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predictors of survival in autoimmune liver disease overlap syndromes

World Journal of Hepatology 2024年第9期16卷 1269-1277页

作者： Dujinthan Jayabalan Yi Huang Luis Calzadilla-Bertot Malik Janjua Bastiaan de Boer John Joseph Wendy Cheng Simon Hazeldine Briohny W Smith Gerry C MacQuillan Michael C Wallace George Garas Leon A Adams gary p.jeffrey Medical School University of Western AustraliaNed-lands 6009Western AustraliaAustralia Department of Hepatology Sir Charles Gairdner HospitalNedlands 6009Western AustraliaAustralia Department of Anatomical pathology PathWest Laboratory MedicineNedlands 6009Western AustraliaAustralia Department of Gastroenterology and Hepatology Royal Perth HospitalPerth 6000Western AustraliaAustralia Department of Gastroenterology and Hepatology Fiona Stanley HospitalMurdoch 6150Western AustraliaAustralia Medical School University of Western AustraliaNedl-ands 6009Western AustraliaAustralia

BACKGROUND Survival in patients with autoimmune liver disease overlap syndromes(AILDOS)compared to those with single autoimmune liver disease is *** To investigate the survival of patients with AILDOS and assess the accuracy of non-invasive serum models for predicting liver-related *** patients with AILDOS were defined as either autoimmune hepatitis and primary biliary cholangitis overlap(AIH-pBC)or autoimmune hepatitis and primary sclerosing cholangitis overlap(AIH-pSC)and were identified from three tertiary centres for this cohort ***-related death or transplantation(liver-related mortality)was determined using a population-based data linkage *** scores for liver-related death were compared for accuracy[including liver outcome score(LOS),Hepascore,Mayo Score,model for end-stage liver disease(MELD)score and MELD incorporated with serum sodium(MELD-Na)score].RESULTS Twenty-two AILDOS patients were followed for a median of 3.1 years(range,0.35-7.7).Fourteen were female,the median age was 46.7 years(range,17.8 to 82.1)and median Hepascore was 1(range,0.07-1).At five years post enrolment,57%of patients remained free from liver-related mortality(74%AIH-pBC,27%AIH-pSC).There was no significant difference in survival between AIH-pBC and *** was a significant predictor of liver-related mortality(ppatients with AIH-pBC(n=14)but not AIH-pSC(n=8).A LOS cut-point of 6 discriminated liver-related mortality in AIH-pBC patients(p=0.012,log-rank test,100%sensitivity,77.8%specificity)(Harrell's C-statistic 0.867).The MELD score,MELD-Na score and Mayo Score were not predictive of liver-related mortality in any *** Survival in the rare,AILDOS is *** current study supports the LOS as a predictor of liver-related mortality in AIH-pBC *** trials investigating predictors of survival in AILDOS are required.

关键词： Autoimmune liver disease overlap syndromes Liver outcome score Liver-related death Hepascore Autoimmune hepatitis primary biliary cholangitis primary sclerosing cholangitis

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Improved Hepascore in hepatitis C predicts reversal in risk of adverse outcome

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World Journal of Hepatology 2017年第19期9卷 850-856页

作者： Angus W jeffrey Yi Huang W Bastiaan de Boer Leon A Adams Gerry MacQuillan David Speers John Joseph gary p.jeffrey School of Medicine University of Notre Dame School of Medicine and pharmacology University of Western Australia Department of Hepatology Sir Charles Gairdner Hospital Department of Anatomical pathology Path West QEII Medical Centre Department of Microbiology Path West QEII Medical Centre Department of Biochemistry Path West QEII Medical Centre

AIM To establish if serial Hepascore tests(referred to as delta Hepascore) in those with chronic hepatitis C(CHC) correlate with the increase and/or decrease in risk of liver related *** Three hundred and forty-six CHC patients who had two Hepascore tests performed were studied. During 1944 patient years follow-up 28(8.1%) reached an endpoint. The Hepascore is a serum test that provides clinically useful data regarding the stage of liver fibrosis andsubsequent clinical outcomes in chronic liver *** patients with a baseline Hepascore > 0.75 had a significantly increased rate of reaching a composite endpoint consisting of hepatocellular carcinoma, liver death, and/or decompensation(p pascore > 0.75, a subsequent improved Hepascore showed a significantly decreased risk for the composite endpoint(p = 0.004). There were no negative outcomes in those with a stable or improved delta Hepascore. The minimum time between tests that was found to give a statically significant result was in those greater than one year(p = 0.03).CONCLUSION In conclusion, Hepascore is an accurate predictor of liver related mortality and liver related morbidity in CHC patients. Of note, we have found that there is a decreased risk of mortality and morbidity in CHC patients when the patient has an improving delta Hepascore. Repeat Hepascore tests, when performed at a minimum one-year interval, may be of value in routine clinical practice to predict liver related clinical outcomes and to guide patient management.

