Kevin Mullen - Academia.edu (original) (raw)

Papers by Kevin Mullen

Journal of Clinical Gastroenterology, Sep 1, 2004

Superimposed non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) m... more Superimposed non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) may affect HCV-related fibrosis. We performed a study to determine the relationship between NAFLD and chronic hepatitis C. One hundred and twenty patients with chronic hepatitis C and available liver biopsies were included. Baseline liver biopsies were read by 1 hepatopathologist using Metavir, as well as a fatty liver pathology protocol. Patients' baseline clinical, demographic, and virologic data were associated with the extent of steatosis (>33% vs. < or =33%), the type of fatty liver (no steatosis vs. steatosis only vs. NASH), and the stage of fibrosis seen on the liver biopsy. Seventy percent of patients were men and 80% were white. The mean age was 47.48+/-5.70 years, mean BMI was 29.01 +/-5.01 kg/m, and mean waist to hip ratio (W/H) was 0.90+/-0.08. Patients with higher grade of steatosis had…

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2014

Current Treatment Options in Gastroenterology

Gastroenterology, 2013

Objective: to observe the impact of two different health education models on the psychological an... more Objective: to observe the impact of two different health education models on the psychological and nutritional status and life quality of HBV-related Liver cirrhosis patients with ascites. Method: 131 cases of patients with decompensated HBV-related cirrhosis are enrolled in the study and are randomly divided into two groups, amongst whom, 61 cases are enrolled in observation group and 60 in control group. Traditional health education method is adopted in the control group: patients are informed with their condition and diet note by the format of doctor's advice; while patients in observation group are under managed health education conducted by hepatologists. The managed health education includes steps as followed: first, the baseline condition, nutritional status and life quality of the patients in observation group are assessed; secondly, personal files of the patients are built and followed up with monthly communication between patients and hepatologists. Finally, patients' psychological condition is assessed with SAS and SDS, their nutritional status is assessed with TSF and MAC and life quality assessed with SF-36. Results: previous to health education, there is no statistical difference in accumulated score of eight dimensionalities of SAS, SDS,TSF and SF-36, Hb and Alb between the two groups; however, after the health education, scores in SAS and SDS of both groups decreased (p,0.001). SAS and SDS score of observation group is lower than the contract group( 39.87±8.76: 49.01±9.43; 40.58±8.75: 51.89±10.14p mean,0.01); TSF,Hb and Alb score of observation group are higher than the control group(p,o.o1 or o.o5); and observation group's accumulated score of eight dimensionalities in SF-36 is significantly higher than the contact group (p,o.o1 or o.oo1). Conclusion: the long-term managed health education for HBV-related hepatocirrhosis patients with ascites can evidently release their psychological pressure, decrease the occurrence of mental disorder, improve nutrition, promoting health condition and significantly increase patients' life quality.

Handbook of Liver Disease, 2004

Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is di... more Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is different. In presence of both fellows and attending the incidence rates of adenoma are shown to increase in a small study reported by Rogart et al [4]. Based on similar hypothesis, a study was undertaken with much larger sample size to improve the power of the study. Aims and objective: To know if presence of additional observer will enhance adenoma detection during colonoscopy. Material and Methods: 2236 consecutive colonoscopies performed at Metro Health Medical Centre, Cleveland, Ohio were included in the study from July 2005 to August 2006. Cases with history of colorectal, surgical re-section of colon, inflammatory bowel diseases and hereditary polyposis syndrome were excluded. Inpatient colonoscopies were also excluded. With all usual precautions for colonoscopy and after giving polyethylene gly-col electrolyte (PEGEL) colonoscopies were performed by one of the nine experienced staf...

