Patients with non-alcoholic AP were divided click here into two groups – with and without NAFLD. We analyzed the frequency of PlE, BISAP score, MAS, DBS, frequency of ICU admission and mean LOS. The results were compared in the two groups using the student’s t- test and CHI square test. Conclusions: NAFLD 1. as a single marker, correlates well with all other indicators of severity;

single as well as well established scoring systems. 2. is associated with increased severity of AP. 3. diagnosed by initial abdominal US or CT performed in the ER should serve as a single, early, easily available, radiological marker of severity in AP. Refer-ences:1. Sawalhi S et al. Does the Presence of Obesity and/ or Metabolic Syndrome Affect the Course of Acute Pancreati-tis?:A Prospective Study. Pancreas 2014; 43(4):565-70. 2. Tenner S et al. American College of Gastroenterology Guideline: Management of Acute Pancreatitis. Am J Gastroenterol 2013;108:1400–15. Disclosures: The following people have nothing to disclose: Sarfaraz A. Jasdanwala, Shivank Madan, Rajagopalan

Sivaprasad, Capecomorin Pitchumoni Objective: NASH is a globally challenging clinical morbidly; causing cirrhosis and liver cancer in due time with formidable cost burden. Therapeutic modalities have GW-572016 solubility dmso not yet been fully established. Anti-oxidants and insulin sensitizers altering insulin resistance, selleckchem inhibiting intra hepatic oxidative stress with inhibition of formation of free radicals and blocking inflammatory cytokines to prevent fibrosis. Berberine is a natural substance extracted

from plants like Berberis which is found to up-reg-ulate intra hepatic pathways as insulin sensitizer, via GLP-1 up regulation and Acyl palmotyl mechanism on fatty acid oxidation, induction of PPAR gama; all that blocks the terminal inflammatory Cytokine release TNF Alfa to prevent fibrosis that will prevent the End stage liver disease (ESLD) and liver cancer. Methods: Hundred and twenty patients (n=120) with NASH were recruited. Mean BMI 29.9% (29% to 32%) with 69 males and 51 females. Hispanic 46, Caucasians 34, Asian Pacific15, Black 11, Asian 14. Mean HbA1C 6.2 (5.9- 6.8), Mean HOMA 2.7 (2.1-3.6), ALT 54 (38-79), Triglyceride 287 (233-344), LDL c 163 (129-176), Leptin 63 (43-98), Adiponec-tin 0.9 (0.1-1.1), RBP 4 of 5.8 (4.0-6.8), TNF Alfa 3.8 (2.1-4.8), IL 12 of 5.3 (3.9-7.8), Serum Fibrotic and Steatotic scores were measured at 0 and then at 6 months. Daily allowed caloric content was 2,000 cal/ day, no documented exercise except daily activities at baseline for 6 months. All patients were divided into: Primary endpoints: ALT normalization, near normalization of HOMA Index and lipid panel Secondary endpoints: Normalization of Inflammatory markers eg. Leptin, TNF Alfa, IL 10, and reversal of fibrosis and steatosis score.

Patients with non-alcoholic AP were divided BMS-907351 mouse into two groups – with and without NAFLD. We analyzed the frequency of PlE, BISAP score, MAS, DBS, frequency of ICU admission and mean LOS. The results were compared in the two groups using the student’s t- test and CHI square test. Conclusions: NAFLD 1. as a single marker, correlates well with all other indicators of severity;

single as well as well established scoring systems. 2. is associated with increased severity of AP. 3. diagnosed by initial abdominal US or CT performed in the ER should serve as a single, early, easily available, radiological marker of severity in AP. Refer-ences:1. Sawalhi S et al. Does the Presence of Obesity and/ or Metabolic Syndrome Affect the Course of Acute Pancreati-tis?:A Prospective Study. Pancreas 2014; 43(4):565-70. 2. Tenner S et al. American College of Gastroenterology Guideline: Management of Acute Pancreatitis. Am J Gastroenterol 2013;108:1400–15. Disclosures: The following people have nothing to disclose: Sarfaraz A. Jasdanwala, Shivank Madan, Rajagopalan

