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Impact of machine perfusion of the liver on post-transplant biliary complications: A systematic review

World Journal of Transplantation 2018年第6期8卷 220-231页

作者： Yuri L Boteon Amanda PCS Boteon joseph attard Lorraine Wallace Ricky H Bhogal Simon C Afford Liver Unit Queen Elizabeth Hospital University Hospitals Birmingham NHS Foundation Trust Centre for Liver and Gastrointestinal Research Institute of Immunology and Immunotherapy College of Medical and Dental Sciences University of Birmingham National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre University of Birmingham and University Hospitals Birmingham NHS Foundation Trust

AIM To review the clinical impact of machine perfusion(MP) of the liver on biliary complications post-transplantation, particularly ischaemic-type biliary lesions(ITBL). METHODS This systematic review was performed in accordance with the Preferred Reporting Systematic Reviews and MetaAnalysis(PRISMA) protocol. The following databases were searched: PubMed, MEDLINE and Scopus. The keyword "liver transplantation" was used in combination with the free term "machine perfusion". Clinical studies reporting results of transplantation of donor human livers following ex situ or in situ MP were analysed. Details relating to donor characteristics, recipients, technique of MP performed and post-operative biliary complications(ITBL, bile leak and anastomotic strictures) were critically *** Fifteen articles were considered to fit the criteria for this review. Ex situ normothermic MP was used in 6 studies, ex situ hypothermic MP in 5 studies and the other 4 studies investigated in situ normothermic regional perfusion(NRP) and controlled oxygenated rewarming. MP techniques which have per se the potential to alleviate ischaemia-reperfusion injury: Such as hypothermic MP and NRP, have also reported lower rates of ITBL. Other biliary complications, such as biliary leak and anastomotic biliary strictures, are reported with similar incidences with all MP techniques. There is currently less clinical evidence available to support normothermic MP as a mitigator of biliary complications following liver transplantation. On the other hand, restoration of organ to full metabolism during normothermic MP allows assessment of hepatobiliary function before transplantation, although universally accepted criteria have yet to be *** MP of the liver has the potential to have a positive impact on post-transplant biliary complications, specifically ITBL, and expand extended criteria donor livers utilisation.

关键词： Liver transplantation Ex situ machine perfusion of the liver Donation after circulatory death Non-anastomotic intra-hepatic stricture Ischemic-type biliary lesions Extended criteria donors

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Pancreatic exocrine insufficiency after pancreaticoduodenectomy: Current evidence and management

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World Journal of Gastrointestinal Pathophysiology 2020年第2期11卷 20-31页

作者： Adithya M Pathanki joseph a attard Elizabeth Bradley Sarah Powell-Brett Bobby V M Dasari John R Isaac Keith J Roberts Nikolaos A Chatzizacharias Department of HPB and Liver Transplantation Queen Elizabeth HospitalUniversity Hospitals BirminghamBirmingham B152THUnited Kingdom Department of Nutrition and Dietetics Queen Elizabeth HospitalUniversity Hospitals BirminghamBirmingham B152THUnited Kingdom

Pancreaticoduodenectomy(PD)is the commonest procedure performed for pancreatic *** exocrine insufficiency(PEI)may be caused or exacerbated by surgery and remains underdiagnosed and *** aim of this review was to ascertain the incidence of PEI,its consequences and management in the setting of PD for indications other than chronic pancreatitis.A literature search of databases(MEDLINE,EMBASE,Cochrane and Scopus)was carried out with the MeSH terms“pancreatic exocrine insufficiency”and“Pancreaticoduodenectomy”.Studies that analysed PEI and its complications in the setting of PD for malignant and benign disease were *** reporting PEI in the setting of PD for chronic pancreatitis,conference abstracts and reviews were *** incidence of PEI approached 100%following PD in some *** pre-operative incidence varied depending on the characteristics of the patient cohort and it was higher(46%-93%)in series where pancreatic cancer was the predominant indication for *** was also recorded with regards to the method used for the diagnosis and evaluation of pancreatic function and *** enzyme replacement therapy is the mainstay of the *** is common and remains undertreated after *** studies are required for the identification of a welltolerated,reliable and reproducible diagnostic test in this setting.

关键词： Pancreatic exocrine insufficiency Pancreaticoduodenectomy Pancreatic enzyme replacement therapy Pancreatic cancer Malabsorption Steatorrhoea

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Comparison of the use of wireless capsule endoscopy with magnetic resonance enterography in children with inflammatory bowel disease

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World Journal of Gastroenterology 2019年第28期25卷 3808-3822页

作者： Nadia Mazen Hijaz Thomas Mario attard Jennifer Marie Colombo Neil joseph Mardis Craig Alan Friesen Division of Gastroenterology Hepatology and Nutrition University of Missouri Kansas City Children’s Mercy Hospital Kansas City

BACKGROUND Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn’s disease exacerbation compared to MRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices. AIM To prospectively compare the findings of MRE and WCE and their agreement with PCDAI or histology in children with CD or IC. METHODS Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient’s demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent MRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (attard TM and Colombo JM) blinded to each other's findings and to the findings on MRE (Mardis NJ). Agreement between WCE reviewers, WCE and MRE findings and concordance between positive PCDAI and SBI based on MRE compared with WCE was computed. RESULTS Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good

关键词： Crohn’s disease Wireless capsule endoscopy Inflammatory bowel disease Magnetic resonance enterography Small bowel involvement Small bowel disease Indeterminate colitis Pediatric Children

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Comparison of the demographic characteristics of pediatric and adult colorectal cancer patients: a national inpatient sample based analysis

