Author
Averell H. Sherker
Bio: Averell H. Sherker is an academic researcher from National Institutes of Health. The author has contributed to research in topics: Biliary atresia & Liver disease. The author has an hindex of 22, co-authored 47 publications receiving 1870 citations.
Papers
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TL;DR: In this article, the authors present characteristics and subgroup analyses from the first 1257 patients enrolled in the study, and conclude that there are no differences in outcomes of patients with short vs long latency of DILI.
576 citations
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Medical University of South Carolina1, University of Michigan2, California Pacific Medical Center3, University of Alabama4, Virginia Commonwealth University5, University of Washington6, Yale University7, University of Nebraska–Lincoln8, Mayo Clinic9, Baylor University Medical Center10, University of Pittsburgh11, Northwestern University12, Oregon Health & Science University13, University of California, Los Angeles14, Harvard University15, Columbia University16, Washington University in St. Louis17, Yeshiva University18, University of Pennsylvania19, University of California, Berkeley20, Ohio State University21, University of Kansas22, Emory University23, University of Alberta24, University of California, San Francisco25, National Institutes of Health26, University of Texas Southwestern Medical Center27
TL;DR: This large cohort study found that despite similar causes and severity of ALF among patients referred to specialty centers from 1998 to 2013, the proportion of patients listed for liver transplantation decreased and survival improved among those who did not receive a transplant as well asThose who did.
Abstract: Whether changes have occurred in the causes of acute liver failure (ALF), its management, or the survival of patients with the condition with or without liver transplantation is not known. This lar...
247 citations
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Cincinnati Children's Hospital Medical Center1, University of Michigan2, University of Pittsburgh3, University of California, San Francisco4, University of Southern California5, University of Pennsylvania6, Merck & Co.7, Baylor College of Medicine8, Emory University9, Icahn School of Medicine at Mount Sinai10, Indiana University11, Seattle Children's12, Johns Hopkins University13, University of Colorado Denver14, Washington University in St. Louis15, Children's Memorial Hospital16, National Institutes of Health17
TL;DR: Among infants with biliary atresia who have undergone hepatoportoenterostomy, high-dose steroid therapy following surgery did not result in statistically significant treatment differences in bile drainage at 6 months, although a small clinical benefit could not be excluded.
Abstract: Importance Biliary atresia is the most common cause of end-stage liver disease in children. Controversy exists as to whether use of steroids after hepatoportoenterostomy improves clinical outcome. Objective To determine whether the addition of high-dose corticosteroids after hepatoportoenterostomy is superior to surgery alone in improving biliary drainage and survival with the native liver. Design, Setting, and Patients The multicenter, double-blind Steroids in Biliary Atresia Randomized Trial (START) was conducted in 140 infants (mean age, 2.3 months) between September 2005 and February 2011 in the United States; follow-up ended in January 2013. Interventions Participants were randomized to receive intravenous methylprednisolone (4 mg/kg/d for 2 weeks) and oral prednisolone (2 mg/kg/d for 2 weeks) followed by a tapering protocol for 9 weeks (n = 70) or placebo (n = 70) initiated within 72 hours of hepatoportoenterostomy. Main Outcomes and Measures The primary end point (powered to detect a 25% absolute treatment difference) was the percentage of participants with a serum total bilirubin level of less than 1.5 mg/dL with his/her native liver at 6 months posthepatoportoenterostomy. Secondary outcomes included survival with native liver at 24 months of age and serious adverse events. Results The proportion of participants with improved bile drainage was not statistically significantly improved by steroids at 6 months posthepatoportoenterostomy (58.6% [41/70] of steroids group vs 48.6% [34/70] of placebo group; adjusted relative risk, 1.14 [95% CI, 0.83 to 1.57]; P = .43). The adjusted absolute risk difference was 8.7% (95% CI, −10.4% to 27.7%). Transplant-free survival was 58.7% in the steroids group vs 59.4% in the placebo group (adjusted hazard ratio, 1.0 [95% CI, 0.6 to 1.8]; P = .99) at 24 months of age. The percentage of participants with serious adverse events was 81.4% [57/70] of the steroids group and 80.0% [56/70] of the placebo group ( P > .99); however, participants receiving steroids had an earlier time of onset of their first serious adverse event by 30 days posthepatoportoenterostomy (37.2% [95% CI, 26.9% to 50.0%] of steroids group vs 19.0% [95% CI, 11.5% to 30.4%] of placebo group; P = .008). Conclusions and Relevance Among infants with biliary atresia who have undergone hepatoportoenterostomy, high-dose steroid therapy following surgery did not result in statistically significant treatment differences in bile drainage at 6 months, although a small clinical benefit could not be excluded. Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia. Trial Registration clinicaltrials.gov Identifier:NCT00294684
141 citations
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TL;DR: Three large, controlled trials of different regimens of oral antiviral agents for chronic hepatitis C, genotype 1, yielded rates of sustained virologic response of 93% to 99%.
