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Disease dependent qualitative and quantitative differences in the inflammatory response to ascites occurring in cirrhotics

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World Journal of hepatology 2014年第2期6卷 85-91页

作者： Bashar M Attar Magdalena George Nicolae Ion-Nedelcu Guilliano Ramadori david h van thiel Division of Gastroenterology and hepatology John H Stroger Hospital of Cook County Rush University Medical Center Victor Babes Infectious and Tropical Disease Clinic Department of Gastroenterology and Endocrinology August Georg University

AIM:To assess differing patterns and levels of ascitic fluid cyctokine and growth factors exist between those with a high risk and low risk of spontaneous bacterial peritonitis(SBP). METhODS: A total of 57 consecutive patients with ascites requiring a large volume paracentesis were studied. Their age, gender, specific underlying disease conditions were recorded after a review of their clinical records. Each underwent a routine assessment prior to their paracentesis consisting of a complete blood count, complete metabolic profile and prothrombin time/international normalized ratio(INR) determination. The ascitic fluid was cultured and a complete cellcount and albumin determination was obtained on the fluid. In addition, blood and ascitic fluid was assessed for the levels of interleukin interleukin(IL)-1A, IL-1B, IL-2, IL-4, IL-8, IL-10, monocyte chemotactic protein(MCP)-1, tumor necrosis factor(TNF)-α, interferon(IFN)-γ, vascular endothelial growth factor(VEGF) and epidermal growth factor(EGF) utilizing the Randox Biochip platforms(Boston, MA). A serum-ascites gradient, for each cytokine and growth factor was calculated. The results are reported as mean ± SEM between disease groups with statistical analysis consisting of the student t-test(two tailed) with a P value of 0.05 defining significance. RESULTS: No clinically important demographic or biochemical differences between the 4 groups studied were evident. In contrast, marked difference in the cytokine and growth factors levels and pattern were evident between the 4 disease groups. Individuals with alcoholic cirrhosis had the highest levels of IL-1A, IL-1B, IL-4, IFNγ. Those with malignant disease had the highest levels of IL-2. Those with hepatitis C virus(hCV) associated cirrhosis had the highest value for IL-6, IL-8, IL-10, MCP-1 and VEGF. Those with cardiac disease had the highest level of TNF-α and EGF. The calculated serum- ascites gradients for the cardiac and malignant disease groups had a greater frequenc

关键词： Ascites Cirrhosis Growth factors Inflammation Procalcitonin

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hepatitis C virus: A time for decisions. Who should be treated and when?

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2016年第1期7卷 33-40页

作者： Bashar M Attar david h van thiel Cook County health and hospitals System Rush University Medical Center Advanced Liver and Gastrointestinal Disease Center

Cirrhosis is the most important risk factor for hepatocellular carcinoma(hCC) regardless of the etiology of cirrhosis. Compared to individuals who are antihepatitis C virus(hCV) seronegative, anti-hCV seropositive individuals have a greater mortality from both hepatic as well as nonhepatic disease processes. The aim of this paper is do describe the burden of hCV infection and consider treatment strategies to reduce hCV-related morbidity and mortality. The newly developed direct acting antiviral(DAA) therapies are associated with greater rates of drug compliance, fewer adverse effects, and appear not to be limited by the presence of a variety of factors that adversely affect the outcome of interferon-based therapies. Because of the cost of the current DAA, their use has been severely rationed by insurers as well as state and federal agencies to those with advanced fibrotic liver disease(Metavir fibrosis stage F3-F4). The rationale for such rationing is that many of those recognized as having the disease progress slowly over many years and will not develop advanced liver disease manifested as chronic hepatitis C, cirrhosis, and experience any of the multiple complications of liver disease to include hCC. This mitigation has a short sided view of the cost of treatment of hepatitis C related disease processes and ignores the long-term expenses of hepatitis C treatment consisting of the cost of treatment of hepatitis C, the management of cirrhosis with or without decompensation as well as the cost of treatment of hCC and liver transplantation. We believe that treatment should include all hCV infected patients including those with stage F0-F2 fibrosis with or without evidence of coexisting liver disease. Specifically, interferon(IFN)-free regimens with the current effective DAAs without liver staging requirements and including those without evidence of hepatic diseases but having recognized extrahepatic manifestations of hCV infection is projected to be the most cost-effe

关键词： hepatitis C virus Direct acting antivirals Cirrhosis of the liver Timing of treatment

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Cirrhotic ascites review: Pathophysiology, diagnosis and management

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World Journal of hepatology 2013年第5期5卷 251-263页

作者： Christopher M Moore david h van thiel Section of hepatology Department of MedicineRush University Medical CenterChicagoIL 60612United States

