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Current and future perspectives on acute-on-chronic liver failure: Challenges of transplantation, machine perfusion, and beyond

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World Journal of Gastroenterology 2022年第48期28卷 6922-6934页

作者： Bianca Della Guardia Amanda P C S Boteon Celso E L Matielo guilherme felga Yuri L Boteon Liver Unit Hospital Israelita Albert EinsteinSão Paulo 05652-900Brazil Instituto Israelita de Ensino e Pesquisa Albert Einstein Faculdade Israelita de Ciências da Saúde Albert EinsteinSão Paulo 05652-900Brazil

Acute-on-chronic liver failure(ACLF)is a syndrome that occurs in patients with chronic liver disease and is characterized by acute decompensation,organ failure and high short-term mortality.Partially due to the lack of universal diagnostic criteria,the actual ACLF prevalence remains unclear;nevertheless,it is expected to be a highly prevalent condition worldwide.Earlier transplantation is an effective protective measure for selected ACLF patients.Besides liver transplantation,diagnosing and treating precipitant events and providing supportive treatment for organ failures are currently the cornerstone of ACLF therapy.Although new clinical specific therapies have been researched,more studies are necessary to assess safety and efficacy.Therefore,future ACLF management strategies must consider measures to improve access to liver transplantation because the time window for this life-saving therapy is frequently narrow.Thus,an urgent and global discussion about allocation and prioritization for transplantation in critically ill ACLF patients is needed because there is evidence suggesting that the current model may not portray their waitlist mortality.In addition,while donor organ quality is meant to be a prognostic factor in the ACLF setting,recent evidence suggests that machine perfusion of the liver may be a safe tool to improve the donor organ pool and expedite liver transplantation in this scenario.

关键词： Acute-on-chronic liver failure Liver cirrhosis Liver transplantation Machine perfusion Hypothermic oxygenated machine perfusion

Update on the management and treatment of viral hepatitis

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World Journal of Gastroenterology 2021年第23期27卷 3249-3261页

作者： Patricia Holanda Almeida Celso E L Matielo Lilian A Curvelo Rodrigo A Rocco guilherme felga Bianca Della Guardia Yuri L Boteon Liver Unit Hospital Israelita Albert EinsteinSão Paulo 05652-900Brazil Instituto Israelita de Ensino e Pesquisa Albert Einstein Faculdade Israelita de Ciências da Saúde Albert EinsteinSão Paulo 05652-900Brazil

This review aims to summarize the current evidence on the treatment of viral hepatitis,focusing on its clinical management.Also,future treatment options and areas of potential research interest are detailed.PubMed and Scopus databases were searched for primary studies published within the last ten years.Keywords included hepatitis A virus,hepatitis B virus(HBV),hepatitis C virus,hepatitis D virus(HDV),hepatitis E virus,and treatment.Outcomes reported in the studies were summarized,tabulated,and synthesized.Significant advances in viral hepatitis treatment were accomplished,such as the advent of curative therapies for hepatitis C and the development and improvement of hepatitis A,hepatitis B,and hepatitis E vaccination.Drugs that cure hepatitis B,going beyond viral suppression,are so far unavailable;however,targeted antiviral drugs against HBV(immunomodulatory therapies and gene silencing technologies)are promising approaches to eradicating the virus.Ultimately,high vaccination coverage and large-scale test-and-treat programmes with high screening rates may eliminate viral hepatitis and mitigate their burden on health systems.The development of curative hepatitis C treatment renewed the enthusiasm for curing hepatitis B,albeit further investigation is required.Novel therapeutic options targeting HDV life cycle are currently under clinical investigation.