Metabolic brain disease, Dec 17, 2016

Clinical Gastroenterology and Hepatology, 2014

Journal of Hepatology, 2013

fold; p,0.001 increase in protein secretion following a 2h or 4h stimulation, respectively. The u... more fold; p,0.001 increase in protein secretion following a 2h or 4h stimulation, respectively. The upregulation of IL-6 expression by adenosine was inhibited by the non-specific adenosine receptor antagonist, CGS-15943. Semi-quantitative RT-PCR experiments demonstrated that A2b was the primary adenosine receptor expressed by H69 cells, and expression of A2b protein was confirmed by confocal immunofluorescence. Thus, we directly tested the role of A2b in IL-6 upregulation using pharmacologic and molecular methods. The specific A2b receptor antagonist MRS-1754 completely blocked adenosine-sensitive IL-6 upregulation; moreover, H69 cells transfected with A2b-specific siRNA, but not an siRNA control, did not upregulate IL-6 in response to adenosine. Since A2b receptors are known to be Gscoupled, we demonstrated that adenosine induced an upregulation of cAMP (6.6-fold; p,0.001). In summary, adenosine, acting via the A2b receptor, activates cholangiocyte IL6 release. Since IL-6 is a critical survival signal, we propose that this signaling pathway is important in the maintenance of liver survival in injury. 1. Cressman, D.E., et al., Liver failure and defective hepatocyte regeneration in interleukin-6-deficient mice. Science, 1996. 274(5291): p. 1379-83. 2. Ezure, T., et al., The development and compensation of biliary cirrhosis in interleukin-6-deficient mice. Am J Pathol, 2000. 156(5): p. 1627-39. 3. Chan, E.S., et al., Adenosine A(2A) receptors play a role in the pathogenesis of hepatic cirrhosis. Br J Pharmacol, 2006. 148(8): p. 1144-55. 4. Chouker, A., et al., In Vivo Hypoxic Preconditioning Protects From Warm Liver Ischemia-Reperfusion Injury Through the Adenosine A2B Receptor. Transplantation, 2012. 94(9): p. 894-902.

Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is di... more Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is different. In presence of both fellows and attending the incidence rates of adenoma are shown to increase in a small study reported by Rogart et al [4]. Based on similar hypothesis, a study was undertaken with much larger sample size to improve the power of the study. Aims and objective: To know if presence of addi-tional observer will enhance adenoma detection during colonoscopy.

Journal of Krishna Institute of Medical Sciences University, 2012

Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is di... more Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is different. In presence of both fellows and attending the incidence rates of adenoma are shown to increase in a small study reported by Rogart et al [4]. Based on similar hypothesis, a study was undertaken with much larger sample size to improve the power of the study. Aims and objective: To know if presence of additional observer will enhance adenoma detection during colonoscopy. Material and Methods: 2236 consecutive colonoscopies performed at Metro Health Medical Centre, Cleveland, Ohio were included in the study from July 2005 to August 2006. Cases with history of colorectal, surgical resection of colon, inflammatory bowel diseases and hereditary polyposis syndrome were excluded. Inpatient colonoscopies were also excluded. With all usual precautions for colonoscopy and after giving polyethylene glycol electrolyte (PEGEL) colonoscopies were performed by one of the nine experienced staff ...

Current treatment options in gastroenterology, 2001

A characteristic feature of the neuropsychiatric changes in hepatic encephalopathy (HE) is the po... more A characteristic feature of the neuropsychiatric changes in hepatic encephalopathy (HE) is the potential for a complete recovery in the majority of patients. In this review, we limit our discussion to HE in individuals with chronic liver disease. The optimal approach to the management of HE includes the following elements. Provide standard supportive therapy for patients with an altered mental status. This is the mainstay of therapy in the majority of clinical situations and includes administration of parenteral fluids and nutrition, care of vascular and bladder catheters, control of self-injurious activities, and instituting aspiration precautions. Rule out or control concomitant causes of encephalopathy. The diagnosis of HE has positive and negative criteria, and ruling out other causes of change in mental status is an essential component of the diagnosis. Identify and correct the precipitating factors of HE. In the majority of patients with HE, a clearly defined precipitating fac...