Abstract: Welcomed and exciting results from three large, controlled trials of different regimens of oral antiviral agents for chronic hepatitis C, genotype 1, have now been published in the Journal.1–3 The regimens all included the combination of ledipasvir and sofosbuvir, two new direct-acting antiviral agents with potent activity against hepatitis C virus (HCV). The two drugs were given as a single tablet once daily for 8, 12, or 24 weeks, with or without ribavirin. The results were consistent and striking: the various regimens yielded rates of sustained virologic response of 93% to 99%. The combination of ledipasvir and sofosbuvir . . .
130 citations
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TL;DR: In a combined analysis of data from 2 large studies, it is found that FIB-4, APRI, and NFS can detect advanced fibrosis and fibrosis progression in patients with NAFLD.
128 citations
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TL;DR: This guidance provides a data-supported approach to the diagnostic, therapeutic, and preventive aspects of NAFLD care.
4,431 citations
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TL;DR: The global prevalence of viral hepatitis remains high, while drug-induced liver injury continues to increase as a major cause of acute hepatitis.
1,799 citations
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TL;DR: Improvements in methodology and reporting are needed for studies that compare modeling algorithms for clinical prediction modeling in the literature and found no evidence of superior performance of ML over LR.
885 citations
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TL;DR: This ACG Clinical Guideline is presented an evidence-based approach to diagnosis and management of DILI with special emphasis on DILi due to herbal and dietary supplements and DilI occurring in individuals with underlying liver disease.
630 citations
08 Nov 2011
TL;DR: ThePHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization.
Abstract: BACKGROUND
Depression, anxiety and somatization are the most common mental disorders in primary care as well as medical specialty populations; each is present in at least 5-10% of patients and frequently comorbid with one another. An efficient means for measuring and monitoring all three conditions would be desirable.
METHODS
Evidence regarding the psychometric and pragmatic characteristics of the Patient Health Questionnaire (PHQ)-9 depression, generalized anxiety disorder (GAD)-7 anxiety and PHQ-15 somatic symptom scales are synthesized from two sources: (1) four multisite cross-sectional studies (three conducted in primary care and one in obstetric-gynecology practices) comprising 9740 patients, and (2) key studies from the literature that have studied these scales.
RESULTS
The PHQ-9 and its abbreviated eight-item (PHQ-8) and two-item (PHQ-2) versions have good sensitivity and specificity for detecting depressive disorders. Likewise, the GAD-7 and its abbreviated two-item (GAD-2) version have good operating characteristics for detecting generalized anxiety, panic, social anxiety and post-traumatic stress disorder. The optimal cutpoint is > or = 10 on the parent scales (PHQ-9 and GAD-7) and > or = 3 on the ultra-brief versions (PHQ-2 and GAD-2). The PHQ-15 is equal or superior to other brief measures for assessing somatic symptoms and screening for somatoform disorders. Cutpoints of 5, 10 and 15 represent mild, moderate and severe symptom levels on all three scales. Sensitivity to change is well-established for the PHQ-9 and emerging albeit not yet definitive for the GAD-7 and PHQ-15.
CONCLUSIONS
The PHQ-9, GAD-7 and PHQ-15 are brief well-validated measures for detecting and monitoring depression, anxiety and somatization.
607 citations