关键词： Viral hepatitis Hepatitis A virus Hepatitis B virus Hepatitis C virus Hepatitis D virus Hepatitis E virus

Long-term outcomes of hepatocellular carcinoma that underwent chemoembolization for bridging or downstaging

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World Journal of Gastroenterology 2019年第37期25卷 5687-5701页

作者： Breno Boueri Affonso Francisco Leonardo Galastri Joaquim Mauricio da Motta Leal Filho Felipe Nasser Priscila Mina Falsarella Rafael Noronha Cavalcante Marcio Dias de Almeida guilherme eduardo goncalves felga Leonardo Guedes Moreira Valle Nelson Wolosker Department of Interventional Radiology Hospital Israelita Albert EinsteinSao Paulo 05651-901Sao PauloBrazil Department of Liver Transplant Hospital Israelita Albert EinsteinSao Paulo 05651-901Sao PauloBrazil Department of Vascular Surgery Hospital Israelita Albert EinsteinSao Paulo 05651-901Sao PauloBrazil

BACKGROUND Prospective study of 200 patients with hepatocellular carcinoma(HCC)that underwent liver transplant(LT)after drug-eluting beads transarterial chemoembolization(DEB-TACE)for downstaging versus bridging.Overall survival and tumor recurrence rates were calculated,eligibility for LT,time on the waiting list and radiological response were compared.After TACE,only patients within Milan Criteria(MC)were transplanted.More patients underwent LT in bridging group.Five-year post-transplant overall survival,recurrence-free survival has no difference between the groups.Complete response was observed more frequently in bridging group.Patients in DS group can achieve posttransplant survival and HCC recurrence-free probability,at five years,just like patients within MC in patients undergoing DEB-TACE.AIM To determine long-term outcomes of patients with HCC that underwent LT after DEB-TACE for downstaging vs bridging.METHODS Prospective cohort study of 200 patients included from April 2011 through June 2014.Bridging group included patients within MC.Downstaging group(out of MC)was divided in 5 subgroups(G1 to G5).Total tumor diameter was≤8 cm for G1,2,3,4(n=42)and was>8 cm for G5(n=22).Downstaging(n=64)and bridging(n=136)populations were not significantly different.Overall survival and tumor recurrence rates were calculated by the Kaplan-Meier method.Additionally,eligibility for LT,time on the waiting list until LT and radiological response were compared.RESULTS After TACE,only patients within MC were transplanted.More patients underwent LT in bridging group 65.9%(P=0.001).Downstaging population presented:higher number of nodules 2.81(P=0.001);larger total tumor diameter 8.09(P=0.001);multifocal HCC 78%(P=0.001);more post-transplantation recurrence 25%(P=0.02).Patients with maximal tumor diameter up to 7.05 cm were more likely to receive LT(P=0.005).Median time on the waiting list was significantly longer in downstaging group 10.6 mo(P=0.028).Five-year posttransplant overall survival was 73.5%in downstaging and 72.3%br

关键词： Hepatocellular carcinoma Down-staging Liver transplantation Localregional therapy Bridging

Feasibility of endoscopic papillary large balloon dilation to remove difficult stones in patients with nondilated distal bile ducts

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World Journal of Gastrointestinal Endoscopy 2022年第7期14卷 424-433页

作者： Julio Carlos Pereira Lima Giusepe Saifert Moresco Ivan David Arciniegas Sanmartin Isabela Contin guilherme Pereira-Lima guilherme Watte Stephan Altmayer Carlos eduardo Oliveira dos Santos Department of Gastroenterology Endoscopy DivisionFederal University of Health Sciences of Porto Alegre/Santa Casa HospitalPorto Alegre 90020-090RSBrazil Department of Biostatistics and Epidemiology Pontifical Catholic University of Rio Grande do SulPorto Alegre 90619-900RSBrazil Department of Gastroenterology and Endoscopy Santa Casa HospitalBage96400-130RSBrazil

