Brief Report
Spleen stiffness can be employed to assess the efficacy of spontaneous portosystemic shunts in relieving portal hypertension
Mauro Giuffrèa,b,
, Giorgio Bedognib, Cristiana Abaziac, Flora Masuttic, Claudio Tiribellib, Lory Saveria Crocèa,b,c
Corresponding author
gff.mauro@gmail.com
Corresponding author at: Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università di Trieste, Strada di Fiume, 447, 34149 Trieste (TS), Italy.
Corresponding author at: Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università di Trieste, Strada di Fiume, 447, 34149 Trieste (TS), Italy.
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"documento" => "simple-article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "cor" "cita" => "Ann Hepatol. 2020;19:694-6" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letters to the editor</span>" "titulo" => "An Outbreak Presents An Opportunity to Learn About A Rare Phenotype: Autoimmune Hepatitis After Acute Hepatitis A" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "694" "paginaFinal" => "696" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1785 "Ancho" => 3259 "Tamanyo" => 226688 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Schematic representation of clinical events with trends of serum liver biochemistries during the clinical course and follow up in patients 1, 2, 3 and 4.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Vijay S.-Are, Lindsay Yoder, Niharika Samala, Lauren Nephew, Craig Lammert, Raj Vuppalanchi" "autores" => array:6 [ 0 => array:2 [ "nombre" => "Vijay" "apellidos" => "S.-Are" ] 1 => array:2 [ "nombre" => "Lindsay" "apellidos" => "Yoder" ] 2 => array:2 [ "nombre" => "Niharika" "apellidos" => "Samala" ] 3 => array:2 [ "nombre" => "Lauren" "apellidos" => "Nephew" ] 4 => array:2 [ "nombre" => "Craig" "apellidos" => "Lammert" ] 5 => array:2 [ "nombre" => "Raj" "apellidos" => "Vuppalanchi" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268120301678?idApp=UINPBA00004N" "url" => "/16652681/0000001900000006/v2_202209140825/S1665268120301678/v2_202209140825/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S1665268120301770" "issn" => "16652681" "doi" => "10.1016/j.aohep.2020.09.006" "estado" => "S300" "fechaPublicacion" => "2020-11-01" "aid" => "262" "documento" => "article" "crossmark" => 1 "licencia" => "http://creativecommons.org/licenses/by-nc-nd/4.0/" "subdocumento" => "pgl" "cita" => "Ann Hepatol. 2020;19:674-90" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical Practice Guidelines</span>" "titulo" => "Latin American Association for the study of the liver (ALEH) practice guidance for the diagnosis and treatment of non-alcoholic fatty liver disease" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "674" "paginaFinal" => "690" ] ] "contieneResumen" => array:1 [ "en" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1772 "Ancho" => 3000 "Tamanyo" => 377246 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Algorithm for the follow-up of patients with NAFLD. MI; myocardial infarction, CV; cardiovascular, HCC; hepatocellular carcinoma.</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Notes</span>. Initial assessment and risk stratification for NAFLD patients (adapted from Castera and Yoneda). Patients with NAFLD should be screened for differential diagnosis, undergo assessment for cardiovascular risk and alcohol consumption. Initial NAFLD fibrosis risk assessment should be performed using non-invasive scores (NAFLD fibrosis score and FIB-4). When advanced fibrosis is not excluded, other non-invasive tests such as transient elastography should be performed. If this test is unavailable or fails to obtain results, other elastography techniques such as shear-wave elastography or magnetic resonance elastography can be selected. In patients with intermediate-high risk for advanced fibrosis, a liver biopsy should be considered. There is no current consensus regarding an interval for the follow up of these patients. It can be tailored according to the presence of risk factors for fibrosis progression. In patients with cirrhosis HCC and esophageal varices screening must be undertaken. In patients with advanced fibrosis, HCC screening should be considered.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Juan Pablo Arab, Melisa Dirchwolf, Mário Reis Álvares-da-Silva, Francisco Barrera, Carlos Benítez, Marlene Castellanos-Fernandez, Graciela Castro-Narro, Norberto Chavez-Tapia, Daniela Chiodi, Helma Cotrim, Kenneth Cusi, Claudia Pinto Marques Souza de Oliveira, Javier Díaz, Eduardo Fassio, Solange Gerona, Marcos Girala, Nelia Hernandez, Sebastián Marciano, Walter Masson, Nahum Méndez-Sánchez, Nathalie Leite, Adelina Lozano, Martín Padilla, Arturo Panduro, Raymundo Paraná, Edison Parise, Marlene Perez, Jaime Poniachik, Juan Carlos Restrepo, Andrés Ruf, Marcelo Silva, Martín Tagle, Monica Tapias, Kenia Torres, Eduardo Vilar-Gomez, José Eduardo Costa Gil, Adrian Gadano, Marco Arrese" "autores" => array:38 [ 0 => array:2 [ "nombre" => "Juan Pablo" "apellidos" => "Arab" ] 1 => array:2 [ "nombre" => "Melisa" "apellidos" => "Dirchwolf" ] 2 => array:2 [ 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17 => array:2 [ "nombre" => "Sebastián" "apellidos" => "Marciano" ] 18 => array:2 [ "nombre" => "Walter" "apellidos" => "Masson" ] 19 => array:2 [ "nombre" => "Nahum" "apellidos" => "Méndez-Sánchez" ] 20 => array:2 [ "nombre" => "Nathalie" "apellidos" => "Leite" ] 21 => array:2 [ "nombre" => "Adelina" "apellidos" => "Lozano" ] 22 => array:2 [ "nombre" => "Martín" "apellidos" => "Padilla" ] 23 => array:2 [ "nombre" => "Arturo" "apellidos" => "Panduro" ] 24 => array:2 [ "nombre" => "Raymundo" "apellidos" => "Paraná" ] 25 => array:2 [ "nombre" => "Edison" "apellidos" => "Parise" ] 26 => array:2 [ "nombre" => "Marlene" "apellidos" => "Perez" ] 27 => array:2 [ "nombre" => "Jaime" "apellidos" => "Poniachik" ] 28 => array:2 [ "nombre" => "Juan Carlos" "apellidos" => "Restrepo" ] 29 => array:2 [ "nombre" => "Andrés" "apellidos" => "Ruf" ] 30 => array:2 [ "nombre" => "Marcelo" "apellidos" => "Silva" ] 31 => array:2 [ "nombre" => "Martín" "apellidos" => "Tagle" ] 32 => array:2 [ "nombre" => "Monica" "apellidos" => "Tapias" ] 33 => array:2 [ "nombre" => "Kenia" "apellidos" => "Torres" ] 34 => array:2 [ "nombre" => "Eduardo" "apellidos" => "Vilar-Gomez" ] 35 => array:2 [ "nombre" => "José Eduardo" "apellidos" => "Costa Gil" ] 36 => array:2 [ "nombre" => "Adrian" "apellidos" => "Gadano" ] 37 => array:2 [ "nombre" => "Marco" "apellidos" => "Arrese" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268120301770?idApp=UINPBA00004N" "url" => "/16652681/0000001900000006/v2_202209140825/S1665268120301770/v2_202209140825/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief Report</span>" "titulo" => "Spleen stiffness can be employed to assess the efficacy of spontaneous portosystemic shunts in relieving portal hypertension" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "691" "paginaFinal" => "693" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Mauro Giuffrè, Giorgio Bedogni, Cristiana Abazia, Flora Masutti, Claudio Tiribelli, Lory Saveria Crocè" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Mauro" "apellidos" => "Giuffrè" "email" => array:1 [ 0 => "gff.mauro@gmail.com" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Giorgio" "apellidos" => "Bedogni" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Cristiana" "apellidos" => "Abazia" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Flora" "apellidos" => "Masutti" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Claudio" "apellidos" => "Tiribelli" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 5 => array:3 [ "nombre" => "Lory Saveria" "apellidos" => "Crocè" "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Italian Liver Foundation, Basovizza (Trieste), Italy" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Liver Clinic, Azienda Sanitaria Universitaria Giuliano-Isontina, Cattinara Hospital, Trieste, Italy" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author at: Dipartimento di Scienze Mediche, Chirurgiche e della Salute, Università di Trieste, Strada di Fiume, 447, 34149 Trieste (TS), Italy." ] ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">1</span><span class="elsevierStyleSectionTitle" id="sect0030">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Portal Hypertension (PH), defined as a portal pressure >10−12 mmHg, is a common and critical complication of liver cirrhosis, which defines the transition to a stage of liver disease characterized by a significant reduced life expectancy and quality of life. [<a class="elsevierStyleCrossRef" href="#bib0005">1</a>] Generally, PH is associated with increased risk of esophageal varices, (EVs) and decompensating events (such as ascites, variceal haemorrhage, and hepatic encephalopathy) [<a class="elsevierStyleCrossRef" href="#bib0010">2</a>]. Therefore, appropriate PH quantification is crucial and spleen elastography seems to address this unmet clinical need. Despite its proven correlation with the invasive gold standard of hepatic venous pressure gradient (HVPG) [<a class="elsevierStyleCrossRef" href="#bib0015">3</a>], spleen stiffness (SS) has been found to mirror dynamic changes in portal pressure after transjugular intrahepatic portosystemic shunt (TIPS) placement [<a class="elsevierStyleCrossRef" href="#bib0020">4</a>,<a class="elsevierStyleCrossRef" href="#bib0025">5</a>].</p><p id="par0010" class="elsevierStylePara elsevierViewall">This led us to investigate the role of SS in the paraphysiological version of TIPS (i.e., spontaneous portosystemic shunts, SPSS). In particular, we aimed to determine if SS could have predicted the efficacy of SPSS in relieving portal pressure, especially considering the fact that a group of patients with esophageal varices (EVs) and without current non-selective beta-blockers (NSBB) administration were not correctly classified by the spleen stiffness probability index, a mathematical device that we had previously developed in a sample of 210 cirrhotic patients [<a class="elsevierStyleCrossRef" href="#bib0030">6</a>]. In detail, this index provides a given probability of having EVs based on the individual value of SS, which could also be employed as a non-invasive surrogate of clinically significant portal hypertension (CSPH). Surprisingly, in this group of patients the SS was either low or comparable to those of healthy individuals [<a class="elsevierStyleCrossRef" href="#bib0035">7</a>,<a class="elsevierStyleCrossRef" href="#bib0040">8</a>] despite the presence of EVs at endoscopy. Of notice all presented SPSS.