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Low platelet count: Predictor of death and graft loss after liver transplantation

World Journal of Hepatology 2019年第1期11卷 99-108页

作者： Pedro Beltrame Santiago Rodriguez ajacio bandeira de mello brand?o Graduate Program in Medicine: Hepatology School of Medicine Universidade Federal de Ciências da Saúde dePorto Alegre (UFCSPA) Liver Transplantation Group Santa Casa de Misericórdia de Porto Alegre

BACKGRoUND The impact of platelets on liver transplantation(LT) is well recognized, but not completely understood. Platelets exert dichotomous effects on the graft and on the patient. on the one hand, they are essential for primary hemostasis and tissue repair and regeneration. on the other hand, they support ischemia/reperfusion injury and inflammatory processes. Recent evidence has shown a new role for platelet count(PC) in predicting outcomes after *** To evaluate if low PC is a predictor of short-and long-term outcomes after *** Four hundred and eighty consecutive LT patients were retrospectively *** from the preoperative to the seventh postoperative day(PoD) were considered. C-statistic analysis defined the ideal cutoff point for PC. Cox regression was performed to check whether low PC was a predictor of death,retransplantation or primary changes in graft function within one year after *** The highest median PC was 86 × 109/L [interquartile range(IQR) = 65–100 ×109/L] on seventh PoD, and the lowest was 51 × 109/L(IQR = 38–71 × 109/L) on third PoD. The C-statistic defined a PC on fifth PoD as the ideal cutoff point for predicting death and retransplantation. In the multivariate analysis, platelets on 5 PoD was an independent risk factor for death at 12 mo after LT [hazard ratio(HR) = 2.01; 95% confidence interval(CI) 1.06-3.79;P = 0.031]. In the Cox regression, patients with PC on 5 PoD had worse graft survival rates up to one year after LT(HR = 2.76; 95%CI 1.52-4.99; P =0.001).CoNCLUSIoN PC on 5 PoD is an independent predictor of death in the first year after LT. These results are in agreement with other studies that indicate that low PC after LT is associated with negative outcomes.

关键词： Predictive factors Prognosis Platelet count Liver transplantation Graft survival Mortality

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Herb-induced liver injury: Systematic review and meta-analysis

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World Journal of Clinical Cases 2021年第20期9卷 5490-5513页

作者： Vinícius Remus Ballotin Lucas Goldmann Bigarella ajacio bandeira de mello brandão Raul Angelo Balbinot Silvana Sartori Balbinot Jonathan Soldera School of Medicine Universidade de Caxias do SulCaxias do Sul 95070-560RSBrazil Post-Graduate Program in Medicine Division of HepatologyUniversidade Federal de Ciências da Saúde de Porto Alegre(UFCSPA)Porto Alegre90050-110RSBrazil department of Clinical Gastroenterology Universidade de Caxias do SulCaxias do Sul 95070-560RSBrazil

BACKGRoUND The use of herbal supplements and alternative medicines has been increasing in the last *** popular belief that the consumption of natural products is harmless,herbs might cause injury to various organs,particularly to the liver,which is responsible for their metabolism in the form of herb-induced liver injury(HILI).AIM To identify herbal products associated with HILI and describe the type of lesion associated with each *** Studies were retrieved using Medical Subject Headings descriptors combined with Boolean *** were run on the electronic databases Scopus,Web of Science,MEDLINE,BIREME,LILACS,Cochrane Library for Systematic Reviews,SciELo,Embase,and *** were restricted to English,Spanish,and *** was no date of publication *** reference lists of the studies retrieved were searched *** access causality,the Maria and Victorino System of Causality Assessment in Drug Induced Liver Injury was *** descriptive analysis were used to summarize the *** The search strategy retrieved 5918 *** the final analysis,446 references were included,with a total of 936 cases *** found 79 types of herbs or herbal compounds related to ***-Shou-Wu,Green tea extract,Herbalife,kava kava,Greater celandine,multiple herbs,germander,hydroxycut,skullcap,kratom,Gynura segetum,garcinia cambogia,ma huang,chaparral,senna,and aloe vera were the most common supplements with HILI *** of these patients had complete clinical recovery(82.8%).However,liver transplantation was necessary for 6.6%of these ***,chronic liver disease and death were observed in 1.5%and 10.4%of the cases,*** HILI is normally associated with a good prognosis,once the implied product is ***,it is paramount to raise awareness in the medical and non-medical community of the risks of the indiscriminate use of herbal products.