BACKGROUND Current guidelines recommend not performing papillary large balloon dilation in patients with nondilated distal bile ducts.AIM To assess the feasibility of balloon dilation to remove difficult stones in patients with nondilated distal bile ducts.METHODS Data from 1289 endoscopic retrograde cholangiopancreatography(ERCP)procedures were obtained from two prospective studies.While 258 cases had difficult stones(>1 cm,multiple>8,impacted,or having a thin distal duct),191 underwent biliary dilation up to 15 mm after endoscopic sphincterotomy.Cholangiographies of these cases were retrospectively reviewed in order to classify the distal bile duct and both the stone size and number.Primary outcomes were clearance rate at first ERCP and complications.RESULTS Of the 191 patients(122 women and 69 men;mean age:60 years)who underwent biliary dilation for difficult stones,113(59%)had a nondilated or tapered distal duct.Patients with a dilated distal duct were older than those with nondilated distal ducts(mean 68 and 52 years of age,respectively;P<0.05),had more stones(median 4 and 2 stones per patient,respectively;P<0.05),and had less need for additional mechanical lithotripsy(6.4%vs 25%,respectively;P<0.05).Clearance rate at first ERCP was comparable between patients with a dilated(73/78;94%)and nondilated distal ducts(103/113;91%).Procedures were faster in patients with a dilated distal duct(mean 17 vs 24 min,respectively;P<0.005).Complications were similar in both groups(6.4%vs 7.1%,respectively).CONCLUSION Large balloon dilation for difficult stones is feasible in patients with a nondilated or even tapered distal duct.

关键词： Difficult bile duct stones Endoscopic retrograde cholangiopancreatography Balloon dilation Complications Biliary dilation Cholangiography

Fecal marker levels as predictors of need for endoscopic balloon dilation in Crohn's disease patients with anastomotic strictures

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World Journal of Gastroenterology 2017年第35期23卷 6482-6490页

作者： Susana Lopes Patrícia Andrade eduardo Rodrigues-Pinto Joana Afonso guilherme Macedo Fernando Magro Gastroenterology Department Faculty of MedicineHospital de Sao Joao Department of Pharmacology and Therapeutics University of Porto

AIM To evaluate the accuracy and best cut-off value of fecal calprotectin(FC) and fecal lactoferrin(FL) to predict disease recurrence in asymptomatic patients presenting with anastomotic strictures. METHODS This was a longitudinal single tertiary center study based on prospectively collected data(recorded in a clinical database created for this purpose) performed between March 2010 and November 2014. Crohn's disease(CD) patients with anastomotic stricture who submitted to postoperative endoscopic evaluation were included. Stools were collected on the day before bowel cleaning for FC and FL. Endoscopic balloon dilation(EBD) was performed if the patient presented an anastomotic stricture not traversed by the colonoscope, regardless of patients' symptoms. Successful dilation was defined as passage of the colonoscope through the dilated stricture into the neotermimal ileum.Postoperative recurrence was defined as a modified Rutgeerts score of ≥ i2 b. RESULTS In a total of 178 patients who underwent colonoscopy, 58 presented an anastomotic stricture, 86% were asymptomatic, and 48(54% male; median age of 46.5 years) were successfully dilated. Immediate success rate was 92% and no complications were recorded. FC and FL levels correlated significantly with endoscopic recurrence(P < 0.001) with an optimal cut-off value of 90.85 μg/g(sensitivity of 95.5%, specificity of 69.2%, positive predictive value(PPV) of 72.4%, negative predictive value(NPV) of 94.7% and accuracy of 81%] for FC and of 5.6 μg/g(sensitivity of 77.3%, specificity of 69.2%, PPV of 68%, NPV of 78.4% and accuracy of 72.9%) for FL.CONCLUSION Fecal markers are good predictors of CD endoscopic recurrence in patients with asymptomatic anastomotic stricture. FC and FL may guide the need for EBD in this context.

