RESULTS: The search identified 496 citations, including 7 retrosp

RESULTS: The search identified 496 citations, including 7 retrospective series, and 692 patients met eligibility criteria. The use of duct-to-duct anastomosis was not associated with a significant difference in clinical outcomes, including 1-year recipient survival rates (OR 1.02; 95% CI 0.65–1.60; p=0.95), 1-year graft survival rates (OR 1.11; 95% CI 0.72–1.71; p=0.64), risk of biliary leaks (OR of 1.23; 95% confidence interval [CI] 0.59–2.59; p=0.33), risk of biliary strictures (OR 1.99; 95% CI 0.98–4.06; p=0.06),

or rate of recurrence of PSC (OR 0.94; 95% CI 0.19–4.78; p=0.94). CONCLUSION: The current evidence presented herein does not support the universal preference of Roux-en-Y choledochojejunostomy for all patients undergoing OLT for PSC, as there is no significance difference XL184 in vitro in clinical outcomes between well-selected patients who receive duct-to-duct anastomosis versus Roux-en-Y loops. Selection will continue to be made by the surgeon at time of LT with or without pre-LT cholangiography, based on donor and recipient characteristics, but barring other factors such as a diseased common bile duct, our results suggest duct-to-duct anastomosis should be preferred. Disclosures: The following people have nothing to disclose: Malcolm M. Wells, Kristopher Croome, Erin Boyce, Natasha check details Chandok [Background] Glucose storage

diseases (GSD) show growth retardation, but there are a few reports about the growth pattern and the effect of portocaval shunt (PCS) and liver transplantation (LT) for GSD patients. This study aims to analyze the change of physical growth and 2nd sexuality after PCS or/and LT in GSD type I. [Patients and Methods] We reviewed retrospectively 56 patients (M : F=38 : 18) with GSD type I

between 1975 and 2013. Among them, 13 underwent LT (at median 14 year-old, range 9–21, LT group) and 17 with PCS (10, 4–12, PCS group). Their data were compared with the normal data of CDC & WHO and the height standard deviation scores (Z-scores) and its annual differences (delta Z-score) were calculated click here and presented. And a modified delta Z-score (m-delta Z-score) was defined an annual difference between Z-score of operation group and the cross-sectional median Z-score of non-operation group. [Results] Regardless of height at birth, Z score for their height was sharply decreased to less than zero within 4 years in all patients. After operations, there was a spurt of height in the postoperative period. The median Z-score was −3.1 in LT group and −2.7 in PCS group at the time of operations. They caught up growth up to Z=−0.25 at postoperative 4 years in LT group and to Z=−0.6 at postoperative 6 years in PCS group. Delta Z-score were +0.4 and +0.6 respectively in the postoperative 1st year after LT or PCS. Then delta Z-score decreased annually.

Ascaris lumbricoides seropositivity correlated with elevated IgE

Ascaris lumbricoides seropositivity correlated with elevated IgE and anti-inflammatory Th2-IgG1 responses to H. pylori, while Toxoplasma gondii seropositivity was linked to elevated IgE, pro-inflammatory Th1-IgG2, IgG3, and IgG4 responses to H. pylori. These infections may have an impact on inflammatory responses to H. pylori and may partially explain differences in gastric cancer risk in Colombia [19]. Hirsch et al. [20] were able to detect H. pylori DNA by PCR in several plaque and root canal samples, and cultured H. pylori from two root canals, suggesting that root canals of endodontic-infected deciduous teeth may be a reservoir for H. pylori

and serve as a potential source of transmission. Mother-to-child transmission p38 MAPK signaling was suspected in 2 of 3 families, and father–child transmission in one family in the study by Osaki et al. [21] using multilocus sequence typing (MLST) of total DNA extracted from fecal specimens. Helicobacter pylori infection is recognized as a cause of gastritis and peptic ulcer disease (PUD) in children. Symptoms, except those related to PUD, are nonspecific. Only a small proportion of children develop symptoms and clinically relevant gastrointestinal disease [22]. Dore et al. [9], in a cross-sectional sero-epidemiologic study,

