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| 1 | Efficacy of current guidelines for the treatment of spontaneous bacterial peritonitis in the clinical practice显示文摘AIM: To verify the validity of the International Ascites Club guidelines for treatment of spontaneous bacterial peritonitis (SBP) in clinical practice. METHODS: All SBP episodes occurring in a group of consecutive cirrhotics were managed accordingly and included in the study. SBP was diagnosed when the ascitic fluid polymorphonuclear (PMN) cell count was > 250 cells/mm3, and empirically treated with cefotaxime. RESULTS: Thirty-eight SBP episodes occurred in 32 cirrhotics (22 men/10 women; mean age: 58.6 ± 11.2 years). Prevalence of SBP, in our population, was 17%. Ascitic fluid culture was positive in nine (24%) cases only. Eleven episodes were nosocomial and 71% community-acquired. Treatment with cefotaxime was successful in 59% of cases, while 41% of episodes required a modification of the initial antibiotic therapy because of a less-than 25% decrease in ascitic PMN count at 48 h. Change of antibiotic therapy led to the resolution of infection in 87% of episodes. Among the cases with positive culture, the initial antibiotic therapy with cefotaxime failed at a percentage (44%) similar to that of the whole series. In these cases, the isolated organisms were either resistant or with an inherent insufficient susceptibility to cefotaxime. CONCLUSION: In clinical practice, ascitic PMN count is a valid tool for starting a prompt antibiotic treatment andevaluating its efficacy. The initial treatment with cefotaxime failed more frequently than expected. An increase in healthcare-related infections with antibiotic-resistant pathogens may explain this finding. A different first-line antibiotic treatment should be investigated. | Stefania Angeloni Cinzia Leboffe Antonella Parente Mario Venditti Alessandra Giordano Manuela Merli Oliviero Riggio | 2008 | World Journal of Gastroenterology2008，14，17： | 42 |
| 2 | Microbiota and the gut-liver axis:Bacterial translocation,inflammation and infection in cirrhosis显示文摘Liver disease is associated with qualitative and quantitative changes in the intestinal microbiota.In cirrhotic patients the alteration in gut microbiota is characterized by an overgrowth of potentially pathogenic bacteria(i.e.,gram negative species)and a decrease in autochthonous familiae.Here we summarize the available literature on the risk of gut dysbiosis in liver cirrhosis and its clinical consequences.We therefore described the features of the complex interaction between gut microbiota and cirrhotic host,the so called'gut-liver axis',with a particular attention to the acquired risk of bacterial translocation,systemic inflammation and the relationship with systemic infections in the cirrhotic patient.Such knowledge might help to develop novel and innovative strategies for the prevention and therapy of gut dysbiosis and its complication in liver cirrhosis. | Valerio Giannelli Vincenza Di Gregorio Valerio Iebba Michela Giusto Serena Schippa Manuela Merli Ulrich Thalheimer | 2014 | World Journal of Gastroenterology2014，20，45： | 43 |
| 3 | Accuracy of the automated cell counters for management of spontaneous bacterial peritonitis显示文摘AIM: To evaluate the accuracy of automated blood cell counters for ascitic polymorphonuclear (PMN) determination for: (1) diagnosis, (2) efficacy of the ongoing antibiotic therapy, and (3) resolution of spontaneous bacterial peritonitis (SBP). METHODS: One hundred and twelve ascitic fluid samples were collected from 52 consecutive cirrhotic patients, 16 of them with SBP. The agreement between the manual and the automated method for PMN count was assessed. The sensitivity/specificity and the positive/negative predictive value of the automated