Sivaprasad, Capecomorin Pitchumoni Objective: NASH is a globally challenging clinical morbidly; causing cirrhosis and liver cancer in due time with formidable cost burden. Therapeutic modalities have check details not yet been fully established. Anti-oxidants and insulin sensitizers altering insulin resistance, selleck screening library inhibiting intra hepatic oxidative stress with inhibition of formation of free radicals and blocking inflammatory cytokines to prevent fibrosis. Berberine is a natural substance extracted

from plants like Berberis which is found to up-reg-ulate intra hepatic pathways as insulin sensitizer, via GLP-1 up regulation and Acyl palmotyl mechanism on fatty acid oxidation, induction of PPAR gama; all that blocks the terminal inflammatory Cytokine release TNF Alfa to prevent fibrosis that will prevent the End stage liver disease (ESLD) and liver cancer. Methods: Hundred and twenty patients (n=120) with NASH were recruited. Mean BMI 29.9% (29% to 32%) with 69 males and 51 females. Hispanic 46, Caucasians 34, Asian Pacific15, Black 11, Asian 14. Mean HbA1C 6.2 (5.9- 6.8), Mean HOMA 2.7 (2.1-3.6), ALT 54 (38-79), Triglyceride 287 (233-344), LDL c 163 (129-176), Leptin 63 (43-98), Adiponec-tin 0.9 (0.1-1.1), RBP 4 of 5.8 (4.0-6.8), TNF Alfa 3.8 (2.1-4.8), IL 12 of 5.3 (3.9-7.8), Serum Fibrotic and Steatotic scores were measured at 0 and then at 6 months. Daily allowed caloric content was 2,000 cal/ day, no documented exercise except daily activities at baseline for 6 months. All patients were divided into: Primary endpoints: ALT normalization, near normalization of HOMA Index and lipid panel Secondary endpoints: Normalization of Inflammatory markers eg. Leptin, TNF Alfa, IL 10, and reversal of fibrosis and steatosis score.

1B). Liver-infiltrating T cells and splenocytes isolated from males and 4-week-old or 14-week-old Cisplatin mouse females showed low specific cytotoxicity against type 2 AIH antigens compared with 7-week-old female mice (Fig. 1C). Seven-week-old female C57BL/6 mice were susceptible, whereas 4-week-old and 14-week-old females were less prone to the development of an experimental AIH. Seven-week-old female mice were also more vulnerable than males at the same age. In this animal model, as was observed in humans, female sex and age are susceptibility factors for the onset of AIH. Antibodies against the injected xenoantigens were measured in the four groups

of mice. Females vaccinated at 7 weeks of age showed the highest titer of antibodies (P < 0.05) (Fig. 2A). Titers reached their maximal

level in the first month and remained elevated until the 8th month post-vaccination. When autoantibodies against murine formiminotransferase-cyclodeaminase (FTCD) and CYP2D9 (the murine homolog of human CYP2D6) were measured, female mice vaccinated at 7 weeks of age showed significantly higher levels of anti-mFTCD autoantibodies than mice from other groups (Fig. 2C). No PF-01367338 molecular weight statistically significant differences in reactivity against CYP2D9 were found between sera from all four groups (Fig. 2B). However, autoantibodies level increased over time, a feature evident in 7-week-old female mice sera reactivity against mFTCD. Interestingly, levels of mFTCD autoantibodies correlated with the histological activity index in mice from all four groups, suggesting a possible role for B cell

response against mFTCD in development of the disease (Fig. 2D). To characterize this B cell response, reactivity against xenoantigens (CYP2D6 selleck screening library and FTCD) and mFTCD were compared by western blot to detect high-affinity antibodies targeting linear epitopes. Early on, reactivity against injected antigens was found in all mice (human CYP2D6-FTCD) (Fig. 2E). However, a shift of B-cell reactivity (human FTCD) to autoreactivity (murine FTCD) occurred in female mice (Fig. 2E). This type of B cell shift to autoreactivity was not observed in male mice. The expression level in the liver of the targeted antigens, mFTCD and CYP2D9 could potentially influence the reactivity of specific T cells and development of AIH. Therefore, their expression level was assessed in livers from newborn and 7-week-old C57BL/6 mice. Male and female newborn (data not shown) and 7-week-old C57BL/6 mice showed similar hepatic expression levels of both mFTCD and CYP2D9 (Fig. 3A). Therefore, the amount of autoantigen in hepatocytes is not related to the female’s susceptibility to AIH. The thymic expression level of FTCD and CYP2D9 was measured in C57BL/6 newborn mice. No differences were observed between males and females (Fig. 3B). FTCD thymic expression level was lower than that of CYP2D9 (Fig.