found that nausea or vomiting and diarrhea were significantly associated with H. pylori infection (OR 2.2 and 2.1, respectively), but not with abdominal pain or heartburn. Perforated ulcer is rare, but several cases learn more of peritonitis secondary to duodenal perforation have been described [23, 24]. Helicobacter pylori infection not only causes damage to the gastric epithelium, it also plays a potential pathogenic role in several extraintestinal diseases. Bradbeer et al. [25] described the resolution of recurrent headaches in a child this website after eradication of H. pylori infection and postulated this possible association. Controversy exists concerning the relationship of H. pylori infection and

somatic growth retardation in children. Dehghani et al. [26] evaluated the relationship between H. pylori infection and growth parameters in Indian children and concluded that symptomatic infection does not appear to influence linear growth. The gastrointestinal hormone ghrelin is a gut–brain peptide that regulates food intake in humans and has strong growth hormone-releasing activity. Decreased appetite in H. pylori-infected children has been related to low plasma ghrelin levels which returned to normal after H. pylori eradication. Deng et al. [27] evaluated plasma and gastric ghrelin production as well as body mass index (BMI), before and after treating H. pylori infection in 50 Chinese children, divided into two groups based on the success of H. pylori treatment. They found that plasma and tissue ghrelin levels increased substantially after treatment in the group with therapeutic success, but only minor changes were observed in the group with treatment failure.

10 However, the dynamic

relationship between lipid metabo

10 However, the dynamic

relationship between lipid metabolic pathways in hepatocytes and stellate cells is incompletely understood and the elements that regulate LD accumulation upon HSC activation remain obscure.11 Mammalian intracellular fatty acid-binding proteins (FABPs) comprise a superfamily of lipid-binding proteins12 involved in the uptake, transport, and metabolism of FA and other lipid ligands. Liver Fabp (L-Fabp or Fabp1) is abundantly expressed in both hepatocytes and enterocytes and binds multiple ligands, including saturated FA and cholesterol.12 Germline L-FABP−/− mice exhibit decreased hepatic triglyceride content13 with altered FA uptake kinetics. In addition, L-FABP−/− mice fed a high saturated fat, high cholesterol

“Western” diet were protected against diet-induced obesity and hepatic steatosis, likely reflecting altered kinetics of saturated FA utilization.14, Birinapant datasheet 15 Proteomic screens revealed L-Fabp to be overexpressed in obese subjects with simple steatosis, along with paradoxically decreased expression in the progressive versus mild forms Fer-1 cell line of NASH.16 Recent studies have validated new models of diet-induced NAFLD with fibrosis in murine models,17, 18 setting the stage for formal exploration of the role of candidate genes in the progressive forms of murine NAFLD. Here we explore a role for L-Fabp in lipid metabolism in both hepatocytes and stellate cells and report the impact of

L-Fabp deletion in diet-induced HSC activation and hepatic fibrosis in vivo. α-SMA, alpha-smooth muscle actin; C/EBPα, CCAAT/enhancer-binding protein-alpha; Cidec, cell death-inducing DFFA-like effector c; CTGF, connective tissue growth factor; DMEM, Dulbecco’s modified Eagle’s medium; ECM, extracellular matrix; ESI-MS, electrospray ionization mass spectrometry; FA, fatty acids; HSCs, hepatic stellate cells; LDs, lipid droplets; L-FABP, liver fatty acid binding protein (Fabp1); NASH, nonalcoholic steatohepatitis; PDGF-βR, platelet-derived growth factor-beta receptor; Plin, perilipin; PPARγ, peroxisome proliferator-activated receptor-gamma; SREBP-1c, sterol regulatory element-binding protein-1c; TFF, trans-fat fructose diet; TG, triglyceride; TGF-βR, transforming growth factor-beta receptor. C57BL/6J mice (Jackson Laboratory, Bar Harbor, ME) and congenic L-FABP−/− mice19 were click here used in all studies (see also Supporting Methods). Hepatic steatosis with fibrosis was induced by feeding female mice a high trans-fat diet supplemented with high fructose corn syrup, modified from Tetri et al.18 HSCs were isolated by pronase-collagenase perfusion and density gradient centrifugation, with >90% purity.20 For lipidomics analysis, isolated HSCs were subjected to a second gradient purification and frozen immediately at −80°C. Details of protein, immunohistochemical, and lipidomics analyses are provided in Supporting Methods.

