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Hypophosphatemia as a prognostic tool for post-hepatectomy liver failure:A systematic review

World Journal of Gastrointestinal Surgery 2023年第2期15卷 249-257页

作者： Romualdas Riauka Povilas Ignatavicius giedrius barauskas Department of Surgery Lithuanian University of Health SciencesKaunas 50161Lithuania

BACKGROUND Post-hepatectomy liver failure(PHLF)is one of the main causes of postoperative mortality and is challenging to predict early in patients after liver resection.Some studies suggest that the postoperative serum phosphorus might predict outcomes in these patients.AIM To perform a systematic literature review on hypophosphatemia and evaluate it as a prognostic factor for PHLF and overall morbidity.METHODS This systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses statement.A study protocol for the review was registered in the International Prospective Register of Systematic Reviews database.PubMed,Cochrane and Lippincott Williams&Wilkins databases were systematically searched up to March 31,2022 for studies analyzing postoperative hypophosphatemia as a prognostic factor for PHLF,overall postoperative morbidity and liver regeneration.The quality assessment of the included cohort studies was performed according to the Newcastle-Ottawa Scale.RESULTS After final assessment,nine studies(eight retrospective and one prospective cohort study)with 1677 patients were included in the systematic review.All selected studies scored≥6 points according to the Newcastle-Ottawa Scale.Cutoff values of hypophosphatemia varied from<1 mg/dL to≤2.5 mg/dL in selected studies with≤2.5 mg/dL being the most used defining value.Five studies analyzed PHLF,while the remaining four analyzed overall complications as a main outcome associated with hypophosphatemia.Only two of the selected studies analyzed postoperative liver regeneration,with reported better postoperative liver regeneration in cases of postoperative hypophosphatemia.In three studies hypophosphatemia was associated with better postoperative outcomes,while six studies revealed hypophosphatemia as a predictive factor for worse patient outcomes.CONCLUSION Changes of the postoperative serum phosphorus level might be useful for predicting outcomes after liver resection.However,routine measurement of perioperative serum p

关键词： Hypophosphatemia Post-hepatectomy liver failure Liver regeneration Serum phosphorus Literature review

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How severe is moderately severe acute pancreatitis? Clinical validation of revised 2012 Atlanta Classification

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World Journal of Gastroenterology 2017年第43期23卷 7785-7790页

作者： Povilas Ignatavicius Aiste Gulla Karolis Cernauskis giedrius barauskas Zilvinas Dambrauskas Department of Surgery Medical AcademyLithuanian University of Health Sciences Department of Surgery Georgetown University Hospital Department of Surgery Division of Vascular SurgeryVilnius UniversitySantariskiu Clinics

AIM To explore the outcomes and the appropriate treatment for patients with moderately severe acute pancreatitis(AP).METHODS Statistical analysis was performed on data from the prospectively collected database of 103 AP patients admitted to the Department of Surgery,Hospital of Lithuanian University of Health Sciences in 2008-2013. All patients were confirmed to have the diagnosis of AP during the first 24 h following admission. The severity of pancreatitis was assessed by MODS and APACHE Ⅱ scale. Clinical course was re-evaluated after 24,48 and 72 h. All patients were categorized into 3 groups based on Atlanta 2012 classification: Mild,moderately severe,and severe.Outcomes and management in moderately severe group were also compared to mild and severe cases according to Atlanta 1992 and 2012 classification.RESULTS Fifty-three-point four percent of patients had edematous while 46.6 % were diagnosed with necrotic AP. The most common cause of AP was alcohol(42.7%) followed by alimentary(26.2%),biliary(26.2%) and idiopathic(4.9%). Under Atlanta 1992 classification 56(54.4%) cases were classified as "mild" and 47(45.6%) as "severe". Using the revised classification(Atlanta 2012),the patient stratification was different: 49(47.6%) mild,27(26.2%) moderately severe and 27(26.2%) severe AP cases. The two severe groups(Atlanta 1992 and Revised Atlanta 2012) did not show statistically significant differences in clinical parameters,including ICU stay,need for interventional treatment,infected pancreatic necrosis or mortality rates. The moderately severe group of 27 patients(according to Atlanta 2012) had significantly better outcomes when compared to those 47 patients classified as severe form of AP(according to Atlanta 1992) with lower incidence of necrosis and sepsis,lower APACHE Ⅱ(P = 0.002) and MODS(P = 0.001) scores,shorter ICU stay,decreased need for interventional and surgical treatment.CONCLUSION Study shows that Atlanta 2012 criteria are more accurate,reduce unnecessary treatments for patients with mild and moderat

