1 00:00:11,440 --> 00:00:13,640 Welcome to the Clinical Center Grand Rounds, 2 00:00:13,640 --> 00:00:17,440 a weekly series of educational lectures for physicians and 3 00:00:17,440 --> 00:00:20,080 health care professionals broadcast from the Clinical 4 00:00:20,080 --> 00:00:23,040 Center at the National Institutes of Health in 5 00:00:23,040 --> 00:00:24,840 Bethesda, MD. 6 00:00:24,840 --> 00:00:28,400 The NIH Clinical Center is the world's largest hospital totally 7 00:00:28,400 --> 00:00:32,080 dedicated to investigational research and leads the global 8 00:00:32,080 --> 00:00:35,040 effort in training today's investigators and discovering 9 00:00:35,040 --> 00:00:37,200 tomorrow's cures. 10 00:00:37,200 --> 00:00:47,560 Learn more by visiting us online at http://clinicalcenter.nih.gov 11 00:00:47,560 --> 00:00:49,280 TODAY, WE ARE HONORED TO HAVE Dr. JESSICA 12 00:00:49,280 --> 00:00:55,960 MELLINGER, ASSISTANT PROFESSOR 13 00:00:55,960 --> 00:00:57,200 OF GASTROENTEROLOGY AND Dr. 14 00:00:57,200 --> 00:00:58,760 BIN GAO, CHIEF AND SENIOR 15 00:00:58,760 --> 00:01:00,480 INVESTIGATORS OF THE LABORATORY 16 00:01:00,480 --> 00:01:03,200 OF LIVER DISEASES, THE NATIONAL 17 00:01:03,200 --> 00:01:05,280 INSTITUTE ON ALCOHOL ABUSE AND 18 00:01:05,280 --> 00:01:06,200 ALCOHOLISM, THE NATIONAL 19 00:01:06,200 --> 00:01:07,280 INSTITUTE OF HEALTH. 20 00:01:07,280 --> 00:01:10,400 Dr. MELLINGER IS A 21 00:01:10,400 --> 00:01:11,680 PROFESSOR AT THE UNIVERSITY OF 22 00:01:11,680 --> 00:01:12,040 MICHIGAN. 23 00:01:12,040 --> 00:01:13,480 SHE RECEIVED HER BACHELORS IN 24 00:01:13,480 --> 00:01:15,280 ENGLISH LITERATURE AND 25 00:01:15,280 --> 00:01:16,800 MICROBIOLOGY FROM THE UNIVERSITY 26 00:01:16,800 --> 00:01:18,080 OF WYOMING. 27 00:01:18,080 --> 00:01:21,040 SHE WAS A ROAD SCHOLAR EARNING A 28 00:01:21,040 --> 00:01:25,560 MASTER OF HISTORY AND MEDIEVAL 29 00:01:25,560 --> 00:01:26,840 HISTORY BEFORE THE SCHOOL OF 30 00:01:26,840 --> 00:01:28,240 MEDICINE IN CHICAGO. 31 00:01:28,240 --> 00:01:30,840 Dr. MELLINGER COMPLETED HER 32 00:01:30,840 --> 00:01:32,280 RESIDENCY IN INTERNAL MEDICINE 33 00:01:32,280 --> 00:01:33,440 AT THE HOSPITAL AND CLINICS AND 34 00:01:33,440 --> 00:01:37,920 SHE COMPLETED A FELLOWSHIP IN 35 00:01:37,920 --> 00:01:38,600 GASTROENTEROLOGY AND TRANSPLANT 36 00:01:38,600 --> 00:01:42,680 HEHEPATOLOGY AT THE UNIVERSITY F 37 00:01:42,680 --> 00:01:44,720 MICHIGAN WHERE SHE'S AN 38 00:01:44,720 --> 00:01:45,160 ASSISTANT PROFESSOR. 39 00:01:45,160 --> 00:01:47,880 Dr. MELLINGER'S CLINICAL 40 00:01:47,880 --> 00:01:49,760 PRACTICE IS DEVELOPING NOVEL 41 00:01:49,760 --> 00:01:52,280 BEHAVIORAL INTERVENTIONS TO HELP 42 00:01:52,280 --> 00:01:54,400 PAY ENTERS STOP ALCOHOL USE AND 43 00:01:54,400 --> 00:01:57,080 ENGAGE IN TREAT ALCOHOL 44 00:01:57,080 --> 00:01:57,480 TREATMENT. 45 00:01:57,480 --> 00:02:00,480 SHE FOUNDED A MICHIGAN ALCOHOL 46 00:02:00,480 --> 00:02:01,640 IMPROVEMENT NETWORKS 47 00:02:01,640 --> 00:02:05,760 MULTI-DISCIPLINARY ALCOHOL 48 00:02:05,760 --> 00:02:06,600 ASSOCIATED LIVER DICE SEIZE AND 49 00:02:06,600 --> 00:02:07,680 PERMISSIONS AND INVESTIGATORS 50 00:02:07,680 --> 00:02:09,160 DEDICATED TO IMPROVING HOW 51 00:02:09,160 --> 00:02:11,000 HEALTHCARE PROVIDERS AND SYSTEM 52 00:02:11,000 --> 00:02:12,720 DIAGNOSE AND TREAT ALCOHOL USE 53 00:02:12,720 --> 00:02:13,080 DISORDER. 54 00:02:13,080 --> 00:02:14,520 THIS CLINIC IS ONE OF THE FIRST 55 00:02:14,520 --> 00:02:17,880 FULLY INTEGRATED CO-LOCATED 56 00:02:17,880 --> 00:02:20,640 TREATMENT CLINICS FOR ALD 57 00:02:20,640 --> 00:02:21,400 PATIENTS. 58 00:02:21,400 --> 00:02:24,200 SHE'S AN NIH-FUNDED INVESTIGATOR 59 00:02:24,200 --> 00:02:25,520 THROUGH NIAAA TO STUDY 60 00:02:25,520 --> 00:02:27,880 BEHAVIORAL TREATMENTS IN ALD. 61 00:02:27,880 --> 00:02:29,960 Dr. MELLINGER IS BOARD 62 00:02:29,960 --> 00:02:34,960 CERTIFIED IN TRANSPLANT HELP 63 00:02:34,960 --> 00:02:36,120 HEPATOLOGY AND INTERNAL MEMBER. 64 00:02:36,120 --> 00:02:37,800 SHE'S A MEMBER OF SOCIETIES 65 00:02:37,800 --> 00:02:38,960 INCLUDING THE EUROPEAN 66 00:02:38,960 --> 00:02:41,840 ASSOCIATION FOR THE SOCIETY OF 67 00:02:41,840 --> 00:02:44,360 LIVER, THE RESEARCH SOCIETY OF 68 00:02:44,360 --> 00:02:46,360 ALCOHOLISM, AMERICAN SOCIETY FOR 69 00:02:46,360 --> 00:02:47,440 TRANSPLANTATION AND THE AMERICAN 70 00:02:47,440 --> 00:02:49,520 ASSOCIATION FOR THE STUDY OF 71 00:02:49,520 --> 00:02:50,080 LIVER DISEASE. 72 00:02:50,080 --> 00:02:51,840 Dr. MELLINGER IS AN 73 00:02:51,840 --> 00:02:52,960 INTERNATIONALLY RECOGNIZED 74 00:02:52,960 --> 00:02:54,880 SPEAKER ON ALCOHOL-RELATED LIVER 75 00:02:54,880 --> 00:02:56,480 DISEASE AS PUBLISHED OVER 50 76 00:02:56,480 --> 00:02:58,040 PAPERS AND CHAPTERS FOCUSES ON 77 00:02:58,040 --> 00:03:01,320 THIS EXPERTISE AND THE SUBJECT 78 00:03:01,320 --> 00:03:01,600 MATTER. 79 00:03:01,600 --> 00:03:04,400 OUR SECOND SPEAKERS IS Dr. BIN 80 00:03:04,400 --> 00:03:04,840 GAO. 81 00:03:04,840 --> 00:03:07,520 HE EARNED HIS DEGREE IN PH.D IN 82 00:03:07,520 --> 00:03:08,840 CHINA POLLING POSTDOC TO BAL 83 00:03:08,840 --> 00:03:10,680 TRAINING AT THE NIAAA AND 84 00:03:10,680 --> 00:03:11,760 MEDICAL COLLEGE OF VIRGINIA HE 85 00:03:11,760 --> 00:03:13,280 SERVED AS A TENURE TRACK ASSIST 86 00:03:13,280 --> 00:03:14,600 APARTMENT PROFESSOR AT THE 87 00:03:14,600 --> 00:03:17,880 MEDICAL COLLEGE OF VIRGINIA FROM 88 00:03:17,880 --> 00:03:18,600 1995 TO 2000. 89 00:03:18,600 --> 00:03:20,120 IN 2000, HE ACCEPTED A TENURE 90 00:03:20,120 --> 00:03:22,720 TRACK POSITION AT THE NIH IN 91 00:03:22,720 --> 00:03:23,320 ESTABLISHED A SESSION OF THE 92 00:03:23,320 --> 00:03:26,040 LIVER BIOLOGY AT THE NIAAA. 93 00:03:26,040 --> 00:03:28,160 AND IN 2009, Dr. GAO 94 00:03:28,160 --> 00:03:29,600 ESTABLISHED A LABORATORY OF 95 00:03:29,600 --> 00:03:33,360 LIVER DISEASES, BECAME CHIEF OF 96 00:03:33,360 --> 00:03:34,760 LIVER DISEASES. 97 00:03:34,760 --> 00:03:37,600 Dr. GAO'S RESEARCH FOCUS ON 98 00:03:37,600 --> 00:03:39,680 LIVER IMMUNOLOGY AND BIOLOGY AND 99 00:03:39,680 --> 00:03:41,080 PATHOGENS OF FATTY LIVER 100 00:03:41,080 --> 00:03:42,840 DISEASES AND ARE ASSOCIATED 101 00:03:42,840 --> 00:03:43,440 LIVER CANCERS. 102 00:03:43,440 --> 00:03:45,480 Dr. GAO'S GROUP HAS INTRODUCED 103 00:03:45,480 --> 00:03:47,520 NOVEL MORE ROBUST MOUSE MODELS 104 00:03:47,520 --> 00:03:50,160 OF ALCOHOL AND SOCIAL LIVER 105 00:03:50,160 --> 00:03:51,560 DISEASE, NON ALCOHOLIC FATTY 106 00:03:51,560 --> 00:03:54,400 LIVER DISEASE AND ACUTE ON 107 00:03:54,400 --> 00:03:55,920 CHRONIC LIVER FAILURE. 108 00:03:55,920 --> 00:03:58,080 Dr. GAO'S GROUP HAS MADE 109 00:03:58,080 --> 00:04:00,400 CONTRIBUTIONS OF ELECTRO 110 00:04:00,400 --> 00:04:01,560 MECHANISM AND LIVER INJURY AND 111 00:04:01,560 --> 00:04:02,320 REPAIR. 112 00:04:02,320 --> 00:04:03,480 FATTY LIVER DISEASE AND LIVER 113 00:04:03,480 --> 00:04:05,000 FAILURE AND THEIR POTENTIAL 114 00:04:05,000 --> 00:04:05,800 TREATMENT. 115 00:04:05,800 --> 00:04:07,680 Dr. GAO'S LAB HAS ALSO 116 00:04:07,680 --> 00:04:09,560 IDENTIFIED A KEY SURVIVAL FACTOR 117 00:04:09,560 --> 00:04:15,320 FOR A KEY ROLE IN LIVER FAILURE. 118 00:04:15,320 --> 00:04:17,040 LEADING TO THE CLINICAL 119 00:04:17,040 --> 00:04:18,600 TREATMENT FOR SEVERE ALCOHOLIC 120 00:04:18,600 --> 00:04:21,040 HEPATITIS AND ACUTE CHRONIC 121 00:04:21,040 --> 00:04:21,720 LIVER FAILURE. 122 00:04:21,720 --> 00:04:24,360 Dr. GAO HAS PUBLISHED OVER 300 123 00:04:24,360 --> 00:04:25,520 PAPERS AND IS CURRENTLY SERVING 124 00:04:25,520 --> 00:04:29,880 OR HAS SERVED ON BOARD FOR 125 00:04:29,880 --> 00:04:33,400 GASTROENTEROLOGY, GUT, HE A TOLL 126 00:04:33,400 --> 00:04:35,080 GEE AND OTHERS AS WELL AS 127 00:04:35,080 --> 00:04:37,280 ASSOCIATE EDITOR FOR SEMINARS IN 128 00:04:37,280 --> 00:04:39,880 LIVER DISEASES, CELLULAR AND 129 00:04:39,880 --> 00:04:42,280 IMMUNOLOGY AND THE INTERNATIONAL 130 00:04:42,280 --> 00:04:43,000 FOR BIOLOGICAL SCIENCE. 131 00:04:43,000 --> 00:04:44,560 Dr. GAO IS A FELLOW OF THE 132 00:04:44,560 --> 00:04:46,360 AMERICAN ASSOCIATION OF STUDY OF 133 00:04:46,360 --> 00:04:48,640 LIVER DISEASES AND RECEIVED 134 00:04:48,640 --> 00:04:49,840 RECOGNITIONS FOR HIS WORK TO 135 00:04:49,840 --> 00:04:51,800 INCLUDE ELECTIONS TO A MER 136 00:04:51,800 --> 00:04:53,840 ADVERTISE SOCIETY FOR CLINICAL 137 00:04:53,840 --> 00:04:54,160 INVESTIGATION. 138 00:04:54,160 --> 00:04:56,760 AND IN 2020, HE RECEIVED THE 139 00:04:56,760 --> 00:04:58,800 NIAAA INTRAMURAL SCIENTIFIC 140 00:04:58,800 --> 00:05:00,320 ACHIEVEMENT AWARD FOR HIS 141 00:05:00,320 --> 00:05:01,520 CONTRIBUTIONS AND WORK IN THE 142 00:05:01,520 --> 00:05:03,440 STUDY OF ALCOHOL ASSOCIATED 143 00:05:03,440 --> 00:05:04,800 LIVER DISEASE. 144 00:05:04,800 --> 00:05:06,240 NOW, PLEASE WELCOME OUR FIRST 145 00:05:06,240 --> 00:05:08,560 SPEAKER, Dr. MELLINGER FOR HER 146 00:05:08,560 --> 00:05:10,560 TALK ENTITLED "INTEGRATED CARE 147 00:05:10,560 --> 00:05:12,600 IN THE MANAGEMENT OF ALCOHOL 148 00:05:12,600 --> 00:05:14,520 RELATED LIVER DISEASE. 149 00:05:14,520 --> 00:05:15,840 IT'S A REAL HONOR TO BE HERE AND 150 00:05:15,840 --> 00:05:17,560 I APPRECIATE THE INVITATION ON 151 00:05:17,560 --> 00:05:20,320 THAT LOVELY INTRODUCTION. 152 00:05:20,320 --> 00:05:20,920 THANK YOU. 153 00:05:20,920 --> 00:05:22,440 THIS WAS ORIGINALLY ADVERTISED 154 00:05:22,440 --> 00:05:29,280 AS THE INTEGRATED CARE 155 00:05:29,280 --> 00:05:29,640 MANAGEMENT OF 156 00:05:29,640 --> 00:05:30,680 ADRENOLEUKODYSTROPHY SO IF YOU 157 00:05:30,680 --> 00:05:31,760 ARE HERE THAT'S NOT WHAT WE'RE 158 00:05:31,760 --> 00:05:32,680 TALKING ABOUT. 159 00:05:32,680 --> 00:05:34,400 I HAVE NO DISCLOSURES. 160 00:05:34,400 --> 00:05:39,000 I'LL GIVE A BRIEF OVERVIEW OF 161 00:05:39,000 --> 00:05:40,760 ALD TRENDS AND THE RESPECT TO 162 00:05:40,760 --> 00:05:42,560 THE EPIDEMIOLOGY TO SET THE 163 00:05:42,560 --> 00:05:44,320 STAGE FOR WHY WE'RE SEEING SUCH 164 00:05:44,320 --> 00:05:45,720 AN UPTICK IN THE NEED FOR 165 00:05:45,720 --> 00:05:46,680 INTEGRATED CARE AND WE'LL TALK 166 00:05:46,680 --> 00:05:48,440 ABOUT WHAT INTEGRATED CARE IS 167 00:05:48,440 --> 00:05:49,680 AND HOW THERE'S A REAL SPECTRUM 168 00:05:49,680 --> 00:05:50,600 OF IT. 169 00:05:50,600 --> 00:05:51,680 FOCUSING ON WHAT WE CAN DO AT 170 00:05:51,680 --> 00:05:53,080 THE INDIVIDUAL AND BEDSIDE LEVEL 171 00:05:53,080 --> 00:05:54,840 AND ALSO AT ORGANIZATIONAL LEVEL 172 00:05:54,840 --> 00:05:57,320 AND THE TIME THAT WE HAVE TODAY. 173 00:05:57,320 --> 00:05:58,760 SO, WE'LL START WITH ALCOHOL USE 174 00:05:58,760 --> 00:06:01,280 AND ALD TRENDS IN THE U.S. 175 00:06:01,280 --> 00:06:03,640 SO, OVER ALL, ALD IS RISING AND 176 00:06:03,640 --> 00:06:06,240 ALONG WITH THAT THE MORTALITY OF 177 00:06:06,240 --> 00:06:09,000 ALD IS GOING UP RATHER 178 00:06:09,000 --> 00:06:09,440 DRAMATICALLY. 179 00:06:09,440 --> 00:06:12,120 WHAT WE'VE SEEN OVER THE PAST 15 180 00:06:12,120 --> 00:06:14,560 TO 20 YEARS IS ABOUT A 181 00:06:14,560 --> 00:06:15,840 TWO-THIRDS INCREASE FOR DEATHS 182 00:06:15,840 --> 00:06:18,000 FOR ALL CAUSE OF CIRRHOSIS BUT 183 00:06:18,000 --> 00:06:20,000 WHEN WE LOOK AT DEATH RATES IN 184 00:06:20,000 --> 00:06:21,520 YOUNG PEOPLE HERE ON THE 185 00:06:21,520 --> 00:06:23,160 FAR-LEFT AND JUST FOR 186 00:06:23,160 --> 00:06:24,320 ALCOHOL-RELATED DISEASE IN 187 00:06:24,320 --> 00:06:25,600 GENERAL, WE REALLY HAVE SEEN 188 00:06:25,600 --> 00:06:27,920 THAT RATES ACROSS ALL 189 00:06:27,920 --> 00:06:33,480 DEMOGRAPHICS AGES, SEXES AND ALL 190 00:06:33,480 --> 00:06:34,880 RACISM AND ETHNICITY HAVE 191 00:06:34,880 --> 00:06:37,400 LARGELY SEEN INCREASES IN 192 00:06:37,400 --> 00:06:42,440 CIRRHOSIS AND IN AL D AND ALD 193 00:06:42,440 --> 00:06:45,640 AND WHY THIS YOUNG POPULATION 194 00:06:45,640 --> 00:06:47,640 HAS HAVE MARKET INCREASES IN 195 00:06:47,640 --> 00:06:49,160 ANNUAL MORTALITY BECAUSE OF 196 00:06:49,160 --> 00:06:49,920 LIVER DISEASE. 197 00:06:49,920 --> 00:06:51,440 IT'S BECAUSE OF ALCOHOL. 198 00:06:51,440 --> 00:06:53,960 AND ALCOHOL USE DISORDERS AND 199 00:06:53,960 --> 00:06:54,600 ALCOHOL-RELATED LIVER DISEASE. 200 00:06:54,600 --> 00:06:56,440 THIS IS BEEN A REAL CHANGE IN 201 00:06:56,440 --> 00:06:58,080 HOW WE THINK ABOUT LIVER DISEASE 202 00:06:58,080 --> 00:07:01,520 AND HOW WE THINK ABOUT 203 00:07:01,520 --> 00:07:02,400 CIRRHOSIS, WHICH WE PREVIOUSLY 204 00:07:02,400 --> 00:07:04,320 SEEN DISEASE OF MIDDLE OR 205 00:07:04,320 --> 00:07:05,520 LATER-MIDDLE AGE BUT WHICH IS 206 00:07:05,520 --> 00:07:07,040 REALLY CHANGING NOW TO SHIFT TO 207 00:07:07,040 --> 00:07:09,200 A YOUNGER POPULATION. 