Hawkey/Textbook of Clinical Gastroenterology and Hepatology, 2012

Zakim and Boyer's Hepatology, 2006

Metabolic brain disease, 1989

Increased benzodiazepine (BZ) receptor density has been reported in brains of rabbits with hepati... more Increased benzodiazepine (BZ) receptor density has been reported in brains of rabbits with hepatic encephalopathy (HE) due to galactosamine (GalN)-induced fulminant hepatic failure (FHF). These data were generated using detergent-Triton X-100-treated neural membranes. While performing further studies it was noted that the increase in BZ receptor density was not demonstrable when Triton X-100 preparation was not employed. Accordingly the binding of [3H] flunitrazepam, a BZ ligand, to neural membranes from cortices of normal rabbits and rabbits with HE due to (GalN)-induced FHF was studied with and without detergent preparation. Scatchard plot analysis of the binding data indicated that when no detergent was employed, the apparent affinity and density of BZ receptors were similar for control membranes and membranes from animals in HE. BZ receptors from animals in HE were shown to be more resistant to solubilization by Triton than control membranes. These findings (a) afford a potential explanation for the apparent increase in density of BZ receptors in this model when Triton treatment of neural membranes is utilized and (b) suggest that recent evidence for increased GABAergic tone in the syndrome of HE is not dependent on an increased density of BZ receptors.

Hepatology, 2003

... STEPHEN A. HARRISON, MD ADRIAN M. DI BISCEGLIE, MD Saint Louis University St. Louis, MO Refer... more ... STEPHEN A. HARRISON, MD ADRIAN M. DI BISCEGLIE, MD Saint Louis University St. Louis, MO References ... 4. Smith TA. Mammalian hexokinases and their abnormal expression in can-cer. Br J Biomed Sci 2000;57:170-178. 5. Mathupala SP, Rempel A, Pedersen PL. ...

…, 1988

Either your web browser doesn't support Javascript or it is currently turned off. In the lat... more Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. ... Randomized, controlled trial of recombinant human alpha-interferon in patients with ...

Hepatic encephalopathy (HE) is considered reversible regarding mental status but may not be cogni... more Hepatic encephalopathy (HE) is considered reversible regarding mental status but may not be cognitively in single-center studies. To evaluate persistence of learning impairment in prior HE compared to those who never experienced HE (no-HE) in a multicenter study. A total of 174 outpatient cirrhotics from three centers (94 Virginia, 30 Ohio, and 50 Rome; 36 prior HE) underwent psychometric hepatic encephalopathy score (PHES) and inhibitory control (ICT) testing at baseline and then at least 7 days apart. ICT learning (change in 2nd half lures compared to 1st half) was compared between patient groups at both visits. Change in the PHES individual sub-tests and total score between visits was compared in both groups. US versus Italian trends were also analyzed. HE patients had worse PHES and ICT results compared to no-HE patients at baseline. Significant improvement (1st half 7.1 vs. 2nd half 6.2, p < 0.0001) was observed in no-HE, but not in HE (1st half 7.9 vs. 2nd half 7.8, p = 0.1) at baseline. At retesting (median 20 days later), no-HE patients continued with significant learning (1st half 6.0 vs. 2nd half 5.4, p < 0.0001), while HE patients again did not improve (1st half 7.8 vs. 2nd half 6.9, p = 0.37). Between visits, no-HE patients improved significantly on four PHES sub-tests and overall score, while HE patients only improved on two sub-tests with similar overall PHES score. Trends were similar between US and Italian subjects. In this multicenter study, prior HE patients showed persistent significant learning impairment compared to those without prior HE, despite adequate medical therapy. This persistent change should increase efforts to reduce the first HE episode.