关键词： Chronic prognosis Direct acting antivirals Serum Hepatitis C

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Effect of airplane transport of donor livers on post-liver transplantation survival

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World Journal of Gastroenterology 2016年第41期22卷 9154-9161页

作者： Yi Huang Gerry MacQuillan Leon A Adams George Garas Megan Collins Albert Nwaba Linjun Mou Max K Bulsara Luc Delriviere gary p.jeffrey School of Medicine and pharmacology University of Western Australia Western Australian Liver Transplantation Service Sir Charles Gairdner Hospital Institute of Health Research University of Notre Dame

AIM To evaluate the effect of long haul airplane transport of donor livers on post-transplant outcomes. METHODS A retrospective cohort study of patients who received a liver transplantation was performed in perth, Australia from 1992 to 2012. Donor and recipient characteristics information were extracted from Western Australian liver transplantation service database. patients were followed up for a mean of six years. patient and graft survival were evaluated and compared between patients who received a local donor liver and those who received an airplane transported donor liver. predictors of survival were determined by univariate and multivariate analysis using cox *** One hundred and ninety-three patients received alocal donor liver and 93 patients received an airplane transported donor liver. Airplane transported livers had a significantly lower alanine transaminase(mean: 45 U/L vs 84 U/L, p = 0.035), higher donor risk index(mean: 1.88 vs 1.42, p p port distance(r2 = 0.29, p p was six years and 93 patients had graft failure. Multivariate analysis found only airplane transport retained significance for graft loss(HR = 1.92, 95%CI: 1.16-3.17). One year graft survival was 0.88 for those with a local liver and was 0.71 for those with an airplane transported liver. One year graft loss was due to primary graft non-function or associated with preservation injury in 20.8% of recipients of an airplane transported liver compared with 4.6% in those with a local liver(p = 0.027). CONCLUSION Airplane transport of donor livers was independently associated with reduced graft survival following liver transplantation.

关键词： Airplane transportation Cold ischemic time Graft survival Donor location Organ damage

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Utility of magnetic resonance imaging in anorectal disease

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World Journal of Gastroenterology 2007年第23期13卷 3153-3158页

作者： Loren Berman gary M Israel Shirley M McCarthy jeffrey C Weinreb Walter E Longo Department of Surgery Yale University School of Medicine New Haven Connecticut United States Department of Radiology Yale University School of Medicine New Haven Connecticut United States

Imaging of both benign and malignant anorectal diseases has traditionally posed a challenge to clinicians, and as a result history and physical exam have been relied on heavily. CT scanning and endorectal ultrasound have become popular in assessment of anatomy and staging of tumors, but have limitations. Magnetic resonance imaging (MRI) has the capability to fill in the gaps left open by more conventional imaging modalities and continues to be promising as the definitive imaging technique in the pelvis, especially with advancement of emerging technologies in this field. A comprehensive review of this topic has been undertaken. Anorectal disease is divided into three broad categories: cancer, fistula/abscess, and pelvic floor disorders. A review of the literature is performed to evaluate the use of MRI and other imaging modalities in these three areas. preoperative imaging is useful in the evaluation of all three areas of anorectal disease. MRI is an effective tool in delineating anatomy and, when correlating with the specific clinical scenario, is an effective adjunct in clinical decision-making in order to optimize outcome. MRI continues to be a promising and novel approach to imaging various afflictions of the anorectum and the pelvic floor. Its role is more well-established in some areas than in others, and there are still signif icant limitations. As technology advances, MRI will shed more light on a complex anatomical area.