Next, the tissue distribution of MIC A/B was examined by immunohi

Next, the tissue distribution of MIC A/B was examined by immunohistochemistry. The diffuse cellular staining pattern of MIC A/B in patients with NASH in Fig. 1C is no artifact but rather typical of this kind of stain.27 In contrast, control hepatocytes were negative while individuals with NAFL weakly expressed MIC A/B. Hepatic NK cells play a critical

role in TRAIL- and Fas-mediated liver injury. The liver harbors many NK cells,28 and approximately 30% to 40% of these constitutively express TRAIL.29 We thus questioned whether the expression of TRAIL–DR5 and CD95/Fas mRNAs is increased selleck kinase inhibitor in NASH livers. Indeed, a 2.7-fold increase in TRAIL–DR5 and a 3.6-fold increase in CD95/Fas mRNA were observed in patients with NASH compared with controls (Fig. 2A). TRAIL–DR5 mRNA was significantly less increased in individuals with NAFL BMS-777607 compared with patients with NASH (1.1 ± 0.1 versus 2.7 ± 0.2, P = 0.01). In contrast,

CD95/Fas transcripts were also reduced in the NAFL group, but this difference was not significant when compared with patients with NASH (2.5 ± 0.5 versus 3.6 ± 0.9; P = 0.16). Up-regulation of CD95/Fas in patients with NASH was further confirmed through ELISA and demonstrated a significant increase as compared with both healthy controls and individuals with NAFL (P < 0.05). However, up-regulation of CD95/Fas was not accompanied by enhancement of selleck compound the Fas ligand (Fig. 2B). Subsequently, histopathological examination was performed along with determination of serum alanine aminotransferase and aspartate aminotransferase values. The NAS is a well-established scoring system for patients with NASH as a progressive form of NAFLD.17 As expected, histopathological examinations from patients with NASH displayed an increase in NAS as compared with

controls. In addition, a marked elevation in serum alanine aminotransferase and aspartate aminotransferase values was also observed in patients with NASH versus controls (Fig. 2C). Liver enzymes from individuals with NAFL were within the reference ranges. In order to examine potential effects of MIC A/B on hepatocyte death rates in NASH, we quantified the intrahepatic rates of apoptotic (by M30 and confirmatory TUNEL assays) and overall cell death (by M65 assay). As expected, M30 expression was significantly elevated in patients with NASH (440.5 ± 71.1 U/L) as compared with controls (94.4 ± 30.9 U/L; P < 0.05) (Fig. 3A), which went along with a likewise significantly increased M65 expression in patients with NASH versus controls (784.9 ± 129.9 U/L versus 230.3 ± 43.5 U/L; P < 0.05). In contrast, M30 levels were significantly reduced in individuals with NAFL (139.5 ± 20.9 U/L), which was again reflected in the significantly lower M65 expression in NAFL (298.2 ± 35.4 U/L).

90, se 007) However, model averaging

revealed that the

90, se 0.07). However, model averaging

revealed that the 95% confidence intervals of all predictor variables included zero. Specifically, the effect of fire salamander on alpine salamander occupancy was rather small and the 95% confidence interval widely overlapped zero (Table 3). Theory predicts that both abiotic factors and interspecific competition determine sharp range margins among species (Bridle & Vines, 2007). Empirical studies have generally confirmed the importance of both of these factor groups for the range margins of parapatric salamanders (Cimmaruta et al., 1999; Arif et al., 2007; Cunningham et al., 2009; Gifford & Kozak, 2012). As expected, we found that the two species had dissimilar species–habitat relationships in their contact zones. The ‘slope’ of a sampling site affected the occupancy probability of Salamandra check details salamandra, while none of the habitat characteristics explained the occupancy probability of S. atra. Unexpectedly, Y-27632 supplier we found no evidence for competition as the local presence or absence of one of the two species had no effect

on the occupancy probability of the other one at the same site. In previous studies, both positive and negative effects of slope on salamanders from North America were found (Diller & Wallace, 1996; Stoddard & Hayes, 2005), while some studies found no effect of slope (Welsh & Lind, 2002). Slope was shown to affect occurrence or abundance of larval S. salamandra (Baumgartner et al., 1999; Tanadini selleck kinase inhibitor et al., 2012).