208 00:07:09,200 --> 00:07:10,640 AND AS A CONSEQUENCE OF THAT, 209 00:07:10,640 --> 00:07:12,400 THE BURDEN OF ALCOHOL LIVER 210 00:07:12,400 --> 00:07:13,680 DISEASE IS CHANGING AND 211 00:07:13,680 --> 00:07:15,200 TRANSPLANT AS WELL AND FOR THE 212 00:07:15,200 --> 00:07:18,560 FIRST TIME, IN U.S. HISTORY, ALD 213 00:07:18,560 --> 00:07:20,800 IS THE NUMBER ONE INDICATION FOR 214 00:07:20,800 --> 00:07:21,680 LIVER TRANSPLANT IN THE U.S. 215 00:07:21,680 --> 00:07:23,440 THIS IS A COMBINATION OF THE 216 00:07:23,440 --> 00:07:26,720 FACT THAT ALCOHOL USE RATES AND 217 00:07:26,720 --> 00:07:28,320 ALD RATES ARE GOING UP AND 218 00:07:28,320 --> 00:07:30,080 BECAUSE HEPATITIS C IS TREATED 219 00:07:30,080 --> 00:07:31,880 WITH DIRECT ACTING ANTIVIRALS 220 00:07:31,880 --> 00:07:33,880 THAT THE PREPORTION OF 221 00:07:33,880 --> 00:07:35,240 TRANSPLANTS BEING DONE FOR 222 00:07:35,240 --> 00:07:37,480 HEPATITIS C HAS DROPPED, FAIRLY 223 00:07:37,480 --> 00:07:38,880 DRAMATICALLY AND MUCH FASTER 224 00:07:38,880 --> 00:07:40,160 THAN WE THOUGHT IT WOULD, 225 00:07:40,160 --> 00:07:42,280 LEAVING US WITH ALCOHOL-SEWATED 226 00:07:42,280 --> 00:07:42,720 LIVER DISEASE. 227 00:07:42,720 --> 00:07:44,760 THIS GRAPHIC ON THE RIGHT YOU 228 00:07:44,760 --> 00:07:46,520 SEE IS FOR ALCOHOLIC HEPATITIS 229 00:07:46,520 --> 00:07:51,000 WHICH IS A SEVERE KIND OF ACUTE 230 00:07:51,000 --> 00:07:51,960 LIVER FAILURE THAT Dr. GAO 231 00:07:51,960 --> 00:07:54,080 WILL TALK ABOUT A LITTLE BIT 232 00:07:54,080 --> 00:07:54,280 MORE. 233 00:07:54,280 --> 00:07:58,640 THIS IS TRANSPLANTS FOR ACUTE 234 00:07:58,640 --> 00:07:59,640 ALCOHOLIC HEPATITIS SO WE'RE 235 00:07:59,640 --> 00:08:01,520 SEEING A PARADIGM SHIFT IN WHO 236 00:08:01,520 --> 00:08:03,080 WE'RE TRANSPLANTING AND MORE AND 237 00:08:03,080 --> 00:08:05,080 MORE CENTERS ARE TRANSPLANTING 238 00:08:05,080 --> 00:08:07,120 PATIENTS CAREFULLY SELECTED 239 00:08:07,120 --> 00:08:08,320 PATIENTS, WITH LESS THAN SIX 240 00:08:08,320 --> 00:08:11,640 MONTHS OF ABSTINENCE. 241 00:08:11,640 --> 00:08:14,480 SO, WHY IS ALD RISING? 242 00:08:14,480 --> 00:08:15,920 BECAUSE ALCOHOL MISUSE ACROSS 243 00:08:15,920 --> 00:08:17,160 THE NATION IS RISEING AND THERE 244 00:08:17,160 --> 00:08:21,080 HAVE BEEN LARGE-SCALE 245 00:08:21,080 --> 00:08:22,480 EPIDEMIOLOGIC SURVEYS THAT HAVE 246 00:08:22,480 --> 00:08:24,760 SHOWN TRENDS IN ALCOHOL USE 247 00:08:24,760 --> 00:08:26,280 RISING FOR MANY MEMBERS OF THE 248 00:08:26,280 --> 00:08:27,920 POPULATION AND MANY 249 00:08:27,920 --> 00:08:28,280 DEMOGRAPHICS. 250 00:08:28,280 --> 00:08:31,680 AND THIS STUDY SHOWS THAT 251 00:08:31,680 --> 00:08:34,280 MORTALITY FROM ALCOHOL USE 252 00:08:34,280 --> 00:08:36,080 DISORDERS WAS INCREASING OVER A 253 00:08:36,080 --> 00:08:38,160 20 TO 30 YEAR TIMEFRAME THAT IN 254 00:08:38,160 --> 00:08:39,320 MOST OF THE COUNTRIES AND MUCH 255 00:08:39,320 --> 00:08:41,320 OF THE COUNTRY WE ACTUALLY HAD 256 00:08:41,320 --> 00:08:42,960 SEEN INCREASE THIS IS SOME CASES 257 00:08:42,960 --> 00:08:44,880 FAIRLY DRAMATIC INCREASES IN 258 00:08:44,880 --> 00:08:47,240 ALCOHOL USE DISORDER MORTALITY 259 00:08:47,240 --> 00:08:49,280 WHICH INCLUDES ALD MORTALITY. 260 00:08:49,280 --> 00:08:50,920 HERE WHERE I'M AT IN MICHIGAN, 261 00:08:50,920 --> 00:08:52,800 KIND OF IN THIS MIDWEST AREA, 262 00:08:52,800 --> 00:08:55,280 YOU CAN SEE THAT THE INCREASES 263 00:08:55,280 --> 00:08:57,760 IN DEATHS FROM ALCOHOL AND USE 264 00:08:57,760 --> 00:08:58,920 DISORDERS AND ALD HAVE REALLY 265 00:08:58,920 --> 00:08:59,480 GONE UP. 266 00:08:59,480 --> 00:09:01,160 SO WE'VE BEEN REALLY FACING THIS 267 00:09:01,160 --> 00:09:04,120 CERTAINLY HERE IN MICHIGAN BUT 268 00:09:04,120 --> 00:09:04,640 ELSEWHERE. 269 00:09:04,640 --> 00:09:05,440 THE PANDEMIC DIDN'T MAKE THIS 270 00:09:05,440 --> 00:09:06,640 ANY BETTER. 271 00:09:06,640 --> 00:09:08,680 THE PANDEMIC ACTUALLY WORSENED 272 00:09:08,680 --> 00:09:09,840 THESE TRENDS AND MANY OF YOU 273 00:09:09,840 --> 00:09:11,040 HAVE HEARD ABOUT THE INCREASES 274 00:09:11,040 --> 00:09:13,920 IN DRINKING THAT OCCURRED AS A 275 00:09:13,920 --> 00:09:14,720 CONSEQUENCE OF THE COVID 276 00:09:14,720 --> 00:09:15,480 PANDEMIC. 277 00:09:15,480 --> 00:09:19,960 WHAT RECEIVE THEN THIS I STUDY N 278 00:09:19,960 --> 00:09:20,760 PARTICULAR, THERE WAS A PEAK 279 00:09:20,760 --> 00:09:22,880 ACROSS ALL RACES, ALL 280 00:09:22,880 --> 00:09:25,360 ETHNICITIES, ALL AGES, SEXES, WE 281 00:09:25,360 --> 00:09:27,600 SAW INCREASES IN ALCOHOL 282 00:09:27,600 --> 00:09:29,000 CONSUMPTION IN THE EARLY PHASE 283 00:09:29,000 --> 00:09:30,440 OF THE PANDEMIC AND THERE'S BEEN 284 00:09:30,440 --> 00:09:31,720 SOME A TEN YOUATION OF THAT AS 285 00:09:31,720 --> 00:09:33,760 THE PANDEMIC HAS GONE ON, AT 286 00:09:33,760 --> 00:09:35,880 LEAST UP TO THIS STUDY'S TIME 287 00:09:35,880 --> 00:09:37,560 POINT WHICH WAS A YEAR AND 288 00:09:37,560 --> 00:09:44,480 CHANGE AFTER THE PANDEMIC BEGAN, 289 00:09:44,480 --> 00:09:45,800 WHAT WE WERE FACING COMING INTO 290 00:09:45,800 --> 00:09:47,840 THE PANDEMIC WAS A TSUNAMI OF 291 00:09:47,840 --> 00:09:49,120 ALD AND NOW COMING OUT OF THE 292 00:09:49,120 --> 00:09:50,640 PANDEMIC, IT'S GOTTEN EVEN WORSE 293 00:09:50,640 --> 00:09:52,680 THAN WE EXPECT AND WE EXPECT TO 294 00:09:52,680 --> 00:09:53,960 SEE MOREMENT WE PUBLISHED ON 295 00:09:53,960 --> 00:09:57,560 THIS RECENTLY AND LOOKING 296 00:09:57,560 --> 00:09:59,640 SPECIFICALLY WAIT LISTING AND 297 00:09:59,640 --> 00:10:02,800 TRANSPLANTS FOR ACUTE ALCOHOLIC 298 00:10:02,800 --> 00:10:03,080 HEPATITIS. 299 00:10:03,080 --> 00:10:04,480 WE FOUND THAT IN THE EARLY 300 00:10:04,480 --> 00:10:06,480 PANDEMIC PERIOD, WE REALLY DID 301 00:10:06,480 --> 00:10:09,800 SEE A BIG SPIKE IN OUR WAIT 302 00:10:09,800 --> 00:10:11,040 LISTINGS FOR ALCOHOLIC HEPATITIS 303 00:10:11,040 --> 00:10:12,960 AND OUR TRANSPLANTS FOR ALCOHOL 304 00:10:12,960 --> 00:10:14,280 AND ALCOHOLIC HEPATITIS WHICH 305 00:10:14,280 --> 00:10:16,240 WERE FAR AND ABOVE WHAT WE WOULD 306 00:10:16,240 --> 00:10:18,000 HAVE EXPECTED FOR THAT 307 00:10:18,000 --> 00:10:18,440 TIMEFRAME. 308 00:10:18,440 --> 00:10:19,680 THIS WAS CONFIRMED IN ANOTHER 309 00:10:19,680 --> 00:10:21,600 STUDY THAT ALSO LOOKED AT THE 310 00:10:21,600 --> 00:10:24,600 OVER ALL INCREASE IN ALD 311 00:10:24,600 --> 00:10:26,760 TRANSPLANTS IN THE COVID ERA. 312 00:10:26,760 --> 00:10:28,520 SO HOPEFULLY IT SETS THE STAGE 313 00:10:28,520 --> 00:10:30,080 FOR WHERE WE'RE AT AND THAT 314 00:10:30,080 --> 00:10:31,360 WE'RE REALLY SEEING A PROBLEM 315 00:10:31,360 --> 00:10:32,880 THAT WAS A BIG PROBLEM EVEN 316 00:10:32,880 --> 00:10:33,960 BEFORE COVID AND IT WAS RISING 317 00:10:33,960 --> 00:10:35,240 BUT THEN WITH COVID IT'S JUST 318 00:10:35,240 --> 00:10:36,960 KIND OF BEEN LIKE GASOLINE ON 319 00:10:36,960 --> 00:10:38,360 FIRE IN TERMS OF WHAT WE'RE 320 00:10:38,360 --> 00:10:39,800 SEEING WITH ALCOHOL USE, ALCOHOL 321 00:10:39,800 --> 00:10:41,880 USE DISORDERS AND ALD. 322 00:10:41,880 --> 00:10:44,480 THE SINGLE MOST IMPORTANT FACTOR 323 00:10:44,480 --> 00:10:47,320 FOR ALD PATIENTS' SURVIVAL IS 324 00:10:47,320 --> 00:10:48,280 ALCOHOL CESSATION. 325 00:10:48,280 --> 00:10:50,720 WE DO NOT HAVE A LOT OF MEDICAL 326 00:10:50,720 --> 00:10:52,640 THERAPY THAT CONSISTENTLY WILL 327 00:10:52,640 --> 00:10:54,160 REVERSE THE COURSE OF THE LIVER 328 00:10:54,160 --> 00:10:56,480 DISEASE AND IMPROVE MORTALITY. 329 00:10:56,480 --> 00:10:58,960 WHAT REALLY WORKS IS ALCOHOL 330 00:10:58,960 --> 00:10:59,440 CESSATION. 331 00:10:59,440 --> 00:11:01,000 THOUGH WE CAN TRANSPLANT 332 00:11:01,000 --> 00:11:04,560 PATIENTS, AS YOU CAN SEE BY THE 333 00:11:04,560 --> 00:11:06,440 EPIDEMIOLOGIC CURVES WE DON'T 334 00:11:06,440 --> 00:11:07,000 HAVE ENOUGH LIVES FOR THE 335 00:11:07,000 --> 00:11:08,320 PATIENTS LISTED AND PATIENTS 336 00:11:08,320 --> 00:11:09,160 THAT NEED THEM. 337 00:11:09,160 --> 00:11:10,680 MOVING UPSTREAM AND TRYING TO 338 00:11:10,680 --> 00:11:11,880 IMPROVE THOSE RATES OF ALCOHOL 339 00:11:11,880 --> 00:11:13,160 CESSATION IS WHERE MANY OF US IN 340 00:11:13,160 --> 00:11:15,080 THE FIELD HAVE BEEN LOOKING. 341 00:11:15,080 --> 00:11:16,960 TO TRY TO GO UPSTREAM AT THIS. 342 00:11:16,960 --> 00:11:18,800 NOW ALCOHOL CESSATION 343 00:11:18,800 --> 00:11:20,560 INTERVENTIONS OCCUR AT MANY 344 00:11:20,560 --> 00:11:21,400 DIFFERENT LEVELS. 345 00:11:21,400 --> 00:11:22,680 WHAT I'LL TALK MOSTLY ABOUT IN 346 00:11:22,680 --> 00:11:24,560 THE REST OF THE TALK IS THIS 347 00:11:24,560 --> 00:11:27,800 YELLOW BOX, THE INTEGRATED CARE 348 00:11:27,800 --> 00:11:30,920 EVERS EFFORTS THAT HELP AT THE 349 00:11:30,920 --> 00:11:31,760 COMMUNITY LEVEL AND THERE ARE 350 00:11:31,760 --> 00:11:33,360 MANY INTERVENTIONS, MANY OF 351 00:11:33,360 --> 00:11:36,400 WHICH ARE HAPPENED ON THE 352 00:11:36,400 --> 00:11:39,000 PATIENT-TO-PATIENT OR 353 00:11:39,000 --> 00:11:40,200 PATIENT-TO-PRO PROVIDER LEVELS 354 00:11:40,200 --> 00:11:41,840 AND OTHER POWERFUL INTERVENTIONS 355 00:11:41,840 --> 00:11:44,120 IN THE FORM OF ALCOHOL AND DRUG 356 00:11:44,120 --> 00:11:44,400 POLICIES. 357 00:11:44,400 --> 00:11:49,040 TAX INCREASES, SETTING MINUTE 358 00:11:49,040 --> 00:11:50,400 YUM UNIT PRICES ON ALCOHOL. 359 00:11:50,400 --> 00:11:53,800 THERE ARE QUITE HELPFUL AT 360 00:11:53,800 --> 00:11:54,600 REDUCING POPULATION-LEVEL 361 00:11:54,600 --> 00:11:56,680 ALCOHOL USE AND BENDING SOME OF 362 00:11:56,680 --> 00:11:58,000 THESE CURVES DOWN AND ALSO ARE 363 00:11:58,000 --> 00:12:00,920 IMPORTANT BUT FOR TIME, WE WILL 364 00:12:00,920 --> 00:12:03,000 FOCUS TODAY EXCLUSIVELY ON 365 00:12:03,000 --> 00:12:04,440 INTEGRATING CARE EFFORTS HERE. 366 00:12:04,440 --> 00:12:06,720 INTEGRATED CARE IS REALLY IS 367 00:12:06,720 --> 00:12:08,800 INTER PROFESSIONAL COLLABORATION 368 00:12:08,800 --> 00:12:10,120 AND COMMUNICATION AROUND THE 369 00:12:10,120 --> 00:12:13,080 CARE OF A PATIENT AND WHAT WE 370 00:12:13,080 --> 00:12:15,880 MEAN BY IT WHEN WE TALK ABOUT 371 00:12:15,880 --> 00:12:17,200 RESPECT TO ALD IS THE COMING 372 00:12:17,200 --> 00:12:20,440 TOGETHER OF ALCOHOL USE DISORDER 373 00:12:20,440 --> 00:12:22,080 AND MENTAL HEALTH PROFESSIONALS 374 00:12:22,080 --> 00:12:24,200 WITH MEDICAL AND HELP TOLL GEE 375 00:12:24,200 --> 00:12:25,440 PROFESSIONALS TO CARE FOR THESE 376 00:12:25,440 --> 00:12:26,760 PATIENTS TOGETHER AND THAT CAN 377 00:12:26,760 --> 00:12:29,320 REALLY HAPPEN ON A SPECTRUM. 378 00:12:29,320 --> 00:12:31,360 SO, AT OUR CENTER, WE STARTED 379 00:12:31,360 --> 00:12:33,840 ONE OF THE NATION'S FIRST NON 380 00:12:33,840 --> 00:12:35,960 TRANSPLANT INTEGRATED CARE 381 00:12:35,960 --> 00:12:37,520 CLINICS FOR ALD PATIENTS WHERE 382 00:12:37,520 --> 00:12:40,880 WE HAVE AN EMBEDDED 383 00:12:40,880 --> 00:12:42,760 PSYCHOLOGIST, PSYCHIATRIST, 384 00:12:42,760 --> 00:12:44,160 HEPATOLOGIST, NURSE, ALL 385 00:12:44,160 --> 00:12:45,600 COLLATED IN THE CLINIC SEEING 386 00:12:45,600 --> 00:12:46,360 PATIENTS TOGETHER. 387 00:12:46,360 --> 00:12:47,760 NOW, THAT'S THE TOP-LEVEL OF 388 00:12:47,760 --> 00:12:49,920 WHAT WE WOULD THINK ABOUT AS 389 00:12:49,920 --> 00:12:50,760 INTEGRATED CARE. 390 00:12:50,760 --> 00:12:52,520 MOST PATIENTS, IN FACT, MANY 391 00:12:52,520 --> 00:12:53,480 PLACES CAN'T DO THAT OR DON'T 392 00:12:53,480 --> 00:12:54,880 HAVE THE RESOURCES OF THE 393 00:12:54,880 --> 00:12:56,200 INTEREST IN DOING THAT. 394 00:12:56,200 --> 00:12:57,720 THERE ARE OTHER STEPS IN THE 395 00:12:57,720 --> 00:12:59,680 INTEGRATED CARE SPECTRUM THAT GO 396 00:12:59,680 --> 00:13:01,680 FROM JUST BEING COMPLETELY 397 00:13:01,680 --> 00:13:03,240 UNAFFILIATE AND MAYBE NOT EVEN 398 00:13:03,240 --> 00:13:05,000 UNDERSTANDING THE LINKS BETWEEN 399 00:13:05,000 --> 00:13:07,200 ALCOHOL USE DISORDER TO MORE 400 00:13:07,200 --> 00:13:08,640 INFORMAL INTEGRATION WHERE 401 00:13:08,640 --> 00:13:10,400 PERHAPS CLINICIANS AND ADDICTION 402 00:13:10,400 --> 00:13:12,040 AND HELP TOLL GEE ARE AWARE OF 403 00:13:12,040 --> 00:13:14,440 ONE ANOTHER SERVICES AND PERHAPS 404 00:13:14,440 --> 00:13:16,920 MAY REGULARLY REFER TO THE SAME 405 00:13:16,920 --> 00:13:17,160 CLINICIAN. 406 00:13:17,160 --> 00:13:24,280 ALL THE WAY UP TO, AGAIN, ACTUAL 407 00:13:24,280 --> 00:13:34,560 CO-LOCATED CARE. 408 00:13:36,560 --> 00:13:37,640 I'M THINKING ABOUT DIAGNOSING 409 00:13:37,640 --> 00:13:40,200 THE DISORDER AND DIRECT THEM TO 410 00:13:40,200 --> 00:13:41,800 AUD TREATMENT, TO GET THEM INTO 411 00:13:41,800 --> 00:13:44,400 TREATMENT SO THAT DETECT, 412 00:13:44,400 --> 00:13:45,560 DIAGNOSE AND DIRECT FRAMEWORK WE 413 00:13:45,560 --> 00:13:47,520 USE IN OUR CLINIC AND ONE I USE 414 00:13:47,520 --> 00:13:50,880 TO TRY TO GET MY PATIENTS INTO 415 00:13:50,880 --> 00:13:51,560 CLINIC. 