关键词： Magnetic resonance imaging, Rectal cancer, pelvic floor disorders Anal fistula and abscess

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protecting the delivery of heart failure: Regenerative Medicine/Stem Cell Therapeutics:potential protections afforded by the Department of Health and Human Services and Health Resources Service Administration’s Bureau of Special programs

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Journal of Geriatric Cardiology 2006年第3期3卷 171-180页

作者： gary S Friedman John S. Tomicki Neil Cohen Robert Marshal philip Lowry jeffrey Warsh New Jersey Stem Cell Research & Education Foundation International Regenerative Medicine Incorporated New Jersey State Legislature Virginia State Legislature New Jersey Stem Cell Research & Education Foundation University of Massachusetts Stem Cell Transplant Program

Advances in stem cell science and potential clinical applications have brought clinical medicine closer to the actualization of Regenerative Medicine—an extension of transplantation of organs and cells and implantation of bioprosthetics and biodevices. The goal of such therapeutics will be intervention prior to onset of severe individual disability, enhance organ function and enhance patient performance status without incurring the economic impacts of standard organ transplantation. Regenerative Medicine is already demonstrating proof of principle or efficacy in restora- tion of myocardial contractility, joint mobility and function, immune competence, pulmonary function, immunologic self- tolerance, motor function and normal hemoglobin production with the next targets—diabetes mellitus (type I and type II), neurologic injury, hepatic dysfunction preparing to enter trials. Expenditures on health care needs of an aging U.S. citizenry approximate 20-25% ($3 trillion) of U.S. GDp currently and may to grow to 40% of U.S. GDp by 2025. As the potential of Regenerative Medicine is clinically realized, the societal impact and economic benefits will be disproportionately magnified in the economies of industrialized nations. The experi- ence of the Department of Health and Human Services (HHS), United Network for Organ Sharing (UNOS), the National Bone Marrow Donor Registry (NBMDR), and the National Vaccine Injury Compensation programs (NVICp) can help ensure that as Regenerative Medicine strives to achieve clinical benefits while avoiding decimation of therapeutic options by product liability and medical malpractice concerns—concerns that crippled the U.S. vaccine manufacturing industry until the creation of the NVICp. The first 50 years of organ/cell/tissue transplantation demonstrates that clinical reality of allogeneic and autologous transplantation can antedate complete understanding of the basic science underlying successful transplantation. product liability and medical

关键词： regenerative medicine stem cell heart failure

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Non-odontogenic toothache revisited

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Open Journal of Stomatology 2011年第3期1卷 92-102页

作者： Ramesh Balasubramaniam Lena N. Turner Dena Fischer gary D. Klasser jeffrey p. Okeson 不详

Although pain of dental origin is the most common orofacial pain, other non-odontogenic pains can af-fect the orofacial region and occasionally mimic den-tal pain. These non-odontogenic pains may pose a diagnostic dilemma for the dental practitioner who routinely diagnoses and treats dental pain. Knowledge of the various non-odontogenic pains will ultimately prevent misdiagnosis and the delivery of incorrect and sometimes irreversible and invasive procedures to patients. The purpose of this article is to review the clinical presentations of the various types of non-odontogenic pains which may be mistaken as dental pain: myofascial, cardiac, sinus, neurovascular, neuropathic, neoplastic and psychogenic pain.

关键词： Non-Odontogenic Toothache Orofacial pain

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Clinical characteristics of young patients with early Barrett’s neoplasia

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World Journal of Gastroenterology 2019年第24期25卷 3069-3078页

作者： Yugo Iwaya Yuto Shimamura Kenichi Goda Enrique Rodríguez de Santiago John Gerard Coneys jeffrey D Mosko Gabor Kandel paul Kortan gary May Norman Marcon Christopher Teshima Advanced Therapeutic Endoscopy Centre St Michael’s HospitalUniversity of TorontoToronto M5B 1W8OntarioCanada Department of Gastroenterology Dokkyo Medical UniversityTochigi 321-0293Japan Department of Gastroenterology Ramón y Cajal university hospitalMadrid 28034Spain

