Because tea Cytoskeletal Signaling inhibitor is the most widely consumed beverage in the world, future studies designed to comprehensively elucidate the association of tea intake and liver diseases are encouraged. Liang Shen Ph.D.*, * Shandong Provincial Research Center for Bioinformatic Engineering and Technique, Shandong University of Technology, Zibo, People’s Republic of China. “
“I read with interest the article by Serste et al.,1 who showed that beta-blockers are deleterious to the survival of patients with cirrhosis and refractory ascites. Because the study was performed with two groups of patients with cirrhosis with striking differences in their characteristics, it should be

interpreted with caution. As indicated in the editorial by Wong and Salerno,2 the patients on beta-blockers were Lorlatinib mw indeed sicker: they had higher bilirubin levels, lower albumin levels, lower arterial pressures, and lower serum sodium levels, and more patients had hepatic encephalopathy, hepatocellular carcinoma, and Child-Pugh class C cirrhosis. In addition, the patients receiving beta-blockers were taking them for the prevention of variceal hemorrhaging, but only 4% of the patients not receiving beta-blockers had esophageal varices. I do not know whether the patients received beta-blockers mainly for primary

or secondary prevention of variceal bleeding. If patients had episodes of variceal bleeding with concomitant refractory ascites and hepatocellular carcinoma, the outcome was naturally very dismal. Moreover, Serste et al. did not disclose the proportions of (1) hepatitis B patients receiving antiviral treatment, (2) alcoholic patients who were abstinent, and (3) patients whose refractory ascites was managed with transjugular intrahepatic portosystemic stent shunts in the two groups. All these factors may partly influence the outcomes of patients with advanced cirrhosis.3, 4 The causes of death in the two groups were not revealed in detail. As many as 25 patients (17%) died at home of unspecified causes. It is generally believed that the use of beta-blockers is contraindicated

in patients with hypotension or bradycardia. However, some patients with hypotension or bradycardia were still enrolled in the beta-blocker group. This appears to be against the principle of using cAMP propranolol to prevent gastrointestinal hemorrhaging.5 My group has previously shown that patients receiving medical therapy have improved survival in comparison with those receiving endoscopic ligation to prevent variceal rebleeding.6 For patients with cirrhosis, refractory ascites, and a high risk of variceal bleeding, controlled trials are still required to compare the efficacy and safety of beta-blockers and endoscopic ligation; otherwise, liver transplantation will be needed. Gin-Ho Lo M.D.*, * Department of Medical Nutrition, I-Shou University, Kaohsiung, Taiwan. “
“We read with great interest the work by Kohly et al.