Schiff/Schiff's Diseases of the Liver, 2011

Journal of Clinical Gastroenterology, Sep 1, 2004

Superimposed non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) m... more Superimposed non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) may affect HCV-related fibrosis. We performed a study to determine the relationship between NAFLD and chronic hepatitis C. One hundred and twenty patients with chronic hepatitis C and available liver biopsies were included. Baseline liver biopsies were read by 1 hepatopathologist using Metavir, as well as a fatty liver pathology protocol. Patients' baseline clinical, demographic, and virologic data were associated with the extent of steatosis (>33% vs. < or =33%), the type of fatty liver (no steatosis vs. steatosis only vs. NASH), and the stage of fibrosis seen on the liver biopsy. Seventy percent of patients were men and 80% were white. The mean age was 47.48+/-5.70 years, mean BMI was 29.01 +/-5.01 kg/m, and mean waist to hip ratio (W/H) was 0.90+/-0.08. Patients with higher grade of steatosis had…

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2014

Current Treatment Options in Gastroenterology

Gastroenterology, 2013

Objective: to observe the impact of two different health education models on the psychological an... more Objective: to observe the impact of two different health education models on the psychological and nutritional status and life quality of HBV-related Liver cirrhosis patients with ascites. Method: 131 cases of patients with decompensated HBV-related cirrhosis are enrolled in the study and are randomly divided into two groups, amongst whom, 61 cases are enrolled in observation group and 60 in control group. Traditional health education method is adopted in the control group: patients are informed with their condition and diet note by the format of doctor's advice; while patients in observation group are under managed health education conducted by hepatologists. The managed health education includes steps as followed: first, the baseline condition, nutritional status and life quality of the patients in observation group are assessed; secondly, personal files of the patients are built and followed up with monthly communication between patients and hepatologists. Finally, patients' psychological condition is assessed with SAS and SDS, their nutritional status is assessed with TSF and MAC and life quality assessed with SF-36. Results: previous to health education, there is no statistical difference in accumulated score of eight dimensionalities of SAS, SDS,TSF and SF-36, Hb and Alb between the two groups; however, after the health education, scores in SAS and SDS of both groups decreased (p,0.001). SAS and SDS score of observation group is lower than the contract group( 39.87±8.76: 49.01±9.43; 40.58±8.75: 51.89±10.14p mean,0.01); TSF,Hb and Alb score of observation group are higher than the control group(p,o.o1 or o.o5); and observation group's accumulated score of eight dimensionalities in SF-36 is significantly higher than the contact group (p,o.o1 or o.oo1). Conclusion: the long-term managed health education for HBV-related hepatocirrhosis patients with ascites can evidently release their psychological pressure, decrease the occurrence of mental disorder, improve nutrition, promoting health condition and significantly increase patients' life quality.

Handbook of Liver Disease, 2004

Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is di... more Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is different. In presence of both fellows and attending the incidence rates of adenoma are shown to increase in a small study reported by Rogart et al [4]. Based on similar hypothesis, a study was undertaken with much larger sample size to improve the power of the study. Aims and objective: To know if presence of additional observer will enhance adenoma detection during colonoscopy. Material and Methods: 2236 consecutive colonoscopies performed at Metro Health Medical Centre, Cleveland, Ohio were included in the study from July 2005 to August 2006. Cases with history of colorectal, surgical re-section of colon, inflammatory bowel diseases and hereditary polyposis syndrome were excluded. Inpatient colonoscopies were also excluded. With all usual precautions for colonoscopy and after giving polyethylene gly-col electrolyte (PEGEL) colonoscopies were performed by one of the nine experienced staf...

