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Critical considerations for the management of acute abdomen in transplant patients

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World Journal of Transplantation 2024年第2期14卷 8-12页

作者： Efstathios T Pavlidis ge.rgios Katsanos Athanasios Kofinas ge.rgios tsoulfas Ioannis N Galanis Theodoros E Pavlidis The 2^(nd)Department of Propaedeutic Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54642Greece Department of Transplantation Surgery Center for Research and Innovation in Solid Organ TransplantationAristotle University of ThessalonikiSchool of MedicineThessaloniki 54642Greece

The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine ***,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute *** problems in immunocompromised patients may not only include graft-related problems but also nongraft-related *** perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these *** perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic *** in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation *** times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and *** computed tomo-graphy is of utmost importance for early diagnosis and *** recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and *** is necessary to follow evidence-based therapeutic ***,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive s

关键词： Acute abdomen Abdominal emergency surgery Transplantation Immunocompromised patients Immuno-suppression Posttransplantation surgery

Hepatocellular carcinoma and metabolic syndrome: The times are changing and so should we

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World Journal of Gastroenterology 2019年第29期25卷 3842-3848页

作者： ge.rgios tsoulfas Department of Surgery Aristotle University of Thessaloniki

Although hepatocellular carcinoma (HCC) is as prevalent as ever as a cancerrelated mortality, and some would even argue that it is increasing, the pattern of its etiologies has been changing. Specifically, the domination of viral hepatitis C virus is being overcome, partly because of the emergence of the antiviral treatments, and partly because of the significant increase, especially in developed countries, of the combination of obesity, diabetes, metabolic syndrome, nonalcoholic fatty liver disease and non-alcoholic steatohepatitis. This editorial will explore the interconnection of this group of diseases and how they are linked to HCC. More importantly, it will argue that this shift in HCC etiology essentially means that we have to change how we approach the treatment of HCC, by changing our focus (and resources) to earlier stages of the disease development in order to prevent the appearance and progression of HCC.

关键词： Hepatocellular carcinoma Diabetes Obesity Steatosis Non-alcoholic fatty liver disease Body-mass index Non-alcoholic steatohepatitis

Challenges and opportunities in the application of artificial intelligence in gastroenterology and hepatology

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World Journal of Gastroenterology 2021年第37期27卷 6191-6223页

作者： Chrysanthos D Christou ge.rgios tsoulfas Organ Transplant Unit Hippokration General HospitalAristotle University of ThessalonikiThessaloniki 54622Greece

Artificial intelligence(AI)is an umbrella term used to describe a cluster of interrelated *** learning(ML)refers to a model that learns from past data to predict future *** and particularly gastroenterology and hepatology,are data-rich fields with extensive data repositories,and therefore fruitful ground for AI/ML-based software *** this study,we comprehensively review the current applications of AI/ML-based models in these fields and the opportunities that arise from their ***,we refer to the applications of AI/ML-based models in prevention,diagnosis,management,and prognosis of gastrointestinal bleeding,inflammatory bowel diseases,gastrointestinal premalignant and malignant lesions,other nonmalignant gastrointestinal lesions and diseases,hepatitis B and C infection,chronic liver diseases,hepatocellular carcinoma,cholangiocarcinoma,and primary sclerosing *** the same time,we identify the major challenges that restrain the widespread use of these models in healthcare in an effort to explore ways to overcome ***,we elaborate on the concerns regarding intrinsic biases,data protection,cybersecurity,intellectual property,liability,ethical challenges,and *** at a slower pace than anticipated,AI is infiltrating the healthcare *** in healthcare will become a reality,and every physician will have to engage with it by necessity.