关键词：尖锐胰腺炎亚特兰大 1992 亚特兰大 2012 严厉层化治疗结果

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Early recognition of abdominal compartment syndrome in patients with acute pancreatitis

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World Journal of Gastroenterology 2009年第6期15卷 717-721页

作者： Zilvinas Dambrauskas Audrius Parseliunas Antanas Gulbinas Juozas Pundzius giedrius barauskas Laboratory for Research of Digestive System Institute for Biomedical Research and Department of SurgeryKaunas University of MedicineEiveniu Str.250009 KaunasLithuania Department of Surgery Kaunas University of MedicineEiveniu Str.250009 KaunasLithuania

AIM:To assess the value of widely used clinical scores in the early identification of acute pancreatitis(AP) patients who are likely to suffer from intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS). METHODS:Patients(n=44)with AP recruited in this study were divided into two groups(ACS and non-ACS) according to intra-abdominal pressure(IAP)determined by indirect measurement using the transvesical route via Foley bladder catheter.On admission and at regular intervals,the severity of the AP and presence of organ dysfunction were assessed utilizing different multifactorial prognostic systems:Glasgow-Imrie score,Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE-Ⅱ)score,and Multiorgan Dysfunction Score(MODS).The diagnostic performance of scores predicting ACS development,cut-off values and specificity and sensitivity were established using receiver operating characteristic(ROC)curve analysis. RESULTS:The incidence of ACS in our study population was 19.35%.IAP at admission in the ACS group was 22.0(18.5-25.0)mmHg and 9.25(3.0-12.4)mmHg in the non-ACS group(P7;MODS>2 or Glasgow-Imrie score>3).

关键词：急性胰腺炎腹部间隔综合症腹部压力高血压器官功能紊乱

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Different profiles of cytokine expression during mild and severe acute pancreatitis

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World Journal of Gastroenterology 2010年第15期16卷 1845-1853页

作者： Zilvinas Dambrauskas Nathalia Giese Antanas Gulbinas Thomas Giese Pascal O Berberat Juozas Pundzius giedrius barauskas Helmut Friess Laboratory for Research of Digestive System Institute for Biomedical ResearchEiveniu Str. 2 50009 Kaunas Lithuania Department of Surgery Kaunas University of MedicineEiveniu Str. 2 50009 Kaunas Lithuania Department of Surgery Heidelberg UniversityIm Neuenheimer Feld 110D-69120 Heidelberg Germany Institute for Immunology Heidelberg UniversityIm Neuenheimer Feld 305D-69120 Heidelberg Germany Department of Surgery University of Technology MunichIsmaninger Str. 2281675 Munich Germany Department of Surgery Kaunas University of MedicineEiveniu Str. 250009 Kaunas Lithuania

AIM:To study secretion patterns of proand anti-in-flammatory cytokines, and activation of various cellular subsets of leukocytes in peripheral blood.METHODS: We have conducted a prospective obser-vational study. One hundred and eight patients with a diagnosis of acute pancreatitis and onset of the disease within last 72 h were included in this study. The mRNA expression of 25 different types of cytokines in white blood cells was determined by quantitative real time polymerase chain reaction. Levels of 8 different cytokines in blood serum were measured by enzymelinked immunosorbent assay. Clinical data and cytokine expression results were subjected to statistical analysis.RESULTS: Severe and necrotizing acute pancreatitis (AP) is characterized by the significant depletion of circulating lymphocytes. Severe acute pancreatitis is as-sociated with a typical systemic inflammatory response syndrome and over-expression of pro-inflammatory cy-tokines [interleukin (IL)-6, IL-8, macrophage migration inhibitory factor (MIF)]. Serum IL-6 and MIF concentra-tions are the best discriminators of severe and necrotiz-ing AP as well as possible fatal outcome during the early course of the disease. CONCLUSION: Deregulation of cellular immune sys-tem is a key event leading to severe and necrotizing AP. IL-6 and MIF could be used as early predictors of complications.