关键词： Herb-induced liver injury Drug induced liver injury Dietary supplements Herbal hepatotoxicity Liver transplantation

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Artificial intelligence and human liver allocation:Potential benefits and ethical implications

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Artificial Intelligence in Gastroenterology 2022年第1期3卷 21-27页

作者： Marcos Mucenic ajacio bandeira de mello brandão Claudio Augusto Marroni Liver Transplant Adult Group Irmandade da Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090RSBrazil Hepatology Universidade Federal de Ciencias da Saude de Porto AlegrePorto Alegre 90050-170RSBrazil

Since its implementation almost two decades ago,the urgency allocation policy has improved the survival of patients on the waiting list for liver transplantation *** Model for End-Stage Liver Disease score is widely used to predict waiting list *** to some limitations related to its use,there is an active investigation to develop other prognostic *** allocation(LA)entails complex decision-making,and grafts are occasionally not directed to the recipients who are more likely to *** scores have,thus far,failed to predict post-operatory ***,the increasing use of marginal donors is associated with worse *** donor-recipient pairing could help avoid retransplantation or futile procedures and reduce postoperative complications,mortality,hospitalization time,and *** intelligence has applications in several medical *** learning algorithms(MLAs)use large amounts of data to detect unforeseen patterns and complex interactions between *** neural networks and decision trees were the most common forms of MLA tested on *** researchers have shown them to be superior for predicting waiting list mortality and graft failure than conventional statistical *** promising techniques are increasingly being considered for implementation.

关键词： Liver transplantation Liver cirrhosis Artificial intelligence Prognosis Survival Machine learning

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Predicting major adverse cardiovascular events after orthotopic liver transplantation using a supervised machine learning model:A cohort study

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World Journal of Hepatology 2024年第2期16卷 193-210页

作者： Jonathan Soldera Leandro Luis Corso Matheus Machado Rech Vinícius Remus Ballotin Lucas Goldmann Bigarella Fernanda Tomé Nathalia Moraes Rafael Sartori Balbinot Santiago Rodriguez ajacio bandeira de mello brandão Bruno Hochhegger Post Graduate Program at Acute Medicine and Gastroenterology University of South WalesCardiff CF371DLUnited Kingdom Postgraduate Program in Pathology Federal University of Health Sciences of Porto Alegre(UFCSPA)Porto Alegre 90050-170Brazil department of Engineering Universidade de Caxias do SulCaxias do Sul 95070-560Brazil School of Medicine Universidade de Caxias do SulCaxias do Sul 95070-560Brazil Postgraduate Program in Hepatology Federal University of Health Sciences of Porto Alegre(UFCSPA)Porto Alegre 90050-170Brazil