关键词： Artificial intelligence Machine learning Gastroenterology Hepatology Artificial neural networks Support vector machine

COVID-19 and Liver Transplantation:Challenges and Opportunities

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Journal of Clinical and Translational Hepatology 2023年第3期11卷 521-522页

作者： ge.rgios tsoulfas Department of Transplantation Surgery Aristotle University School of MedicineThessalonikiGreece

Coronavirus disease 2019(COVID-19)has presented hu-manity with a significant global challenge that has neces-sitated changes and adaptations at all *** transplant(LT)activity could not have been an exception,as it was impacted both by changes in the urgency of the use of medi-cal resources,including shortage of hospital and intensive care unit beds,problems in outpatient follow-up,redefining the urgency of a LT among *** addition to the fact that the quarantines placed and the resulting emotional isolation have led to increased alcohol use and abuse.1,2 An effort by several transplant associations and the Centers for Medicare and Medicaid led to issuing guidance and recommendations regarding transplantation surgery during COVID-19.3,4 In the paper“Impact of COVID-19 on Liver Transplant Activity in the USA:Variation by Etiology and Cirrhosis Complications”by Kuo et al.,5 the authors provide us with a thorough evalu-ation of the impact of the COVID-19 pandemic on LT activity based on etiology in the USA,by analysing data from the United Network of Organ Sharing(UNOS)database(2018-2021).The authors looked at two different time periods,one in the pre-COVID era between April 2018 and February 2020.

关键词： Liver alcohol unit

Role of three-dimensional printing and artificial intelligence in the management of hepatocellular carcinoma:Challenges and opportunities

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World Journal of Gastrointestinal Oncology 2022年第4期14卷 765-793页

作者： Chrysanthos D Christou ge.rgios tsoulfas Department of Transplantation Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54622Greece

Hepatocellular carcinoma(HCC)constitutes the fifth most frequent malignancy worldwide and the third most frequent cause of cancer-related ***,treatment selection is based on the stage of the *** fields such as three-dimensional(3D)printing,3D bioprinting,artificial intelligence(AI),and machine learning(ML)could lead to evidence-based,individualized management of *** this review,we comprehensively report the current applications of 3D printing,3D bioprinting,and AI/ML-based models in HCC management;we outline the significant challenges to the broad use of these novel technologies in the clinical setting with the goal of identifying means to overcome them,and finally,we discuss the opportunities that arise from these ***,regarding 3D printing and bioprinting-related challenges,we elaborate on cost and cost-effectiveness,cell sourcing,cell viability,safety,accessibility,regulation,and legal and ethical ***,regarding AI/ML-related challenges,we elaborate on intellectual property,liability,intrinsic biases,data protection,cybersecurity,ethical challenges,and *** findings show that AI and 3D printing applications in HCC management and healthcare,in general,are steadily expanding;thus,these technologies will be integrated into the clinical setting sooner or ***,we believe that physicians need to become familiar with these technologies and prepare to engage with them constructively.

关键词： Artificial intelligence Machine learning Three-dimensional printing Bioprinting Hepatocellular carcinoma Liver cancer

Challenges involved in the application of artificial intelligence in gastroenterology:The race is on!

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World Journal of Gastroenterology 2023年第48期29卷 6168-6178页

作者： Chrysanthos D Christou ge.rgios tsoulfas Department of Transplantation Surgery Hippokration General HospitalSchool of MedicineAristotle University of ThessalonikiThessaloniki 54622Greece Center for Research and Innovation in Solid Organ Transplantation School of MedicineAristotle University of ThessalonikiThessaloniki 54622Greece

Gastroenterology is a particularly data-rich field,generating vast repositories of data that are a fruitful ground for artificial intelligence(AI)and machine learning(ML)*** this opinion review,we initially elaborate on the current status of the application of AI/ML-based software in ***,AI/ML-based models have been developed in the following applications:Models integrated into the clinical setting following real-time patient data flagging patients at high risk for developing a gastrointestinal disease,models employing non-invasive parameters that provide accurate diagnoses aiming to either replace,minimize,or refine the indications of endoscopy,models utilizing genomic data to diagnose various gastrointestinal diseases,computer-aided diagnosis systems facilitating the interpretation of endoscopy images,models to facilitate treatment allocation and predict the response to treatment,and finally,models in prognosis predicting complications,recurrence following treatment,and overall ***,we elaborate on several challenges and how they may negatively impact the widespread application of AI in healthcare and ***,we elaborate on concerns regarding accuracy,cost-effectiveness,cybersecurity,interpretability,oversight,and *** AI is unlikely to replace physicians,it will transform the skillset demanded by future physicians to ***,physicians are expected to engage with AI to avoid becoming obsolete.