Ascites is a pathologic accumulation of peritoneal fluidcommonly observed in decompensated cirrhotic states. Its causes are multi-factorial, but principally involve significant volume and hormonal dysregulation in the setting of portal hypertension. The diagnosis of ascites is considered in cirrhotic patients given a constellation of clinical and laboratory findings, and ultimately confirmed, with insight into etiology, by imaging and paracentesis procedures. Treatment for ascites is multimodal including dietary sodium restriction, pharmacologic therapies, diagnostic and therapeutic paracentesis, and in certain cases transjugular intra-hepatic portosystemic shunt. Ascites is associated with numerous complications including spontaneous bacterial peritonitis, hepato-hydrothorax and hepatorenal syndrome. Given the complex nature of ascites and associatedcomplications, it is not surprising that it heralds increased morbidity and mortality in cirrhotic patients and increased cost-utilization upon the health-care system. This review will detail the pathophysiology of cirrhotic ascites, common complications derived from it, and pertinent treatment modalities.

关键词： Ascites Cirrhosis hepato-hydrothorax hepatorenal syndrome Spontaneous bacterial peritonitis

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Successful transjugular intrahepatic portal-systemic shunt in an ineligible liver transplant patient with primary biliary cirrhosis with refractory ascites and aplastic anemia

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Open Journal of Gastroenterology 2013年第1期3卷 1-4页

作者： Christopher M. Moore George Behrens hector Ferral david h. van thiel Section of hepatology Department of Medicine Rush University Medical Center Chicago USA Section of Interventional Radiology Department of Radiology Rush University Medical Center Chicago USA

A transjugular intrahepatic portal-systemic shunt (TIPS) is a standard way to decompress the portal system in cirrhotic patients as a bridge to orthotopic liver transplantation (OLT). Traditionally, TIPS has been indicated for certain portal hypertensive sequelae such as refractory ascites, varices treatment and even hepato-hydrothorax. herein is a case report on the efficacy of TIPS in an OLT ineligible patient with primary biliary cirrhosis and aplastic anemia who had developed refractive ascites requiring serial paracentesis and esophageal varices. he survived 2.5 years post-TIPS placement and died from complications related to severe leucopenia and the development of sepsis.

关键词： Aplastic Anemia Ascites Liver Transplantation Paracentesis TIPS

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Colonic perforation with duodenal-colic fistula formation by a biliary stent in a liver transplant recipient

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Open Journal of Gastroenterology 2012年第2期2卷 91-92页

作者： Christopher M. Moore Raza hamdani hector Ferral david h. van thiel Advanced Gastroenterology Yorkville USA Section of hepatology Rush University Medical Center Chicago USA Section of Radiology Rush University Medical Center Chicago USA

Endoscopic retrograde cholangio-pancreatography (ERCP) is increasing utilized in the setting of liver transplantation for a number of post-operative related biliary issues. Although ERCP represents an excellent technology, it is not without attendant risk including sepsis, bleeding and perforation. In this case report, the first of its kind, is described the occurrence of a migrated biliary stent induced duodenal-colic fistula formation in a liver transplantation patient who had required dual biliary stenting given post-operative biliary structuring. The placement of dual stents and their size are likely implicated in the cause of perforation. The enteric anatomy and the medical immunosuppression likely contributed to a delay in diagnosis and worse outcome.

关键词： Biliary Stent Colonic Perforation Duodenal-Colic Fistula hepatitis C Virus Orthotopic Liver Transplant

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high-Dose Intra-Dermal hepatitis B Vaccine in a Liver Transplant Patient Who Failed Prior Intramuscular Vaccination: A Brief Case Report

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World Journal of Vaccines 2013年第1期3卷 16-18页

作者： Sonu Dhillon Kartik Sampath Christopher M. Moore Anil Dosanjh david h. van thiel Division of Gastroenterology and hepatology Saint Francis Medical Center Peoria USA Divison of Digestive Diseases Rush University Medical Center Chicago USA University of California Davis USA

hepatitis B virus (hBV) chronic infection represents a significant cause of morbidity and mortality worldwide. While traditional intramuscular (IM) hBV vaccination is an excellent method for robust and sustained seroconversion in healthy individuals, its efficacy in chronic liver disease is sub-optimal and scant data exists in the post-liver transplant state. Importantly, hBV complications are even more severe in these same immunocompromised populations. Intra-dermal (ID) vaccination has shown initial promise as a successful alternative to achieving hBV seroconversion in patients refractory to standard vaccination protocols. herein is a case report of a 61 year-old female who underwent liver transplantation for chronic hBV infection and achieved hBsAg seroconversion with a robust hSsAb titer with ID vaccination after having failed both standard and double dose IM vaccination.