416 00:13:51,560 --> 00:13:53,360 SO, INTEGRATING CARE CAN BE A 417 00:13:53,360 --> 00:13:55,600 SIMPLE AND ONE OF THE SIMPLEST 418 00:13:55,600 --> 00:13:56,800 INTEGRATED CARE TASKS THAT ONE 419 00:13:56,800 --> 00:14:02,200 CAN DO IS TO SCREEN FOR ALCOHOL 420 00:14:02,200 --> 00:14:02,480 USE. 421 00:14:02,480 --> 00:14:03,640 BE AWARE OF ALCOHOL AS A 422 00:14:03,640 --> 00:14:04,000 PROBLEM. 423 00:14:04,000 --> 00:14:05,240 EVEN IF PATIENTS DON'T SEEM 424 00:14:05,240 --> 00:14:07,480 ALCOHOL MIGHT BE A PROBLEM. 425 00:14:07,480 --> 00:14:09,640 WE USE THE AUDIT C REGULARLY AND 426 00:14:09,640 --> 00:14:13,040 RE WWERECOMMEND THIS. 427 00:14:13,040 --> 00:14:14,400 THIS IS STANDARD FOR ALCOHOL. 428 00:14:14,400 --> 00:14:16,360 THIS IS A SHORTENED 429 00:14:16,360 --> 00:14:17,400 THREE-QUESTION VERSION OF THE 430 00:14:17,400 --> 00:14:19,440 LONGER 10-QUESTION AUDIT. 431 00:14:19,440 --> 00:14:21,520 AND THIS HAS DECADES OF 432 00:14:21,520 --> 00:14:22,920 VALIDATION BEHIND BOTH OF THESE, 433 00:14:22,920 --> 00:14:24,560 THE SHORTER AND THE LONGER 434 00:14:24,560 --> 00:14:24,920 FORM. 435 00:14:24,920 --> 00:14:26,200 AND WITHOUT THESE TYPES OF 436 00:14:26,200 --> 00:14:27,280 SURVEYS, WE CAN REALLY 437 00:14:27,280 --> 00:14:29,520 UNDERESTIMATE DRINKING AND OVER 438 00:14:29,520 --> 00:14:30,200 ESTIMATE ABSTINENCE AND THIS 439 00:14:30,200 --> 00:14:32,240 STUDY IS ONE THAT I ABSOLUTELY 440 00:14:32,240 --> 00:14:32,440 LOVE. 441 00:14:32,440 --> 00:14:33,840 IT WAS DONE IN THE TRANSPLANT 442 00:14:33,840 --> 00:14:36,720 CLINIC IN A POST TRANSPLANT 443 00:14:36,720 --> 00:14:37,160 CLINIC. 444 00:14:37,160 --> 00:14:40,280 THEY LOOKED AT PATIENTS WHO HAD 445 00:14:40,280 --> 00:14:41,080 ALCOHOL-RELATED LIVER DISEASE 446 00:14:41,080 --> 00:14:42,840 TRANSPLANTED FOR THAT AND THEY 447 00:14:42,840 --> 00:14:45,320 HAD IN A BLINDED FASHION 448 00:14:45,320 --> 00:14:46,040 HEPATOLOGISTS ASK THEM IF THEY 449 00:14:46,040 --> 00:14:47,320 WERE DRINKING AND THE PATIENT 450 00:14:47,320 --> 00:14:49,560 GOT AN AUDIT C AND ADDICTION 451 00:14:49,560 --> 00:14:50,680 SPECIALIST SAW THEM AND ASKED 452 00:14:50,680 --> 00:14:55,720 THEM ABOUT THEIR ALCOHOL USE AND 453 00:14:55,720 --> 00:14:56,800 BETWEEN THE SPECIALISTS THEY 454 00:14:56,800 --> 00:15:01,640 PICKED UP 20% MORE SO 1/5 WERE 455 00:15:01,640 --> 00:15:03,200 MISSED OF PEOPLE DRINKING MISSED 456 00:15:03,200 --> 00:15:05,680 BY A HEPATOLOGIST ALONE ASKING. 457 00:15:05,680 --> 00:15:07,840 15% MORE WERE ACTUALLY PICKED UP 458 00:15:07,840 --> 00:15:09,840 BY AN AUDIT C SO IMPLEMENTING 459 00:15:09,840 --> 00:15:11,240 THAT REGULARLY IN OUR PRACTICE 460 00:15:11,240 --> 00:15:14,560 BY ITSELF MAY BE A MEANS BY 461 00:15:14,560 --> 00:15:15,480 WHICH WE CAN DISCOVER DRINKING 462 00:15:15,480 --> 00:15:16,760 AND REALLY CONNECT PEOPLE TO THE 463 00:15:16,760 --> 00:15:19,240 TYPES OF RESOURCES THAT THEY 464 00:15:19,240 --> 00:15:21,960 NEED TO NOT REGAIN ABSTINENCE. 465 00:15:21,960 --> 00:15:23,400 THE OTHER ASPECT OF INTEGRATED 466 00:15:23,400 --> 00:15:24,800 CARE THAT WE ALWAYS REALLY WANT 467 00:15:24,800 --> 00:15:25,880 TO BE DOING IN TERMS OF 468 00:15:25,880 --> 00:15:27,040 SCREENING AND LOOKING FOR 469 00:15:27,040 --> 00:15:29,320 ALCOHOL USE, IS USING READILY 470 00:15:29,320 --> 00:15:30,760 AVAILABLE DIRECT ALCOHOL 471 00:15:30,760 --> 00:15:33,240 BIOMARKERS. 472 00:15:33,240 --> 00:15:34,400 SO, BIOMARKERS COME IN INDIRECT 473 00:15:34,400 --> 00:15:35,280 AND DIRECT FLAVORS. 474 00:15:35,280 --> 00:15:36,080 INDIRECTION ARE THINGS LIKE 475 00:15:36,080 --> 00:15:39,000 ELEVATED AST TO ALT LEVELS AND 476 00:15:39,000 --> 00:15:41,480 AST TO ALT RATIOS OF TWO-TO-ONE 477 00:15:41,480 --> 00:15:43,720 AND GGT LEVELS AND THOSE ARE 478 00:15:43,720 --> 00:15:45,240 INDIRECT BUT DIRECT ALCOHOL 479 00:15:45,240 --> 00:15:46,560 BIOMARKERS ARE BREAKDOWN 480 00:15:46,560 --> 00:15:49,240 PRODUCTS OF ALCOHOL. 481 00:15:49,240 --> 00:15:51,600 SO THESE ARE METABOLIZED 482 00:15:51,600 --> 00:15:53,040 PRODUCTS OF VOLUME EX COTTAGE 483 00:15:53,040 --> 00:16:04,360 COUNTREXCRETED INTHE AND IT'S BO 484 00:16:05,440 --> 00:16:06,120 FIVE DAYS. 485 00:16:06,120 --> 00:16:10,360 FOR THE URINE STUDIES, YOU HAVE 486 00:16:10,360 --> 00:16:12,120 TO WATCH RENAL FAILURE THAT CAN 487 00:16:12,120 --> 00:16:13,840 EXTENT AND PROLONG THAT 488 00:16:13,840 --> 00:16:15,240 DETECTION TIME. 489 00:16:15,240 --> 00:16:19,640 BUT THEY HAVE GOOD SENSITIVITY 490 00:16:19,640 --> 00:16:21,520 SPECIFICITY AND THIS DATA SCHEER 491 00:16:21,520 --> 00:16:22,280 IN LIVER DISEASE PATIENTS. 492 00:16:22,280 --> 00:16:24,680 THIS IS THE VALIDATION IN LIVER 493 00:16:24,680 --> 00:16:26,080 DISEASE PATIENTS IN ALD 494 00:16:26,080 --> 00:16:26,320 PATIENTS. 495 00:16:26,320 --> 00:16:30,480 WE DON'T REALLY USE HAIR. 496 00:16:30,480 --> 00:16:32,280 THIS IS USED FORENSICALLY 497 00:16:32,280 --> 00:16:35,200 BECAUSE IT TAKES A GOOD CHUNK OF 498 00:16:35,200 --> 00:16:38,040 HAIR SO OUR PATIENTS DON'T WANT 499 00:16:38,040 --> 00:16:38,840 TO GIVE HAIR. 500 00:16:38,840 --> 00:16:40,640 IT GIVES DETECTIONS BACK SEVERAL 501 00:16:40,640 --> 00:16:44,200 MONTHS WITH VERY GOOD DIAGNOSTIC 502 00:16:44,200 --> 00:16:47,640 STATISTICS AS WELL. 503 00:16:47,640 --> 00:16:51,160 AND THEN FOSSPHAIT ALCOHOL AND 504 00:16:51,160 --> 00:16:53,880 THIS IS A BLOOD PRODUCT AND THIS 505 00:16:53,880 --> 00:16:57,440 IS A ATTACHED TO THE RED BLOOD 506 00:16:57,440 --> 00:17:00,440 CELLS AND DETECTED AND IT 507 00:17:00,440 --> 00:17:02,320 DETECTS ALCOHOL USE ABOUT TWO TO 508 00:17:02,320 --> 00:17:03,120 THREE WEEKS BACK. 509 00:17:03,120 --> 00:17:05,520 AS YOU CAN SEE, THE DIAGNOSTICS 510 00:17:05,520 --> 00:17:07,960 STATISTICS ARE ACTUALLY QUITE 511 00:17:07,960 --> 00:17:09,400 GOOD ON THIS IN ALD PATIENTS, 512 00:17:09,400 --> 00:17:11,040 THIS IS A DIRECT SIDE BY SIDE 513 00:17:11,040 --> 00:17:13,400 COMPARISON OF THE PERFORMANCE 514 00:17:13,400 --> 00:17:15,400 CHARACTERISTICS AND PERCENT, 515 00:17:15,400 --> 00:17:17,760 CASH ROW HYDRATE IN THE PURPLE 516 00:17:17,760 --> 00:17:19,400 IS NOT RECOMMENDED FOR USE. 517 00:17:19,400 --> 00:17:21,440 THIS IS A INDIRECT BIOMARKER AND 518 00:17:21,440 --> 00:17:23,200 IT'S INACCURATE IN ADVANCED 519 00:17:23,200 --> 00:17:24,640 LIVER DISEASE SO WE DO NOT USE 520 00:17:24,640 --> 00:17:26,800 THIS ANY LONGER. 521 00:17:26,800 --> 00:17:29,480 URINE AND ETH HE WILL AND 522 00:17:29,480 --> 00:17:31,880 ETHANOL SHOW AGAIN PRETTY GOOD 523 00:17:31,880 --> 00:17:33,760 DIAGNOSTIC SENSITIVITY 524 00:17:33,760 --> 00:17:36,120 CHARACTERISTICS AND THE WAY WE 525 00:17:36,120 --> 00:17:38,600 USE THIS IN MICHIGAN WE GET BOTH 526 00:17:38,600 --> 00:17:39,320 OF THESE. 527 00:17:39,320 --> 00:17:41,480 TO GET KIND OF MORE RECENT USE 528 00:17:41,480 --> 00:17:43,480 AND THEN A ETHANOL AS WELL TO 529 00:17:43,480 --> 00:17:45,240 PICK UP ANY LONG-TERM USE AND 530 00:17:45,240 --> 00:17:46,920 THE CHARACTERISTICS OF THESE ARE 531 00:17:46,920 --> 00:17:48,800 ACTUALLY FAIRLY GOOD. 532 00:17:48,800 --> 00:17:51,000 FALSE POSITIVES AND FALSE 533 00:17:51,000 --> 00:17:52,400 NEGATIVES OCCUR SO BE AWARE OF 534 00:17:52,400 --> 00:17:54,760 THAT IF YOU USE THESE WITH YOUR 535 00:17:54,760 --> 00:17:55,840 PATIENTS AND DISCUSS IT UP 536 00:17:55,840 --> 00:17:56,360 FRONT. 537 00:17:56,360 --> 00:17:57,440 WE WANT TO MAKE SURE OUR 538 00:17:57,440 --> 00:17:59,880 PATIENTS ARE AWARE THAT WE'LL 539 00:17:59,880 --> 00:18:01,600 CHECK ALCOHOL BIO MACKERS AND WE 540 00:18:01,600 --> 00:18:03,240 CHECK THEM NOT TO TRY TO CATCH 541 00:18:03,240 --> 00:18:04,640 THEM IN THE ACTOR GET THEM INTO 542 00:18:04,640 --> 00:18:08,640 TROUBLE BUT BECAUSE WE WANT TO 543 00:18:08,640 --> 00:18:10,280 DETECT UNDISCLOSED ALCOHOL USE 544 00:18:10,280 --> 00:18:11,880 SO THAT WE CAN GET PATIENTS 545 00:18:11,880 --> 00:18:13,200 CONNECTED TO TREATMENT AND BACK 546 00:18:13,200 --> 00:18:14,520 TO ABSTINENCE. 547 00:18:14,520 --> 00:18:15,760 BECAUSE ON GOING ALCOHOL USE IN 548 00:18:15,760 --> 00:18:19,080 THE CONTEXT OF ALD IS ACTUALLY 549 00:18:19,080 --> 00:18:21,040 THE SINGLE BIGGEST PRO 550 00:18:21,040 --> 00:18:22,560 DICTIONARY OR OF MORTALITY. 551 00:18:22,560 --> 00:18:26,280 ON GOING DRINKING IF SOMEONE HAS 552 00:18:26,280 --> 00:18:26,920 CIRRHOSIS, DOUBLES OR MORE THEIR 553 00:18:26,920 --> 00:18:28,840 RISK OF MORTALITY IF THEY DRINK 554 00:18:28,840 --> 00:18:30,760 ONE TO TWO DRINKS A DAY SO IT'S 555 00:18:30,760 --> 00:18:33,240 IMPORTANT PEOPLE ABSTAIN AND TOX 556 00:18:33,240 --> 00:18:34,280 SCREENS, AUDIT SCORES AND THOSE 557 00:18:34,280 --> 00:18:36,040 THINGS ARE A WAY WE CAN DETECT A 558 00:18:36,040 --> 00:18:40,320 PROBLEM AND THEN THEM INTO 559 00:18:40,320 --> 00:18:40,720 TREATMENT. 560 00:18:40,720 --> 00:18:42,320 WHY IS IT IMPORTANT TO INTEGRATE 561 00:18:42,320 --> 00:18:43,880 FOR CARE FOR LIVER DISEASE. 562 00:18:43,880 --> 00:18:46,680 THE LIVER DISEASE IS IT A HUGE 563 00:18:46,680 --> 00:18:47,600 MOTIVATOR FOR CHANGE WITH 564 00:18:47,600 --> 00:18:48,760 RESPECT TO ALCOHOL. 565 00:18:48,760 --> 00:18:50,800 STUDIES OF STIGMA THAT SHOWN 566 00:18:50,800 --> 00:18:54,240 THAT PEOPLE WITH CIRRHOSIS FEEL 567 00:18:54,240 --> 00:18:55,400 STIGMATIZED HAVING CIRRHOSIS BUT 568 00:18:55,400 --> 00:18:58,000 THE REASON IS BECAUSE THEY 569 00:18:58,000 --> 00:18:59,920 ASSOCIATE, MOST PEOPLE ASSOCIATE 570 00:18:59,920 --> 00:19:01,440 CIRRHOSIS WITH ALCOHOL USE. 571 00:19:01,440 --> 00:19:04,040 SO, HIGHLY STIGMATIZED CONDITION 572 00:19:04,040 --> 00:19:05,840 AND WHEN PEOPLE GET LIVER 573 00:19:05,840 --> 00:19:09,360 DISEASE FROM THEIR ALCOHOL, THIS 574 00:19:09,360 --> 00:19:10,200 IS A LEVERAGE POINT AND 575 00:19:10,200 --> 00:19:11,040 MOTIVATION TO CHANGE. 576 00:19:11,040 --> 00:19:12,520 THIS IS A GREAT STUDY OUT OF 577 00:19:12,520 --> 00:19:14,440 ENGLAND WHERE THEY LOOKED AT 578 00:19:14,440 --> 00:19:15,640 PRIMARY CARE AUDIT SCREENS. 579 00:19:15,640 --> 00:19:17,240 THIS IS A PRIMARY CARE CLINIC 580 00:19:17,240 --> 00:19:19,320 AND THEY DID A LIVER CHECKUP 581 00:19:19,320 --> 00:19:23,000 THAT WAS A ALGORITHM WITH A 582 00:19:23,000 --> 00:19:24,040 GREEN, YELLOW AND RED. 583 00:19:24,040 --> 00:19:26,160 IF YOU WERE IN THE YELLOW-RED 584 00:19:26,160 --> 00:19:27,960 YOU WERE MORE SEVERE AND MAYBE 585 00:19:27,960 --> 00:19:28,600 MORE LIVER DAMAGE FROM ALCOHOL 586 00:19:28,600 --> 00:19:29,440 WAS GOING ON. 587 00:19:29,440 --> 00:19:31,240 IF YOU WERE GREEN, MAYBE LESS. 588 00:19:31,240 --> 00:19:32,600 AND WHAT THEY FOUND WAS THAT 589 00:19:32,600 --> 00:19:34,240 JUST BY DOING THE AUDIT SCREEN 590 00:19:34,240 --> 00:19:36,560 AND PROVIDING THEM WITH SOME 591 00:19:36,560 --> 00:19:37,760 LIVER-SPECIFIC FEEDBACK ABOUT 592 00:19:37,760 --> 00:19:40,240 WHERE THEY WERE, ON THIS LIVER 593 00:19:40,240 --> 00:19:42,640 CHECKUP, PATIENTS WHO HAD MORE 594 00:19:42,640 --> 00:19:43,600 SEVERE LIVER DISEASE IN THIS 595 00:19:43,600 --> 00:19:45,720 YELLOW AND RED CATEGORY AT ONE 596 00:19:45,720 --> 00:19:48,120 YEAR AFTER, THAT INFORMATION, 597 00:19:48,120 --> 00:19:50,480 HAD TWO-THIRDS OF THEM HAD HAD 598 00:19:50,480 --> 00:19:51,200 SIGNIFICANT REDUCTION THIS IS 599 00:19:51,200 --> 00:19:53,280 THEIR AUDIT GRADES SO THEY WERE 600 00:19:53,280 --> 00:19:53,880 DRINKING LESS. 601 00:19:53,880 --> 00:19:55,560 MAYBE NOT TOTALLY ABSTINENT BUT 602 00:19:55,560 --> 00:19:57,600 THEY HAD ACTUALLY REDUCED THEIR 603 00:19:57,600 --> 00:19:58,760 DRINKING DRAMATICALLY AND EVEN 604 00:19:58,760 --> 00:19:59,880 ABOUT ONE-THIRD OF THE PEOPLE IN 605 00:19:59,880 --> 00:20:02,800 THE GREEN CATEGORY HAD REDUCED 606 00:20:02,800 --> 00:20:03,600 THEIR ALCOHOL USE. 607 00:20:03,600 --> 00:20:05,560 SO THIS WAS REALLY AN IMPORTANT 608 00:20:05,560 --> 00:20:12,120 STUD SKI'STUDY AND SHOWS THE I L 609 00:20:12,120 --> 00:20:13,080 INTEGRATIONS INTEGRATING THE 610 00:20:13,080 --> 00:20:15,320 ALCOHOL DISCUSSION WITH IN A 611 00:20:15,320 --> 00:20:17,480 SYSTEM TIESED AWAY HAD A GOOD 612 00:20:17,480 --> 00:20:17,760 OUTCOME. 613 00:20:17,760 --> 00:20:19,320 WE ALSO WANT TO TRY TO CONNECT 614 00:20:19,320 --> 00:20:20,440 PATIENTS TO TREATMENT AND THAT 615 00:20:20,440 --> 00:20:22,440 CAN BE A REAL CHALLENGE IN OUR 616 00:20:22,440 --> 00:20:24,440 STUDY OF ADMINISTRATIVE DATA, 617 00:20:24,440 --> 00:20:26,240 PRIVATELY INSURED PATIENTS AND 618 00:20:26,240 --> 00:20:28,000 ALSO IN A SUBSEQUENT STUDY IN 619 00:20:28,000 --> 00:20:29,200 PITTSBURG BY SHERRY RECOGNIZEEL 620 00:20:29,200 --> 00:20:31,560 AND THE CV THERE WAS A REALLY 621 00:20:31,560 --> 00:20:33,200 LOW RATE OF ALCOHOL USE DISORDER 622 00:20:33,200 --> 00:20:34,880 TREATMENT IN PATIENTS WITH 623 00:20:34,880 --> 00:20:36,800 ADVANCED ALCOHOL RELATED LIVER 624 00:20:36,800 --> 00:20:37,000 DISEASE. 