BACKGROUND Esophageal adenocarcinoma(EAC)and high-grade dysplasia(HGD)may appear in young patients with Barrett's esophagus(BE).However,characteristics of Barrett's-related neoplasia in this younger population remain *** To identify clinical characteristics that differ between young and old patients with early-stage Barrett's-related *** We conducted a retrospective analysis of a prospectively maintained database comprised of consecutive patients with early-stage EAC(pT1)and HGD at a tertiary-referral center between 2001 and *** characteristics,drug and risk factor exposures,clinicopathological staging of EAC/HGD and treatment outcomes[complete eradication of neoplasia(CE-N),complete eradication of intestinal metaplasia(CE-IM),recurrence of neoplasia and recurrence of intestinal metaplasia]were *** analyses were performed to identify factors that differed significantly between older and younger(≤50 years)*** We identified 450 patients with T1 EAC and HGD(74%and 26%,respectively);45(10%)were≤50 *** to the older group,young patients were more likely to present with ongoing gastroesophageal reflux disease(GERD)symptoms(55%vs 38%,p=0.04)and to be obese(body mass index>30,48%vs 32%,p=0.04).Multivariate logistic regression analysis showed that young patients were significantly more likely to have ongoing GERD symptoms[odds ratio(OR)2.00,95%confidence interval(CI)1.04-3.85,p=0.04]and to be obese(OR 2.06,95%CI 1.07-3.98,p=0.03)whereas the young group was less likely to have a smoking history(OR 0.39,95%CI 0.20-0.75,ppared to the old ***,there were no significant differences regarding tumor histology,CE-N,CE-IM,recurrence of neoplasia and recurrence of intestinal metaplasia(mean follow-up,44.3 mo).CONCLUSION While guidelines recommend BE screening in patients>50 years of age,younger patients should be considered for screening endoscopy if they suffer from obesity and GERD symptoms.

关键词： Barrett's Esophagus Gastroesophageal reflux disease Obesity Esophageal adenocarcinoma High-grade dysplasia Guideline Young patient

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Desferrioxamine in warm reperfusion media decreases liver injury aggravated by cold storage

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World Journal of Gastroenterology 2013年第5期19卷 673-681页

作者： peter G Arthur Xian-Wa Niu Wen-Hua Huang Bastiaan DeBoer Ching Tat Lai Enrico Rossi John Joseph gary p.jeffrey School of Biomedical Biomolecular and Chemical Sciencesthe University of Western AustraliaCrawleyWA 6009Australia School of Medicine and pharmacology the University of Western AustraliaCrawleyWA 6009Australia Gastroenterology/Hepatology Sir Charles Gairdner HospitalNedlandsWA 6009Australia WA Liver and Kidney Transplantation Services QEII Medical CentreHospital AvenueNedlandsWA 6009Australia Division of Anatomical pathology PathWestQEII Medical CentreHospital AvenueNedlandsWA 6009Australia Department of Biochemistry Path-WestQEII Medical CentreHospital AvenueNedlandsWA6009Australia

AIM:To evaluate whether desferrioxamine decreases ischemia and perfusion injury aggravated by cold storage(CS)in a rat liver perfusion model. METHODS:Isolated rat livers were kept in CS in University of Wisconsin Solution for 20 h at 4℃,then exposed to 25 min of warm ischemia(WI)at 37℃ followed by 2 h of warm perfusion(Wp)at 37℃with oxygenated(95%oxygen and 5%carbon dioxide) Krebs-Henseleit ***(DFO),an iron chelator,was added at different stages of storage,ischemia and perfusion:in CS only,in WI only,in Wp only, in WI and perfusion,or in all *** samples were collected after CS and after *** samples and bile were collected every 30 min(0,0.5,1,1.5 and 2 h)during liver *** injury was assessed by the determination of lactate dehydrogenase(LDH) and aspartate aminotransferase(AST)in the effluent and perfusate *** iron was analysed in the perfusate *** Wp,the liver was collected for the determination of liver swelling(wet to dry ratio) and liver morphological examination(hematoxylin and eosin staining). RESULTS:Increased CS time caused increased liver dysfunction during *** 2 h of Wp,liver injury was indicated by increased release of AST(0.5 h CS:9.4± 2.2 U/g liver vs 20 h CS:45.9±10.8 U/g liver,ppperfusate(0.5 h CS:0.11 ±0.03μmoL/g liver vs 20 h CS:0.58±0.10μmoL/g liver,ppp following 20 h of CS,release of iron into the perfusate was de- creased(DFO absent 0.58±0.10μmoL/g liver vs DFO present 0.31±0.06μmoL/g liver,pproved with decreased release of AST(DFO absent 45.9±10.8 U/g liver vs DFO present 8.1±0.9 U/g liver,ppresent 56±7 U/g liver,p<0.05),and inc

关键词： Iron chelation Ischemia and perfusion injury Liver Organ preservation Rat

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Efficacy of vasopressin, steroid, and epinephrine protocol for in-hospital cardiac arrest resuscitation: a systematic review and meta-analysis of randomized controlled trials with trial sequential analysis

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Journal of Geriatric Cardiology 2022年第9期19卷 705-711页