Metabolic brain disease, Dec 17, 2016

Clinical Gastroenterology and Hepatology, 2014

Journal of Hepatology, 2013

fold; p,0.001 increase in protein secretion following a 2h or 4h stimulation, respectively. The u... more fold; p,0.001 increase in protein secretion following a 2h or 4h stimulation, respectively. The upregulation of IL-6 expression by adenosine was inhibited by the non-specific adenosine receptor antagonist, CGS-15943. Semi-quantitative RT-PCR experiments demonstrated that A2b was the primary adenosine receptor expressed by H69 cells, and expression of A2b protein was confirmed by confocal immunofluorescence. Thus, we directly tested the role of A2b in IL-6 upregulation using pharmacologic and molecular methods. The specific A2b receptor antagonist MRS-1754 completely blocked adenosine-sensitive IL-6 upregulation; moreover, H69 cells transfected with A2b-specific siRNA, but not an siRNA control, did not upregulate IL-6 in response to adenosine. Since A2b receptors are known to be Gscoupled, we demonstrated that adenosine induced an upregulation of cAMP (6.6-fold; p,0.001). In summary, adenosine, acting via the A2b receptor, activates cholangiocyte IL6 release. Since IL-6 is a critical survival signal, we propose that this signaling pathway is important in the maintenance of liver survival in injury. 1. Cressman, D.E., et al., Liver failure and defective hepatocyte regeneration in interleukin-6-deficient mice. Science, 1996. 274(5291): p. 1379-83. 2. Ezure, T., et al., The development and compensation of biliary cirrhosis in interleukin-6-deficient mice. Am J Pathol, 2000. 156(5): p. 1627-39. 3. Chan, E.S., et al., Adenosine A(2A) receptors play a role in the pathogenesis of hepatic cirrhosis. Br J Pharmacol, 2006. 148(8): p. 1144-55. 4. Chouker, A., et al., In Vivo Hypoxic Preconditioning Protects From Warm Liver Ischemia-Reperfusion Injury Through the Adenosine A2B Receptor. Transplantation, 2012. 94(9): p. 894-902.

Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is di... more Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is different. In presence of both fellows and attending the incidence rates of adenoma are shown to increase in a small study reported by Rogart et al [4]. Based on similar hypothesis, a study was undertaken with much larger sample size to improve the power of the study. Aims and objective: To know if presence of addi-tional observer will enhance adenoma detection during colonoscopy.

Journal of Krishna Institute of Medical Sciences University, 2012

Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is di... more Background: Due to varied level of experience, the detection rate of adenoma on colonoscopy is different. In presence of both fellows and attending the incidence rates of adenoma are shown to increase in a small study reported by Rogart et al [4]. Based on similar hypothesis, a study was undertaken with much larger sample size to improve the power of the study. Aims and objective: To know if presence of additional observer will enhance adenoma detection during colonoscopy. Material and Methods: 2236 consecutive colonoscopies performed at Metro Health Medical Centre, Cleveland, Ohio were included in the study from July 2005 to August 2006. Cases with history of colorectal, surgical resection of colon, inflammatory bowel diseases and hereditary polyposis syndrome were excluded. Inpatient colonoscopies were also excluded. With all usual precautions for colonoscopy and after giving polyethylene glycol electrolyte (PEGEL) colonoscopies were performed by one of the nine experienced staff ...

Current treatment options in gastroenterology, 2001

A characteristic feature of the neuropsychiatric changes in hepatic encephalopathy (HE) is the po... more A characteristic feature of the neuropsychiatric changes in hepatic encephalopathy (HE) is the potential for a complete recovery in the majority of patients. In this review, we limit our discussion to HE in individuals with chronic liver disease. The optimal approach to the management of HE includes the following elements. Provide standard supportive therapy for patients with an altered mental status. This is the mainstay of therapy in the majority of clinical situations and includes administration of parenteral fluids and nutrition, care of vascular and bladder catheters, control of self-injurious activities, and instituting aspiration precautions. Rule out or control concomitant causes of encephalopathy. The diagnosis of HE has positive and negative criteria, and ruling out other causes of change in mental status is an essential component of the diagnosis. Identify and correct the precipitating factors of HE. In the majority of patients with HE, a clearly defined precipitating fac...