625 00:20:37,000 --> 00:20:39,440 SO THAT'S CIRRHOSIS OR ALCOHOLIC 626 00:20:39,440 --> 00:20:41,360 HEPATITIS SO MOST ADVANCE FORM, 627 00:20:41,360 --> 00:20:44,000 ONLY ABOUT 10%, 10% TO 15% OF 628 00:20:44,000 --> 00:20:45,160 PATIENTS A YEAR AFTER THEIR 629 00:20:45,160 --> 00:20:48,240 FIRST DIAGNOSIS OF 630 00:20:48,240 --> 00:20:50,000 ALCOHOL-RELATED CIRRHOSIS GOT 631 00:20:50,000 --> 00:20:52,840 INTO BEHAVIORAL THERAPY OR GOT 632 00:20:52,840 --> 00:20:55,440 PHARMA CO THERAPY SO REALLY LOW 633 00:20:55,440 --> 00:20:55,800 RATES. 634 00:20:55,800 --> 00:20:57,440 BUT WHEN THEY DID GET INTO 635 00:20:57,440 --> 00:20:59,840 ALCOHOL TREATMENT, THEY HAD 636 00:20:59,840 --> 00:21:01,520 SIGNIFICANTLY LESS DECREASE 637 00:21:01,520 --> 00:21:02,760 LIKELIHOOD OF DECOMPENSATION AND 638 00:21:02,760 --> 00:21:07,440 THAT MEANS DEVELOPING GI 639 00:21:07,440 --> 00:21:10,600 BLEEDING OR LIVER RELATED 640 00:21:10,600 --> 00:21:12,600 CONFUSION. 641 00:21:12,600 --> 00:21:14,160 THESE MAJOR CLINICAL POINTS AT 642 00:21:14,160 --> 00:21:15,320 WHICH WE SAY SOMEONE IS GOING 643 00:21:15,320 --> 00:21:17,960 INTO A MORE SEVERE CATEGORY OF 644 00:21:17,960 --> 00:21:20,000 LIVER DISEASE THAT IS 645 00:21:20,000 --> 00:21:21,640 DECOMPENSATION AND THOSE WHO GOT 646 00:21:21,640 --> 00:21:22,800 INTO ALCOHOL TREATMENT WHEN THEY 647 00:21:22,800 --> 00:21:25,080 WERE COMPENSATED HAD DECREASED 648 00:21:25,080 --> 00:21:28,400 RISKS, 15% AT ONE YEAR OF 649 00:21:28,400 --> 00:21:29,720 DECOMPENSATION AND THEY HAD A 650 00:21:29,720 --> 00:21:31,640 DECREASE MORTALITY AND THERE 651 00:21:31,640 --> 00:21:33,400 ISN'T MUCH THAT WE HAVE IN 652 00:21:33,400 --> 00:21:34,840 ADVANCED ALCOHOL RELATED LIVER 653 00:21:34,840 --> 00:21:36,480 DISEASE THAT DECREASES 654 00:21:36,480 --> 00:21:36,840 MORTALITY. 655 00:21:36,840 --> 00:21:38,920 BUT THIS IS IT. 656 00:21:38,920 --> 00:21:40,440 GETTING INTO ALCOHOL TREATMENT, 657 00:21:40,440 --> 00:21:41,800 REDUCING OR STOPPING YOUR 658 00:21:41,800 --> 00:21:43,400 ALCOHOL USE IS REALLY CRITICAL 659 00:21:43,400 --> 00:21:43,800 HERE. 660 00:21:43,800 --> 00:21:44,800 AND THERE ARE A LOT OF REASONS 661 00:21:44,800 --> 00:21:46,240 WHY PEOPLE DON'T GET INTO 662 00:21:46,240 --> 00:21:46,960 ALCOHOL TREATMENT. 663 00:21:46,960 --> 00:21:50,040 IT CAN BE MANY BARRIERS FROM 664 00:21:50,040 --> 00:21:51,000 LOGISTICAL BARRIERS LIKE 665 00:21:51,000 --> 00:21:53,920 INSURANCE COVERAGE, FINANCES, 666 00:21:53,920 --> 00:21:54,880 CHILDCARE, TRANSPORTATION, 667 00:21:54,880 --> 00:21:56,680 MINIMAL MENTAL HEALTH PROVIDERS, 668 00:21:56,680 --> 00:21:57,800 SUBSTANCE USE PROVIDERS WHERE 669 00:21:57,800 --> 00:21:59,480 YOU ARE AT BUT THE SINGLE 670 00:21:59,480 --> 00:22:00,920 BIGGEST REASON IN MY STUDIES AND 671 00:22:00,920 --> 00:22:02,600 IN THE BROADER ALCOHOL USE 672 00:22:02,600 --> 00:22:04,640 LITERATURE, IS REALLY AN 673 00:22:04,640 --> 00:22:06,560 ATTITUDINAL BARRIERS THAT IS 674 00:22:06,560 --> 00:22:08,120 PEOPLE DON'T FEEL LIKE THEY NEED 675 00:22:08,120 --> 00:22:13,600 TREATMENT AND THEY DON'T FEEL 676 00:22:13,600 --> 00:22:17,880 LIKE THEY CAN DO IT ON THEIR OWN 677 00:22:17,880 --> 00:22:19,160 AND BY AND LARGE THERE'S A SENSE 678 00:22:19,160 --> 00:22:20,520 THAT THEY DON'T REALLY FEEL LIKE 679 00:22:20,520 --> 00:22:21,440 THEY NEED IT. 680 00:22:21,440 --> 00:22:23,280 THAT'S WHERE WE, AS MEDICAL 681 00:22:23,280 --> 00:22:24,800 PROFESSIONALS, CAN COME IN AND 682 00:22:24,800 --> 00:22:26,240 START TALKING ABOUT ALCOHOL 683 00:22:26,240 --> 00:22:27,160 TREATMENT WHEN WE'RE TALKING 684 00:22:27,160 --> 00:22:29,480 ABOUT THE MEDICAL TREATMENT. 685 00:22:29,480 --> 00:22:31,280 NOT AS SOMETHING DIFFERENT. 686 00:22:31,280 --> 00:22:32,680 ADDRESS THESE ATTITUDE NAL 687 00:22:32,680 --> 00:22:33,520 BARRIERS UP FRONT BECAUSE PEOPLE 688 00:22:33,520 --> 00:22:35,200 DON'T PAY ATTENTION TO THEIR 689 00:22:35,200 --> 00:22:36,360 MEDICAL DOCTORS WHEN THEY TELL 690 00:22:36,360 --> 00:22:37,520 THEM, YOU KNOW, YOU REALLY NEED 691 00:22:37,520 --> 00:22:39,520 TO DO THIS FOR YOUR LIVER HEALTH 692 00:22:39,520 --> 00:22:40,720 AND MEDICAL HEALTH AND TALK 693 00:22:40,720 --> 00:22:42,720 ABOUT THE BENEFITS OF ALCOHOL 694 00:22:42,720 --> 00:22:44,360 COUNSELING AND TREATMENT, NOT 695 00:22:44,360 --> 00:22:46,400 JUST ON ALCOHOL CESSATION BUT 696 00:22:46,400 --> 00:22:47,000 THEIR LIVER HEALTH, MEDICAL 697 00:22:47,000 --> 00:22:48,320 HEALTH AND THE OTHER THINGS THAT 698 00:22:48,320 --> 00:22:49,760 THEY CARE ABOUT LIKE, FEELING 699 00:22:49,760 --> 00:22:51,280 BETTER AT WORK OR FUNCTIONING 700 00:22:51,280 --> 00:22:54,240 BETTER IN LIFE OR HAVING BETTER 701 00:22:54,240 --> 00:22:54,840 RELATIONSHIPS. 702 00:22:54,840 --> 00:22:56,600 THAT MESSAGE COMING FROM A 703 00:22:56,600 --> 00:22:59,520 MEDICAL PROFESSIONAL, IS REALLY 704 00:22:59,520 --> 00:22:59,880 POWERFUL. 705 00:22:59,880 --> 00:23:01,400 SO MOVING ON TO SOME KIND OF 706 00:23:01,400 --> 00:23:02,880 BROADER MORE ORGANIZATIONAL 707 00:23:02,880 --> 00:23:04,560 LEVEL INTERVENTIONS, WE'LL TALK 708 00:23:04,560 --> 00:23:06,920 ABOUT INTEGRATED CARE KIND OF AT 709 00:23:06,920 --> 00:23:08,320 THE CLINIC LEVEL OR HIGHER. 710 00:23:08,320 --> 00:23:10,120 SO THIS IS A STUDY THAT LOOKED 711 00:23:10,120 --> 00:23:11,720 AT, AGAIN, THAT KIND OF THE MOST 712 00:23:11,720 --> 00:23:13,720 BASIC INTEGRATED CARE TASK THAT 713 00:23:13,720 --> 00:23:16,000 NEEDS TO BE PERFORMED WHICH IS 714 00:23:16,000 --> 00:23:17,400 SCREENING FOR THE ALCOHOL USE. 715 00:23:17,400 --> 00:23:19,200 HERE AGAIN, IN ENGLAND, THIS 716 00:23:19,200 --> 00:23:21,600 WAS, I BELIEVE, AT THE PORT 717 00:23:21,600 --> 00:23:22,800 SMITH HOSPITAL IN ENGLAND THAT 718 00:23:22,800 --> 00:23:24,680 HAS THE HIGHEST RATES OF 719 00:23:24,680 --> 00:23:25,320 ALCOHOL-RELATED CONDITIONS AND 720 00:23:25,320 --> 00:23:27,240 PROBLEMS OF ALL OF THE UNITED 721 00:23:27,240 --> 00:23:27,640 KINGDOM. 722 00:23:27,640 --> 00:23:29,760 THEY IMPLEMENTED A NURSE-LED 723 00:23:29,760 --> 00:23:30,720 ALCOHOL SCREENING PROGRAM FOR 724 00:23:30,720 --> 00:23:31,880 EVERYONE WHO CAME IN THEIR 725 00:23:31,880 --> 00:23:32,160 HOSPITAL. 726 00:23:32,160 --> 00:23:33,680 AND WHAT THEY SHOWED WITH THIS 727 00:23:33,680 --> 00:23:35,480 WAS IT WAS VERY FEASIBLE, 90% OF 728 00:23:35,480 --> 00:23:37,320 THE PATIENTS HAD A COMPLETED 729 00:23:37,320 --> 00:23:37,640 SCREEN. 730 00:23:37,640 --> 00:23:39,280 AND THEY WERE ABLE TO IDENTIFY 731 00:23:39,280 --> 00:23:41,480 SOME HIGHER-RISK GROUPS 732 00:23:41,480 --> 00:23:43,840 INCLUDING THOSE WERE HIGHER RISK 733 00:23:43,840 --> 00:23:44,080 FOR ALD. 734 00:23:44,080 --> 00:23:45,360 THEY CONNECTED THEM TO A 735 00:23:45,360 --> 00:23:46,760 AUTOMATIC REFERRAL SYSTEM TO DO 736 00:23:46,760 --> 00:23:49,040 A WARM HAND OFF TO AUD CARE 737 00:23:49,040 --> 00:23:50,000 DEPENDING IF THEY WERE HIGH 738 00:23:50,000 --> 00:23:52,480 VERSUS LOW RISK AND FOR THOSE 739 00:23:52,480 --> 00:23:53,800 WERE LOWER RISK DRINKERS WHERE 740 00:23:53,800 --> 00:23:55,920 THE EVIDENCE IS THE STRONGEST, 741 00:23:55,920 --> 00:23:57,600 ANY MEDICAL PROFESSIONAL WAS 742 00:23:57,600 --> 00:23:59,120 ENCOURAGED TO OFFER A BRIEF 743 00:23:59,120 --> 00:24:01,920 INTERVENTION FOR ALCOHOL USE. 744 00:24:01,920 --> 00:24:04,040 IN ADDITION, IN THE U.K. THEY 745 00:24:04,040 --> 00:24:05,840 HAVE, FOR MANY YEARS, HAD 746 00:24:05,840 --> 00:24:07,120 ALCOHOL CARE TEAMS AND THIS IS 747 00:24:07,120 --> 00:24:09,560 REALLY KIND OF THE CREM DE LA 748 00:24:09,560 --> 00:24:11,120 CREM OF INTEGRATED CARRYING 749 00:24:11,120 --> 00:24:11,320 RIGHT. 750 00:24:11,320 --> 00:24:12,760 YOU SEE FROM THE LIST HERE, THIS 751 00:24:12,760 --> 00:24:14,640 INVOLVES A LOT OF COORDINATION 752 00:24:14,640 --> 00:24:16,080 AND A LOT OF INTEGRATED CARE 753 00:24:16,080 --> 00:24:18,960 TASKS THAT ARE BEING PERFORMED. 754 00:24:18,960 --> 00:24:21,520 A LOT OF COMMUNICATION HAPPENING 755 00:24:21,520 --> 00:24:24,160 ACROSS AWFUL THESE DIFFERENT 756 00:24:24,160 --> 00:24:24,760 MULTI-DISCIPLINARY TEAM MEMBERS 757 00:24:24,760 --> 00:24:27,680 BUT THEY'VE REALLY GONE TO 758 00:24:27,680 --> 00:24:29,320 LENGTHS TO IMPLEMENT THESE 759 00:24:29,320 --> 00:24:30,520 ALCOHOL CARE TEAMS AND WHAT THEY 760 00:24:30,520 --> 00:24:33,560 SEEN IS THAT BY IMPLEMENTING 761 00:24:33,560 --> 00:24:35,080 THESE, AND DOING THE RIGHT WORK 762 00:24:35,080 --> 00:24:35,920 WITH IT. 763 00:24:35,920 --> 00:24:37,720 LOOKING AT THEIR OUTCOMES AND 764 00:24:37,720 --> 00:24:39,440 TAKING THOSE OUTCOMES AND MAKING 765 00:24:39,440 --> 00:24:40,760 CHANGES ITERATING TO IMPROVE 766 00:24:40,760 --> 00:24:42,040 THEIR QUALITY AND TO IMPROVE 767 00:24:42,040 --> 00:24:43,800 THEIR OUTCOMES, THEY HAVE BEEN 768 00:24:43,800 --> 00:24:45,680 ABLE TO SHOW REDUCTIONS IN ACUTE 769 00:24:45,680 --> 00:24:47,720 HOSPITAL ADMISSIONS, 770 00:24:47,720 --> 00:24:50,960 READMISSIONS AND PORTAL TEE FOR 771 00:24:50,960 --> 00:24:52,320 ALCOHOL-RELATED INDICATIONS AND 772 00:24:52,320 --> 00:24:56,120 THEY'VE IMPROVE T PROVED THEIR . 773 00:24:56,120 --> 00:24:58,560 THIS IS A GREAT MODEL THAT MOST 774 00:24:58,560 --> 00:25:01,360 OF US IN THE U.S. SHOULD BE 775 00:25:01,360 --> 00:25:01,760 IMPLEMENTING. 776 00:25:01,760 --> 00:25:03,440 THE NURSE-LED ALCOHOL CARE 777 00:25:03,440 --> 00:25:05,200 TEAMS, AS OPPOSED TO THE 778 00:25:05,200 --> 00:25:06,400 PHYSICIAN-LED CARE TEAMS 779 00:25:06,400 --> 00:25:07,920 ACTUALLY HAD GREATER REDUCTIONS 780 00:25:07,920 --> 00:25:09,560 AT SIX AND 12 MONTHS IN ALCOHOL 781 00:25:09,560 --> 00:25:11,320 INTAKE AND GGT LEVELS SO THAT 782 00:25:11,320 --> 00:25:14,160 BIO MARKER, THAT INDIRECT 783 00:25:14,160 --> 00:25:15,240 BIOMARKER OF ALCOHOL USE. 784 00:25:15,240 --> 00:25:16,760 SO AGAIN, JUST SHOWING THAT WE 785 00:25:16,760 --> 00:25:18,520 REALLY NEED THE 786 00:25:18,520 --> 00:25:19,360 MULTI-DISCIPLINARY CARE HERE. 787 00:25:19,360 --> 00:25:20,760 IT'S NOT JUST PHYSICIANS DOING 788 00:25:20,760 --> 00:25:23,960 T. IT'S THE ENTIRE TEAM COMING 789 00:25:23,960 --> 00:25:24,560 TOGETHER. 790 00:25:24,560 --> 00:25:26,800 NURSES, SOCIAL WORKERS, 791 00:25:26,800 --> 00:25:27,520 PSYCHOLOGISTS, PSYCHIATRISTS AND 792 00:25:27,520 --> 00:25:30,160 PHYSICIANS TO HELP THESE 793 00:25:30,160 --> 00:25:30,560 PATIENTS. 794 00:25:30,560 --> 00:25:32,400 IN THE TRANSPLANT WORLD, AGAIN, 795 00:25:32,400 --> 00:25:33,720 THE TRANSPLANT WORLD IS OFTEN 796 00:25:33,720 --> 00:25:35,720 VERY INTEGRATED JUST AT 797 00:25:35,720 --> 00:25:36,000 BASELINE. 798 00:25:36,000 --> 00:25:37,520 OUR TEAMS INCLUDE SURGEONS AND 799 00:25:37,520 --> 00:25:39,400 SOCIAL WORKERS, NURSES, 800 00:25:39,400 --> 00:25:42,240 HEPATOLOGISTS AND INCREASINGLY, 801 00:25:42,240 --> 00:25:43,160 PSYCHIATRIST TREE, PSYCHOLOGY AS 802 00:25:43,160 --> 00:25:45,640 WE RECOGNIZE THAT THE FACE OF 803 00:25:45,640 --> 00:25:46,880 TRANSPLANT, PARTICULARLY LIVER 804 00:25:46,880 --> 00:25:48,480 TRANSPLANT, IS VERY MUCH 805 00:25:48,480 --> 00:25:48,800 CHANGING. 806 00:25:48,800 --> 00:25:49,920 MORE AND MORE OF OUR PATIENTS 807 00:25:49,920 --> 00:25:51,480 ARE COMING IN FOR TRANSPLANT 808 00:25:51,480 --> 00:25:54,320 WITH VERY COMPLEX, UNDERLINING 809 00:25:54,320 --> 00:25:55,320 PSYCHO, SOCIAL AND ADDICTION 810 00:25:55,320 --> 00:25:56,800 ISSUES AND IT REALLY MANDATES 811 00:25:56,800 --> 00:25:58,960 HAVING A STRONG, INTEGRATED 812 00:25:58,960 --> 00:25:59,160 TEAM. 813 00:25:59,160 --> 00:26:01,160 AND THIS STUDY, THIS WAS ABOUT 814 00:26:01,160 --> 00:26:03,360 10 YEARS AGO IN ITALY, GEOVANNI 815 00:26:03,360 --> 00:26:05,160 HAD SHOWN AN INTEGRATED ALCOHOL 816 00:26:05,160 --> 00:26:07,200 ADDICTION UNIT IN A RIGHT IN THE 817 00:26:07,200 --> 00:26:09,200 CLINIC, WITH THE TRANSPLANT 818 00:26:09,200 --> 00:26:10,840 CENTER, ACTUALLY PRODUCED LOWER 819 00:26:10,840 --> 00:26:15,440 RATES OF RELAPSE IN ALCOHOL AND 820 00:26:15,440 --> 00:26:17,760 ALCOHOL RECURRENCE USING AN 821 00:26:17,760 --> 00:26:19,240 OUTDATED TERM RECIDIVISM WHICH 822 00:26:19,240 --> 00:26:22,840 WE HAVE MOVED AWAY FROM IN THE 823 00:26:22,840 --> 00:26:23,840 FIELD, RELAPSE OR ALCOHOL USE 824 00:26:23,840 --> 00:26:24,480 RECURRENCE AND THERE WAS NO 825 00:26:24,480 --> 00:26:26,600 DIFFERENCE IN MORTALITY, THESE 826 00:26:26,600 --> 00:26:27,920 DECREASES IN RELAPSE IN THE 827 00:26:27,920 --> 00:26:29,800 ALCOHOL ADDICTION UNIT ARE 828 00:26:29,800 --> 00:26:31,120 REALLY SIGNIFICANT. 829 00:26:31,120 --> 00:26:32,520 BECAUSE RELAPSE OFTEN LEADS TO 830 00:26:32,520 --> 00:26:34,560 DECREASED MEDICAL ADHERENCE AND 831 00:26:34,560 --> 00:26:40,440 MORE REJECTIONS AND MORE OF THE 832 00:26:40,440 --> 00:26:42,200 GRAPH LOSS NOWHERE RECURRENT 833 00:26:42,200 --> 00:26:42,440 CIRRHOSIS. 