关键词： hepatitis B Virus Intra-Dermal Vaccination Orthotopic Liver Transplant

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Impact of pre- and peri-operative risk factors on length of stay and hospital readmission following minimally-invasive partial nephrectomy

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Asian Journal of Urology 2024年第1期11卷 72-79页

作者： vanessa A.Lukas Rahul Dutta Ashok K.hemal Matvey Tsivian Timothy E.Craven Nicholas A.Deebel david D.thiel Ram Anil Pathak Brigham and Women's hospital Division of UrologyDepartment of Surgery75 Francis StreetBostonMAUSA Atrium health Wake Forest Baptist Medical Center Department of Urology1 Medical Center BlvdWinston-SalemNCUSA Mayo Clinic Florida Department of Urology4500 San Pablo RoadJacksonvilleFLUSA

Objective:We conducted an analysis of the American College of Surgeons National Surgical Quality Improvement Program database for minimally-invasive partial nephrectomy cases reported with the goal to identify pre-and peri-operative variables associated with length of stay(LOS)greater than 3 days and readmission within 30 ***:Records from 2008 to 2018 for“laparoscopy,surgical;partial nephrectomy”for prolonged LOS and readmission cohorts were *** analysis with Chi-square,t-tests,and multivariable logistic regression analysis with odds ratios(ORs),p-values,and 95%confidence intervals assessed statistical ***:Totally,20306 records for LOS greater than 3 days and 15854 for readmission within 30 days were *** and multivariable analysis exhibited similar *** LOS greater than 3 days,undergoing non-elective surgery(OR=5.247),transfusion of greater than four units within 72 h prior to surgery(OR=5.072),pre-operative renal failure or dialysis(OR=2.941),and poor pre-operative functional status(OR=2.540)exhibited the strongest statistically significant *** hospital readmission within 30 days,loss in body weight greater than 10%in 6 months prior to surgery(OR=2.227)and bleeding disorders(OR=2.081)exhibited strongest statistically significant ***:Multiple pre-and peri-operative risk factors are independently associated with prolonged LOS and hospital readmission within 30 days of surgery using the American College of Surgeons National Surgical Quality Improvement Program *** the risks factors that can potentially be improved prior to minimally-invasive partial nephrectomy is crucial to informing patient selection,optimization strategies,and patient education.

关键词： Minimally-invasive partial nephrectomy The American College of Surgeons National Surgical Quality Improvement Program Lengthof stay hospital readmission

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Procalcitonin,and cytokines document a dynamic inflammatory state in non-infected cirrhotic patients with ascites

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World Journal of Gastroenterology 2014年第9期20卷 2374-2382页

作者： Bashar M Attar Christopher M Moore Magdalena George Nicolae Ion-Nedelcu Rafael Turbay Annamma Zachariah Guiliano Ramadori Jawed Fareed david h van thiel Division of Gastroenterology and hepatology John H Stroger Hospital of Cook County Chicago IL 60612 United States david h van thiel Division of Gastroenterology and HepatologyRush University Medical Center Chicago IL 60612 United States Division of Gastroenterology and hepatology Victor Babes Infectious Clinic 050094 Bucharest Romania Division of Gastroenterology and hepatology August Georg University D-37075 Gottingen Germany Division of Gastroenterology and hepatology Loyola University Medical Center Maywood IL 60153 United States

AIM:To quantitate the simultaneous serum and ascitic fluid levels of procalcitonin and inflammatory markers in cirrhotics with and without ***:A total of 88 consecutive severe cirrhotic patients seen in a large city hospital liver clinic were studied and divided into two groups,those with and without *** 1 consisted of 41 cirrhotic patients with massive ascites,as demonstrated by necessity for therapeutic large-volume *** 2consisted of 47 cirrhotic patients without any clinically documented ascites to include either a recent abdominal computed tomography scan or ultrasound *** and ascitic fluid levels of an array of inflammatory markers,including procalcitonin,were measured and compared to each other and a normal plasma panel(NPP).RESULTS:The values for inflammatory markers assayed in the serum of Groups 1 and 2,and ascitic fluid of the Group *** plasma levels of the inflammatory cytokines interleukin(IL)-2,IL-4,IL-6,IL-8,interferon gamma(IFNγ)and epidermal growth factor(EGF)were all significantly greater in the serum of Group 1as compared to that of the serum obtained from the Group 2 subjects(all Phere were significantly greater serum levels of IL-6,IL-8,IL-10,monocyte chemoattractant protein-1,tumor necrosis factor-α,vascular endothelial growth factor and EGF when comparing Group 2 to the *** was no significant difference for IL-1A,IL-1B,IL-2,IL-4 and IFNγlevels between these two *** procalcitonin levels were increased in cirrhotics with ascites compared to cirrhotics without ascites,but serum levels were similar to ascites levels within the ascites ***,many of these cytokines,but not procalcitonin,demonstrate an ascites-to-serum *** procalcitonin does not demonstrate any significant difference segregated by liver etiology in the ascites group;but ascitic fluid procalcitonin is elevated significantly in car-diac cirrhosis/miscellaneous subgroup compared to the hepatitis