关键词： Artificial intelligence Machine learning Gastroenterology Costeffectiveness Interpretability Accuracy

Evolving role of Sorafenib in the management of hepatocellular carcinoma

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World Journal of Clinical Oncology 2017年第3期8卷 203-213页

作者： Ioannis A Ziogas ge.rgios tsoulfas Aristotle University of Thessaloniki School of Medicine 1st Department of Surgery Aristotle University of Thessaloniki

Hepatocellular carcinoma(HCC) is one of the most common malignant diseases worldwide and comes third in cancer-related *** there is a broad spectrum of treatment options to choose from,only a few patients are eligible candidates to receive a curative therapy according to their stage of disease,and thus palliative treatment is implemented in the majority of the patients suffering from liver ***,a multikinase inhibitor,is the only currently approved agent for systemic therapy in patients with advanced stage HCC and early stage liver *** has been shown to improve the overall survival,but with various side effects,while its cost is not *** has been in the market for a decade and has set the stage for personalized targeted *** role during this time has ranged from monotherapy to neoadjuvant and adjuvant treatment with surgical resection,liver transplantation and chemoembolization or even in combination with other chemotherapeutic *** this review our aim is to highlight in depth the current position of Sorafenib in the armamentarium against HCC and how that has evolved over time in its use either as a single agent or in combination with other therapies.

关键词： Sorafenib Hepatocellular carcinoma Liver neoplasm Multikinase inhibitor Targeted therapy Tumor angiogenesis Signaling pathways Adjuvant therapy Liver cancer Liver transplantation Liver resection

Advances and challenges in laparoscopic surgery in the management of hepatocellular carcinoma

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World Journal of Gastrointestinal Surgery 2017年第12期9卷 233-245页

作者： Ioannis A Ziogas ge.rgios tsoulfas Medical School Aristotle University of Thess-aloniki 1~(st) Department of Surgery Aristotle University of Thessaloniki

Hepatocellular carcinoma is the fifth most common malignancy and the third most common cause of cancer-related mortality worldwide. From the wide variety of treatment options, surgical resection and liver transplantation are the only therapeutic ones. However, due to shortage of liver grafts, surgical resection is the most common therapeutic modality implemented. Owing to rapid technological development, minimally invasive approaches have been incorporated in liver surgery. Liver laparoscopic resection has been evaluated in comparison to the open technique and has been shown to be superior because of the reported decrease in surgical incision length and trauma, blood loss, operating theatre time, postsurgical pain and complications, R0 resection, length of stay, time to recovery and oral intake. It has been reported that laparoscopic excision is a safe and feasible approach with near zero mortality and oncologic outcomes similar to open resection. Nevertheless, current indications include solid tumors in the periphery geons with high expertise in laparoscopic and hepatobiliary surgery in tertiary centers. It is necessary for a surgeon to surpass the 60-cases learning curve observed in order to accomplish the desirable outcomes and preserve patient safety. In this review, our aim is to thoroughly describe the general principles and current status of laparoscopic liver resection for hepatocellular carcinoma, as well as future prospects.

关键词： Hepatocellular carcinoma Laparoscopic liver resection Minimally invasive surgery Laparoscopic hepatectomy Liver malignant disease Surgical excision

Surgical treatment of hepatic metastases from colorectal cancer

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World Journal of Gastrointestinal Oncology 2011年第1期3卷 1-9页

作者： ge.rgios tsoulfas Manousos ge.rgios Pramateftakis Ioannis Kanellos Department of Surgery Aristoteleion University of ThessalonikiThessaloniki 54622Greece

Colorectal carcinoma is one of the most frequent cancers in Western societies with an incidence of around 700 per million *** half of the patients develop metastases from the primary tumor and liver is the primary metastatic *** survival rates after hepatectomy for metastatic colorectal cancer have been reported in the last few years and these may be the result of a variety of factors,such as advances in systemic chemotherapy,radiographic imaging techniques that permit more accurate determination of the extent and location of the metastatic burden,local ablation methods,and in surgical techniques of hepatic *** have led to a more aggressive approach towards liver metastatic disease,resulting in longer *** goal of this paper is to review the role of various forms of surgery in the treatment of hepatic metastases from colorectal cancer.

关键词： Hepatic metastases Colorectal cancer Liver resection