A." 3 => "Chawla Y.K." 4 => "Sharma A." 5 => "Agarwal R." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.21533" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2007" "volumen" => "45" "paginaInicial" => "549" "paginaFinal" => "559" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17326150" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Efficacy of lactulose in cirrhotic patients with sub-clinical hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Dhiman R.K." 1 => "Sawhney M.S." 2 => "Chawla Y.K." 3 => "Das G." 4 => "Ram S." 5 => "Dila-wari J.B." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2000" "volumen" => "45" "paginaInicial" => "1549" "paginaFinal" => "1552" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11007104" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical efficacy of lactulose in cirrhotic patients with and without subclinical hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Watanabe A." 1 => "Sakai T." 2 => "Sato S." 3 => "Imai F." 4 => "Ohto M." 5 => "Arakawa Y." 6 => "Toda G." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/jhep.1997.v26.pm0009397979" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "1997" "volumen" => "26" "paginaInicial" => "1410" "paginaFinal" => "1414" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9397979" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0080" "etiqueta" => "16." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lactulose improves psychometric testing incirrhotic patients with subclinical encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Horsmans Y." 1 => "Solbreux P.M." 2 => "Daenens C." 3 => "Desager J.P." 4 => "Geubel A.P." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Aliment Pharmacol Ther" "fecha" => "1997" "volumen" => "11" "paginaInicial" => "165" "paginaFinal" => "170" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9042989" "web" => "Medline" ] ] ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0085" "etiqueta" => "17." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rifaximin improves psychometric performance and health-related quality of life in patients with minimal hepatic enceph-alopathy (the RIME Trial)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Sidhu S.S." 1 => "Goyal O." 2 => "Mishra B.P." 3 => "Sood A." 4 => "Chhina R.S." 5 => "Soni R.K." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ajg.2010.455" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2011" "volumen" => "106" "paginaInicial" => "307" "paginaFinal" => "316" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21157444" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0090" "etiqueta" => "18." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rifaximin improves driving simulator performance in a randomized trial of patients with minimal hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Bajaj J.S." 1 => "Heuman D.M." 2 => "Wade J.B." 3 => "Gibson D.P." 4 => "Saeian K." 5 => "Wege-lin J.A." 6 => "Hafeezullah M." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2010.08.061" "Revista" => array:7 [ "tituloSerie" => "Gastroenterology" "fecha" => "2011" "volumen" => "140" "paginaInicial" => "478" "paginaFinal" => "487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20849805" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0168827811008129" "estado" => "S300" "issn" => "01688278" ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0095" "etiqueta" => "19." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Probiotic yogurt for the treatment of minimal hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Bajaj J.S." 1 => "Saeian K." 2 => "Christensen K.M." 3 => "Hafeezullah M." 4 => "Varma R.R." 5 => "Franco J." 6 => "Pleuss J.A." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Am J Gastroenter-ol" "fecha" => "2008" "volumen" => "103" "paginaInicial" => "1707" "paginaFinal" => "1715" ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0100" "etiqueta" => "20." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Symbiotic modulation of gut flora: effect on minimal hepatic encephalopathy in patients with cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Liu Q." 1 => "Duan Z.P." 2 => "Ha D.K." 3 => "Bengmark S." 4 => "Kurtovic J." 5 => "Riordan S.M." 6 => "Hafeezullah M." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.20194" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2004" "volumen" => "39" "paginaInicial" => "1441" "paginaFinal" => "1449" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15122774" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0105" "etiqueta" => "21." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Bifidobacterium longum with fruc-to-oligosaccharide (fos) treatment in minimal hepatic encephalopathy: a randomized, double-blind, placebo-controlled study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "Malaguarnera M." 1 => "Greco F." 2 => "Barone G." 3 => "Gargante M.P." 4 => "Mala-guarnera M." 5 => "Toscano M.A." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-006-9687-y" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2008" "volumen" => "52" "paginaInicial" => "3259" "paginaFinal" => "3265" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17393330" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0110" "etiqueta" => "22." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Can Lactobacillus acidophilus improve minimal hepatic encephalopathy? A neurometabolite study using magnetic resonance spectroscopy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Ziada D.H." 1 => "Soliman H.H." 2 => "El Yamany S.A." 3 => "Hamisa M.F." 4 => "Hasan A.M." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ajg.2013.08.002" "Revista" => array:6 [ "tituloSerie" => "Arab J Gastroenterol" "fecha" => "2013" "volumen" => "14" "paginaInicial" => "116" "paginaFinal" => "122" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24206740" "web" => "Medline" ] ] ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0115" "etiqueta" => "23." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Oral L-ornithine-L-aspartate in minimal hepatic encephalopathy: a randomized, double-blind, placebo-controlled trial" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Alvares-da-Silva M.R." 1 => "de Araujo A." 2 => "Vicenzi J.R." 3 => "da Silva G.V." 4 => "Oliveira F.B." 5 => "Schacher F." 6 => "Oliboni L." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/hepr.12235" "Revista" => array:6 [ "tituloSerie" => "Hepatol Res" "fecha" => "2014" "volumen" => "44" "paginaInicial" => "956" "paginaFinal" => "963" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24033861" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0120" "etiqueta" => "24." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "L-ornithine-L-aspartate for hepatic encephalopathy in patients with cirrhosis: a meta-analysis of randomized controlled trials" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Bai M." 1 => "Yang Z." 2 => "Qi X." 3 => "Fan D." 4 => "Han G." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Gastroen-terol Hepatol" "fecha" => "2013" "volumen" => "28" "paginaInicial" => "783" "paginaFinal" => "792" ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0125" "etiqueta" => "25." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of L-ornithine L-aspartate and branch chain amino acids on encephalopa-thy and nutritional status in liver cirrhosis with malnutrition" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Ndraha S." 1 => "Hasan I." 2 => "Simadibrata M." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Acta Med Indones" "fecha" => "2011" "volumen" => "43" "paginaInicial" => "18" "paginaFinal" => "22" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21339541" "web" => "Medline" ] ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0130" "etiqueta" => "26." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A randomized controlled trial comparing lactulose, probiotics, and L-ornithine L- aspartate in treatment of minimal hepatic encepha-lopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Mittal V.V." 1 => "Sharma B.C." 2 => "Sharma P." 3 => "Sarin S.K." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MEG.0b013e32834696f5" "Revista" => array:6 [ "tituloSerie" => "Eur J Gastroenterol Hepatol" "fecha" => "2011" "volumen" => "23" "paginaInicial" => "725" "paginaFinal" => "732" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21646910" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0135" "etiqueta" => "27." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Acetyl-L-carnitine treatment in minimal hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Malaguarnera M." 1 => "Gargante M.P." 2 => "Cristaldi E." 3 => "Vacante M." 4 => "Risino C." 5 => "Cammalleri L." 6 => "Pennisi G." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-008-0238-6" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2008" "volumen" => "53" "paginaInicial" => "3018" "paginaFinal" => "3025" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18357530" "web" => "Medline" ] ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0140" "etiqueta" => "28." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Branched chain ami-no acids in the treatment of latent portosystemic encepha-lopathy. A double blind placebo-controlled crossover study" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Egberts E.H." 1 => "Schomerus H." 2 => "Hamster W." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterology" "fecha" => "1985" "volumen" => "88" "paginaInicial" => "887" "paginaFinal" => "895" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3882509" "web" => "Medline" ] ] ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0145" "etiqueta" => "29." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "MHE. Consensus statement of a working party of the Indian national association for study of the liver" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Dhiman R.K." 1 => "Saraswat V." 2 => "Duseja A." 3 => "Chawla Y.K." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1440-1746.2010.06318.x" "Revista" => array:6 [ "tituloSerie" => "J Gastroenterol Hepatol" "fecha" => "2010" "volumen" => "25" "paginaInicial" => "1029" "paginaFinal" => "1041" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20594216" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0150" "etiqueta" => "30." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of covert hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Waghray A." 1 => "Waghray N." 2 => "Mullen K." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.jceh.2014.02.007" "Revista" => array:6 [ "tituloSerie" => "J Clin Exp Hepatol" "fecha" => "2015" "volumen" => "5" "paginaInicial" => "S75" "paginaFinal" => "S81" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26041963" "web" => "Medline" ] ] ] ] ] ] ] ] 30 => array:3 [ "identificador" => "bib0155" "etiqueta" => "31." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Ramalingaswamy P." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Manual of Indian Adaptation of WAIS Performance Scale" "paginaInicial" => "2" "paginaFinal" => "29" "serieFecha" => "1974" ] ] ] ] ] ] 31 => array:3 [ "identificador" => "bib0160" "etiqueta" => "32." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Figure connection test: a universal test for assessment of mental state" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Dhiman R.K." 1 => "Saraswat V.A." 2 => "Verma M." 3 => "Naik S.R." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Gastroenterol Hepatol" "fecha" => "1995" "volumen" => "10" "paginaInicial" => "14" "paginaFinal" => "23" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7620102" "web" => "Medline" ] ] ] ] ] ] ] ] 32 => array:3 [ "identificador" => "bib0165" "etiqueta" => "33." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rifaximin vs. lactulose in treatment of minimal hepatic encephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Sidhu S.S." 1 => "Goyal O." 2 => "Parker R.A." 3 => "Kishore H." 4 => "Sood A." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/liv.12921" "Revista" => array:6 [ "tituloSerie" => "Liver Int" "fecha" => "2016" "volumen" => "36" "paginaInicial" => "378" "paginaFinal" => "385" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26201713" "web" => "Medline" ] ] ] ] ] ] ] ] 33 => array:3 [ "identificador" => "bib0170" "etiqueta" => "34." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management options for minimal hepatic encepha-lopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "Bajaj J.S." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1586/17474124.2.6.785" "Revista" => array:6 [ "tituloSerie" => "Expert Rev Gastroenterol Hepatol" "fecha" => "2008" "volumen" => "2" "paginaInicial" => "785" "paginaFinal" => "790" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19090738" "web" => "Medline" ] ] ] ] ] ] ] ] 34 => array:3 [ "identificador" => "bib0175" "etiqueta" => "35." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimal Hepatic En-cephalopathy: The Reality Beyond Our Eyes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Barbosa M." 1 => "Marinho C." 2 => "Mota P." 3 => "Cotter J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:7 [ "tituloSerie" => "Acta Med Port" "fecha" => "2015" "volumen" => "28" "paginaInicial" => "480" "paginaFinal" => "485" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26574984" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0002937815006043" "estado" => "S300" "issn" => "00029378" ] ] ] ] ] ] ] 35 => array:3 [ "identificador" => "bib0180" "etiqueta" => "36." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and treatment of hepatic encephalopathy in Spain: results of a survey of hepatologists" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "Vergara Gomez M." 1 => "Flavia-Olivella M." 2 => "Gil-Prades M." 3 => "Dalmau Obrador B." 4 => "Cordoba-Cardona J." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Gastroenterol Hepatol" "fecha" => "2006" "volumen" => "29" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/16393622" "web" => "Medline" ] ] ] ] ] ] ] ] 36 => array:3 [ "identificador" => "bib0185" "etiqueta" => "37." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Testing for minimal hepatic encephalopathy in the United States: an AASLD survey" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Bajaj J.S." 1 => "Etemadian A." 2 => "Hafeezullah M." 3 => "Saeian K." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.21515" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2007" "volumen" => "45" "paginaInicial" => "833" "paginaFinal" => "834" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17326210" "web" => "Medline" ] ] ] ] ] ] ] ] 37 => array:3 [ "identificador" => "bib0190" "etiqueta" => "38." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Minimal hepatic encephalopathy and critical flicker frequency are associated with survival of patients with cirrhosis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Ampuero J." 1 => "Simón M." 2 => "Montoliú C." 3 => "Jover R." 4 => "Serra M.A." 5 => "Córdo-ba J." 6 => "Romero-Gómez M." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.gastro.2015.07.067" "Revista" => array:7 [ "tituloSerie" => "Gastroenterology" "fecha" => "2015" "volumen" => "149" "paginaInicial" => "1483" "paginaFinal" => "1489" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26299413" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0016508512011870" "estado" => "S300" "issn" => "00165085" ] ] ] ] ] ] ] 38 => array:3 [ "identificador" => "bib0195" "etiqueta" => "39." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Nutritional management contributes to improvement in minimal hepatic encephalopathy and quality of life in patients with liver cirrhosis: a preliminary, prospective, open-label study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Kato A." 1 => "Tanaka H." 2 => "Kawaguchi T." 3 => "Kanazawa H." 4 => "Iwasa M." 5 => "Sakaida I." 6 => "Moriwaki H." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1872-034X.2012.01092.x" "Revista" => array:6 [ "tituloSerie" => "Hepatol Res" "fecha" => "2013" "volumen" => "43" "paginaInicial" => "452" "paginaFinal" => "458" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22994429" "web" => "Medline" ] ] ] ] ] ] ] ] 39 => array:3 [ "identificador" => "bib0200" "etiqueta" => "40." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Diagnosis and prognostic significance of minimal hepatic encephalopathy in patients with cirrhosis of liver" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:7 [ 0 => "Dhiman R.K." 1 => "Kurmi R." 2 => "Thumburu K.K." 3 => "Venkataramarao S.H." 4 => "Agarwal R." 5 => "Duseja A." 6 => "Chawla Y." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10620-010-1249-7" "Revista" => array:6 [ "tituloSerie" => "Dig Dis Sci" "fecha" => "2010" "volumen" => "55" "paginaInicial" => "2381" "paginaFinal" => "2390" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20508990" "web" => "Medline" ] ] ] ] ] ] ] ] 40 => array:3 [ "identificador" => "bib0205" "etiqueta" => "41." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Covert hepatic encephalopa-thy is independently associated with poor survival and increased risk of hospitalization" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Patidar K.R." 1 => "Thacker L.R." 2 => "Wade J.B." 3 => "Sterling R.K." 4 => "Sanyal A.J." 5 => "Siddiqui M.S." 6 => "Matherly S.C." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/ajg.2014.264" "Revista" => array:6 [ "tituloSerie" => "Am J Gastroenterol" "fecha" => "2014" "volumen" => "109" "paginaInicial" => "1757" "paginaFinal" => "1763" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25178701" "web" => "Medline" ] ] ] ] ] ] ] ] 41 => array:3 [ "identificador" => "bib0210" "etiqueta" => "42." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Secondary prophylaxis of hepatic encephalopathy: an open label randomized controlled trial of lactulose versus placebo" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "Sharma B.C." 1 => "Sharma P." 2 => "Agrawal A." 3 => "Sarin S.K." ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Gastro-enterology" "fecha" => "2009" "volumen" => "137" "paginaInicial" => "885" "paginaFinal" => "891" ] ] ] ] ] ] 42 => array:3 [ "identificador" => "bib0215" "etiqueta" => "43." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Rifaximin treatment in hepatic encephalop-athy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Bass N.M." 1 => "Mullen K.D." 2 => "Sanyal A." 3 => "Poordad F." 4 => "Neff G." 5 => "Leevy C.B." 6 => "Sigal S." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1056/NEJMoa0907893" "Revista" => array:6 [ "tituloSerie" => "N Engl J Med" "fecha" => "2010" "volumen" => "362" "paginaInicial" => "1071" "paginaFinal" => "1081" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20335583" "web" => "Medline" ] ] ] ] ] ] ] ] 43 => array:3 [ "identificador" => "bib0220" "etiqueta" => "44." "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Durability of rifaximin response in hepatic en-cephalopathy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:7 [ 0 => "Neff G.W." 1 => "Jones M." 2 => "Broda T." 3 => "Jonas M." 4 => "Ravi R." 5 => "Novick D." 6 => "Kaiser T.E." ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCG.0b013e318231faae" "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "2012" "volumen" => "46" "paginaInicial" => "168" "paginaFinal" => "171" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22011586" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/0000001600000001/v1_201905311015/S1665268119303680/v1_201905311015/en/main.assets" "Apartado" => array:4 [ "identificador" => "77721" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Original Article" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/0000001600000001/v1_201905311015/S1665268119303680/v1_201905311015/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268119303680?idApp=UINPBA00004N" ]
Year/Month | Html | Total | |
---|---|---|---|
2024 November | 8 | 0 | 8 |
2024 October | 74 | 8 | 82 |
2024 September | 67 | 12 | 79 |
2024 August | 46 | 12 | 58 |
2024 July | 78 | 5 | 83 |
2024 June | 69 | 6 | 75 |
2024 May | 50 | 7 | 57 |
2024 April | 62 | 11 | 73 |
2024 March | 57 | 4 | 61 |
2024 February | 50 | 8 | 58 |
2024 January | 59 | 11 | 70 |
2023 December | 60 | 7 | 67 |
2023 November | 75 | 5 | 80 |
2023 October | 71 | 17 | 88 |
2023 September | 46 | 4 | 50 |
2023 August | 74 | 8 | 82 |
2023 July | 93 | 7 | 100 |
2023 June | 67 | 4 | 71 |
2023 May | 71 | 2 | 73 |
2023 April | 79 | 3 | 82 |
2023 March | 81 | 5 | 86 |
2023 February | 52 | 4 | 56 |
2023 January | 54 | 8 | 62 |
2022 December | 57 | 2 | 59 |
2022 November | 31 | 5 | 36 |
2022 October | 29 | 7 | 36 |
2022 September | 28 | 7 | 35 |
2022 August | 67 | 11 | 78 |
2022 July | 54 | 9 | 63 |
2022 June | 50 | 7 | 57 |
2022 May | 55 | 7 | 62 |
2022 April | 56 | 10 | 66 |
2022 March | 49 | 11 | 60 |
2022 February | 53 | 11 | 64 |
2022 January | 51 | 14 | 65 |
2021 December | 23 | 17 | 40 |
2021 November | 32 | 10 | 42 |
2021 October | 32 | 14 | 46 |
2021 September | 23 | 10 | 33 |
2021 August | 27 | 12 | 39 |
2021 July | 26 | 16 | 42 |
2021 June | 28 | 12 | 40 |
2021 May | 30 | 5 | 35 |
2021 April | 125 | 32 | 157 |
2021 March | 73 | 8 | 81 |
2021 February | 63 | 12 | 75 |
2021 January | 56 | 18 | 74 |
2020 December | 52 | 6 | 58 |
2020 November | 48 | 14 | 62 |
2020 October | 48 | 8 | 56 |
2020 September | 43 | 14 | 57 |
2020 August | 56 | 11 | 67 |
2020 July | 34 | 9 | 43 |
2020 June | 24 | 7 | 31 |
2020 May | 39 | 7 | 46 |
2020 April | 24 | 1 | 25 |
2020 March | 22 | 6 | 28 |
2020 February | 18 | 6 | 24 |
2020 January | 21 | 8 | 29 |
2019 December | 11 | 8 | 19 |
2019 November | 2 | 6 | 8 |
2019 October | 4 | 0 | 4 |
2019 September | 11 | 3 | 14 |
2019 August | 5 | 1 | 6 |
2019 July | 5 | 12 | 17 |
2019 June | 10 | 5 | 15 |
2019 May | 2 | 3 | 5 |