Methods: we engineered Huh7.5 and HepG2 human hepatoma cell lines to express Omomyc under the control of a tetracycline inducible promoter.

Epigenetics inhibitor Then, we determined by microscope examination, MTS assay and cytofluorimetric analysis, morphology, proliferation and viability of mock transduced cells, of cells transduced with Omomyc without induction of its expression, and of cells induced to express Omomyc. Real-time PCR and Western blot analysis were used for determining the expression of Myc, PCNA (Proliferating Cellular Nuclear Antigen), CCD1 (Cyclin D1), Hedgehog and its target gene Gli1. Results: Microscope examination, MTS assay and FACS analysis clearly revealed that Omomyc expression is able to reduce human hepatocel-lular carcinoma cell proliferation up to 70% in 8 days upon doxycycline induction. Analysis of mRNA expression of genes involved in cell proliferation and the correspondent protein levels confirmed the Omomyc effect in halting tumor cell growth. In particular, the expression of Hedgehog and its target gene Gli1 were decreased after Omomyc induction. Conclusion: The Myc dominant negative miniprotein CDK inhibitor Omomyc is able to prevent HCC proliferation in vitro by specifically counteracting the Hedgehog-mediated signaling. We are now testing the outcome of this strategy in preventing tumor progression

in vivo in SCID mice injected with HCC cells expressing Omomyc and luciferase, in order to follow cancer growth by bioluminescence imaging. Disclosures: The following people have nothing to disclose: Barbara Barbaro, Cristiana Porcu, Gabriele Toietta, Roberta Maggio, Mauro Savino, Sergio Nasi, Clara Balsano Background & Aim: Hepatocytes play a crucial role in the homeostatic control of energy metabolism. When hepatocytes are exposed to an intolerably high amount of fat under overfed state, their toxic metabolites excessively

accumulate in the cells, often leading to the lipotoxic liver injury called nonalcoholic fatty liver disease (NAFLD). selleckchem Although epigenetic mechanisms have been discussed for the maintenance of metabolic homeo-stasis, it is unclear how epigenetic factors selectively control gene expression for the metabolic adaptation. Lysine-specific demethylase 1 and 2 (LSD1 and LSD2) comprise the flavin-dependent amine oxidase family of histone demethylases. We have previously reported that LSD1 represses energy expenditure genes in adipose cells under lipogenic conditions, giving a hint that another flavin-dependent epigenetic factor, LSD2 may link environmental information to metabolic programming. This study was aimed to identify a key role of LSD2 in the homeostatic control of energy metabolism in hepatocytes. Methods: Transcriptome analysis and bioinformatic approach using gene set enrichment analysis (GSEA) was carried out to identify the target genes of LSD2 in LSD2-depleted HepG2 human hepatic cells.

Methods: we engineered Huh7.5 and HepG2 human hepatoma cell lines to express Omomyc under the control of a tetracycline inducible promoter.

PLX4032 order Then, we determined by microscope examination, MTS assay and cytofluorimetric analysis, morphology, proliferation and viability of mock transduced cells, of cells transduced with Omomyc without induction of its expression, and of cells induced to express Omomyc. Real-time PCR and Western blot analysis were used for determining the expression of Myc, PCNA (Proliferating Cellular Nuclear Antigen), CCD1 (Cyclin D1), Hedgehog and its target gene Gli1. Results: Microscope examination, MTS assay and FACS analysis clearly revealed that Omomyc expression is able to reduce human hepatocel-lular carcinoma cell proliferation up to 70% in 8 days upon doxycycline induction. Analysis of mRNA expression of genes involved in cell proliferation and the correspondent protein levels confirmed the Omomyc effect in halting tumor cell growth. In particular, the expression of Hedgehog and its target gene Gli1 were decreased after Omomyc induction. Conclusion: The Myc dominant negative miniprotein EPZ-6438 cost Omomyc is able to prevent HCC proliferation in vitro by specifically counteracting the Hedgehog-mediated signaling. We are now testing the outcome of this strategy in preventing tumor progression