作者： Danish Iltaf Satti Yan Hiu Athena Lee Keith Sai Kit Leung Jeremy Man Ho Hui Thompson Ka Ming Kot Arslan Babar Gauranga Mahalwar Abraham KC Wai Tong Liu Leonardo Roever gary Tse jeffrey Shi Kai Chan International Health Informatics Study(IHIS)Network Cardiovascular Analytics Group Hong KongChina-UK Collaboration Emergency Medicine Unit Li Ka Shing Fac-ulty of MedicineThe University of Hong KongHong KongChina Aston Medical School Faculty of Health&Life SciencesAston UniversityBirminghamUnited Kingdom Li Ka Shing Faculty of Medicine The University of Hong KongHong KongChina Department of Anaesthesia and pain Service Princess Margaret HospitalLai Chi KokKowloonHong KongChina Department of Medicine Cleveland Clinic FoundationClevelandUSA Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease Department of CardiologyTianjin Institute of Cardi-ologySecond Hospital of Tianjin Medical UniversityTianjinChina Department of Clinical Research Federal Uni-versity of UberlândiaUberlândiaBrazil Kent and Medway Medical School CanterburyKentUnited Kingdom 不详

OBJECTIVES To assess the effect of vasopressin,steroid and epinephrine(VSE)combination therapy on return of spontan-eous circulation(ROSC)after in-hospital cardiac arrest(IHCA),and test the conclusiveness of evidence using trial sequential ana-lysis(TSA).METHODS The systematic search included pubMed,EMBASE,Scopus,and Cochrane Central Register of Controlled *** controlled trials(RCTs)that included adult patients with IHCA,with at least one group receiving combined VSE therapy were *** was extracted independently by two *** main outcome of interest was *** out-comes included survival to hospital discharge or survival to 30 and 90 days,with good neurological *** We included a total of three RCTs(n=869).Results showed that VSE combination therapy increased ROSC(risk ra-tio=1.41;95%CI:1.25-1.59)as compared to *** demonstrated that the existing evidence is *** was also validated by the alpha-spending adjusted relative risk(1.32[1.16,1.49],ppy administered in cardiopulmonary resuscitation led to improved rates of ***-ture trials of VSE therapy should evaluate survival to hospital discharge,neurological function and long-term survival.

关键词： resuscitation analysis return

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Addition of Capsaicin to Local Anesthetics for Spinal Anesthesia in Rats Shortens Motor Deficits and prolongs Anti-Nociception

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Open Journal of Anesthesiology 2014年第6期4卷 123-130页

作者： Charles H. Wang jeffrey C. Wang Mieke A. Soens peter Gerner gary Strichartz California Institute of Technology Pasadena USA Department of Anesthesiology Critical Care and Pain Medicine General Hospital Salzburg Paracelsus Medical University Salzburg Austria pain Research Center Department of Anesthesiology Perioperative and Pain Medicine Brigham & Women’s Hospital Harvard Medical School Boston USA

Background and Objectives: Sensory-selective anesthesia, greater or longer-lasting anti-nociception than motor or autonomic deficits, is often clinically desirable but traditional local anesthetics rarely have such selective actions. Addition of capsaicin to tertiary amine local anesthetics has recently been reported to affect a preferential prolongation of nociceptive over motor block in rat sciatic nerve. We hypothesized that this combination when used intrathecally will also prolong nociceptive block. Methods: Under sevoflurane inhalation anesthesia, rats were injected intrathecally either with local anesthetics (bupivacaine, lidocaine, and articaine) alone or simultaneously with capsaicin. Motor block was evaluated by the contractile function of foot muscles, from proximal to distal. Anti-nociception was assessed by reductions in nocifensive withdrawal and vocalization induced by pinching the skin fold over the lateral metatarsus. Durations and degrees of deficits were assessed, along with complete recovery times and compared between local anesthetics alone and in combination with capsaicin. Results: Addition of capsaicin to any of the local anesthetics shortened motor deficits. Bupivacaine, lidocaine and articaine motor blocks were reduced upon combination with capsaicin to 0.32, 0.32 ans 0.43 of the duration from the respective local anesthetic alone. Duration of anti-nociceptive action was increased by capsaicin only for articaine. The ratios of block nociceptive to sensory block durations were 3.5, 5.1 and 3.3 for the respective local anesthetics. Conclusions: Intrathecal injection of capsaicin combined with local anesthetics produced a preferentially longer anti-nociceptive deficit. These combinations have potential clinical applications, including peri-operative spinal anesthesia and pain management.

关键词： Spinal Anesthesia Differential Blockade Analgesia TRpV-1

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