关键词： Acute pancreatitis Cytokines Prognostic factors

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Narrow line between benefit and harm: Additivity of hyperthermia to cisplatin cytotoxicity in different gastrointestinal cancer cells

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World Journal of Gastroenterology 2018年第10期24卷 1072-1083页

作者： Vaidotas Cesna Arturas Sukovas Aldona Jasukaitiene Rima Naginiene giedrius barauskas Zilvinas Dambrauskas Saulius Paskauskas Antanas Gulbinas Department of Surgery Lithuanian University of Health Sciences Department of Obstetrics and Gynecology Lithuanian University of Health Sciences Institute for Digestive Research Lithuanian University of Health Sciences Neuroscience Institute Lithuanian University of Health Sciences

AIM To investigate the response to hyperthermia and chemotherapy, analyzing apoptosis, cytotoxicity, and cisplatin concentration in different digestive system cancer cells.METHODS AGS(gastric cancer cell line), Caco-2(colon cancer cell line) and T3M4(pancreatic cancer cell line) were treated by cisplatin and different temperature setting(37 ℃ to 45 ℃) either in isolation, or in combination. Treatment lasted for one hour. 48 h after the treatment viability was evaluated by MTT, cell apoptosis by Annexin V-PE and 7 ADD flow cytometry. Intracellular cisplatin concentration was measured immediately after the treatment, using mass spectrometry. Isobologram analysis was performed to evaluate the mathematical combined effect of temperature and cisplatin.RESULTS AGS cells were the most sensitive to isolated application of hyperthermia. Hyperthermia, in addition to cisplatin treatment, did not provoke a synergistic effect at intervals from 37 ℃ to 41 ℃ in neither cancer cell line. However, a temperature of 43 ℃ enhanced cisplatin cytotoxicity for Caco-2 cells. Moreover, isobologram analysis revealed mathematical antagonistic effects of cisplatin and temperature combined treatment in AGS cells; variations between synergistic, additive, and antagonistic effects in Caco-2 cells; and additive and antagonistic effects in T3 M4 cells. Combined treatment enhanced initiation of cell apoptosis in AGS, Caco-2, and T3 M4 cells by 61%, 20%, and 19% respectively. The increase of intracellular cisplatin concentration was observed at 43 ℃ by 30%, 20%, and 18% in AGS, Caco-2, and T3 M4 cells, respectively.CONCLUSION In addition to cisplatin, hyperthermia up to 43 ℃ does not affect the viability of cancer cells in a synergistic manner.

关键词： hyperthermal intraperitoneal chemotherapy Cisplatin Hyperthermia Isobolograms Gastric cancer Pancreatic cancer Colon cancer

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Non-anatomic fixation for longstanding traumatic pubic diastasis using a bone graft： A report of two cases

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Chinese Journal of Traumatology 2017年第6期20卷 362-365页

作者： giedrius Petryla Valentinas Uvarovas Igoris Satkauskas Povilas Masionis Narunas Porvaneckas Department of Orthopedics and Traumatology Vilnius University Faculty of Medicine Republican Vilnius University Hospital Siltnamiu Str. 29 04130 Vilnius Lithuania

膜连脱离的内部固定失败的发生从 6% ～ 75% 变化。硬件破裂或移植和膜连混乱复发经常是无征状的，仅仅在一些情况中，操作被要求。当完成前面的骨盆的戒指的解剖减小是技术上不可能的时，这份报告在没有通过的内部固定和忽视的创伤的... 详细信息