834 00:26:42,440 --> 00:26:44,600 WE HAD FOLLOW-UP OF SIX TO 12 835 00:26:44,600 --> 00:26:45,400 MONTHS. 836 00:26:45,400 --> 00:26:47,400 LONGER PEOPLE IF PEOPLE GO INTO 837 00:26:47,400 --> 00:26:48,800 RELAPSE POST TRANSPLANT THEY CAN 838 00:26:48,800 --> 00:26:50,200 GET RECURRENT ALCOHOL RELATED 839 00:26:50,200 --> 00:26:52,080 CIRRHOSIS IN THAT GRAFT IN AS 840 00:26:52,080 --> 00:26:53,040 LITTLE AS FIVE YEARS. 841 00:26:53,040 --> 00:26:55,280 SO PREVENTING AND TREATING 842 00:26:55,280 --> 00:26:56,000 ALCOHOL RELAPSE IN THE 843 00:26:56,000 --> 00:26:57,440 TRANSPLANT WORLD IS INCREASE 844 00:26:57,440 --> 00:26:58,920 BLEE IMPORTANT TO US. 845 00:26:58,920 --> 00:27:00,840 THIS WAS A VERY INTERESTING 846 00:27:00,840 --> 00:27:04,360 STUDY THAT IS DONE BY JAY LUTHER 847 00:27:04,360 --> 00:27:05,200 AT MASSACHUSETTS GENERAL 848 00:27:05,200 --> 00:27:07,440 HOSPITAL AND THEY DID A PILOT 849 00:27:07,440 --> 00:27:09,360 STUDY OF AN INPATIENT LIVER 850 00:27:09,360 --> 00:27:11,440 CONSULT SERVICE WHERE THEY WERE 851 00:27:11,440 --> 00:27:14,240 INTEGRATED ALD DIAGNOSTICS WITH 852 00:27:14,240 --> 00:27:15,800 ALCOHOL USE PATIENTS. 853 00:27:15,800 --> 00:27:18,600 WHAT THEY DID WAS THEY HAD A 854 00:27:18,600 --> 00:27:19,880 CONSULT SERVICE SAID IF SOMEONE 855 00:27:19,880 --> 00:27:21,600 HAS ALCOHOL USE DISORDER OR 856 00:27:21,600 --> 00:27:24,160 EXCESSIVE ALCOHOL USE IF THAT'S 857 00:27:24,160 --> 00:27:25,600 IDENTIFIED, SO THE PROVIDER CAN 858 00:27:25,600 --> 00:27:29,400 PLACE THIS CONSULT AND A NURSE 859 00:27:29,400 --> 00:27:32,280 PRACTITIONER HEPATOLOGIST TEAM 860 00:27:32,280 --> 00:27:34,720 WILL SPEAK WITH A PATIENT. 861 00:27:34,720 --> 00:27:35,680 GIVE THEM LIVER FOCUSED 862 00:27:35,680 --> 00:27:36,680 COUNSELING WITH THE COUNSELING 863 00:27:36,680 --> 00:27:38,720 WE SAW FROM THE STUDY THAT WAS 864 00:27:38,720 --> 00:27:40,000 EFFECTIVE IN PRIMARY CARE. 865 00:27:40,000 --> 00:27:41,760 THEY'LL DO FIBER SKINS OR 866 00:27:41,760 --> 00:27:43,920 BIOPSIES AND FIBER SKIN IS A 867 00:27:43,920 --> 00:27:45,800 NON-INVASIVE WAY OF ASSESSING 868 00:27:45,800 --> 00:27:48,280 FOR CIRRHOSIS AND ADVANCED 869 00:27:48,280 --> 00:27:49,320 SCARRING OF LIVER DISEASE. 870 00:27:49,320 --> 00:27:50,720 AND WHAT THEY FOUND IS THAT THEY 871 00:27:50,720 --> 00:27:52,160 DID HAVE AN INCREASE IN THE 872 00:27:52,160 --> 00:27:55,000 NUMBER OF PATIENTS WHO ARE SEEN 873 00:27:55,000 --> 00:27:58,080 IN ALD CLINIC, 44% OF THOSE CAME 874 00:27:58,080 --> 00:28:00,320 INTO THERE ALD CLINIC AFTER 875 00:28:00,320 --> 00:28:03,720 THEIR DISCHARGE VERSUS ABOUT 27% 876 00:28:03,720 --> 00:28:05,480 COMING IN WITH ACCESSORY FER 877 00:28:05,480 --> 00:28:08,200 ALS. 878 00:28:08,200 --> 00:28:16,960 ACCESS REFERRAL.THIS IS HOW WEE 879 00:28:16,960 --> 00:28:19,000 THESE PATIENTS TOGETHER. 880 00:28:19,000 --> 00:28:19,920 TIME PROVE OUTCOMES. 881 00:28:19,920 --> 00:28:21,440 THIS WAS DATA THAT WE PUBLISHED 882 00:28:21,440 --> 00:28:23,920 FROM THE FIRST YEAR FROM THE 883 00:28:23,920 --> 00:28:25,480 FIRST 12 TO 15 MONTHS OF OUR ALD 884 00:28:25,480 --> 00:28:27,640 CLINIC HERE AT UNIVERSITY OF 885 00:28:27,640 --> 00:28:28,000 MICHIGAN. 886 00:28:28,000 --> 00:28:29,480 AND TO SHOW FEASIBILITY IN THAT 887 00:28:29,480 --> 00:28:30,920 ONE COULD DO THIS AND WHAT WE 888 00:28:30,920 --> 00:28:32,240 FOUND WAS THAT, YOU KNOW, WE HAD 889 00:28:32,240 --> 00:28:34,600 A LOT OF PATIENTS WHO COULD HAVE 890 00:28:34,600 --> 00:28:36,960 BEEN REFERRED BUT ABOUT 89 WERE 891 00:28:36,960 --> 00:28:38,600 REFERRED OVER THAT TIMEFRAME, 892 00:28:38,600 --> 00:28:39,840 AND WE CERTAINLY HAD PEOPLE WHO 893 00:28:39,840 --> 00:28:42,200 DID NOT COME IN BECAUSE THEY 894 00:28:42,200 --> 00:28:43,280 KNOW-SHOWED OR WEREN'T INTEREST 895 00:28:43,280 --> 00:28:44,480 OR BECAUSE THEY WERE TOO SICK 896 00:28:44,480 --> 00:28:46,480 AND UNFORTUNATELY WE HAD 897 00:28:46,480 --> 00:28:49,800 PATIENTS WHO WERE TOO SICK. 898 00:28:49,800 --> 00:28:51,160 WE WERE ABLE TO FOLLOW ENOUGH OF 899 00:28:51,160 --> 00:28:54,400 THOSE PATIENTS THROUGH A YEAR'S 900 00:28:54,400 --> 00:28:56,040 PROCESS TO FIND THAT WE DID SEE 901 00:28:56,040 --> 00:28:58,400 SOME IMPROVEMENTS, WE DID SEE 902 00:28:58,400 --> 00:28:59,760 PATIENTS CONNECTED TO ALCOHOL 903 00:28:59,760 --> 00:29:01,760 USE TREATMENT AND PREFERENCES 904 00:29:01,760 --> 00:29:04,560 WERE LARGELY FOR ONE-ON-ONE 905 00:29:04,560 --> 00:29:06,640 TREATMENT AND PEOPLE DIDN'T 906 00:29:06,640 --> 00:29:08,880 ENJOY THE GROUP OR AA AS MUCH IN 907 00:29:08,880 --> 00:29:11,280 OUR COHORT AND AT THE SIX-MONTH 908 00:29:11,280 --> 00:29:13,160 POST VISIT, FOR SIX MONTHS AFTER 909 00:29:13,160 --> 00:29:15,080 COMING IN VERSUS THE SIX MONTHS 910 00:29:15,080 --> 00:29:18,000 PREVIOUSLY TO IT, WHAT WE FOUND 911 00:29:18,000 --> 00:29:19,920 AND AGAIN THIS IS RETROSPECTIVE 912 00:29:19,920 --> 00:29:21,160 FASHION, UTILIZATION OF THE 913 00:29:21,160 --> 00:29:22,800 EMERGENCY DEPARTMENT AND THE 914 00:29:22,800 --> 00:29:23,920 INPATIENT ADMISSIONS WERE DOWN 915 00:29:23,920 --> 00:29:25,960 BY ABOUT 50% IN THIS GROUP WHO 916 00:29:25,960 --> 00:29:27,600 GOT INTO CLINIC. 917 00:29:27,600 --> 00:29:28,880 MOST OF THESE PATIENTS WERE 918 00:29:28,880 --> 00:29:30,280 REFERRED FROM OUR OWN 919 00:29:30,280 --> 00:29:31,800 HEPATOLOGIST SO THESE WERE NOT 920 00:29:31,800 --> 00:29:33,400 PATIENTS WHO NEVER HAD LIVER 921 00:29:33,400 --> 00:29:34,400 CARE AND WERE GETTING LIVER CARE 922 00:29:34,400 --> 00:29:39,240 FOR THE FIRST TIME. 923 00:29:39,240 --> 00:29:42,480 THE VALUE IS THE ADDICTION 924 00:29:42,480 --> 00:29:42,760 SPECIALIST. 925 00:29:42,760 --> 00:29:45,480 THEY ARE FOCUSED ON GETTING THAT 926 00:29:45,480 --> 00:29:46,440 CO LOCATED INTEGRATED CARE FOR 927 00:29:46,440 --> 00:29:48,360 THIS ADDICTION AND THEIR ALCOHOL 928 00:29:48,360 --> 00:29:49,360 USE. 929 00:29:49,360 --> 00:29:53,000 AND IN THIS VERY EXCITING AND 930 00:29:53,000 --> 00:29:55,360 PROVOCATIVE EARLY DATA, WE FOUND 931 00:29:55,360 --> 00:29:57,600 THAT WE HAD SIGNIFICANTLY 50% 932 00:29:57,600 --> 00:29:59,160 LOWER RATES OF BEING SEEN IN THE 933 00:29:59,160 --> 00:30:01,400 E.R. OR THE INPATIENT WARD 4 934 00:30:01,400 --> 00:30:04,440 LIVER RELATED OR ALCOHOL RELATED 935 00:30:04,440 --> 00:30:04,760 CONDITIONS. 936 00:30:04,760 --> 00:30:06,480 SO MORE TO COME THERE. 937 00:30:06,480 --> 00:30:08,240 WE'VE ALSO PUBLISHED THE COST 938 00:30:08,240 --> 00:30:10,080 EFFECTIVENESS OF ALCOHOL USE 939 00:30:10,080 --> 00:30:10,800 TREATMENT IN ALD. 940 00:30:10,800 --> 00:30:12,160 THIS WAS REALLY THE FIRST STUDY 941 00:30:12,160 --> 00:30:12,920 TO DO THIS. 942 00:30:12,920 --> 00:30:15,560 WE FOUND THAT MEDICAL ASSISTED 943 00:30:15,560 --> 00:30:17,160 THERAPY SO THIS IS THE RELAPSE 944 00:30:17,160 --> 00:30:21,720 PREVENTION MEDICATIONS WHICH ARE 945 00:30:21,720 --> 00:30:24,080 THE TWO FDA APPROVED RELAPSE 946 00:30:24,080 --> 00:30:25,000 MEDICATION THAT'S CAN BE GIVEN 947 00:30:25,000 --> 00:30:28,320 TO PATIENTS WITH LIVER DISEASE, 948 00:30:28,320 --> 00:30:30,720 DIE SULFUR UM OR ANTIBUSE IS 949 00:30:30,720 --> 00:30:32,680 INDICATED FOR RELAPSE BUT IT'S 950 00:30:32,680 --> 00:30:35,240 NOT AND SHOULD NOT BE GIVEN TO 951 00:30:35,240 --> 00:30:37,200 PATIENTS WITH LIVER DISEASE. 952 00:30:37,200 --> 00:30:41,120 WE ANALYZED AND OFF-LABEL 953 00:30:41,120 --> 00:30:42,040 RELAPSE PREVENTION MEDICATION 954 00:30:42,040 --> 00:30:44,600 THAT'S HAVE DATA BEHIND THEM IN 955 00:30:44,600 --> 00:30:48,200 LIVER DISEASE IN THE CASE OF 956 00:30:48,200 --> 00:30:49,600 BACKLAFIN AND THE GENERAL 957 00:30:49,600 --> 00:30:51,240 ALCOHOL USE DISORDER. 958 00:30:51,240 --> 00:30:53,320 WE FOUND THAT ACROSS THE BOARD, 959 00:30:53,320 --> 00:30:55,320 WHETHER YOU DID A RELAPSE 960 00:30:55,320 --> 00:30:56,760 PREVENTION MEDICATION THAT WAS 961 00:30:56,760 --> 00:30:59,120 FDA APPROVED, NON FDA APPROVED 962 00:30:59,120 --> 00:31:00,880 OR JUST COUNSELING, ANY OF THOSE 963 00:31:00,880 --> 00:31:01,960 SCENARIOS WAS MORE COST 964 00:31:01,960 --> 00:31:07,400 EFFECTIVE THAN DOING NOTHING AND 965 00:31:07,400 --> 00:31:09,560 IN MANY CASES IT WAS COST 966 00:31:09,560 --> 00:31:12,120 SAVINGS TO UTILIZE THOSE IN A 967 00:31:12,120 --> 00:31:13,800 POPULATION WITH ALCOHOL RELATED 968 00:31:13,800 --> 00:31:14,840 CIRRHOSIS. 969 00:31:14,840 --> 00:31:16,720 SO, NOT ONLY DOES INTEGRATING 970 00:31:16,720 --> 00:31:18,120 THAT CARE FOR YOUR PATIENTS 971 00:31:18,120 --> 00:31:20,040 GETTING THEM THE ALCOHOL USE 972 00:31:20,040 --> 00:31:21,680 TREATMENT IMPROVE THEIR LIVER 973 00:31:21,680 --> 00:31:23,760 DISEASE FROM ALCOHOL CESSATION 974 00:31:23,760 --> 00:31:26,760 BUT GETTING THEM THAT TREATMENT 975 00:31:26,760 --> 00:31:28,640 MAY BE COST EFFECTIVE AND COST 976 00:31:28,640 --> 00:31:32,080 OF ACOSTSAVINGS AS A HEALTHCARE 977 00:31:32,080 --> 00:31:32,760 COMMUNITY. 978 00:31:32,760 --> 00:31:35,000 FINALLY, I BRING UP THIS STUDY 979 00:31:35,000 --> 00:31:36,640 BY RAMONE BATIA BECAUSE THIS 980 00:31:36,640 --> 00:31:38,960 SHOWED THAT THOUGH WE KNOW AND 981 00:31:38,960 --> 00:31:40,040 WE HAVE A GREAT DEAL OF 982 00:31:40,040 --> 00:31:41,360 KNOWLEDGE ABOUT WHAT IMPACTS 983 00:31:41,360 --> 00:31:43,600 LIVER DISEASE AND WHAT IMPACTS 984 00:31:43,600 --> 00:31:44,280 ALCOHOL-RELATED LIVER DISEASE 985 00:31:44,280 --> 00:31:46,920 AND WE KNOW CLEARLY THAT ALCOHOL 986 00:31:46,920 --> 00:31:48,080 REALLY THE LIVER DISEASE 987 00:31:48,080 --> 00:31:49,160 PATIENTS GET WORSE IF THEY 988 00:31:49,160 --> 00:31:51,640 DRINK, THE AMOUNT OF FUNDING 989 00:31:51,640 --> 00:31:54,120 THAT IS DEVOTED TO ALD IS 990 00:31:54,120 --> 00:31:55,200 NOWHERE NEAR THAT FROM OTHER 991 00:31:55,200 --> 00:31:58,120 LIVER DISEASES THAT HAVE 992 00:31:58,120 --> 00:32:00,520 SUBSTANTIALLY LESS CLINICAL 993 00:32:00,520 --> 00:32:00,880 BURDEN. 994 00:32:00,880 --> 00:32:02,600 SO ALD IS FAR AWAY, THE MOST 995 00:32:02,600 --> 00:32:04,400 BURDEN SOME OF LIVER DISEASES IN 996 00:32:04,400 --> 00:32:06,080 TERMS OF HOSPITALIZATIONS, 997 00:32:06,080 --> 00:32:07,720 MORTALITY, NOW LIVER TRANSPLANT, 998 00:32:07,720 --> 00:32:09,360 BUT IT GETS JUST A FRACTION OF 999 00:32:09,360 --> 00:32:12,320 THE FUNDING FROM PHARMACEUTICAL 1000 00:32:12,320 --> 00:32:13,760 COMPANIES OR PUBLIC FUNDING 1001 00:32:13,760 --> 00:32:18,040 AGENCIES TO TREAT IT AND SO 1002 00:32:18,040 --> 00:32:19,200 HOPEFULLY THIS WILL CHANGE OVER 1003 00:32:19,200 --> 00:32:19,680 TIME. 1004 00:32:19,680 --> 00:32:22,240 THE TREND IN EPIDEMIOLOGY IS 1005 00:32:22,240 --> 00:32:24,360 CHANGING AND INCREASING BUT THE 1006 00:32:24,360 --> 00:32:26,280 INCREASING COST FOR INTEGRATED 1007 00:32:26,280 --> 00:32:28,000 CARE AND THE INCREASING NUMBER 1008 00:32:28,000 --> 00:32:31,320 OF PEOPLE WORKING ON THIS 1009 00:32:31,320 --> 00:32:32,640 CERTAINLY GIVES US A CAUSE FOR 1010 00:32:32,640 --> 00:32:32,880 HOPE. 1011 00:32:32,880 --> 00:32:35,560 WITH THAT I'LL END AND TURN IT 1012 00:32:35,560 --> 00:32:38,760 OVER TO Dr. GAO. 1013 00:32:38,760 --> 00:32:39,800 >>SO, FIRST I WANT TO THANK YOU 1014 00:32:39,800 --> 00:32:42,840 FOR THE INVITATION. 1015 00:32:42,840 --> 00:32:46,600 SO, Dr. MELLINGER JUST GAVE A 1016 00:32:46,600 --> 00:32:47,760 NICE OVERVIEW ABOUT ALCOHOL 1017 00:32:47,760 --> 00:32:48,920 ASSOCIATED LIVER DISEASE AND 1018 00:32:48,920 --> 00:32:51,160 ALCOHOL USE DISORDER AND THE 1019 00:32:51,160 --> 00:32:52,080 TREATMENTS. 1020 00:32:52,080 --> 00:32:56,800 SO TODAY, I WILL MAINLY DISCUSS 1021 00:32:56,800 --> 00:33:00,960 HOW OUR AT NIH HAS A STUDY AS A 1022 00:33:00,960 --> 00:33:02,280 PATHOGENESIS AND SEARCH 1023 00:33:02,280 --> 00:33:04,560 THERAPEUTIC TARGET FORWARD 1024 00:33:04,560 --> 00:33:06,320 TREATMENT OF ALCOHOLIC HEPATITIS 1025 00:33:06,320 --> 00:33:09,720 OVER THE LAST 20 YEARS. 1026 00:33:09,720 --> 00:33:14,400 SO I HAVE NOTHING TO DISCLOSE. 1027 00:33:14,400 --> 00:33:16,040 THE PROTEIN DISCUSSED IN THE 1028 00:33:16,040 --> 00:33:22,200 CLINICAL TRIALS WAS PROVIDED BY 1029 00:33:22,200 --> 00:33:22,880 GENARON. 1030 00:33:22,880 --> 00:33:24,600 EXCESSIVE ALCOHOL CONSUMPTION IS 1031 00:33:24,600 --> 00:33:27,720 TO THE FATTY LIVER SOME OF THEM 1032 00:33:27,720 --> 00:33:29,720 MAY PROGRESS INTO MORE SEVERE 1033 00:33:29,720 --> 00:33:32,560 FORMS OF LIVER INJURIES SUCH AS 1034 00:33:32,560 --> 00:33:34,560 ALCOHOLIC AND HEPATITIS AND 1035 00:33:34,560 --> 00:33:37,160 CIRRHOSIS AND THE LIVER CANCER. 