Our results imply that slope positively affected the occupancy probability of S. salamandra (Table 3, Fig. 2). Both the terrestrial and the aquatic habitats are important for this species with stream characteristics being the more important of them (Ficetola et al., 2009, 2011; Manenti et al., 2009). Slope affects both the terrestrial and the stream habitat. Assuming that the stream characteristics are important (Manenti et al., 2009), an explanation could be that the effect of slope is caused by its influence on stream characteristics. This interpretation is supported by the fact that ‘pools’ were also in the top ranking models, even though the confidence interval of the parameter estimate included zero (Tables 2 and 3). One possible explanation is that the streams with limited slope were closer to the valley floor where human modification of streams is most intense (P. Werner, unpubl. data). Stream modifications are known to result in physical changes of stream and riparian characteristics and that are likely to negatively influence amphibian habitats (Hazell, Osborne & Lindenmayer, 2003). This will especially be the case if human modification of streams resulted in a loss of microhabitats, such as pools with lower current velocity that are important for fire salamander larvae (Thiesmeier & Schuhmacher, 1990; Baumgartner et al., 1999; but see Tanadini et al., 2012). In contrast to S. salamandra, none of the habitat predictors explained occupancy probability of S. atra.

1A) and spotted necrosis (Supporting Fig 1) in wild-type (WT) C5

1A) and spotted necrosis (Supporting Fig. 1) in wild-type (WT) C57BL/6 mice by 16 hours postinjection. However, to our surprise, α-Galcer induced 5- to 6-fold higher serum ALT and AST levels and a larger area of necrosis in IL-4−/−IFN-γ−/− dKO mice than those in WT mice at 16 hours after α-Galcer injection (Fig. 1; Supporting Fig. 1). In addition, administration of α-Galcer induced an accumulation of inflammatory foci in the livers of learn more WT mice, with the peak effect occurring

at 72 hours postinjection (Supporting Fig. 1), and the number of inflammatory foci was also much higher in dKO mice than that in WT mice (Supporting Fig. 1). To determine the role of early production of IL-4 in α-Galcer-induced liver injury, we examined the effects in IL-4−/− and IL-4R−/− Selleckchem GDC-0068 mice. As illustrated in Fig. 2A,B, α-Galcer-induced elevation of serum ALT and AST was lower in IL-4−/− and

IL-4R−/− mice than in WT controls. Liver histology analyses further revealed that IL-4−/− and IL-4R−/− mice had reduced liver necrosis and fewer inflammatory foci than WT control mice after α-Galcer administration (Figs. 2C-D). The number of myeloperoxidase (MPO)-positive neutrophils was also lower in IL-4−/− and IL-4R−/− mice than in WT mice 72 hours after α-Galcer administration (Fig. 2C,D). The above findings indicated that the number of inflammatory foci (iNKT expansion) in the liver was lower in IL-4−/− or IL-4R−/− mice than in WT mice 72 hours post-α-Galcer injection, which may have been due to IL-4-mediated promotion of iNKT proliferation, selleck products as demonstrated previously.[17] Fluorescence-activated cell sorting (FACS) analyses of liver MNCs revealed that WT and IL-4−/− mice had a similar number of iNKT cells at the early timepoints post-α-Galcer injection (data not shown), which does not explain the reduced liver injury in IL-4−/− mice. To further explore the mechanisms underlying α-Galcer-induced liver injury, we examined NK cells and neutrophils in the liver. In this case, FACS analyses revealed that the number of NK cells was not increased post-α-Galcer injection and that depletion of NK cells using an anti-ASGM1

antibody did not affect α-Galcer-induced liver injury in mice (data not shown), suggesting that NK cells are not involved in this process. In contrast, there was a striking increase in the percentage and total number of neutrophils in the liver after α-Galcer injection. As illustrated in Fig. 3A,B, the percentage of neutrophils was elevated 4-fold, whereas the total number of neutrophils was elevated 30-fold at 3 hours post-α-Galcer administration. Moreover, depletion of neutrophils markedly reduced serum ALT and AST levels (Fig. 3C), suggesting that the accumulation of neutrophils contributes to α-Galcer-induced hepatocellular damage. Figure 3D shows that the percentage and total number of hepatic neutrophils were lower in IL-4−/− mice than in WT mice at 3 hours post-α-Galcer administration. Furthermore, Fig.