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">2</span><span class="elsevierStyleSectionTitle" id="sect0035">Methods</span><p id="par0015" class="elsevierStylePara elsevierViewall">Spleen and Liver Stiffness as well as the laboratory tests reported in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> were performed, as per the standard clinical practice, on patients who were evaluated by the Liver Clinic between January 2018 and December 2018. The methodology behind elastography measurement was already explained in detail elsewhere [<a class="elsevierStyleCrossRef" href="#bib0030">6</a>,<a class="elsevierStyleCrossRef" href="#bib0040">8</a>,<a class="elsevierStyleCrossRef" href="#bib0045">9</a>].</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">We retrospectively selected patients with confirmed SPSS and EVs at endoscopic examination, and recorded any decompensating event (i.e., variceal hemorrhage, overt hepatic encephalopathy, refractory ascites, spontaneous bacterial peritonitis, hepatorenal syndrome) in the first twelve months following elastography examination.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">3</span><span class="elsevierStyleSectionTitle" id="sect0040">Results</span><p id="par0025" class="elsevierStylePara elsevierViewall">Patients were stratified in two groups based on the development of decompensating events; their characteristics are reported in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Patients were predominantly male (57.5%), with a median age of 65 (62; 68) years. The etiology of liver disease was alcohol abuse in 55.8% of patients and virus-related in 44.2% of patients. The patients who presented decompensating events showed lower platelet count (94.5 vs. 121.5 g/L, p < 0.001), higher SS (44 vs. 30 kPa, p < 0.001), higher probability of EVs according to SS (77 vs. 2%, p < 0.001), and higher spleen diameter (14 vs. 12 cm, p = 0.043). They also showed a higher prevalence of splenorenal shunts (66.7 vs. 31.2%), and a significantly wider SPSS major diameter (14.5 vs. 8 mm, p < 0.001).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleLabel">4</span><span class="elsevierStyleSectionTitle" id="sect0045">Discussion</span><p id="par0030" class="elsevierStylePara elsevierViewall">The importance of these findings resides in the fact that SPSS can be interpreted as a physiological attempt of the human body to decompress the portal venous system. Unfortunately, SPSS often does not allow adequate reduction of portal pressure, which can present elevated value despite the presence of massive SPSS [<a class="elsevierStyleCrossRef" href="#bib0050">10</a>]. What if we could employ a simple and non-invasive method to check if SPSS are effectively accomplishing their purpose of reducing the portal pressure? The answer to this question yields high relevance (given the fact that SPSS are relatively common in liver cirrhosis and that the clinical evolution of cirrhotic patients is extremely variable) and could find a possible answer in SS, especially because SS has already been reported to predict hepatic decompensation [<a class="elsevierStyleCrossRef" href="#bib0055">11</a>].</p><p id="par0035" class="elsevierStylePara elsevierViewall">These results, albeit interesting, must be taken with caution due to the relatively low numerosity of the sample size and the possible limitations related to selection bias. While waiting for the essential external validation, we strongly believe that SS may be valuable in the everyday clinical evaluation of cirrhotic patients.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Authors’ contributions</span><p id="par0040" class="elsevierStylePara elsevierViewall">M.G., G.B., C.A., F.M., C.T. and L.S.C. were involved in the conceptualization and supervision of the current work. M.G., C.A., F.M., L.S.C. were involved in patients’ investigation and data collection. M.G. and L.S.C. performed formal statistical analysis. M.G., G.B., C.A., F.M., C.T. and L.S.C. were involved in the writing the original draft and approving the final version of the manuscript.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Funding statement</p><p id="par0050" class="elsevierStylePara elsevierViewall">The authors received no specific funding for this work.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conflict of interest</span><p id="par0055" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:8 [ 0 => array:3 [ "identificador" => "xres1770766" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] 1 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 2 => array:2 [ "identificador" => "sec0010" "titulo" => "Methods" ] 3 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 4 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 5 => array:2 [ "identificador" => "sec0025" "titulo" => "Authors’ contributions" ] 6 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflict of interest" ] 7 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-06-21" "fechaAceptado" => "2020-07-18" "tieneResumen" => true "resumen" => array:1 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Spleen stiffness (SS) has been found to mirror dynamic changes in portal pressure after transjugular intrahepatic portosystemic shunt (TIPS) placement. However, there is no data available regarding SS in patients with spontaneous portosystemic shunting (SPSS), especially in regards to prediction of hepatic decompensation.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">We retrospectively selected patients with confirmed SPSS and esophageal varices (EVs) at endoscopic examination, and recorded any decompensating event (i.e., variceal hemorrhage, overt hepatic encephalopathy, refractory ascites, spontaneous bacterial peritonitis, hepatorenal syndrome) in the first twelve months following liver and spleen elastography.