关键词： Crohn's disease Anastomotic strictures Endoscopic balloon dilation Fecal markers Po stoperative recurrence

Endoscopic balloon dilation of crohn's disease stricturessafety,efficacy and clinical impact

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World Journal of Gastroenterology 2017年第41期23卷 7397-7406页

作者： Susana Lopes eduardo Rodrigues-Pinto Patrícia Andrade Joana Afonso Todd H Baron Fernando Magro guilherme Macedo Gastroenterology Department Faculty of MedicineHospital de Sao Joao Department of Pharmacology and Therapeutics University of Porto Division of Gastroenterology and Hepatology University of North Carolina

AIM To evaluate the incidence of anastomotic strictures after intestinal resection in Crohn's disease(CD), demonstrate long-term efficacy and safety of endoscopic balloon dilation(EBD) in CD strictures and its impact on the diagnosis of subclinical postoperative endoscopic recurrence. METHODS Retrospective single tertiary center study based on prospectively collected data between 2010 and 2015including anastomotic and non-anastomotic strictures. RESULTS29% of 162 CD patients included developed an anastomotic stricture. 43 patients with anastomotic strictures and 37 with non-anastomotic strictures underwent EBD; technical success was 97.7% and 100%, respectively, however, 63% and 41% needed repeat dilation during the 4.4-year follow-up. Longer periods between surgery and index colonoscopy and higher lactoferrin levels were associated with the presence of stricture after surgery. Calprotectin levels > 83.35 μg/g and current or past history of smoking were associated with a shorter time until need for dilation(HR = 3.877, 95%CI: 1.480-10.152 and HR = 3.041, 95%CI: 1.213-7.627). Anastomotic strictures had a greater need for repeat dilation(63% vs 41%, P = 0.047). No differences were found between asymptomatic and symptomatic cohorts. Disease recurrence diagnosis was only possible after EBD in a third of patients. CONCLUSION EBD is an effective and safe alternative to surgery, with a good short and long-term outcome, postponing or even avoiding further surgery. EBD may allow to diagnose disease recurrence in patients with no clinical signs/biomarkers of disease activity.

关键词： Crohn’s disease Endoscopic recurrence Anastomotic strictures Non-anastomotic strictures Endoscopic balloon dilation

Development and validation of a morphological model for multiple sediment classes

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International Journal of Sediment Research 2017年第4期32卷 585-596页

作者： guilherme Franz Paulo Leit?o Lígia Pinto eduardo Jauch Luís Fernandes Ramiro Neves Maretec Instituto Superior TécnicoUniversidade de Lisboa Hidromod Rua Rui Teles Palhinha Action Modulers Estrada Principal

The complexity of sediment dynamics in aquatic systems can be better understood by applying numerical models. The development of a comprehensive morphological model is presented in this paper.The model aims to predict the sediment transport and bed evolution in natural systems composed of different sediment types. The morphological model was implemented in MOHID, a modelling system that solves the three-dimensional hydrodynamics and advection-diffusion transport of suspended sediments. Multiple sediment classes were taken into account(non-cohesive and cohesive) considering the effects of sediment mixtures and bed consolidation on resistance to erosion. To represent bottom stratigraphy, the bottom column can be divided into several layers. The key points of the simulated processes are discussed in this paper. Model results are assessed in six test cases through comparison with analytic solutions or experimental data. The outcomes demonstrate the model's capacity to simulate the transport dynamics of non-cohesive and cohesive sediments. The speed up of morphological changes by an acceleration factor permitted modelling bed evolution for long time periods.Moreover, a test case for the Tagus Estuary demonstrated the model's capacity for generating realistic sediment distribution based on the local hydrodynamic conditions. Limitations in the availability of bed composition data can be overcome by considering a warm-up run to provide realistic initial conditions for further predictions of morphological developments.

关键词： Sediment transport Sand-mud mixtures Morphodynamics Large-scale models MOHID modelling system

Comprehensive analysis of sodium polystyrene sulfonate-induced colitis:A systematic review

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World Journal of Meta-Analysis 2023年第7期11卷 351-367页

作者： Gabriel Peixoto Aver guilherme Ferreira Ribeiro Vinícius Remus Ballotin Francisco Souza dos Santos Lucas Goldmann Bigarella Floriano Riva eduardo Brambilla Jonathan Soldera School of Medicine Universidade de Caxias do SulCaxias do Sul 95070-560Brazil Department of Pathology CPM Laboratório de PatologiaCaxias do Sul 95084-900RSBrazil Clinical Gastroenterology Universidade de Caxias do SulCaxias do Sul 95070-560RSBrazil Acute Medicine and Gastroenterology University of South WalesCardiff CF371DLUnited Kingdom