关键词： Ascites Bacterial translocation Inflammatory marke

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Evidence for Mesoproterozoic collision,deep burial and rapid exhumation of garbenschiefer in the Namaqua Front,South Africa

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Geoscience Frontiers 2020年第2期11卷 511-531页

作者： Valby van Schijndel david hCornell Robert Anczkiewicz Anders Schersten Department of Earth Sciences University of GothenburgSE-40530Sweden Department of Earth Sciences University of StellenboschPrivate Bag X1Matieland7602South Africa Institute of Geological Sciences Polish Academy of SciencesKrakow Research CentreUl.Senacka 131-002KrakowPoland Lund University Department of GeologyS€olvegatan 12SE-22362LundSweden University of Potsdam Institute of Earth and Environmental Sciences14476PotsdamGermany

Metamorphic provinces such as the^1 Ga Grenvillian,~400 Ma Caledonide and Triassic Qinling Provinces often contain rocks with high-pressure assemblages such as eclogites,which formed at mantle depths in subduction *** are evidence of the accretion of terranes by subduction of oceans and collision to form large tectonostratigraphic *** Mesoproterozoic Namaqua-Natal Province comprises a number of terranes thought to have been assembled by plate-tectonic processes,but they have generally yielded metamorphic pressures below 5 kbar,corresponding tohs,lacking evidence for subduction *** Kaaien Terrane in the Namaqua Front contains two large garbenschiefer units with the unusual paragenesis garnet-hornblende-epidote-white *** protoliths are graywackes influenced by andesitic volcanism during their deposition at^1870 Ma,in a passive margin of the Rehoboth Province or Kaapvaal *** garnet growth dated at 11655 Ma culminated in peak metamorphic conditions of 64530C and 10.40.7 kbar,corresponding to 40 km *** is attributed to subduction of these rocks before collision between the overriding arc-related Areachap Terrane,the Kaaien Terrane and the Kaapvaal-Rehoboth cratonic block during the Namaqua *** of the garbenschiefer slabs was followed by rapid cooling,as the 11435 Ma argon dates of hornblende and white mica,with closure temperatures^540C and^440C respectively,are the same within *** was probably due to tectonic juxtaposition of the garbenschiefer slab with much cooler rock *** exhumation was accommodated along the Trooilapspan-Brakbosch Shear Zone due to ongoing *** components of the Namaqua Front have distinctly different P-T-t paths,exemplified by greenschist metamorphism in the 1300 Ma Wilgenhoutsdrift Group,and medium-pressure metamorphism in the Areachap *** were juxtaposed by late-tectonic uplift and transpr

关键词： Collision orogeny P-T-t path Garbenschiefer Lu–hf garnet U–Pb zircon 40Ar/39Ar dating

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Reply to comment by S.h.Büttner on “Evidence for Mesoproterozoic collision,deep burial and rapid exhumation of garbenschiefer in the Namaqua Front,South Africa”

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Geoscience Frontiers 2020年第5期11卷 1895-1899页

作者： Valby van Schijndel david h.Cornell Robert Anczkiewicz Anders Schersten Institute of Geosciences University of Potsdam14476PotsdamGermany Department of Earth Sciences University of GothenburgSE-40530GothenburgSweden Department of Earth Sciences University of StellenboschMatieland7602South Africa Institute of Geological Sciences Polish Academy of SciencesKrakow Research Centre31-002KrakowPoland Lund University Department of GeologySE-22362LundSweden

*** We thank *** for his comments on our paper(van Schijndel et al.,2020),which allow us to clarify our work and the tectonic model we proposed for the eastern margin of the Namaqua Sector of the Namaqua Natal Metamorphic *** Kaaien Terrane forms a tectonic transition between the Kaapvaal Craton,Rehoboth Province,Kheis belt and the Archeachap Terrane of the Namaqua Sector and forms part of a NW-vergent foreland thrust sequence in the Namaqua Front(*** et al.,2006).The exact tectonic extent of the Kaaien Terrane is still unclear and it has recently been proposed to be part of the newly defined Kheis Terrane(van Niekerk and Beukes,2019).

关键词： Province. collision comment

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