1036 00:33:37,160 --> 00:33:40,600 MANY ARE PATIENTS WITH FATTY 1037 00:33:40,600 --> 00:33:43,640 LIVER OR ALCOHOLIC HEPATITIS DO 1038 00:33:43,640 --> 00:33:46,840 NOT HAVE SIGNIFICANT CLINICAL 1039 00:33:46,840 --> 00:33:47,440 SYMPTOMS. 1040 00:33:47,440 --> 00:33:51,760 SOME PATIENTS WITH ALCOHOLIC 1041 00:33:51,760 --> 00:33:54,640 LIVER DISEASE DO DEVELOP ACUTE 1042 00:33:54,640 --> 00:33:56,360 ALCOHOLIC HEPATITIS WITH A 1043 00:33:56,360 --> 00:33:59,680 SIGNIFICANT CLINICAL SYMPTOMS 1044 00:33:59,680 --> 00:34:01,920 SUCH AS JAUNDICE. 1045 00:34:01,920 --> 00:34:03,360 SO THE ALCOHOLIC HEPATITIS WAS 1046 00:34:03,360 --> 00:34:08,560 FIRST REPORTED IN 1961 AS ACUTE 1047 00:34:08,560 --> 00:34:10,480 LIVER DISEASE. 1048 00:34:10,480 --> 00:34:11,520 JAUNDICE IN ALCOHOLICS BY A 1049 00:34:11,520 --> 00:34:14,600 GROUP OF PHYSICIANS FROM THE 1050 00:34:14,600 --> 00:34:14,840 U.K. 1051 00:34:14,840 --> 00:34:17,000 SO THAT DETAILED DIAGNOSIS OF 1052 00:34:17,000 --> 00:34:19,520 ALCOHOLIC HEPATITIS WAS 1053 00:34:19,520 --> 00:34:23,040 PUBLISHED IN 2016 GASTRO 1054 00:34:23,040 --> 00:34:27,480 NEUROLOGY BY THE NIAAA CONSORTIA 1055 00:34:27,480 --> 00:34:29,520 THAT INCLUDED ALCOHOL DRINKING 1056 00:34:29,520 --> 00:34:32,840 HISTORY AND JAUNDICE AND THE LAB 1057 00:34:32,840 --> 00:34:33,440 TESTS. 1058 00:34:33,440 --> 00:34:35,880 SO THE SEVERE ALCOHOLIC 1059 00:34:35,880 --> 00:34:38,280 HEPATITIS HAS HIGH SHORT-TERM 1060 00:34:38,280 --> 00:34:38,560 MORTALITY. 1061 00:34:38,560 --> 00:34:42,040 FOR EXAMPLE, ON THE PATIENT WITH 1062 00:34:42,040 --> 00:34:43,520 DIS CRIMINAL INVESTMENT FUNCTION 1063 00:34:43,520 --> 00:34:49,200 MORE THAN EQUAL TO 32 ONE MONTH 1064 00:34:49,200 --> 00:34:51,680 MORTALITY IS 20 TO 50%. 1065 00:34:51,680 --> 00:34:54,720 IF THE MALE SCORES MORE THAN 1066 00:34:54,720 --> 00:35:00,440 THEN THE 90-DAY MORTALITY IS 1067 00:35:00,440 --> 00:35:01,080 20%. 1068 00:35:01,080 --> 00:35:04,200 SO THE CURRENT ONLY EFFECTIVE 1069 00:35:04,200 --> 00:35:05,920 THERAPY FOR THE END-STAGE OF A 1070 00:35:05,920 --> 00:35:08,840 SEVERE ALCOHOLIC HEPATITIS IS 1071 00:35:08,840 --> 00:35:09,800 LIVER TRANSPLANTATION. 1072 00:35:09,800 --> 00:35:12,000 THERE'S NO EFFECTIVE FORM 1073 00:35:12,000 --> 00:35:13,200 LOGICAL THERAPY FOR THE 1074 00:35:13,200 --> 00:35:15,920 TREATMENT OF SEVERE ALCOHOLIC 1075 00:35:15,920 --> 00:35:16,560 HEPATITIS. 1076 00:35:16,560 --> 00:35:18,800 SO THE ONE OF THE MAJOR PROJECTS 1077 00:35:18,800 --> 00:35:22,520 IN OUR LAB IS TO STUDY THE 1078 00:35:22,520 --> 00:35:26,400 PATHOGENESIS AND TARGETS FOR THE 1079 00:35:26,400 --> 00:35:27,040 ALCOHOLIC HEPATITIS. 1080 00:35:27,040 --> 00:35:29,320 SO WHAT IS THE MAJOR PROBLEM IN 1081 00:35:29,320 --> 00:35:32,040 THE LIVER OF THE SEVERE 1082 00:35:32,040 --> 00:35:34,040 ALCOHOLIC HEPATITIS? 1083 00:35:34,040 --> 00:35:38,520 THIS IS THE HISTOLOGY FROM THE 1084 00:35:38,520 --> 00:35:39,800 SEVERE ALCOHOL HEPATITIS AND YOU 1085 00:35:39,800 --> 00:35:42,680 CAN SEE THE LARGE NUMBER OF 1086 00:35:42,680 --> 00:35:44,160 INFLAMMATORY CELLS INFILTRATING 1087 00:35:44,160 --> 00:35:44,880 THAT LIVER. 1088 00:35:44,880 --> 00:35:47,800 SO THE FIRST IS A PROBLEM, MAJOR 1089 00:35:47,800 --> 00:35:50,440 PROBLEM IS TOO MUCH 1090 00:35:50,440 --> 00:35:50,880 INFLAMMATION. 1091 00:35:50,880 --> 00:35:54,720 IN ADDITION, YOU CAN SEE ON THE 1092 00:35:54,720 --> 00:35:56,640 PARASITES WAS DETECTED IN THE 1093 00:35:56,640 --> 00:35:58,520 LIVER SO THE SECOND MAJOR 1094 00:35:58,520 --> 00:36:04,160 PROBLEM IS NOT ENOUGH IN THE 1095 00:36:04,160 --> 00:36:04,600 REGENERATION. 1096 00:36:04,600 --> 00:36:09,680 SO WHAT OTHER TRIGGER FO FOR 1097 00:36:09,680 --> 00:36:10,480 INFLAMMATION. 1098 00:36:10,480 --> 00:36:13,440 THE TRIGGERS OF LIVER 1099 00:36:13,440 --> 00:36:15,120 INFLAMMATION ARE NOT CLEAR. 1100 00:36:15,120 --> 00:36:17,800 SO, HERE JUST LISTED SEVERAL 1101 00:36:17,800 --> 00:36:20,240 POTENTIAL TRIGGERS FOR THE 1102 00:36:20,240 --> 00:36:20,880 INFLAMMATION. 1103 00:36:20,880 --> 00:36:24,240 MANY PATIENTS WASTE ALCOHOLIC 1104 00:36:24,240 --> 00:36:27,440 HEPATITIS HAVE REASON TO BINGE 1105 00:36:27,440 --> 00:36:29,080 DRINKING. 1106 00:36:29,080 --> 00:36:30,160 SO, THOSE BINGE DRINKING COULD 1107 00:36:30,160 --> 00:36:33,960 COWS ACUTE HEPATOCYTE DAMAGE AND 1108 00:36:33,960 --> 00:36:35,320 TRIGGER INFLAMMATION. 1109 00:36:35,320 --> 00:36:37,400 MANY PATIENTS WITH ALCOHOLIC 1110 00:36:37,400 --> 00:36:39,560 HEPATITIS ARE ASSOCIATED WITH 1111 00:36:39,560 --> 00:36:40,960 BACTERIAL INFECTION WHICH CAN 1112 00:36:40,960 --> 00:36:44,480 TRIGGER LIVER INFLAMMATION. 1113 00:36:44,480 --> 00:36:47,560 THE BACTERIA OVER GROWS IS 1114 00:36:47,560 --> 00:36:49,600 ASSOCIATED WITH ALCOHOLIC LIVER 1115 00:36:49,600 --> 00:36:52,640 DISEASE CAN CAUSE GUT LEAKAGE 1116 00:36:52,640 --> 00:36:54,960 AND THE TRIGGER LIVER 1117 00:36:54,960 --> 00:36:56,680 INFLAMMATION. 1118 00:36:56,680 --> 00:36:58,600 FINALLY, ADAPTIVE IMMUNE 1119 00:36:58,600 --> 00:37:00,240 RESPONSES MAY OCCUR COME SOME 1120 00:37:00,240 --> 00:37:02,600 PATIENTS WITH SEVERE ALCOHOLIC 1121 00:37:02,600 --> 00:37:08,240 HEPATITIS DUE TO OXIDATED 1122 00:37:08,240 --> 00:37:10,640 MORTIFIED PRO. 1123 00:37:10,640 --> 00:37:12,600 THE TYPE OF INPRACTICE MISSION 1124 00:37:12,600 --> 00:37:15,440 IN ALCOHOLIC LIVER DISEASE ARE 1125 00:37:15,440 --> 00:37:17,520 STILL NOT CLEAR. 1126 00:37:17,520 --> 00:37:19,400 SO, WHETHER INNATE IMMUNE OR 1127 00:37:19,400 --> 00:37:24,200 ADAPT IMMUNE SPONSOR BOTH, ARE 1128 00:37:24,200 --> 00:37:25,120 IN ALCOHOL PICK AND LIVER 1129 00:37:25,120 --> 00:37:27,080 INFLAMMATION IN SEVERE ALCOHOLIC 1130 00:37:27,080 --> 00:37:30,560 HEPATITIS IS NOT CLEAR. 1131 00:37:30,560 --> 00:37:32,240 MANY METHODS CAN BE USE TO 1132 00:37:32,240 --> 00:37:36,000 EXAMINE THE INFLAMMATION. 1133 00:37:36,000 --> 00:37:38,520 SUCH AS IMMUNO CHEMISTRY, 1134 00:37:38,520 --> 00:37:43,640 QUANTITIVE REAL-TIME PCR, THIS 1135 00:37:43,640 --> 00:37:48,920 IS MANY PUBLISH DATASETS SUCH AS 1136 00:37:48,920 --> 00:37:51,960 MICRO ARRAY, RNA-SEQ AND SINGLE 1137 00:37:51,960 --> 00:37:56,720 CELL SEQ AND PROTEOMICS. 1138 00:37:56,720 --> 00:37:59,880 THEY CAN BE USED TO ANALYZE THE 1139 00:37:59,880 --> 00:38:03,160 INFLAMMATORY MARKERS IN SEVERE 1140 00:38:03,160 --> 00:38:04,160 HEPATITIS. 1141 00:38:04,160 --> 00:38:08,200 RECENTLY, WE PERFORMED THIS 1142 00:38:08,200 --> 00:38:09,600 MULTI-PLEX IMMUNO SO WE CAN 1143 00:38:09,600 --> 00:38:12,280 DETECT THE MANY CELL TYPES AT 1144 00:38:12,280 --> 00:38:16,560 THE SAME TIME AND ENABLE US TO 1145 00:38:16,560 --> 00:38:18,360 PHENOTYPE THE FOR SET OF OF 1146 00:38:18,360 --> 00:38:20,440 DIVERSITY OF THE SEVERE 1147 00:38:20,440 --> 00:38:21,200 ALCOHOLIC HEPATITIS AND THIS IS 1148 00:38:21,200 --> 00:38:23,840 A SPECIAL CONTEXT. 1149 00:38:23,840 --> 00:38:30,360 SO WE PERFORMED ON THIS MARKET 1150 00:38:30,360 --> 00:38:33,160 PLEX AND OF THE SEVERE ALCOHOLIC 1151 00:38:33,160 --> 00:38:35,200 HEPATITIS BY USING MULTIPLE 1152 00:38:35,200 --> 00:38:39,520 CELLULAR SURFACE MARKERS SUCH AS 1153 00:38:39,520 --> 00:38:43,280 CDA TO CD4 AND CD20 AND IBA ONE 1154 00:38:43,280 --> 00:38:46,920 FOR THE MACROPHAGES. 1155 00:38:46,920 --> 00:38:48,920 THIS IS REPRESENTATIVE IMAGE 1156 00:38:48,920 --> 00:38:52,960 FROM MULTI PLEX IMMUNO OF ONE 1157 00:38:52,960 --> 00:38:53,920 ALCOHOLIC HEPATITIS SAMPLE. 1158 00:38:53,920 --> 00:38:57,200 AS YOU CAN SEE, THE LARGE NUMBER 1159 00:38:57,200 --> 00:39:01,680 OF INFLAMMATORY CELLS ARE IN THE 1160 00:39:01,680 --> 00:39:02,920 MIDDLE. 1161 00:39:02,920 --> 00:39:06,440 ON THE HIGH, YOU CAN SEE MANY 1162 00:39:06,440 --> 00:39:12,320 ARE MACROPHAGES, T CELLS, AND B 1163 00:39:12,320 --> 00:39:12,640 CELLS. 1164 00:39:12,640 --> 00:39:14,240 ONE THING WE NOTICED THE 1165 00:39:14,240 --> 00:39:15,640 INFLAMMATION IS VERY DIFFERENT 1166 00:39:15,640 --> 00:39:18,440 FROM PATIENTS TO PATIENTS. 1167 00:39:18,440 --> 00:39:20,240 PARTICULARLY WE NOTICED THE 1168 00:39:20,240 --> 00:39:22,800 ACTIVE CORRELATION BETWEEN THE 1169 00:39:22,800 --> 00:39:26,920 NUMBER OF T-CELLS IN THOSE 1170 00:39:26,920 --> 00:39:27,520 PATIENTS. 1171 00:39:27,520 --> 00:39:29,240 HERE, ON THIS SLIDE, SUMMARIZES 1172 00:39:29,240 --> 00:39:36,120 A NUMBER OF NEUTROPHIL AND T 1173 00:39:36,120 --> 00:39:37,360 CELLS FROM 40 PATIENTS. 1174 00:39:37,360 --> 00:39:43,280 THIS PATIENT HAS A HIGH NUMBER 1175 00:39:43,280 --> 00:39:45,000 OF NEWT ROW FILLS. 1176 00:39:45,000 --> 00:39:47,600 SO THE CORRELATION BETWEEN THE 1177 00:39:47,600 --> 00:39:49,880 NEWT ROW FILL AND THE CD 4:00 1178 00:39:49,880 --> 00:40:00,240 CELLS WAS OBSERVED. 1179 00:40:00,920 --> 00:40:04,160 ON TYPES OF KNEW TREE FILL HIGH 1180 00:40:04,160 --> 00:40:10,000 AND THE NEUTROPHILS HIGH AND 1181 00:40:10,000 --> 00:40:10,720 LOW. 1182 00:40:10,720 --> 00:40:13,360 THEY SHOW FOR NEUTROPHILS AND 1183 00:40:13,360 --> 00:40:15,720 THE T CELLS IS ASSOCIATED WITH 1184 00:40:15,720 --> 00:40:17,360 THE STAGE OF LIVER FIBRO SIS. 1185 00:40:17,360 --> 00:40:21,400 SO HERE, BASED ON THOSE STUDIES, 1186 00:40:21,400 --> 00:40:24,560 WE PROPOSED TWO DIFFERENT HYSTE 1187 00:40:24,560 --> 00:40:27,040 PATHO LOGICAL PHENOTYPE OF 1188 00:40:27,040 --> 00:40:28,040 ALCOHOLIC HEPATITIS WHICH 1189 00:40:28,040 --> 00:40:29,640 SUGGESTED A DIFFERENT MECHANISMS 1190 00:40:29,640 --> 00:40:31,440 MAY CONTRIBUTE TO THE LIVER 1191 00:40:31,440 --> 00:40:34,240 INJURY AND THE FAILURE IN THOSE 1192 00:40:34,240 --> 00:40:34,480 PATIENTS. 1193 00:40:34,480 --> 00:40:40,440 IN PATIENTS WITH LESS FIBRO SIS, 1194 00:40:40,440 --> 00:40:41,920 NEUTROPHILS MAY PLAY MORE 1195 00:40:41,920 --> 00:40:44,120 IMPORTANT ROLE IN PROMOTING THE 1196 00:40:44,120 --> 00:40:44,480 LIVER INJURY. 1197 00:40:44,480 --> 00:40:47,680 BUT A PATIENTS WITH MORE FIBRO 1198 00:40:47,680 --> 00:40:50,000 SCISSOR CIRRHOSIS THE T CELLS 1199 00:40:50,000 --> 00:40:52,200 ARE HIGHER AND THE T-CELL MAY 1200 00:40:52,200 --> 00:40:55,720 PLAY A MORE IMPORTANT ROLE THAN 1201 00:40:55,720 --> 00:40:56,040 NEUTROPHILS. 1202 00:40:56,040 --> 00:40:59,640 TO STUDY THE IMMUNE CELLS IN THE 1203 00:40:59,640 --> 00:41:00,360 ALCOHOL PICK AND LIVER DISEASE, 1204 00:41:00,360 --> 00:41:03,640 SO WE NEED ANIMAL MODELS. 1205 00:41:03,640 --> 00:41:04,640 UNFORTUNATELY THERE'S NO GOOD 1206 00:41:04,640 --> 00:41:07,240 MOUSE MODELS WITH A SEVERE FIBRO 1207 00:41:07,240 --> 00:41:10,280 SIS CIRRHOSIS AND THE T-CELL 1208 00:41:10,280 --> 00:41:12,920 INFILTRATION SO IT'S A DIFFICULT 1209 00:41:12,920 --> 00:41:15,000 TO DISSECT THE FUNCTION OF A T 1210 00:41:15,000 --> 00:41:16,680 CELLS IN ALCOHOLIC HEPATITIS IN 1211 00:41:16,680 --> 00:41:18,200 MOUSE MODELS. 1212 00:41:18,200 --> 00:41:21,280 LUCKILY, WE DEVELOPED A MOUSE 1213 00:41:21,280 --> 00:41:23,360 MODEL WITH LESS FIBRO SIS BUT A 1214 00:41:23,360 --> 00:41:25,440 SIGNIFICANT NEUTROPHILS 1215 00:41:25,440 --> 00:41:25,880 INFILTRATION. 1216 00:41:25,880 --> 00:41:28,400 SO, WE CAN STUDY THE ROLE OF A 1217 00:41:28,400 --> 00:41:35,080 NANEW TREE FILLS IN MOUSE MODEL. 1218 00:41:35,080 --> 00:41:38,040 A CHRONIC LIVER INJURY MODEL WAS 1219 00:41:38,040 --> 00:41:39,600 DEVELOPED ON FIVE DECADES AGO 1220 00:41:39,600 --> 00:41:42,080 AND THE MICE WAS CHRONIC ALCOHOL 1221 00:41:42,080 --> 00:41:44,920 FEEDING FOR SIX TO EIGHT WEEKS 1222 00:41:44,920 --> 00:41:46,800 AND THOSE CHRONIC ALCOHOL 1223 00:41:46,800 --> 00:41:49,520 FEEDING LEADS TO THE FATTY LIVER 1224 00:41:49,520 --> 00:41:53,200 AND MILDER LIVER INJURY. 1225 00:41:53,200 --> 00:41:58,640 AND MACROPHAGE ACTIVATION BUT A 1226 00:41:58,640 --> 00:42:00,400 VERY FEW NEUTROPHIL IN THE LIVER 1227 00:42:00,400 --> 00:42:03,720 AND THEY HAVE THE MACROPHAGES. 1228 00:42:03,720 --> 00:42:05,720 SO RECENTLY, WE DEVELOPED ACUTE 1229 00:42:05,720 --> 00:42:10,120 AND CHRONIC LIVER INJURY MODEL 1230 00:42:10,120 --> 00:42:12,400 BY INTRODUCING INTAKE ON MICE 1231 00:42:12,400 --> 00:42:17,760 AND THE DETAILED PROTOCOL WAS 1232 00:42:17,760 --> 00:42:19,760 PUBLISHED IN NATURE PROTOCOLS. 1233 00:42:19,760 --> 00:42:21,560 THIS FEEDING PROTOCOL IS 1234 00:42:21,560 --> 00:42:24,040 DRINKING PATTERNS IN SOME 1235 00:42:24,040 --> 00:42:29,320 ALCOHOLIC HEPATITIS PATIENTS 1236 00:42:29,320 --> 00:42:34,840 RAISES SIGNIFICANT NEUTROPHILS 1237 00:42:34,840 --> 00:42:36,160 IN THE WATER. 1238 00:42:36,160 --> 00:42:41,960 IT DERIVED ACTIVE O OXYGEN PLAYA 1239 00:42:41,960 --> 00:42:43,040 ROLE IN ALCOHOLIC HEPATITIS 1240 00:42:43,040 --> 00:42:48,560 WHICH INHIBITING A MP KINASE OR 1241 00:42:48,560 --> 00:42:50,840 METABOLISM AND INHIBITING THE 1242 00:42:50,840 --> 00:42:55,520 ANTI INFLAMMATORY AND ANTI 1243 00:42:55,520 --> 00:42:58,240 MYCRON IN TWO AND THREE. 