BACKGRoUND Liver transplant(LT)patients have become older and *** rate of post-LT major adverse cardiovascular events(MACE)has increased,and this in turn raises 30-d post-LT *** cardiac stress testing loses accuracy when applied to pre-LT cirrhotic *** To assess the feasibility and accuracy of a machine learning model used to predict post-LT MACE in a regional *** This retrospective cohort study involved 575 LT patients from a Southern Brazilian academic *** developed a predictive model for post-LT MACE(defined as a composite outcome of stroke,new-onset heart failure,severe arrhythmia,and myocardial infarction)using the extreme gradient boosting(XGBoost)machine learning *** addressed missing data(below 20%)for relevant variables using the k-nearest neighbor imputation method,calculating the mean from the ten nearest neighbors for each *** modeling dataset included 83 features,encompassing patient and laboratory data,cirrhosis complications,and pre-LT cardiac *** performance was assessed using the area under the receiver operating characteristic curve(AURoC).We also employed Shapley additive explanations(SHAP)to interpret feature *** dataset was split into training(75%)and testing(25%)*** was evaluated using the Brier *** followed Transparent Reporting of a Multivariable Prediction Model for Individual Prognosis or Diagnosis guidelines for ***-learn and SHAP in Python 3 were used for all *** supplementary material includes code for model development and a user-friendly online MACE prediction *** of the 537 included patients,23(4.46%)developed in-hospital MACE,with a mean age at transplantation of 52.9 *** majority,66.1%,were *** XGBoost model achieved an impressive AURoC of 0.89 during the training *** model exhibited accuracy,precision,recall,and F1-score values of 0.84,0.85,0.80,and 0.79,***

关键词： Liver transplantation Major adverse cardiac events Machine learning Myocardial perfusion imaging Stress test

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Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant

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World Journal of Clinical oncology 2022年第8期13卷 688-701页

作者： ajacio bandeira de mello brandão Santiago Rodriguez Alfeu de Medeiros Fleck Jr Claudio Augusto Marroni Mário B Wagner Alex Hörbe Matheus V Fernandes Carlos TS Cerski Gabriela Perdomo Coral Graduate Program in Medicine:Hepatology School of MedicineUniversidade Federal de Ciências da Saúde de Porto AlegrePorto Alegre 90050170RSBrazil Liver Transplantation Group Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020090RSBrazil department of Hepatology Hospital Vozandes Quito-HVQQuito 170521Ecuador School of Medicine Universidade Federal do Rio Grande do Sul(UFRGS)Porto Alegre 90035002RSBrazil Interventional Radiology Unit Santa Casa de Misericórdia dePorto Alegre 90020090RSBrazil department of Pathology School of MedicineUniversidade Federal do Rio Grande do SulPorto Alegre 90035002RSBrazil

BACKGRoUND Cholangiocarcinoma(CC)is a rare tumor that arises from the epithelium of the bile *** is classified according to anatomic location as intrahepatic,perihilar,and *** CC(ICC)is rare in patients with cirrhosis due to causes other than primary sclerosing *** hepatocellular carcinoma-CC(HCC-CC)is a rare neoplasm that shows histologic findings of both HCC and ICC within the same tumor *** to the difficulties in arriving at the correct diagnosis,patients eventually undergo liver transplantation(LT)with a presumptive diagnosis of HCC on imaging when,in fact,they have ICC or *** To evaluate the outcomes of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma on pathological examination after liver *** Propensity score matching was used to analyze tumor recurrence(TR),overall mortality(oM),and recurrence-free survival(RFS)in LT recipients with pathologically confirmed ICC or HCC-CC matched 1:8 to those with ***-free survival and overall mortality rates were computed with the Kaplan-Meier method using Cox regression for *** of 475 HCC LT recipients,1.7%had the diagnosis of ICC and 1.5%of HCC-CC on pathological examination of the *** recipients with ICC had higher TR(46%vs 11%;P=0.006),higher oM(63%vs 23%;P=0.002),and lower RFS(38%vs 89%;P=0.002)than those with HCC when matched for pretransplant tumor characteristics,as well as higher TR(46%vs 23%;P=0.083),higher oM(63%vs 35%;P=0.026),and lower RFS(38%vs 59%;P=0.037)when matched for posttransplant tumor *** pairings were performed to compare the outcomes of LT recipients with HCC-CC vs *** was no significant difference between the outcomes in either *** Patients with ICC had worse outcomes than patients undergoing LT for *** outcomes of patients with HCC-CC did not differ significantly from those of patients with HCC.