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The patients who presented decompensating events showed lower platelet count (94.5 vs. 121.5 g/L, p < 0.001), higher SS (44 vs. 30 kPa, p < 0.001), higher probability of EVs according to SS (77 vs. 2 %, p < 0.001), and higher spleen diameter (14 vs. 12 cm, p = 0.043). They also showed a higher prevalence of splenorenal shunts (66.7 vs. 31.2%), and a significantly wider SPSS major diameter (14.5 vs. 8 mm, p < 0.001).</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusion</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">SS could predict SPSS efficacy in relieving portal pressure, and could predict decompensating events in patients with SPSS.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusion" ] ] ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:1 [ "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="" 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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Totaln = 52 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients withoutDecompensating Eventsn = 22 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Patients withDecompensatingEventsN = 30 \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Significance \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-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Gender, 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">30 (57.7) \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">14 (63.6) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 (53.3) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" 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">65 (62;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">65.5 (63;69) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">64.5 (62;67) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Etiology, N(%)AlcoholAbuseViralHepatitis \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">29 (55.8)23 (44.2) \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">15 (68.2)7 (31.8) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (46.7)16 (53.3) \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="" 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-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Type of SPSS,N (%)ParaumbilicalSplenorenal \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">25 (48.1)27 (51.9) \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">15 (68.2)7 (31.2) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (33.3)20 (66.7) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P = 0.013Cramer's Phi = 0.345 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AST (IU/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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (23;29.5) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">28.5 (24.25;31.75) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">26 (23;28.75) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ALT (IU/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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (20;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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">21.5 (19.25;23.5) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">22 (20;30.75) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">GGT (IU/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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (26;39) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 (23.75;36.75) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27.5 (26;39) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">ALP (IU/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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 (80;91) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">81.5 (80;90) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">82 (80; 97.75) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total Bilirubin(mg/dL) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (1.75;2.20) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.95 (1.60; 2.20) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.04 (1.70; 2.32) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Albumin(g/dL) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.2 (2.9;3.4) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.4 (3;3.6) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3.3 (2.9;3.6) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">NS \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Platelet (g/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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">110 (92.75;121) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">121.5 (115.75;123.75) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">94.5 (78.25;100) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P < 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">LS (kPa) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (40;46) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">40.5 (32.5;43) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 (40.25;47.75) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p = 0.003 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probability ofEVs accordingto LS (%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">74 (73;75) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">73 (69;74) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">75 (74;77) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">P = 0.006 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SS (kPa) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">39.5 (30;45) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (26.5;32.75) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">44 (41.25;55) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p < 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Probability ofEVs accordingto SS (%) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">56 (4;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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (0.5;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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">77 (66;94) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p < 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SPSSDiameter(mm) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (11;16) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 (7;10) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14.5 (10.25;19) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p < 0.001 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">SpleenDiameter (cm) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 (12;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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (12;14) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (12;16) \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="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">p = 0.043 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Patients were stratified in two groups according to the development of decompensating events in two groups. 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Crocè" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.3390/microorganisms8030348" "Revista" => array:4 [ "tituloSerie" => "Microorganisms" "fecha" => "2020" "volumen" => "8" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33202599" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "[10]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Effect of spontaneous portosystemic shunts on hemorrhage from esophagogastric varices" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "J.S. Hsieh" 1 => "J.Y. Wang" 2 => "C.J. Huang" 3 => "F.-M. Chen" 4 => "T.-J. Huang" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00268-003-7068-7" "Revista" => array:6 [ "tituloSerie" => "World J Surg" "fecha" => "2004" "volumen" => "28" "paginaInicial" => "23" "paginaFinal" => "28" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14648045" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "[11]" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Spleen stiffness differentiates between acute and chronic liver damage and predicts hepatic decompensation" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Meister" 1 => "A. Dechêne" 2 => "M. Büchter" 3 => "Julia Kälsch" 4 => "G. Gerken" 5 => "A. Canbay" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/MCG.0000000000001044" "Revista" => array:6 [ "tituloSerie" => "J Clin Gastroenterol" "fecha" => "2019" "volumen" => "53" "paginaInicial" => "457" "paginaFinal" => "463" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29738353" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/16652681/0000001900000006/v2_202209140825/S1665268120300776/v2_202209140825/en/main.assets" "Apartado" => array:4 [ "identificador" => "77718" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case Report" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/16652681/0000001900000006/v2_202209140825/S1665268120300776/v2_202209140825/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1665268120300776?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 4 | 1 | 5 |
| 2024 October | 9 | 2 | 11 |
| 2024 September | 12 | 6 | 18 |
| 2024 August | 14 | 3 | 17 |
| 2024 July | 12 | 4 | 16 |
| 2024 June | 15 | 2 | 17 |
| 2024 May | 13 | 6 | 19 |
| 2024 April | 9 | 4 | 13 |
| 2024 March | 29 | 5 | 34 |
| 2024 February | 22 | 5 | 27 |
| 2024 January | 11 | 5 | 16 |
| 2023 December | 16 | 9 | 25 |
| 2023 November | 18 | 3 | 21 |
| 2023 October | 14 | 11 | 25 |
| 2023 September | 7 | 1 | 8 |
| 2023 August | 8 | 5 | 13 |
| 2023 July | 13 | 2 | 15 |
| 2023 June | 24 | 4 | 28 |
| 2023 May | 39 | 4 | 43 |
| 2023 April | 38 | 8 | 46 |
| 2023 March | 40 | 2 | 42 |
| 2023 February | 28 | 6 | 34 |
| 2023 January | 14 | 9 | 23 |
| 2022 December | 10 | 10 | 20 |
| 2022 November | 21 | 5 | 26 |
| 2022 October | 18 | 11 | 29 |
| 2022 September | 18 | 10 | 28 |
| 2022 August | 11 | 4 | 15 |
| 2022 July | 14 | 13 | 27 |
| 2022 June | 10 | 6 | 16 |
| 2022 May | 16 | 8 | 24 |
| 2022 April | 12 | 6 | 18 |
| 2022 March | 15 | 14 | 29 |
| 2022 February | 13 | 4 | 17 |
| 2022 January | 21 | 6 | 27 |
| 2021 December | 11 | 15 | 26 |
| 2021 November | 19 | 5 | 24 |
| 2021 October | 51 | 11 | 62 |
| 2021 September | 23 | 13 | 36 |
| 2021 August | 26 | 6 | 32 |
| 2021 July | 21 | 11 | 32 |
| 2021 June | 13 | 9 | 22 |
| 2021 May | 19 | 8 | 27 |
| 2021 April | 33 | 5 | 38 |
| 2021 March | 29 | 12 | 41 |
| 2021 February | 9 | 9 | 18 |
| 2021 January | 9 | 10 | 19 |
| 2020 December | 16 | 14 | 30 |
| 2020 November | 27 | 18 | 45 |
| 2020 October | 3 | 1 | 4 |
| 2020 September | 11 | 11 | 22 |
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