BACKGROUND Sodium polystyrene sulfonate(SPS)is commonly prescribed for the management of hyperkalemia,a critical electrolyte imbalance contributing to over 800000 annual visits to emergency departments.AIM To conduct a systematic review of documented cases of SPS-induced colitis and assess its associated prognosis.METHODS Following the PRISMA-P guidelines,our study employed Medical Subject Headings and Health Sciences Descriptors,skillfully combined using Boolean operators,to conduct comprehensive searches across various electronic databases,including Scopus,Web of Science,MEDLINE(PubMed),BIREME(Biblioteca Regional de Medicina),LILACS(Latin American and Caribbean Health Sciences Literature),SciELO(Scientific Electronic Library Online),Embase,and Opengray.eu.Language criteria were confined to English,Spanish,and Portuguese,with no limitations on the publication date.Additionally,we manually scrutinized the reference lists of retrieved studies.To present our findings,we utilized simple descriptive analysis.RESULTS Our search strategy yielded a total of 442 references.After rigorous evaluation,we included 51 references,encompassing 59 documented cases of colitis.Predominant clinical presentations included abdominal pain,observed in 35(60.3%)cases,and bloating,reported in 18(31%)cases.The most frequently affected sites of inflammation were the cecum,rectum,and small intestine,accounting for 31%,25.8%,and 22.4%of cases,respectively.Colonoscopy findings were described in 28(48.2%)cases,and 29(50%)of patients required surgical intervention.Among the subset of patients for whom outcome data was available,39(67.2%)experienced favorable outcomes,while 12(20.6%)unfortunately succumbed to the condition.The mean time required for resolution was 36.7 d,with a range spanning from 1 to 120 d.CONCLUSION SPS demonstrates the capacity to effectively lower serum potassium levels within 24 h.However,this benefit is not without the risk of bowel injury.Our study highlights the absence of high-quality data pertaining to the incidence o

关键词： Sodium polystyrene sulfonate Hyperkalemia Colitis Bowel necrosis Kayexalate

Cerium alleviates drought-induced stress in Phaseolus vulgaris

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Journal of Rare Earths 2020年第3期38卷 324-331页

作者： Olívia Graziela Gelioli Salgado Jéssica Cristina Teodoro Joyce Pereira Alvarenga Cynthia de Oliveira Teotonio Soares de Carvalho Débora Domiciano Paulo eduardo Ribeiro Marchiori Luiz Roberto Guimaraes guilherme Department of Soil Science Federal University of LavrasCP 3037Campus UFLALavras37200-000Brazil Department of Biology Federal University of LavrasCP 3037Campus UFLALavras37200-000Brazil

Extreme drought events are expected to be one of the main challenges for tropical agriculture and,consequently,for global food security.For this reason,it is urgent to develop strategies to increase water use efficiency,as well as to increase crops’ ability to cope with drought.Because rare earth elements(REEs) are known to alleviate damages in plants under abiotic stresses,we hypothesized that addition of Ce^3+to nutrient solution would promote the growth of common bean,especially under simulated drought stress.To test this hypothesis,we conducted an experiment evaluating the effect of six Ce^3+concentrations on the development and physiological traits of common bean grown in nutrient solution under normal condition and under induced drought stress,caused by the addition of polyethylene glycol6000 to the nutrient solution.Our results show that Ce^3+alleviates water stress in common bean plants,increasing their survival rate and growth.In addition,Ce^3+application increases photosynthesis rate,chlorophyll content and water use efficiency under water stress.However,we observe no significant effect of Ce^3+on plants growing under normal condition.Therefore,Ce3+seems to be a promising attenuator of drought stress for common bean.

关键词： Water stress Polyethylene glycol Rare earth elements Cerium nitrate Mitigation Common bean