膜连脱离的内部固定失败的发生从 6% ～ 75% 变化。硬件破裂或移植和膜连混乱复发经常是无征状的，仅仅在一些情况中，操作被要求。当完成前面的骨盆的戒指的解剖减小是技术上不可能的时，这份报告在没有通过的内部固定和忽视的创伤的膜连脱离以后描述二个案例的管理。为膜连没有的内部固定和骨头接枝解剖重新定位被执行。病人完成了好结果并且没在每日的活动期间有疼痛的抱怨。解剖的恢复不应该是在在没有通过的固定以后对待膜连脱离的复发的目的。外科的目的是有骨头 grafting 的前面的骨盆的戒指的静态的固定。

关键词：膜连脱离骨盆的戒指静态的固定骨头 grafting

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Reciprocal hematogenous osteomyelitis of the femurs caused by Anaerococcus prevotii:A case report

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World Journal of Clinical Cases 2021年第4期9卷 830-837页

作者： Karolina Daunaraite Valentinas Uvarovas Donatas Ulevicius Tomas Sveikata giedrius Petryla JauniusKurtinaitis Igoris Satkauskas Vilnius University Institute of Clinical MedicineFaculty of MedicineVilnius LT-08661Lithuania Department of Orthopedics and Traumatology Institute of Clinical MedicineFaculty of MedicineVilnius UniversityVilnius LT-08661Lithuania Department of Orthopedics and Traumatology Vilnius LT-04130Lithuania

BACKGROUND Haematogenous osteomyelitis is an extremely rare disease occurring in adults,especially in developed countries.It is clearly a systemic infection,because bacteraemia spreads over proximal and distal long bones or paravertebral plexuses,resulting in acute or chronic bone infection and destruction.CASE SUMMARY A 46-year-old Caucasian male was complaining of a left thigh pain.It is known from the anamnesis that the patient developed severe pneumonia three months ago before the onset of these symptoms.The patient was diagnosed with haematogenous osteomyelitis,which developed a turbulent course and required complex combination therapy.The primary pathogen is thought to be Anaerococcus prevotii,which caused pneumonia before the onset of signs of osteomyelitis.Unfortunately,due to the complexity of identifying anaerobes and contributing nosocomial infections,the primary pathogen was not extracted immediately.After the manifestation of this disease,pathological fractures occurred in both femurs,as well as purulent processes in the lungs and molars accompanied.The patient received broad-spectrum antibiotic therapy and countless amounts of orthopaedic and reconstructive surgeries,but no positive effect was observed.The patient underwent osteosynthesis using an Ilizarov’s external fixation apparatus,re-fixations,external AO,debridements,intramedullary osteosynthesis with a silver-coated intramedullary nail,abscessotomies.The right femur healed completely after the pathological fracture and osteomyelitis did not recur.Left femur could not be saved due to non-healing,knee contracture and bone destruction.After almost three years of struggle,it was decided to amputate the left limb,after which the signs of osteomyelitis no longer appeared.CONCLUSION To sum it all up,complicated or chronic osteomyelitis requires surgery to remove the infected tissue and bone.Osteomyelitis surgery prevents the infection from spreading further or getting even worse up to such condition that amputation is the only option left.

关键词： Hematogenous Femur osteomyelitis Reciprocal Pathologic fracture Anaeroccocus prevotii Case report

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Sleep disordered breathing in coronary heart disease patients with mild and moderate heart failure

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Health 2013年第8期5卷 36-43页

作者： giedrius Varoneckas Aurelija Podlipskyte Audrius Alonderis Arvydas Martinkenas Behavioral Medicine Institute of the Lithuanian University of Health Sciences Palanga Lithuania