1244 00:42:58,240 --> 00:43:02,880 SO IN SUMMARY, WE THINK A SEVERE 1245 00:43:02,880 --> 00:43:05,680 ALCOHOLIC HEPATITIS HAVE TWO SUB 1246 00:43:05,680 --> 00:43:10,240 TYPES BASED ON THE RACIAL OF T 1247 00:43:10,240 --> 00:43:10,760 CELLS. 1248 00:43:10,760 --> 00:43:12,640 THE MACROPHAGES. 1249 00:43:12,640 --> 00:43:19,680 THE MACROPHAGES ARE THE MOST 1250 00:43:19,680 --> 00:43:21,080 ABUNDANT IMMUNE CELLS AND THEY 1251 00:43:21,080 --> 00:43:23,480 HAVE PROMOTING LIVER INJURY AND 1252 00:43:23,480 --> 00:43:26,960 ALSO PROMOTING THE LIVER REPAIR. 1253 00:43:26,960 --> 00:43:29,920 SO DEFINITELY WE NEED MORE STUDY 1254 00:43:29,920 --> 00:43:31,560 TO CHARACTERIZE THE FUNCTION OF 1255 00:43:31,560 --> 00:43:33,960 MACRO PAGES IN THE SEVERE 1256 00:43:33,960 --> 00:43:36,360 ALCOHOLIC HEPATITIS. 1257 00:43:36,360 --> 00:43:40,800 RECENT STUDY FROM OUR 1258 00:43:40,800 --> 00:43:42,680 COLLABORATOR AND DREW AND ALSO 1259 00:43:42,680 --> 00:43:44,920 ANDREW CAMERA FROM THE JOHNS 1260 00:43:44,920 --> 00:43:47,920 HOPKINS DEMONSTRATED THE B CELLS 1261 00:43:47,920 --> 00:43:51,000 ALSO PLAY A ROLE IN PROMOTING 1262 00:43:51,000 --> 00:43:53,480 ALCOHOLIC HEPATITIS BY PRODUCING 1263 00:43:53,480 --> 00:43:54,880 THE CROSS RADIO ANTIBODIES 1264 00:43:54,880 --> 00:43:57,080 AGAINST THE BACTERIA IN 1265 00:43:57,080 --> 00:43:58,040 ALCOHOLIC HEPATITIS. 1266 00:43:58,040 --> 00:43:59,720 MANY OTHER TYPES OF IMMUNE CELLS 1267 00:43:59,720 --> 00:44:02,800 WAS ALSO DETECTED IN ALCOHOLIC 1268 00:44:02,800 --> 00:44:04,920 HEPATITIS BUT THEY ARE FUNCTION 1269 00:44:04,920 --> 00:44:08,200 IN THE PATHOGENESIS OF ALCOHOLIC 1270 00:44:08,200 --> 00:44:10,560 HEPATITIS REMAINS UNKNOWN. 1271 00:44:10,560 --> 00:44:12,760 SO THE NEXT QUESTION WHETHER WE 1272 00:44:12,760 --> 00:44:17,600 CAN TARGET INFLAMMATION TO TREAT 1273 00:44:17,600 --> 00:44:20,960 ALCOHOLIC HEPATITIS. 1274 00:44:20,960 --> 00:44:23,480 YOU CAN SEE THERE ARE STEROID 1275 00:44:23,480 --> 00:44:24,400 THAT HAS BEEN USED FOR THE 1276 00:44:24,400 --> 00:44:27,520 TREATMENT OF ALCOHOLIC HEPATITIS 1277 00:44:27,520 --> 00:44:33,680 FOR MANY YEARS, SINCE 1970s. 1278 00:44:33,680 --> 00:44:35,320 THE TREATMENT IS STILL INCLUDED 1279 00:44:35,320 --> 00:44:37,520 TODAY FOR THE TREATMENT OF 1280 00:44:37,520 --> 00:44:38,240 ALCOHOLIC HEPATITIS. 1281 00:44:38,240 --> 00:44:40,720 BUT AS WE KNOW, THE STEROID 1282 00:44:40,720 --> 00:44:44,160 TREATMENT CAN CAUSE MANY SIDE 1283 00:44:44,160 --> 00:44:44,520 EFFECTS. 1284 00:44:44,520 --> 00:44:46,440 SO THUS THERE ARE SPECIFIC 1285 00:44:46,440 --> 00:44:50,400 INHIBITORS FOR THE INFLATION TO 1286 00:44:50,400 --> 00:44:51,360 TREAT ALCOHOL HEPATITIS ON EX 1287 00:44:51,360 --> 00:44:53,800 TENSE I HAVELY STUDIED OVER THE 1288 00:44:53,800 --> 00:44:58,600 LAST DECADE. 1289 00:44:58,600 --> 00:45:06,800 THERE IS PEP TOE SIS RECOGNIZING 1290 00:45:06,800 --> 00:45:08,920 TRIGGER THE LIVER INFLAMMATION 1291 00:45:08,920 --> 00:45:12,560 AND SO THUS IS INHIBITOR HAS 1292 00:45:12,560 --> 00:45:14,120 TEST IN CLINIC FOR THE TREATMENT 1293 00:45:14,120 --> 00:45:15,760 OF ALCOHOLIC HEPATITIS. 1294 00:45:15,760 --> 00:45:18,480 THE TRIAL WAS STOPPED DUE TO 1295 00:45:18,480 --> 00:45:20,800 BECAUSE THERE'S NO BENEFICIAL 1296 00:45:20,800 --> 00:45:21,720 EFFECT IT WAS OBSERVED. 1297 00:45:21,720 --> 00:45:26,200 SEVERAL YEARS AGO, A GROUP 1298 00:45:26,200 --> 00:45:27,040 DEMONSTRATORS INTRODUCED ONE 1299 00:45:27,040 --> 00:45:30,080 PLAY IMPORTANT ROLE IN PROMOTING 1300 00:45:30,080 --> 00:45:32,080 ALCOHOLIC LIVER INJURY IN MOUSE 1301 00:45:32,080 --> 00:45:34,480 MODELS SO THEY'RE TESTING THE 1302 00:45:34,480 --> 00:45:35,640 INHIBITOR FOR THE TREATMENT OF 1303 00:45:35,640 --> 00:45:41,680 ALCOHOL LIVER DISEASE. 1304 00:45:41,680 --> 00:45:42,960 THE TRIAL DATA WAS RECENTLY 1305 00:45:42,960 --> 00:45:50,200 PUBLISHED IN THE HELP HEPATOLOY 1306 00:45:50,200 --> 00:45:52,560 MARCH ISSUE. 1307 00:45:52,560 --> 00:45:55,160 THE PLUS ZINC PROVIDES A 1308 00:45:55,160 --> 00:45:59,800 SURVIVAL BENEFIT COMPARED TO 1309 00:45:59,800 --> 00:46:03,560 COURT CO STEROID THERAPY IN 1310 00:46:03,560 --> 00:46:04,200 ALCOHOL HEPATITIS. 1311 00:46:04,200 --> 00:46:05,880 AS YOU CAN SEE THE DATA FROM OUR 1312 00:46:05,880 --> 00:46:08,040 STUDY IS THE INFLAMMATION IS 1313 00:46:08,040 --> 00:46:10,280 VERY DIFFERENT FROM THE PATIENT 1314 00:46:10,280 --> 00:46:11,120 TO PATIENT. 1315 00:46:11,120 --> 00:46:14,320 THE PROBLEM IS A PERSON ANALYZED 1316 00:46:14,320 --> 00:46:16,200 MEDICINE IS THE REQUIRE TO 1317 00:46:16,200 --> 00:46:17,720 TARGET INFLAMMATION FOR THE 1318 00:46:17,720 --> 00:46:23,480 TREATMENT OF ALCOHOLIC 1319 00:46:23,480 --> 00:46:23,760 HEPATITIS. 1320 00:46:23,760 --> 00:46:25,360 BECAUSE THE BACTERIAL INFECTION 1321 00:46:25,360 --> 00:46:27,960 IT'S OFTEN ASSOCIATED WITH A 1322 00:46:27,960 --> 00:46:30,400 SEVERE ALCOHOLIC HEPATITIS SO 1323 00:46:30,400 --> 00:46:32,680 THERE AREN'T ANTIBIOTICS 1324 00:46:32,680 --> 00:46:34,240 TREATMENT ARE IMPORTANT TO 1325 00:46:34,240 --> 00:46:39,160 REDUCE INFLAMMATION IN ALCOHOLIC 1326 00:46:39,160 --> 00:46:40,720 HEPATITIS. 1327 00:46:40,720 --> 00:46:42,800 SO NEXT I WILL SWITCH GEARS TO 1328 00:46:42,800 --> 00:46:46,760 DISCUSS HOW WE TARGET ANOTHER 1329 00:46:46,760 --> 00:46:48,440 MAJOR PROBLEM HAVING IMPAIRED 1330 00:46:48,440 --> 00:46:51,000 REGENERATION IN THE LIVER. 1331 00:46:51,000 --> 00:46:53,720 BUT WITH THE LAST DECADES, TWO 1332 00:46:53,720 --> 00:46:58,280 DECADES OUR LAB HAVE EXTENSIVELY 1333 00:46:58,280 --> 00:47:00,560 SEARCHED FOR THE PROTECT OR 1334 00:47:00,560 --> 00:47:03,280 PROTEINS FOR THE TREATMENT OF 1335 00:47:03,280 --> 00:47:06,400 ALCOHOLIC HEPATITIS. 1336 00:47:06,400 --> 00:47:08,520 WE HAVE STUDIED MANY CYTOKINES 1337 00:47:08,520 --> 00:47:11,880 IN THE LIVER AND MOST OF THE 1338 00:47:11,880 --> 00:47:13,440 THOSE DATA SUMMARIZED IN ONE OF 1339 00:47:13,440 --> 00:47:15,560 THE REVIEW ARTICLES WE PUBLISHED 1340 00:47:15,560 --> 00:47:22,200 IN THE LAST YEAR CELLULAR. 1341 00:47:22,200 --> 00:47:32,920 ONE IS IN '22 AND WE THINK SIGH. 1342 00:47:34,800 --> 00:47:37,520 IT WAS CLONE FROM THE T CELLS IN 1343 00:47:37,520 --> 00:47:37,840 2000. 1344 00:47:37,840 --> 00:47:41,200 BASED ON THE STRUCTURE, IL-22 1345 00:47:41,200 --> 00:47:44,040 BELONGS TO IL-10 FAMILY BUT 1346 00:47:44,040 --> 00:47:46,640 IL-22 DOES NOT HAVE IL-10 1347 00:47:46,640 --> 00:47:48,200 INFLAMMATORY FUNCTIONS SO THE 1348 00:47:48,200 --> 00:47:50,640 FUNCTION OF IL-22 REMAINED 1349 00:47:50,640 --> 00:47:52,760 UNCLEAR AT THAT TIME. 1350 00:47:52,760 --> 00:47:55,920 SO OUR LAB WAS FIRST REPORTED 1351 00:47:55,920 --> 00:48:01,560 THAT IL-22 AND A PROTECT AGAINST 1352 00:48:01,560 --> 00:48:03,960 LIVER INJURIES IS SEVERE MODELS 1353 00:48:03,960 --> 00:48:04,960 SO WE TEST. 1354 00:48:04,960 --> 00:48:07,600 SO WE PUBLISHED THOSE DATA IN 1355 00:48:07,600 --> 00:48:10,200 2004 AND SINCE THEN, WE HAVE 1356 00:48:10,200 --> 00:48:13,440 EXTENSIVELY STUDIED THE I-22 1357 00:48:13,440 --> 00:48:14,400 BIOLOGY IN THE LIVER AND TEST 1358 00:48:14,400 --> 00:48:16,880 THE PROTECTIVE FUNCTION OF IL-22 1359 00:48:16,880 --> 00:48:19,640 IN SEVERAL MODELS OF LIVER 1360 00:48:19,640 --> 00:48:21,760 INJURY SUCH AS ALCOHOLIC LIVER 1361 00:48:21,760 --> 00:48:24,920 AND DRUG INDUCED INJURY, ACUTE 1362 00:48:24,920 --> 00:48:29,680 AND CHRONIC FAILURE AND THE NASH 1363 00:48:29,680 --> 00:48:30,960 AND THERE WAS A PHASE 2B TRIAL 1364 00:48:30,960 --> 00:48:33,560 FOR ALCOHOLIC HEPATITIS AND ON 1365 00:48:33,560 --> 00:48:35,200 GOING TRIALS FOR ACUTE AND 1366 00:48:35,200 --> 00:48:37,960 CHRONIC LIVER FAILURE. 1367 00:48:37,960 --> 00:48:45,160 THE IL-22 IS ALSO EPITHELLIAL 1368 00:48:45,160 --> 00:48:47,760 CELLS SO IT'S A CLINICAL TRIALS 1369 00:48:47,760 --> 00:48:53,000 FOR IL-22 TREATMENT OTHER ORGAN 1370 00:48:53,000 --> 00:48:54,480 FAILURE. 1371 00:48:54,480 --> 00:48:56,400 SO MOLECULAR MECHANISMS THAT ARE 1372 00:48:56,400 --> 00:48:59,640 TURNED INTO PROMOTE THE IS TO 1373 00:48:59,640 --> 00:49:05,040 ACTIVATE A STATUS 3 AND 1374 00:49:05,040 --> 00:49:06,360 EPITHELIAL CELLS WHICH IS 1375 00:49:06,360 --> 00:49:09,440 SIMILAR TO THE SO THE MAJOR 1376 00:49:09,440 --> 00:49:12,080 DIFFERENCE BETWEEN AND IL-6 IS 1377 00:49:12,080 --> 00:49:14,000 THE TARGET IN SPECIFICITY. 1378 00:49:14,000 --> 00:49:18,000 AS CAN YOU SEE HERE, IL-2 USES 1379 00:49:18,000 --> 00:49:21,280 THE RECEPTORS 2 AND IL-22 1380 00:49:21,280 --> 00:49:21,840 RECEPTORS 1. 1381 00:49:21,840 --> 00:49:26,080 THE IL-22 RECEPTOR 1 IS MANY 1382 00:49:26,080 --> 00:49:28,960 EXPRESSED IN THE EPITHELIAL 1383 00:49:28,960 --> 00:49:29,480 CELLS. 1384 00:49:29,480 --> 00:49:33,920 AND THE IL-6 AND THE GP130 AND 1385 00:49:33,920 --> 00:49:39,080 THE IL-6 AND THE GP-130 IS RIDE 1386 00:49:39,080 --> 00:49:40,360 WE EXPRESSED SO THEY TARGET 1387 00:49:40,360 --> 00:49:43,640 ALMOST ALL TYPE OF CELLS IN THE 1388 00:49:43,640 --> 00:49:43,960 BODY. 1389 00:49:43,960 --> 00:49:45,640 HERE JUST TO SUMMARIZE A KEY 1390 00:49:45,640 --> 00:49:49,280 FEATURE OF IL-22. 1391 00:49:49,280 --> 00:49:53,280 IT'S THE SAME USE IL-10 COMPLEX 1392 00:49:53,280 --> 00:49:56,920 AND IL-22 IS SPECIFICALLY 1393 00:49:56,920 --> 00:50:00,680 TARGETS EPITHELIAL CELLS AND NOT 1394 00:50:00,680 --> 00:50:01,280 IMMUNE CELLS. 1395 00:50:01,280 --> 00:50:05,400 IT'S A SIMPLE AND SPECIFIC 1396 00:50:05,400 --> 00:50:08,240 STATUS 3 AND IL-22 THERAPY 1397 00:50:08,240 --> 00:50:10,920 EXPECTED ON MINOR SIDE EFFECTS. 1398 00:50:10,920 --> 00:50:14,600 SO IR22 IS CYTOKINES PRODUCED BY 1399 00:50:14,600 --> 00:50:18,440 IMMUNE CELLS BUT DOES NOT TARGET 1400 00:50:18,440 --> 00:50:18,800 IMMUNE CELLS. 1401 00:50:18,800 --> 00:50:22,240 SO WE THINK THAT IL-22 MAY HAVE 1402 00:50:22,240 --> 00:50:23,400 THERAPEUTIC POTENTIAL FOR THE 1403 00:50:23,400 --> 00:50:27,280 TREATMENT OF ALCOHOLIC 1404 00:50:27,280 --> 00:50:27,840 HEPATITIS. 1405 00:50:27,840 --> 00:50:31,320 IN ADDITION, THE ALCOHOLIC 1406 00:50:31,320 --> 00:50:33,080 HEPATITIS IS ASSOCIATED WITH 1407 00:50:33,080 --> 00:50:34,640 BACTERIAL INFECTION AND ALSO AS 1408 00:50:34,640 --> 00:50:37,840 A COMPLICATIONS SUCH AS RENAL 1409 00:50:37,840 --> 00:50:41,680 FAILURE OR INJURY. 1410 00:50:41,680 --> 00:50:43,320 IL-22 MAY GENERATE ADDITIONAL 1411 00:50:43,320 --> 00:50:45,840 BENEFITS SUCH AS INHIBITING 1412 00:50:45,840 --> 00:50:49,480 BACTERIA INFECTION AND 1413 00:50:49,480 --> 00:50:50,800 PROTECTION AGAINST EPITHELIAL 1414 00:50:50,800 --> 00:50:53,360 CELLS IN OTHER ORGANS SO THAT'S 1415 00:50:53,360 --> 00:50:56,600 THE SHOT FROM MAYO CLINIC AND I 1416 00:50:56,600 --> 00:50:58,760 PROPOSED COMBINATION THERAPY FOR 1417 00:50:58,760 --> 00:51:01,080 THE TREATMENT OF ALCOHOLIC 1418 00:51:01,080 --> 00:51:04,880 HEPATITIS BY USING IL-22 AND 1419 00:51:04,880 --> 00:51:07,680 INFLAMMATION INHIBITORS. 1420 00:51:07,680 --> 00:51:11,000 Dr. SHAW LED A CLINICAL TRIAL 1421 00:51:11,000 --> 00:51:18,000 OF USE FC AND IL-22FC IS A TIME 1422 00:51:18,000 --> 00:51:20,960 OF MOLECULES AND BY FC AND AS 1423 00:51:20,960 --> 00:51:27,200 YOU CAN SEE THE IT'S LESS THAN 1424 00:51:27,200 --> 00:51:30,880 200 BUT AFTER INJECTION OF THIS 1425 00:51:30,880 --> 00:51:35,400 IL-22FC THE PEAK LEVEL CAN REACH 1426 00:51:35,400 --> 00:51:40,400 TO 900 PREMIERE AND ALMOST MORE 1427 00:51:40,400 --> 00:51:46,640 THAN 4,500 HIGHER THAN 1428 00:51:46,640 --> 00:51:52,440 INDIGENOUSES SO THE 18 PATIENTS 1429 00:51:52,440 --> 00:51:54,680 WERE TESTED AND THERE WAS A 1430 00:51:54,680 --> 00:51:56,960 SIGNIFICANT DECREASE IN THE 1431 00:51:56,960 --> 00:51:59,240 SCORE AND TOTAL WOULD BE AND 1432 00:51:59,240 --> 00:52:02,440 IMMUNO TRANSFERASE AT A DAY OF 1433 00:52:02,440 --> 00:52:07,680 42 AFTER I-22FC TREATMENT AND SO 1434 00:52:07,680 --> 00:52:09,360 INCONCLUSION, IT'S SAFE AND IT'S 1435 00:52:09,360 --> 00:52:11,520 ASSOCIATED WITH A CLINICALLY 1436 00:52:11,520 --> 00:52:14,680 SIGNIFICANT CHANGE IN THE SCORE 1437 00:52:14,680 --> 00:52:18,280 AND MULTI CENTER RANDOMIZED 1438 00:52:18,280 --> 00:52:20,520 CONTROL TRIAL IS WARRANTED COULD 1439 00:52:20,520 --> 00:52:24,880 CONFIRM THE EFFICACY TREATMENT 1440 00:52:24,880 --> 00:52:29,360 FOR THE ALCOHOLIC HEPATITIS. 1441 00:52:29,360 --> 00:52:33,000 SO, IN SUMMARY, THE TOO MUCH 1442 00:52:33,000 --> 00:52:35,600 LIVER INFLAMMATION IN THE 1443 00:52:35,600 --> 00:52:37,520 ALCOHOLIC HEPATITIS BUT AGAIN, 1444 00:52:37,520 --> 00:52:39,160 STILL ON THE EXACTLY WHAT TYPE 1445 00:52:39,160 --> 00:52:41,400 OF INFLAMMATION, WHAT TRIGGER 1446 00:52:41,400 --> 00:52:44,680 INFLAMMATION IS STILL NOT CLEAR. 1447 00:52:44,680 --> 00:52:47,280 SO THE FURTHER STUDY REQUIRED TO 1448 00:52:47,280 --> 00:52:49,040 IDENTIFY THE TYPE OF 1449 00:52:49,040 --> 00:52:52,640 INFLAMMATION OR THE TRIGGER 1450 00:52:52,640 --> 00:52:53,240 INFLAMMATION. 