blood cell counter were also calculated by considering the manual method as the 'gold standard' . RESULTS: The mean ± SD of the difference between manual and automated measurements was 7.8 ± 58 cells/mm3, while the limits of agreement were +124 cells/mm3 [95% confidence interval (CI): +145 to +103] and -108 cells/mm3 (95% CI: -87 to -129). The automated cell counter had a sensitivity of 100% and a specificity of 97.7% in diagnosing SBP, and a sensitivity of 91% and a specificity of 100% for the efficacy of the ongoing antibiotic therapy. The two methods showed a complete agreement for the resolution of infection. CONCLUSION: Automated cell counters not only have a good diagnostic accuracy, but are also very effective in monitoring the antibiotic treatment in patients with SBP. Because of their quicker performance, they should replace the manual counting for PMN determination in the ascitic fluid of patients with SBP. | Oliviero Riggio Stefania Angeloni Antonella Parente Cinzia Leboffe Giorgio Pinto Teresa Aronne Manuela Merli | 2008 | World Journal of Gastroenterology2008，14，37： | 6 |
| 4 | Changes in nutritional status after liver transplantation显示文摘Chronic liver disease has an important effect on nutritional status, and malnourishment is almost universally present in patients with end-stage liver disease who undergo liver transplantation. During recent decades,a trend has been reported that shows an increase in number of patients with end-stage liver disease and obesity in developed countries. The importance of carefully assessing the nutritional status during the workup of patients who are candidates for liver replacement is widely recognised. Cirrhotic patients with depleted lean body mass(sarcopenia) and fat deposits have an increased surgical risk; malnutrition may further impact morbidity, mortality and costs in the post-transplantation setting. After transplantation and liver function is restored, many metabolic alterations are corrected,dietary intake is progressively normalised, and lifestyle changes may improve physical activity. Few studies have examined the modifications in body composition that occur in liver recipients. During the first 12 mo, the fat mass progressively increases in those patients who had previously depleted body mass, and the muscle mass recovery is subtle and non-significant by the end of the first year. In some patients, unregulated weight gain may lead to obesity and may promote metabolicdisorders in the long term. Careful monitoring of nutritional changes will help identify the patients who are at risk for malnutrition or over-weight after liver transplantation. Physical and nutritional interventions must be investigated to evaluate their potential beneficial effect on body composition and muscle function after liver transplantation. | Michela Giusto Barbara Lattanzi Vincenza Di Gregorio Valerio Giannelli Cristina Lucidi Manuela Merli | 2014 | World Journal of Gastroenterology2014，20，31： | 5 |
| 5 | Incidence and natural history of small esophageal varices in cirrhotic patients显示文摘 | Manuela Merli Giorgia Nicolini Stefania Angeloni Vittorio Rinaldi Adriano De Santis Carlo Merkel Adolfo Francesco Attili Oliviero Riggio | 2002 | Journal of Hepatology2002，，3： | 4 |
| 6 | Cirrhotic Patients Are at Risk for Health Care–Associated Bacterial Infections显示文摘 | Manuela Merli Cristina Lucidi Valerio Giannelli Michela Giusto Oliviero Riggio Marco Falcone Lorenzo Ridola Adolfo Francesco Attili Mario Venditti | 2010 | Clinical Gastroenterology and Hepatology2010，，11： | 3 |
| 7 | MELD score is better than Child–Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt显示文摘 | Francesco Salerno Manuela Merli Massimo Cazzaniga Valentina Valeriano Plinio Rossi Andrea Lovaria Daniele Meregaglia Antonio Nicolini Lorenzo Lubatti Oliviero Riggio | 2002 | Journal of Hepatology2002，，4： | 2 |