in vivo in SCID mice injected with HCC cells expressing Omomyc and luciferase, in order to follow cancer growth by bioluminescence imaging. Disclosures: The following people have nothing to disclose: Barbara Barbaro, Cristiana Porcu, Gabriele Toietta, Roberta Maggio, Mauro Savino, Sergio Nasi, Clara Balsano Background & Aim: Hepatocytes play a crucial role in the homeostatic control of energy metabolism. When hepatocytes are exposed to an intolerably high amount of fat under overfed state, their toxic metabolites excessively

accumulate in the cells, often leading to the lipotoxic liver injury called nonalcoholic fatty liver disease (NAFLD). check details Although epigenetic mechanisms have been discussed for the maintenance of metabolic homeo-stasis, it is unclear how epigenetic factors selectively control gene expression for the metabolic adaptation. Lysine-specific demethylase 1 and 2 (LSD1 and LSD2) comprise the flavin-dependent amine oxidase family of histone demethylases. We have previously reported that LSD1 represses energy expenditure genes in adipose cells under lipogenic conditions, giving a hint that another flavin-dependent epigenetic factor, LSD2 may link environmental information to metabolic programming. This study was aimed to identify a key role of LSD2 in the homeostatic control of energy metabolism in hepatocytes. Methods: Transcriptome analysis and bioinformatic approach using gene set enrichment analysis (GSEA) was carried out to identify the target genes of LSD2 in LSD2-depleted HepG2 human hepatic cells.

These often involve exposure to ionizing radiation. The reasons for these repeated and unnecessary scans are not well understood, but probably include physician fear of missing a dangerous cause of headache and a desire to allay patient anxiety over possible missed abnormalities, especially when treatment is unsuccessful. In some cases, duplicate scans may be ordered because the physician is unaware of previous testing. The risk of unneeded testing may be especially high in the emergency department, where physicians are unfamiliar with the patient and fear missing serious causes of headache. In ordering diagnostic tests, though, the possible adverse

effects of testing must be balanced against the likely benefits to the patient. In particular, the potential adverse health effects of Carfilzomib research buy radiation exposure should be taken into consideration when ordering diagnostic testing for headache. In many situations, it is very unlikely that a Talazoparib mouse repeat imaging study of the head will identify any abnormality that will alter management. The radiation risks of CT scanning are not negligible. Younger people are at higher risk of radiation adverse effects than older people.

The authors of a recent review of the risks of diagnostic CT scans concluded, “In summary, there is direct evidence from epidemiologic studies that the organ doses corresponding to a common CT study … result in an increased risk of cancer. The evidence is reasonably convincing for adults and very convincing for children.”[8] A single this website CT scan of the head exposes patients to an average of 2 mSV of radiation, the equivalent of 8 months of background radiation.[9] A recently published article noted that 24 of the initial 45 Choosing Wisely recommendations concerned diagnostic

radiology tests or procedures. The authors suggested that this emphasis is appropriate in view of the known risks of radiation exposure. They noted that “if Choosing Wisely is successful and dissuades only nonindicated examinations, it may save lives in addition to money.”[10] One other professional society has also released a recommendation relating to appropriate use of imaging studies for headache. The American College of Radiology Five Things List includes a recommendation that states, “Don’t do imaging for uncomplicated headache.”[11] The AHS recommendation is more specific and limited to patients who meet diagnostic criteria for migraine. The committee did not find sufficient high-quality evidence to make a broader recommendation about headaches that do not meet criteria for migraine. Previous recommendations on chronic headache and neuroimaging found sufficient evidence to state that the incidence of imaging abnormalities in migraine patients is not greater than in nonmigraine patients, but for headaches that are not consistent with migraine, there is insufficient evidence to make a recommendation.[12] It is not easy to define what constitutes an “uncomplicated” headache.

These often involve exposure to ionizing radiation. The reasons for these repeated and unnecessary scans are not well understood, but probably include physician fear of missing a dangerous cause of headache and a desire to allay patient anxiety over possible missed abnormalities, especially when treatment is unsuccessful. In some cases, duplicate scans may be ordered because the physician is unaware of previous testing. The risk of unneeded testing may be especially high in the emergency department, where physicians are unfamiliar with the patient and fear missing serious causes of headache. In ordering diagnostic tests, though, the possible adverse

effects of testing must be balanced against the likely benefits to the patient. In particular, the potential adverse health effects of MLN8237 radiation exposure should be taken into consideration when ordering diagnostic testing for headache. In many situations, it is very unlikely that a selleck compound repeat imaging study of the head will identify any abnormality that will alter management. The radiation risks of CT scanning are not negligible. Younger people are at higher risk of radiation adverse effects than older people.