关键词： Cholangiocarcinoma Hepatocellular carcinoma Liver Prognosis Recurrence Survival analysis Transplantation

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Correction:Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellularcholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant

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World Journal of Clinical oncology 2023年第6期14卷 227-229页

作者： ajacio bandeira de mello brandão Santiago Rodriguez Alfeu de Medeiros Fleck Jr Claudio Augusto Marroni Mário B Wagner Alex Hörbe Matheus V Fernandes Carlos TS Cerski Gabriela Perdomo Coral Graduate Program in Medicine:Hepatology School of MedicineUniversidade Federal de Ciências da Saúde de Porto AlegrePorto Alegre 90050170RSBrazil Liver Transplantation Group Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020090RSBrazil department of Hepatology Hospital Vozandes Quito-HVQQuito 170521Ecuador School of Medicine Universidade Federal do Rio Grande do Sul(UFRGS)Porto Alegre 90035002RSBrazil Interventional Radiology Unit Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020090RSBrunei Darussalam department of Pathology School of MedicineUniversidade Federal do Rio Grande do Sul(UFRGS)Porto Alegre 90035002RSBrazil

Rereading the article“Propensity-matched analysis of patients with intrahepatic cholangiocarcinoma or mixed hepatocellular-cholangiocarcinoma and hepatocellular carcinoma undergoing a liver transplant”(DoI:10.5306/wjco.v13.i8.688),published on August 24,we observe,with concern,that figures 3 and 4 are *** authors have attached the correct figures for correction.

关键词： Cholangiocarcinoma Hepatocellular carcinoma Liver Prognosis Recurrence Survival analysis Correction

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Liver transplantation and alcoholic liver disease:History,controversies,and considerations

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World Journal of Gastroenterology 2018年第26期24卷 2785-2805页

作者： Claudio Augusto Marroni Alfeu de Medeiros Fleck Jr Sabrina Alves Fernandes Lucas Homercher Galant Marcos Mucenic Mario Henrique de Mattos Meine Guilherme Mariante-Neto ajacio bandeira de mello brandao Graduate Program in Medicine:Hepatology Universidade Federal de Ciências da Saúde de Porto Alegre(UFCSPA)Porto Alegre 90430-080RSBrazil Liver Transplant Adult Group Irmandade da Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90035-072RSBrazil Nutrition at the Centro Universitário Metodista(IPA) Porto Alegre 90420-060RSBrazil

Alcohol consumption accounts for 3.8% of annual global mortality worldwide, and the majority of these deaths are due to alcoholic liver disease(ALD), mainly alcoholic cirrhosis. ALD is one of the most common indications for liver transplantation(LT). However, it remains a complicated topic on both medical and ethical grounds, as it is seen by many as a "self-inflicted disease". one of the strongest ethical arguments against LT for ALD is the probability of relapse. However, ALD remains a common indication for LT worldwide. For a patient to be placed on an LT waiting list, 6 mo of abstinence must have been achieved for most LT centers. However, this "6-mo rule" is an arbitrary threshold and has never been shown to affect survival, sobriety, or other outcomes. Recent studies have shown similar survival rates among individuals who undergo LT for ALD and those who undergo LT for other chronic causes of end-stage liver disease. There are specific factors that should be addressed when evaluating LT patients with ALD because these patients commonly have a high prevalence of multisystem alcohol-related changes. Risk factors for relapse include the presence of anxiety or depressive disorders, short pre-LT duration of sobriety, and lack of social support. Identification of risk factors and strengthening of the social support system may decrease relapse among these patients. Family counseling for LT candidates is highly encouraged to prevent alcohol consumption relapse. Relapse has been associated with unique histopathological changes, graft damage, graft loss, and even decreased survival in some studies. Research has demonstrated the importance of a multidisciplinary evaluation of LT candidates. Complete abstinence should be attempted to overcome addiction issues and to allow spontaneous liver recovery. Abstinence is the cornerstone of ALD therapy. Psychotherapies, including 12-step facilitation therapy, cognitive-behavioral therapy, and motivational enhancement therapy, help