The purpose of the study was to investigate the relationship between sleep disordered breathing (SDB) and degree of heart failure (HF) in patients with coronary heart disease (CHD). A total of 3017 patients (77.4% men and 22.6% women) were included in the study. Clinical examination and echocardiography for evaluation of HF using NYHA functional classification and sleep polysomnography were performed. The study demonstrated that SDB is more common in CHD patients with higher NYHA functional class. The prevalence of central sleep apneas against obstructive apneas was observed in patients with mild and moderate HF. The number of central apneas was strongly related to the severity of heart failure. More frequent appearance of central sleep apneas is predominantly due to instability of ventilatory control systems during sleep because of impaired cardiac function in HF patients. Sleep architecture was more disturbed in CHD patients with higher NYHA functional class. A gradual increase of stage 1 and wakefulness after sleep onset and a decrease of sleep stages 3-4 and REM sleep as well as a diminution of sleep efficiency with worsening of NYHA functional class were observed. We suggest that both SDB and disturbed sleep variables independently significantly correlate with manifestation of HF.

关键词： Sleep Sleep Apnoea Oxygen Desaturation Coronary Heart Disease Heart Failure

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Neuroprotective Effects of Mas-receptor Ligands in an Experimental Rat Glaucoma

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Journal of Pharmacy and Pharmacology 2014年第2期2卷 114-122页

作者： Anu Vaajanen Jooseppi Puranen giedrius Kalesnykas Heikki Vapaatalo Hannu Uusitalol Department of Ophthalmology Tampere University Hospital Tampere 33521 Finland SILK Department of Ophthalmology School of Medicine University of Tampere Tampere 33014 Finland Department of Ophthalmology Institute of Clinical Medicine University of Eastern Finland Kuopio 70211 Finland Institute of Biomedicine Pharmacology University of Helsinki Helsinki 00014 Finland

Objectives: Ocular effects of Mas-receptor ligands were studied in an experimental rat glaucoma. Elevated IOP (intraocular pressure) was induced unilaterally by laser photocoagulation of the episcleral and limbal veins in anesthetized rats. A Mas-receptor agonist (Ang (1-7)) and an antagonist (A779) were administered intravitreally in the glaucomatous eye. IOP was measured by a rebound tonometer. Effects of the treatment on RGCL (retinal ganglion cell layer) were determined stereologically and on the axons of optic nerve by a modified Gallyas silver-staining method. Key findings: Mean IOP during the 14 days follow-up in the solvent treated glaucoma eyes (n = 18) was 28.7 ± 1.9 mmHg vs. the fellow eyes 11.0 ± 0.3 mmHg. A significant axon damage was detected in the glaucomatous eyes vs. the fellow normotensive eye. The Mas-receptor ligands did not influence high IOP resulted by laser treatment. Despite of the ineffectiveness on IOP, Ang (1-7) protected RGCL cells as determined by stereology (P = 0.016). No significant effects in Gallyas silver-staining were found. Summary: Intravitreally administered Ang (1-7) showed a significant protective effect against neuronal damage. The present and our previous studies suggest that stimulation of Mas-receptor may have therapeutic potential to treat glaucoma.

关键词：药剂学药理学药学药物分析药典

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前海腾讯五带一城

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城市环境设计 2023年第3期143卷 204-211页

作者：尼尔逊郑宇淇黄盟金振科 giedrius Mamavicius Junsik Oh Connor Sullivan Natasha Trice Gabriele Ubarevi?iūté 岳阳 Frans Parthesius

腾讯公司成立于1998年,目前是世界上最大的互联网公司之一。出于对未来发展的预期,腾讯决定为其员工开发一个新园区。在设计竞赛中,我们遇到了几个问题:如何制定一个总体规划来展示腾讯的形象,同时随着时间的推移实现最大的灵活性?如何...

腾讯公司成立于1998年,目前是世界上最大的互联网公司之一。出于对未来发展的预期,腾讯决定为其员工开发一个新园区。在设计竞赛中,我们遇到了几个问题:如何制定一个总体规划来展示腾讯的形象,同时随着时间的推移实现最大的灵活性?如何为一家结构变化比设计总体规划更快的公司制定总体规划?如何让更多的公众能够接触到中国的创新产业?

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