The authors of a recent review of the risks of diagnostic CT scans concluded, “In summary, there is direct evidence from epidemiologic studies that the organ doses corresponding to a common CT study … result in an increased risk of cancer. The evidence is reasonably convincing for adults and very convincing for children.”[8] A single selleck products CT scan of the head exposes patients to an average of 2 mSV of radiation, the equivalent of 8 months of background radiation.[9] A recently published article noted that 24 of the initial 45 Choosing Wisely recommendations concerned diagnostic

radiology tests or procedures. The authors suggested that this emphasis is appropriate in view of the known risks of radiation exposure. They noted that “if Choosing Wisely is successful and dissuades only nonindicated examinations, it may save lives in addition to money.”[10] One other professional society has also released a recommendation relating to appropriate use of imaging studies for headache. The American College of Radiology Five Things List includes a recommendation that states, “Don’t do imaging for uncomplicated headache.”[11] The AHS recommendation is more specific and limited to patients who meet diagnostic criteria for migraine. The committee did not find sufficient high-quality evidence to make a broader recommendation about headaches that do not meet criteria for migraine. Previous recommendations on chronic headache and neuroimaging found sufficient evidence to state that the incidence of imaging abnormalities in migraine patients is not greater than in nonmigraine patients, but for headaches that are not consistent with migraine, there is insufficient evidence to make a recommendation.[12] It is not easy to define what constitutes an “uncomplicated” headache.

Migraine prevalence Selleck LY2109761 was defined as the percentage of patients with a diagnosis of migraine headache (ICHD-2 diagnoses 1.1-1.5). Migraine frequency represented the number of days per month with migraine headache self-reported during the headache interview and migraine disability was the number of days with disability obtained from the Migraine Disability Assessment questionnaire. Generalized linear models were used to analyze the migraine prevalence, frequency, and disability

with the degree of allergic sensitization (percentage of positive allergy tests) and administration of immunotherapy as covariates. Patients were categorized into high (> 45% positiveallergy tests) and low (≤45% positive allergy tests) atopic groups based on the number of allergy tests that were positive for the frequency and disability analyses. Results.— A total of 536 patients (60% female, mean age 40.9 years) participated in the study. The prevalence of migraine was not associated with the degree of allergic sensitization, but there was a significant age/immunotherapy interaction (P < .02). Migraine headaches were less prevalent in the immunotherapy group than the nonimmunotherapy at ages <40 years and more prevalent in the immunotherapy group at ages ≥40 years of age. In subjects ≤45 years of age, increasing percentages of allergic sensitization were associated with

a decreased frequency and disability of migraine Lumacaftor headache in the low atopic group (risk ratios [RRs] of 0.80 [95% CI; 0.65, 0.99] and 0.81[95% CI; 0.68, 0.97]) while increasing percentages were associated with an increased frequency see more (not disability) in the

high atopic group (RR = 1.60; [95% CI; 1.11, 2.29]). In subjects ≤45 years of age, immunotherapy was associated with decreased migraine frequency and disability (RRs of 0.48 [95% CI; 0.28, 0.83] and 0.55 [95% CI; 0.35, 0.87]). In those >45 years of age, there was no effect of degree of allergic sensitization or immunotherapy on the frequency and disability of migraine headache. Conclusions.— Our study suggests that the association of allergy with migraine headaches depends upon age, degree of allergic sensitization, administration of immunotherapy, and the type of headache outcome measure that are studied. Lower “degrees of atopy” are associated with less frequent and disabling migraine headaches in younger subjects while higher degrees were associated with more frequent migraines. The administration of immunotherapy is associated with a decreased prevalence, frequency, and disability of migraine headache in younger subjects. “
“(Headache 2011;51:507-517) Objective.— To evaluate the efficacy and tolerability of MAP0004 compared with placebo for a single migraine in adult migraineurs: The FREEDOM-301 Study. Background.