1 The abnormality in the signaling pathway, including insulin rec

1 The abnormality in the signaling pathway, including insulin receptor (IR), insulin receptor substrate (IRS), and their downstream molecules,2 marks the main pathophysiological characteristics of insulin resistance. However, the molecular mechanisms underlying insulin resistance and impairment of insulin signaling network in the liver are not completely understood yet. Protein tyrosine phosphatase (PTP) constitutes a family of phosphatases including PTP1B, SHP1, SHP2, and LAR.3, 4 As a negative Selleck FDA approved Drug Library regulator of insulin signaling cascade,

PTP1B functions as a key phosphatase and reverses tyrosine kinase action.5 A deficiency of PTP1B improved glycemic control by enhancing sensitivity to insulin and made animals more resistant to diet-induced obesity.6 In addition, antisense oligonucleotides

of PTP1B decreased blood glucose content, insulin level, and fat mass in diabetic animals.7 However, the upstream regulators or mediators that control transcription and translation of the PTP1B gene are not well defined. Moreover, pharmacological agents that intervene with PTP1B activity are not available, despite recognition of PTP1B inhibition as an effective way to improve insulin sensitivity.8 The microRNAs (miRNAs) have diverse Ibrutinib functions in normal or pathological states.9 The consequences of changes in miRNA levels can affect not only lipid metabolism, but insulin signaling, potentially influencing glucose homeostasis and the development of diabetes. In fact, dysregulation of miRNA is implicated in defective insulin secretion, diabetic kidney,

and heart diseases.10 Hepatocyte-specific deletion of Dicer, an enzyme essential for miRNA processing, resulted in the depletion of glycogen storage and led to mild hyperglycemia in the fed state and severe hypoglycemia in the fasting state.11 However, the genes targeted by miRNAs and their individual biological functions largely remain to be established. In particular, more information is necessary to understand the involvement find more of miRNAs in insulin resistance and find the pharmacological methods to modulate their levels. DN-JNK1, dominant-negative JNK1; G6Pase, glucose 6-phosphatase; HA-JNK1, HA-tagged JNK1; HFD, high-fat diet; HNF4α, hepatocyte nuclear factor 4α; IR, insulin receptor; IRS, insulin receptor substrate; IsoLQ, isoliquiritigenin; JNK, c-Jun N-terminal kinase; LQ, liquiritigenin; miR-122, microRNA-122; miRNA, microRNA; ND, normal diet; PTP, protein tyrosine phosphatase; TNF-α, tumor necrosis factor-α; 3′UTR, 3′-untranslated region.

Using the 10th and 90th percentile hourly national wage for a hom

Using the 10th and 90th percentile hourly national wage for a home health aide, annual cost of Selumetinib solubility dmso informal caregiving

ranged from US $3700 to US $6700 for patients with cirrhosis and from US $1600 to US $2900 for patients without cirrhosis. In this nationally representative sample of older Americans, we found that individuals with cirrhosis had significantly worse health status and greater functional disability compared to those without cirrhosis, requiring nearly twice the amount of informal caregiving at an annual societal cost of approximately US $4700 per individual. Nearly 20% of subjects with cirrhosis experienced severe functional decline (loss of two or more ADLs) over a median of approximately 2 years, more than doubling that of age-matched individuals without cirrhosis.

As the incidence of nonalcoholic fatty liver disease increases and the population infected with hepatitis C virus BMS-907351 solubility dmso ages, cirrhosis among the elderly will become increasingly prevalent and is expected to impose a significant burden to patients and their caregivers. In addition to the potential burden to caregivers, individuals with cirrhosis also strain the health care system. Annually, cirrhosis results in 50,000 hospitalizations22; of those who survive hospitalization, approximately 20% are readmitted within 30 days.23 Our findings show that more than two-thirds of individuals with cirrhosis report being admitted to the hospital within the prior 2 years, an incidence twice that of age-matched individuals without cirrhosis. Moreover, fewer than one-quarter of individuals with cirrhosis received home health care services after hospital see more discharge, indicating a potentially lost opportunity for improved

care transitions. In other diseases, improving patient and caregiver knowledge about chronic disease management and integrating caregivers in the health care process have been shown to significantly decrease hospital admission rates.24, 25 Our findings suggest that applying these concepts and services among patients with cirrhosis has the potential to result in significant cost savings. It is important to emphasize this study compared subjects with cirrhosis to age-matched individuals, not healthy controls. As expected with advancing age, individuals in the comparison group had several comorbidities (e.g., arthritis in 62%, cardiac disease in 31%, diabetes in 18%, and cancer in 16%; Table 2), all of which can be independently associated with significant functional decline and cost. Thus, the current study highlights the incremental disability, cost, and caregiver burden of cirrhosis, even relative to other serious chronic illnesses.