| 8 | Recipient Interleukin-28B Rs12979860 C/T Polymorphism and Acute Cellular Rejection After Liver Transplantation: Role of the Calcineurin Inhibitor Used显示文摘 | Davide Bitetto Carlo Fabris Edmondo Falleti Ezio Fornasiere Claudio Avellini Sara Cmet Annarosa Cussigh Elisabetta Fontanini Mario Pirisi Stefano Ginanni Corradini Manuela Merli Antonio Molinaro Pierluigi Toniutto | 2012 | Transplantation Journal2012，，10： | 2 |
| 9 | Hepatic Encephalopathy After Transjugular Intrahepatic Portosystemic Shunt显示文摘 | Oliviero Riggio Silvia Nardelli Federica Moscucci Chiara Pasquale Lorenzo Ridola Manuela Merli | 2012 | Clinics in Liver Disease2012，，1： | 1 |
| 10 | Factors associated with poor health-related quality of life of patients with cirrhosis显示文摘 | Giulio Marchesini Giampaolo Bianchi Piero Amodio Francesco Salerno Manuela Merli Carmine Panella Carmela Loguercio Giovanni Apolone Mauro Niero Roberto Abbiati The Italian Study Group for Quality of Life in Cirrhosis | 2001 | Gastroenterology2001，，1： | 1 |
| 11 | Incidence and natural history of small esophageal varices in cirrhotic patients显示文摘 | Manuela Merli Giorgia Nicolini Stefania Angeloni Vittorio Rinaldi Adriano De Santis Carlo Merkel Adolfo Francesco Attili Oliviero Riggio | 2002 | Journal of Hepatology2002，，3： | 1 |
| 12 | Interaction between infection and Hepatic Encephalopathy显示文摘 | Manuela Merli Oliviero Riggio | 2014 | Journal of Hepatology2014，，： | 1 |
| 13 | The chronic use of beta‐blockers and proton pump inhibitors may affect the rate of bacterial infections in cirrhosis显示文摘 | Manuela Merli Cristina Lucidi Vincenza Di Gregorio Valerio Giannelli Michela Giusto Giancarlo Ceccarelli Oliviero Riggio Mario Venditti | 2015 | Liver Int2015，，： | 1 |
| 14 | Modifications of cardiac function in cirrhotic patients treated with transjugular intrahepatic portosystemic shunt (TIPS)显示文摘 | Manuela Merli Valentina Valeriano Stefania Funaro Adolfo Francesco Attili Andrea Masini Cesare Efrati Stefano De Castro Oliviero Riggio | 2002 | The American Journal of Gastroenterology2002，，1： | 1 |
| 15 | Modification of cardiac function in cirrhotic patients with and without ascites显示文摘 | Valentina Valeriano Stefania Funaro Raffaella Lionetti Oliviero Riggio Giovanna Pulcinelli Pierluigi Fiore Andrea Masini Stefano De Castro Manuela Merli | 2000 | The American Journal of Gastroenterology2000，，11： | 1 |
| 16 | Diagnosis, treatment and survival of patients with hepatorenal syndrome: A survey on daily medical practice显示文摘 | Francesco Salerno Massimo Cazzaniga Manuela Merli Giancarlo Spinzi Simone Saibeni Andrea Salmi Stefano Fagiuoli Antonio Spadaccini Elisa Trotta Giacomo Laffi Maurizio Koch Oliviero Riggio Sergio Boccia Martina Felder Simona Balzani Savino Bruno Paolo Ange | 2011 | Journal of Hepatology2011，，6： | 1 |
| 17 | Nutritional supplementation with branched-chain amino acids in advanced cirrhosis: a double-blind, randomized trial显示文摘 | Giulio Marchesini Giampaolo Bianchi Manuela Merli Piero Amodio Carmine Panella Carmela Loguercio Fillipo Rossi Fanelli Roberto Abbiati | 2003 | Gastroenterology2003，，7： | 1 |
| 18 | Mu RF ‐1 and p‐ GSK 3β expression in muscle atrophy of cirrhosis显示文摘 | Manuela Merli Michela Giusto Alessio Molfino Andrea Bonetto Massimo Rossi Stefano Ginanni Corradini Francesco M. Baccino Filippo Rossi Fanelli Paola Costelli Maurizio Muscaritoli | 2013 | Liver Int2013，，5： | 1 |
| 19 | Dietary and nutritional indications in hepatic encephalopathy显示文摘 | Manuela Merli Oliviero Riggio | 2009 | Metabolic Brain Disease2009，，1： | 1 |
| 20 | Bacterial resistance in cirrhotic patients: An emerging reality显示文摘 | Manuela Merli Cristina Lucidi | 2012 | Journal of Hepatology2012，，4： | 1 |
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