M. LAFFAN E-mail: [email protected] Extending the half-life of infused coagulation factors offers the possibility to improve treatment for patients either by reducing the frequency of injections, Epigenetics Compound Library price by increasing the sustained level of protection from bleeds or by some combination of both. Unfortunately, in the case of FVIII the natural physiology of the molecule

is a significant barrier to extensive prolongation. Nonetheless, some progress has been made with FVIII molecules modified by the addition of other molecules such as polyethylene glycol (PEG) and the Fc portion of immunoglobulin. So far, these molecules appear to have a favourable safety profile and low immunogenicity. However, complications arising from their behaviour in in vitro assays have AZD1208 chemical structure yet to be fully explored. Extending the half-life of FVIII has been the aim of research in haemophilia for some time. The anticipated benefits include reducing the frequency of injections, achieving higher trough levels of FVIII and using fewer units of FVIII overall, possibly resulting in reduced cost of treatment. With very large increases in the half-life all three may be achieved, but with more modest increases there will have to be some compromise between these three objectives. This will require a decision as to which is the most important, both for health services and

for the patient. When considering the ways in which FVIII half-life could be increased it is very important to consider

first the normal physiology of FVIII, as this will have a major impact on progress. FVIII is normally synthesized in many tissues but most notably in hepatocytes and endothelial cells, including those of the hepatic sinusoids. Within endothelial cells, von Willebrand factor (VWF) is transported to the Weibel–Palade bodies where it is co-stored with FVIII. In plasma, FVIII binds rapidly to VWF with a very high affinity and a Kd of <1 nmol [101]. As a result of this, approximately 95% of plasma FVIII is bound to VWF multimers. The importance of this selleck chemicals llc relationship is immediately apparent from the situation in type 3 von Willebrand disease where a complete absence of VWF is associated with very low levels of FVIII. This is because free FVIII in plasma has a half-life of approximately 2 h, which in normal circumstances is greatly extended to approximately 12 h by binding to VWF [102]. In this sense the vast majority of FVIII already exists in plasma as an extended half-life preparation. That is to say we have a small molecule with a very short half-life attached to a much larger molecule with a longer half-life which then dictates the half-life of the small molecule. It therefore seems unlikely that we will be able to prolong the half-life of the FVIII–VWF complex by modifying the FVIII molecule. Thus, we are limited to modifying the survival of the free 5% of FVIII that is not bound to VWF and which has a short half-life.

Of the proposed methods for accurate dosing of chemotherapy agents, only therapeutic drug monitoring has been studied in the HCT setting.12 If a CY/TBI regimen must be used for a patient at risk for fatal SOS, modifications should be considered for both CY and TBI dosing. The total dose of CY should be 90-110 mg/kg range21 and TBI doses should not exceed 12 Gy unless there is an oncologic imperative for higher doses.20 Shielding the liver during TBI will lessen liver injury but leads to relapse of underlying hematological disease. Accurate methods are available to target CY doses to a metabolic endpoint,

based on exposure to the CY metabolites Venetoclax molecular weight 4-hydroxyCY and carboxyethylphosphoramide mustard.21 If a BU/CY regimen must be used for a

patient at risk for fatal SOS, liver toxicity may be less frequent if CY is given before targeted BU or if dosing of CY is delayed for 1-2 days after completion of BU. BU and phenytoin to prevent BU-related seizures result in increased exposure to toxic CY metabolites Dinaciclib clinical trial when CY is given second in order, compared to giving CY first in order.22 A lower incidence of SOS has been reported following iv BU/CY, compared to oral BU/CY, when neither BU formulation was adjusted for metabolism. The metabolic profile of intravenously administered

BU is variable, with a several-fold range in the area under the curve for BU (AUCBU), a problem that can be addressed by therapeutic drug monitoring.33 Pharmaceutical prevention of SOS has been achieved in animal models of sinusoidal injury17 but these strategies (repletion of intracellular glutathione or inhibition of matrix metalloproteinase enzymes) have not been studied in the clinical setting. Infusion of defibrotide has been reported to be effective as prophylaxis; preliminary results from a large randomized trial in children reported less liver disease and better outcomes in those receiving defibrotide.34 Prospective studies have shown selleck chemicals no benefit from use of prophylactic heparin or antithrombin III in preventing fatal SOS. A meta analysis suggests that ursodiol may prevent SOS, but SOS was not differentiated from cholestatic liver disease in these studies and a large randomized trial showed no effect of ursodiol on the frequency of SOS.2 For >70% of patients with SOS who will recover spontaneously, treatment involves management of sodium and water balance, preservation of renal blood flow, and repeated paracenteses for ascites that is associated with discomfort or pulmonary compromise.