Hawkey/Textbook of Clinical Gastroenterology and Hepatology, 2012

Zakim and Boyer's Hepatology, 2006

Metabolic brain disease, 1989

Increased benzodiazepine (BZ) receptor density has been reported in brains of rabbits with hepati... more Increased benzodiazepine (BZ) receptor density has been reported in brains of rabbits with hepatic encephalopathy (HE) due to galactosamine (GalN)-induced fulminant hepatic failure (FHF). These data were generated using detergent-Triton X-100-treated neural membranes. While performing further studies it was noted that the increase in BZ receptor density was not demonstrable when Triton X-100 preparation was not employed. Accordingly the binding of [3H] flunitrazepam, a BZ ligand, to neural membranes from cortices of normal rabbits and rabbits with HE due to (GalN)-induced FHF was studied with and without detergent preparation. Scatchard plot analysis of the binding data indicated that when no detergent was employed, the apparent affinity and density of BZ receptors were similar for control membranes and membranes from animals in HE. BZ receptors from animals in HE were shown to be more resistant to solubilization by Triton than control membranes. These findings (a) afford a potential explanation for the apparent increase in density of BZ receptors in this model when Triton treatment of neural membranes is utilized and (b) suggest that recent evidence for increased GABAergic tone in the syndrome of HE is not dependent on an increased density of BZ receptors.

Hepatology, 2003

... STEPHEN A. HARRISON, MD ADRIAN M. DI BISCEGLIE, MD Saint Louis University St. Louis, MO Refer... more ... STEPHEN A. HARRISON, MD ADRIAN M. DI BISCEGLIE, MD Saint Louis University St. Louis, MO References ... 4. Smith TA. Mammalian hexokinases and their abnormal expression in can-cer. Br J Biomed Sci 2000;57:170-178. 5. Mathupala SP, Rempel A, Pedersen PL. ...

…, 1988

Either your web browser doesn't support Javascript or it is currently turned off. In the lat... more Either your web browser doesn't support Javascript or it is currently turned off. In the latter case, please turn on Javascript support in your web browser and reload this page. ... Randomized, controlled trial of recombinant human alpha-interferon in patients with ...

Hepatic encephalopathy (HE) is considered reversible regarding mental status but may not be cogni... more Hepatic encephalopathy (HE) is considered reversible regarding mental status but may not be cognitively in single-center studies. To evaluate persistence of learning impairment in prior HE compared to those who never experienced HE (no-HE) in a multicenter study. A total of 174 outpatient cirrhotics from three centers (94 Virginia, 30 Ohio, and 50 Rome; 36 prior HE) underwent psychometric hepatic encephalopathy score (PHES) and inhibitory control (ICT) testing at baseline and then at least 7 days apart. ICT learning (change in 2nd half lures compared to 1st half) was compared between patient groups at both visits. Change in the PHES individual sub-tests and total score between visits was compared in both groups. US versus Italian trends were also analyzed. HE patients had worse PHES and ICT results compared to no-HE patients at baseline. Significant improvement (1st half 7.1 vs. 2nd half 6.2, p < 0.0001) was observed in no-HE, but not in HE (1st half 7.9 vs. 2nd half 7.8, p = 0.1) at baseline. At retesting (median 20 days later), no-HE patients continued with significant learning (1st half 6.0 vs. 2nd half 5.4, p < 0.0001), while HE patients again did not improve (1st half 7.8 vs. 2nd half 6.9, p = 0.37). Between visits, no-HE patients improved significantly on four PHES sub-tests and overall score, while HE patients only improved on two sub-tests with similar overall PHES score. Trends were similar between US and Italian subjects. In this multicenter study, prior HE patients showed persistent significant learning impairment compared to those without prior HE, despite adequate medical therapy. This persistent change should increase efforts to reduce the first HE episode.

Schiff/Schiff's Diseases of the Liver, 2011