关键词： Alcoholic liver disease Alcoholic hepatitis Alcoholic cirrhosis Alcoholism Liver transplantation Alcoholic recurrence Controversies Alcoholic abstinence Relapse Selection criteria

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Comparison between Care Strategies for Patients with osteoarthritis of the Hands Based on the Use of Joint Protection, Assistive Technology and Exercises

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open Journal of orthopedics 2024年第7期14卷 295-311页

作者： Daniele dos Santos Scarcella Talita Dias da Silva Victoria Yanara Hernandes da Silva Maria Cândida de Miranda Luzo Selma Lancman Marcia Uchoa de Rezende Carlos bandeira de mello Monteiro Instituto de ortopedia e Traumatologia Hospital das Clnicas HCFMUSP Faculdade de Medicina Universidade de So Paulo So Paulo Brazil Programa de Ps-Graduao em Cincias da Reabilitao Faculdade de Medicina Universidade de So Paulo So Paulo Brazil Escola de Artes Cincias e Humanidades Universidade de So Paulo So Paulo Brazil

Background: osteoarthritis (oA) is a disabling disease that can affect 6% to 12% of the adult population and more than a third of people over 65 years of age. Purpose: To assess whether a group of people with hand osteoarthritis (hoA) who received different types of treatment improved their function after two years of follow-up. Method: The entire sample (n = 97) underwent three follow-up assessments regarding anthropometric parameters of the upper limbs and ability to perform functional activities. Subsequently, the sample was divided into two groups for the intervention periods, called the First Period (n = 73) and the Second Period (n = 24);the First Period kept the same protocol with orientations, and the Second Period went to an intervention with orientation strength exercises and use of orthosis. Findings: In the separate analysis of the three questions of the DASH pain module, no differences were found between the assessment moments for groups of guidelines, treatment, or symptoms. Significant effects were observed for F(2, 162) = 3.5, p = 0.033, η2 = 0.04, and interaction for moments and intervention F(2, 162) = 4.3, p = 0.016, η2 = 0.05. Implications: It can be concluded that only guidance treatment does not benefit patients with hand osteoarthritis. In contrast, guidance, exercise, and orthosis treatment can significantly improve the disease.

关键词： Hand osteoarthritis Hand deformities occupational Therapy

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The Brunel Mood Scale Rating in Mental Health for Physically Active and Apparently Healthy Populations

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Health 2016年第2期8卷 125-132页

作者： Ricardo brandt Dafne Herrero Thaís Massetti Tânia Brusque Crocetta Regiani Guarnieri Carlos bandeira de mello Monteiro Maick da Silveira Viana Guilherme Guimarães Bevilacqua Luiz Carlos de Abreu Alexandro Andrade State University of West Parana Marechal Candido Rondon Brazil Laboratory of Sport and Exercise Psychology Santa Catarina State University Florianópolis Brazil Faculty Public Health Sao Paulo Brazil Post-Graduate Program in Rehabilitation Sciences Faculty of Medicine University of Sao Paulo Sao Paulo Brazil department of Morphology and Physiology Faculty of Medicine of ABC Santo André Brazil

There is a positive relationship between mood states and mental health. The aim of the present study was to investigate the construct validity and internal consistency of the Brunel Mood Scale (BRUMS) for use with different populations, which are physically active and apparently healthy. Measures were obtained from 1295 male (N = 709, 34 ± 20 years, mean ± SD) and female (N = 576, 43 ± 24 years, mean ± SD) volunteers. Factor analysis was used, verifying that six factors (components) accounted for 62.65% of the total variance of the scale. The Varimax method with Kaiser Normalization for the rotation of the factors for the main components, and it was observed that the 24 scale items loaded on six mood factors (anger, depression, tension, vigor, fatigue, and confusion). Internal consistency was good for all the factors identified. We suggest that the results provide some support for validity of the BRUMS for use with different populations, which are physically active and apparently healthy.

关键词： Mental Health Mood States Psychometrics Brunel Mood Scale BRUMS

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