Using the 10th and 90th percentile hourly national wage for a hom

Using the 10th and 90th percentile hourly national wage for a home health aide, annual cost of Trametinib research buy informal caregiving

ranged from US $3700 to US $6700 for patients with cirrhosis and from US $1600 to US $2900 for patients without cirrhosis. In this nationally representative sample of older Americans, we found that individuals with cirrhosis had significantly worse health status and greater functional disability compared to those without cirrhosis, requiring nearly twice the amount of informal caregiving at an annual societal cost of approximately US $4700 per individual. Nearly 20% of subjects with cirrhosis experienced severe functional decline (loss of two or more ADLs) over a median of approximately 2 years, more than doubling that of age-matched individuals without cirrhosis.

As the incidence of nonalcoholic fatty liver disease increases and the population infected with hepatitis C virus this website ages, cirrhosis among the elderly will become increasingly prevalent and is expected to impose a significant burden to patients and their caregivers. In addition to the potential burden to caregivers, individuals with cirrhosis also strain the health care system. Annually, cirrhosis results in 50,000 hospitalizations22; of those who survive hospitalization, approximately 20% are readmitted within 30 days.23 Our findings show that more than two-thirds of individuals with cirrhosis report being admitted to the hospital within the prior 2 years, an incidence twice that of age-matched individuals without cirrhosis. Moreover, fewer than one-quarter of individuals with cirrhosis received home health care services after hospital learn more discharge, indicating a potentially lost opportunity for improved

care transitions. In other diseases, improving patient and caregiver knowledge about chronic disease management and integrating caregivers in the health care process have been shown to significantly decrease hospital admission rates.24, 25 Our findings suggest that applying these concepts and services among patients with cirrhosis has the potential to result in significant cost savings. It is important to emphasize this study compared subjects with cirrhosis to age-matched individuals, not healthy controls. As expected with advancing age, individuals in the comparison group had several comorbidities (e.g., arthritis in 62%, cardiac disease in 31%, diabetes in 18%, and cancer in 16%; Table 2), all of which can be independently associated with significant functional decline and cost. Thus, the current study highlights the incremental disability, cost, and caregiver burden of cirrhosis, even relative to other serious chronic illnesses.

Using the 10th and 90th percentile hourly national wage for a hom

Using the 10th and 90th percentile hourly national wage for a home health aide, annual cost of Hormones antagonist informal caregiving

ranged from US $3700 to US $6700 for patients with cirrhosis and from US $1600 to US $2900 for patients without cirrhosis. In this nationally representative sample of older Americans, we found that individuals with cirrhosis had significantly worse health status and greater functional disability compared to those without cirrhosis, requiring nearly twice the amount of informal caregiving at an annual societal cost of approximately US $4700 per individual. Nearly 20% of subjects with cirrhosis experienced severe functional decline (loss of two or more ADLs) over a median of approximately 2 years, more than doubling that of age-matched individuals without cirrhosis.

As the incidence of nonalcoholic fatty liver disease increases and the population infected with hepatitis C virus check details ages, cirrhosis among the elderly will become increasingly prevalent and is expected to impose a significant burden to patients and their caregivers. In addition to the potential burden to caregivers, individuals with cirrhosis also strain the health care system. Annually, cirrhosis results in 50,000 hospitalizations22; of those who survive hospitalization, approximately 20% are readmitted within 30 days.23 Our findings show that more than two-thirds of individuals with cirrhosis report being admitted to the hospital within the prior 2 years, an incidence twice that of age-matched individuals without cirrhosis. Moreover, fewer than one-quarter of individuals with cirrhosis received home health care services after hospital find more discharge, indicating a potentially lost opportunity for improved

care transitions. In other diseases, improving patient and caregiver knowledge about chronic disease management and integrating caregivers in the health care process have been shown to significantly decrease hospital admission rates.24, 25 Our findings suggest that applying these concepts and services among patients with cirrhosis has the potential to result in significant cost savings. It is important to emphasize this study compared subjects with cirrhosis to age-matched individuals, not healthy controls. As expected with advancing age, individuals in the comparison group had several comorbidities (e.g., arthritis in 62%, cardiac disease in 31%, diabetes in 18%, and cancer in 16%; Table 2), all of which can be independently associated with significant functional decline and cost. Thus, the current study highlights the incremental disability, cost, and caregiver burden of cirrhosis, even relative to other serious chronic illnesses.