1451 00:52:53,240 --> 00:52:55,000 SO THEY'RE NOT ENOUGH HELP OWE 1452 00:52:55,000 --> 00:52:58,840 SIGHT IN THE REGENERATION SO I 1453 00:52:58,840 --> 00:53:00,400 IL-22 MAY HAVE A GOOD THEY ARE 1454 00:53:00,400 --> 00:53:02,480 PEWS I CAN POTENTIAL TO PROTECT 1455 00:53:02,480 --> 00:53:03,880 AGAINST INJURY AND PROMOTE THE 1456 00:53:03,880 --> 00:53:06,360 LIVER REGENERATION. 1457 00:53:06,360 --> 00:53:08,120 OF COURSE, AS A TREATMENT SUCH 1458 00:53:08,120 --> 00:53:10,680 AS ARTIFICIAL LIVER SUPPORT 1459 00:53:10,680 --> 00:53:12,920 SYSTEMS, TRANSPLANTATION, LIVER 1460 00:53:12,920 --> 00:53:17,280 STEM CELL TRANSPLANTATION MAY BE 1461 00:53:17,280 --> 00:53:20,120 REQUIRED TO SOLVE THIS PROBLEM. 1462 00:53:20,120 --> 00:53:23,480 LASTLY, I WANT TO THANK MY 1463 00:53:23,480 --> 00:53:27,800 FORMER LAB MEMBERS AND THE 1464 00:53:27,800 --> 00:53:29,200 CURRENT LAB MEMBERS FOR 1465 00:53:29,200 --> 00:53:30,160 CONTRIBUTE TO GO THE WORK I 1466 00:53:30,160 --> 00:53:30,760 PRESENTED TODAY. 1467 00:53:30,760 --> 00:53:33,920 I WANT TO THANK MANY 1468 00:53:33,920 --> 00:53:39,840 COLLABORATORS, Dr. SHAH AND 1469 00:53:39,840 --> 00:53:42,320 Dr. SUN AND Dr. SEW AND 1470 00:53:42,320 --> 00:53:46,320 Dr. CAMERON AND FROM INDIANA 1471 00:53:46,320 --> 00:53:52,360 AND Dr. BATALLAR AND SEVERE 1472 00:53:52,360 --> 00:53:54,520 ALCOHOLIC HEPATITIS AND PAL AND 1473 00:53:54,520 --> 00:53:55,960 GEORGE FOR THE MOUSE MODEL 1474 00:53:55,960 --> 00:53:57,600 STUDIES AND MY LAB IS SUPPORTED 1475 00:53:57,600 --> 00:54:01,480 BY THE INTRAMURAL PROGRAM OF 1476 00:54:01,480 --> 00:54:01,720 NIAAA. 1477 00:54:01,720 --> 00:54:02,280 I STOP HERE. 1478 00:54:02,280 --> 00:54:11,000 THANK YOU SO MUCH. 1479 00:54:11,000 --> 00:54:14,080 >> THANK YOU Dr. GAO AND Dr. 1480 00:54:14,080 --> 00:54:14,440 MELLINGER. 1481 00:54:14,440 --> 00:54:16,640 WE APPRECIATE YOUR VERY ELEGANT 1482 00:54:16,640 --> 00:54:18,800 PRESENTATIONS OFFERING US A 1483 00:54:18,800 --> 00:54:20,880 COMPREHENSIVE UNDERSTANDING AND 1484 00:54:20,880 --> 00:54:24,720 INSIGHTS INTO ALCOHOLIC LIVER 1485 00:54:24,720 --> 00:54:25,040 DISEASE. 1486 00:54:25,040 --> 00:54:26,400 FROM THE BOLD INFORMATION WITHIN 1487 00:54:26,400 --> 00:54:28,080 ALD AND ALSO THE CHALLENGES AND 1488 00:54:28,080 --> 00:54:29,840 THE TREATMENTS OF ALCOHOL USE 1489 00:54:29,840 --> 00:54:31,400 DISORDERS AND THOSE PATIENTS 1490 00:54:31,400 --> 00:54:35,480 WITH ALCOHOLIC LIVER DISEASE. 1491 00:54:35,480 --> 00:54:37,480 ESPECIALLY AFTER LIVER 1492 00:54:37,480 --> 00:54:37,840 TRANSPLANTATION. 1493 00:54:37,840 --> 00:54:40,760 WE HAVE TIME FOR A FEW 1494 00:54:40,760 --> 00:54:41,360 QUESTIONS. 1495 00:54:41,360 --> 00:54:45,000 THE FIRST ONE WE HAVE, THIS IS 1496 00:54:45,000 --> 00:54:49,000 ACTUALLY FOR Dr. GAO. 1497 00:54:49,000 --> 00:54:53,480 QUESTION -- DOES IL-22 INHIBIT 1498 00:54:53,480 --> 00:54:53,760 GUT LEAK? 1499 00:54:53,760 --> 00:54:57,320 >> YES. 1500 00:54:57,320 --> 00:55:02,600 SO, THE THEY EXPRESS HIGH LEVEL 1501 00:55:02,600 --> 00:55:04,040 OF ITR2. 1502 00:55:04,040 --> 00:55:06,080 MY COLLABORATOR. 1503 00:55:06,080 --> 00:55:13,200 THE DATA STUDY, PROTECT AGAINST 1504 00:55:13,200 --> 00:55:13,720 THE GUT LEAKAGE. 1505 00:55:13,720 --> 00:55:16,360 >> THANK YOU. 1506 00:55:16,360 --> 00:55:19,360 ON THE SAME LINES, MANY PATIENTS 1507 00:55:19,360 --> 00:55:20,880 WITH SEVERE ALCOHOLIC HEPATITIS 1508 00:55:20,880 --> 00:55:23,000 HAVE CIRRHOSIS WHICH IS A MAJOR 1509 00:55:23,000 --> 00:55:25,200 RISK FOR LIVER CANCER. 1510 00:55:25,200 --> 00:55:27,240 CAN YOU COMMENT ON THE POTENTIAL 1511 00:55:27,240 --> 00:55:29,720 EFFECT OF IL-22 THERAPY IN LIVER 1512 00:55:29,720 --> 00:55:33,040 CANCER IN PATIENTS WITH SEVERE 1513 00:55:33,040 --> 00:55:39,520 ALCOHOL HEPATITIS OR ACUTE LIVER 1514 00:55:39,520 --> 00:55:39,720 FAILURE. 1515 00:55:39,720 --> 00:55:40,400 >> Dr. Bin Gao: THIS IS A GREAT 1516 00:55:40,400 --> 00:55:40,880 QUESTION. 1517 00:55:40,880 --> 00:55:43,840 THE FIRST IL-22 IS NOT A CAR SIN 1518 00:55:43,840 --> 00:55:50,160 CARCINOGEN. 1519 00:55:50,160 --> 00:55:53,360 YOU CAN LIVER CANCER 1520 00:55:53,360 --> 00:55:54,240 PROLIFERATION AND FOR THE 1521 00:55:54,240 --> 00:55:56,960 TREATMENT OF ACUTE ALCOHOLIC 1522 00:55:56,960 --> 00:56:00,840 HEPATITIS, WITH IR-22 IS A SHORT 1523 00:56:00,840 --> 00:56:01,160 TIME. 1524 00:56:01,160 --> 00:56:02,480 IT'S THREE OR FOUR WEEKS. 1525 00:56:02,480 --> 00:56:05,440 SO IF THE PATIENT HAS POTENTIAL 1526 00:56:05,440 --> 00:56:07,600 LIVER CANCER WE PROBABLY WILL 1527 00:56:07,600 --> 00:56:12,920 NOT USE IL-22 TO TREAT THEM. 1528 00:56:12,920 --> 00:56:13,520 >> Tom: GREAT. 1529 00:56:13,520 --> 00:56:13,680 OK. 1530 00:56:13,680 --> 00:56:14,040 THANK YOU. 1531 00:56:14,040 --> 00:56:15,720 FOR Dr. MELLINGER, YOU 1532 00:56:15,720 --> 00:56:18,440 MENTIONED BIOMARKERS. 1533 00:56:18,440 --> 00:56:19,880 HOW DO YOU USE ALCOHOL 1534 00:56:19,880 --> 00:56:21,160 BIOMARKERS IN THESE INTEGRATED 1535 00:56:21,160 --> 00:56:22,720 CARE MODEL TEAMS? 1536 00:56:22,720 --> 00:56:26,320 IS IT ROUTINE OR SUSPECTED BY 1537 00:56:26,320 --> 00:56:28,200 INDIVIDUALS AND DO YOU HAVE A 1538 00:56:28,200 --> 00:56:29,400 PREFERRED ONE AND YOU KNOW, HOW 1539 00:56:29,400 --> 00:56:32,280 DO YOU USE THOSE IN 1540 00:56:32,280 --> 00:56:32,960 COMMUNICATIONS, THIS INFORMATION 1541 00:56:32,960 --> 00:56:34,920 TO PATIENTS WHO MAY BE 1542 00:56:34,920 --> 00:56:35,200 RELAPSING? 1543 00:56:35,200 --> 00:56:38,040 >> I THINK THE FIRST THING WE DO 1544 00:56:38,040 --> 00:56:39,520 IS MY ALD CLINIC IN MY 1545 00:56:39,520 --> 00:56:43,840 TRANSPLANT CLINIC WHEN I SEE A 1546 00:56:43,840 --> 00:56:45,280 PATIENT WHERE COLOR USE IS PART 1547 00:56:45,280 --> 00:56:47,840 OR ALL OF THEIR LIVER DISEASE. 1548 00:56:47,840 --> 00:56:49,520 I TELL THEM WE CHECK THESE 1549 00:56:49,520 --> 00:56:50,920 BIOMARKERS SO WE TELL THEM UP 1550 00:56:50,920 --> 00:56:53,840 FRONT WE'LL CHECK IT. 1551 00:56:53,840 --> 00:56:55,760 LIKE PEOPLE CHECK A HEMOGLOBIN 1552 00:56:55,760 --> 00:56:57,160 A1C IF YOU ARE DIABETIC. 1553 00:56:57,160 --> 00:56:58,880 THIS IS HOW WE FRAME IT. 1554 00:56:58,880 --> 00:57:00,200 IT'S LIKE ANOTHER MEDICAL 1555 00:57:00,200 --> 00:57:00,440 CONDITION. 1556 00:57:00,440 --> 00:57:01,600 WE'RE NOT TRYING TO DO THIS TO 1557 00:57:01,600 --> 00:57:03,160 CATCH YOU OR CATCH YOU OUT OR 1558 00:57:03,160 --> 00:57:04,080 ANYTHING LIKE THAT. 1559 00:57:04,080 --> 00:57:06,840 BUT THAT WE DO KNOW THIS IS A 1560 00:57:06,840 --> 00:57:09,080 CHRONIC CONDITION THAT OFTEN CAN 1561 00:57:09,080 --> 00:57:10,640 IN MANY PATIENTS RELAPSE OVER 1562 00:57:10,640 --> 00:57:12,520 TIME AND WE WANT TO HELP DETECT 1563 00:57:12,520 --> 00:57:13,840 THAT, IF THAT'S HAPPENING, AND 1564 00:57:13,840 --> 00:57:15,760 GET PEOPLE INTO TREATMENT. 1565 00:57:15,760 --> 00:57:17,880 SO, I START BY UP FRONT AND OPEN 1566 00:57:17,880 --> 00:57:19,520 COMMUNICATION WITH MY PATIENTS. 1567 00:57:19,520 --> 00:57:21,400 I DON'T SNEAK IT IN ON PEOPLE. 1568 00:57:21,400 --> 00:57:23,040 THAT IS A GOOD WAY TO DAMAGE 1569 00:57:23,040 --> 00:57:25,160 YOUR RELATIONSHIP WITH YOUR 1570 00:57:25,160 --> 00:57:25,480 PATIENTS. 1571 00:57:25,480 --> 00:57:30,760 AND WE TYPICALLY USE, AS I SAID, 1572 00:57:30,760 --> 00:57:31,520 PATH ETHANOL AT THE UNIVERSITY 1573 00:57:31,520 --> 00:57:32,200 OF MICHIGAN. 1574 00:57:32,200 --> 00:57:35,800 WE GET BOTH OF THOSE AND THE ONE 1575 00:57:35,800 --> 00:57:37,320 URINARY IS GETTING SHORT TERM 1576 00:57:37,320 --> 00:57:39,080 THREE TO FIVE DAY USE AND THE 1577 00:57:39,080 --> 00:57:41,240 PATH IS A LONGER TERM BACK USE 1578 00:57:41,240 --> 00:57:43,240 TWO OR THREE WEEKS BACK. 1579 00:57:43,240 --> 00:57:45,080 PATIENTS ARE OFTEN NOT USED TO 1580 00:57:45,080 --> 00:57:47,560 GETTING URINE FOR TOX TESTING 1581 00:57:47,560 --> 00:57:48,720 AND SOMETIMES MAYBE DON'T WANT 1582 00:57:48,720 --> 00:57:52,080 TO GIVE URINE OR WON'T GIVE 1583 00:57:52,080 --> 00:57:53,600 URINE BUT BLOOD IS MORE AMENABLE 1584 00:57:53,600 --> 00:57:55,120 BECAUSE WE'RE GETTING BLOOD FOR 1585 00:57:55,120 --> 00:57:56,360 OTHER THINGS SO THE PATH HAS 1586 00:57:56,360 --> 00:57:58,320 BEEN USEFUL IN THAT SENSE IF 1587 00:57:58,320 --> 00:57:59,760 PEOPLE CAN'T URINATE. 1588 00:57:59,760 --> 00:58:01,040 IT'S WHAT WE'VE BEEN USEING AND 1589 00:58:01,040 --> 00:58:02,680 HOW WE'VE BEEN USING THEM AND 1590 00:58:02,680 --> 00:58:06,400 COMMUNICATING BACK TO PEOPLE IS 1591 00:58:06,400 --> 00:58:14,160 ALWAYS A DELL INDI DELICATE, WAE 1592 00:58:14,160 --> 00:58:15,880 ANYTHING YOU FORGOT ABOUT OR ANY 1593 00:58:15,880 --> 00:58:17,640 ALCOHOL CONSUMPTION THAT MIGHT 1594 00:58:17,640 --> 00:58:18,720 HAVE SLIPPED YOUR MIND OR NOT 1595 00:58:18,720 --> 00:58:20,000 BEEN DISCLOSE AND WE CAN TALK 1596 00:58:20,000 --> 00:58:21,560 ABOUT YOU KNOW, WHAT MAY OR MAY 1597 00:58:21,560 --> 00:58:23,000 NOT HAVE HAPPENED. 1598 00:58:23,000 --> 00:58:24,280 FALSE POSITIVES OCCUR SO WE TALK 1599 00:58:24,280 --> 00:58:26,240 ABOUT THAT TOO. 1600 00:58:26,240 --> 00:58:31,720 >> Tom: THANK YOU, VERY MUCH. 1601 00:58:31,720 --> 00:58:34,680 YOU SHOWED SOME DATA SHOWING IN 1602 00:58:34,680 --> 00:58:37,480 SOME NURSING LED INTEGRATION 1603 00:58:37,480 --> 00:58:38,560 CARE TEAMS MAY HAVE BETTER 1604 00:58:38,560 --> 00:58:40,720 OUTCOMES COMPARED TO THE 1605 00:58:40,720 --> 00:58:41,880 PHYSICIAN-LED TEAMS. 1606 00:58:41,880 --> 00:58:43,680 I INSIGHTS WHY THAT MIGHT BE? 1607 00:58:43,680 --> 00:58:46,240 >> WELL, IN THAT STUDY, THEY 1608 00:58:46,240 --> 00:58:48,400 DIDN'T REALLY SAY, GET INTO THE 1609 00:58:48,400 --> 00:58:49,800 MECHANISM OF IT. 1610 00:58:49,800 --> 00:58:51,800 SO, I DON'T KNOW WHY IN THAT 1611 00:58:51,800 --> 00:58:54,280 STUDY IN PARTICULAR IT WAS THE 1612 00:58:54,280 --> 00:58:54,800 CASE. 1613 00:58:54,800 --> 00:58:56,280 IN MY OWN EXPERIENCE WITH THE 1614 00:58:56,280 --> 00:58:57,560 NURSING TEAMS THAT I WORK WITH 1615 00:58:57,560 --> 00:59:00,480 IN OUR ALD CLINIC, THEY'RE JUST 1616 00:59:00,480 --> 00:59:02,280 OUR NURSES ARE JUST PHENOMENAL 1617 00:59:02,280 --> 00:59:04,240 AND OUR PATIENTS OFTEN IDENTIFY 1618 00:59:04,240 --> 00:59:06,360 AND WILL TALK TO THE NURSES JUST 1619 00:59:06,360 --> 00:59:07,560 IN A DIFFERENT WAY THAN THEY 1620 00:59:07,560 --> 00:59:09,640 WERE WITH THEIR PHYSICIANS, YOU 1621 00:59:09,640 --> 00:59:11,920 KNOW, OFTEN TIMES, THE NURSES 1622 00:59:11,920 --> 00:59:13,520 ARE CALLING OUR PATIENTS AND 1623 00:59:13,520 --> 00:59:14,760 TALKING TO THEM IN BETWEEN THE 1624 00:59:14,760 --> 00:59:15,080 VISITS. 1625 00:59:15,080 --> 00:59:17,000 SO, PATIENTS MAY FEEL MORE 1626 00:59:17,000 --> 00:59:20,520 COMFORTABLE DISCLOSING SOMETHING 1627 00:59:20,520 --> 00:59:23,040 ABOUT ALCOHOL USE OR FEEL LESS 1628 00:59:23,040 --> 00:59:24,440 INTIMIDATED BY SOMEONE IN A 1629 00:59:24,440 --> 00:59:27,200 NURSINGEL ROLE AS OPPOSED TO THE 1630 00:59:27,200 --> 00:59:28,920 PHYSICIAN IN THE WHITE COAT WHO 1631 00:59:28,920 --> 00:59:30,600 INTIMIDATEING AND WHO MAYBE THEY 1632 00:59:30,600 --> 00:59:31,720 FEEL LIKE THEY HAVE TO IMPRESSES 1633 00:59:31,720 --> 00:59:33,080 SO THEY CAN GET A TRANSPLANT AND 1634 00:59:33,080 --> 00:59:34,240 THOSE TYPES OF THINGS. 1635 00:59:34,240 --> 00:59:36,560 SO, I THINK NURSING AS A 1636 00:59:36,560 --> 00:59:38,320 PROFESSION, IS TRAINED TO REALLY 1637 00:59:38,320 --> 00:59:40,360 HAVE THAT INTERACTION AND HAVE 1638 00:59:40,360 --> 00:59:41,640 THAT GOOD RELATIONSHIP WITH THE 1639 00:59:41,640 --> 00:59:43,960 PATIENTS AND I THINK IT SHOWS IN 1640 00:59:43,960 --> 00:59:46,000 DATA LIKE THAT AND HOW IMPORTANT 1641 00:59:46,000 --> 00:59:48,200 THAT IS. 1642 00:59:48,200 --> 00:59:49,040 >> Tom: WONDERFUL. 1643 00:59:49,040 --> 00:59:50,200 WELL, THAT TAKES US UP TO THE 1644 00:59:50,200 --> 00:59:50,400 HOUR. 1645 00:59:50,400 --> 00:59:54,000 I WANT TO SAY Dr. MELLINGER 1646 00:59:54,000 --> 00:59:55,400 AND Dr. GAO THANK YOU FOR 1647 00:59:55,400 --> 00:59:57,400 SHARING THE EXPERTISE WITH OUR 1648 00:59:57,400 --> 00:59:57,640 COMMUNITY. 1649 00:59:57,640 --> 00:59:59,040 I WISH BOTH OF YOU A GOOD 1650 00:59:59,040 --> 01:00:00,080 AFTERNOON AND TO EVERYBODY GOOD 1651 01:00:00,080 --> 01:00:02,000 AFTERNOON AND WE'LL SEE EVERYONE 1652 01:00:02,000 --> 01:00:04,680 NEXT WEEK FOR OUR NEXT TALK IN 1653 01:00:04,680 --> 01:00:06,400 OUR GRAND ROUNDS SERIES. 1654 01:00:06,400 --> 01:00:09,120 IT WILL BE ON SIMULATION 1655 01:00:09,120 --> 01:00:10,040 TRAINING AND HEALTHCARE. 1656 01:00:10,040 --> 01:00:10,920 THANK YOU, VERY MUCH AND 1657 01:00:10,920 --> 00:00:00,000 GOOD-BYE.