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World Journal of Pediatrics 2019年第1期15卷 37-41页

作者： Thomas M.attard Caitlin E.Lawson University of Missouri Kansas City Kansas CityMOUSA Pediatric Gastroenterology Children's Mercy Hospital2401Gillham RdKansas CityMO 64108USA Division of Genetics Children's Mercy HospitalKansas CityMOUSA

Background Colorectal cancer in children is rare,but characterized by late presentation,unfavorable histology and poor *** factors for colorectal cancer in children overlap with those for adults with greater influence of hereditary *** epidemiology of colon cancer in children is poorly understood;the aim of this study was to characterize and compare the demographics and relevant clinical characteristics of pediatric and adult colon cancer,using a national inpatient *** The AHRQ online resource HCUPnet/KID database was queried for children,under the age of 18 admitted with ICD 9 CM diagnoses relating to colorectal cancer,at the time of *** comparison,the corresponding diagnoses in adult patients were queried for each successive *** demographics including residential type and median income by zip-code,tumor localization;if recorded,and mean hospital charges were all accrued and *** Inpatient admissions for pediatric colorectal cancer were more likely male (54%),in the 15-17 years age bracket (57%).They were significantly more likely from Southwestern regions of the Unites States,and were significantly more likely from residential zip-codes identified as at or below the lowest income quartile than adult CRC patients or pediatric patients as a *** charges have more than quadrupled over the time period studied (1997-2012).Conclusions Pediatric colorectal cancer is the most common primary gastrointestinal malignancy in *** understanding associated risk factors including those associated with gender,geographic region and social economic status may contribute to future prevention or early detection strategies.

关键词： Colorectal cancer Colorectal neoplasms Demography International classification of diseases Pediatric risk factors

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Clinical outcome of pediatric collagenous gastritis: Case series and review of literature

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World Journal of Gastroenterology 2013年第9期19卷 1478-1484页

作者： Nadia Mazen Hijaz Seth Steven Septer James Degaetano Thomas Mario attard Section of Pediatric Gastroenterology Children's Mercy Hospital Kansas MO 64108 United States Department of Pathology Mater Dei Hospital Malta Mater Dei Hospital MSD 2090 Msida Malta Department of Pediatrics Mater Dei Hospital Malta Mater Dei Hospital MSD 2090 Msida Malta

Collagenous gastritis (CG) is characterized by patchy subepithelial collagen bands. Effective treatment and the clinical and histological outcome of CG in children are poorly defined. The aim of this study is to summarize the published literature on the clinical outcome and response to therapy of pediatric CG including two new cases. We performed a search in Pubmed, OVID for related terms; articles including management and clinical and/or endo-histologic follow up information were included and abstracted. Reported findings were pooled in a dedicated database including the corresponding data extracted from chart review in our patients with CG. Twenty-four patients were included (17 females) with a mean age of 11.7 years. The clinical presentation included iron deficiency anemia and dyspepsia. The reported duration of follow up (in 18 patients) ranged between 0.2-14 years. Despite most subjects presenting with anemia including one requiring blood transfusion, oral iron therapy was only documented in 12 patients. Other treatment modalities were antisecretory measures in 13 patients; proton pump inhibitors (12), or histamine-2 blockers (3), sucralfate (5), prednisolone (6), oral budesonide in 3 patients where one received it in fish oil and triple therapy (3). Three (13%) patients showed no clinical improvement despite therapy; conversely 19 out of 22 were reported with improved symptoms including 8 with complete symptom resolution. Spontaneous clinical resolution without antisecretory, anti-inflammatory or gastroprotective agents was noted in 5 patients (4 received only supplemental iron). Follow up endohistopathologic data (17 patients) included persistent collagen band and stable Mononuclear cell infiltrate in 12 patients with histopathologic improvement in 5 patients. Neither collagen band thickness nor mononuclear cell infiltrate correlated with clinical course. Intestinal metaplasia and endocrine cell hyperplasia were reported (1) raising the concern of long term

关键词： Collagenous gastritis Pediatric Gastritis Collagenous colitis Lymphocytic gastritis

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Mortality associated with gastrointestinal bleeding in children: A retrospective cohort study

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World Journal of Gastroenterology 2017年第9期23卷 1608-1617页

作者： Thomas M attard Mikaela Miller Chaitanya Pant Ashwath Kumar Mike Thomson Department of Gastroenterology Children’s Mercy Hospital Clinical Decision Support Children’s Mercy Hospital Department of Gastroenterology The University of Kansas Hospital University of Missouri Medical School Sheffield Children’s Hospital Western Bank

To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their *** interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, *** population with GIB was 19528; 54.6% were male, overall mortality was 2.07%; (0.37% in patients with the principal diagnosis of GIB). When considering only the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8% c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission (OR = 0.489, P < 0.0001). Chronic liver disease associated with a greater likelihood of endoscopy. Mortalities were significantly more likely to have multiple complex chronic *** associated mortality in children is highest within 7 d of admission. Multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective.

关键词： Pediatrics Gastrointestinal hemorrhage Endoscopy Proton pump inhibitors Mortality Liver disease Hospital Information Systems Octreotide

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Aggressive juvenile polyposis in children with chromosome 10q23 deletion

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World Journal of Gastroenterology 2013年第14期19卷 2286-2292页

作者： Seth Septer Lei Zhang Caitlin E Lawson Jose Cocjin Thomas attard Holly H Ardinger Department of Gastroenterology and Hepatology Children's Mercy Hospital and ClinicsKansas CityMO 64108United States Division of Cytogenetics Department of Pathology Children's Mercy Hospital and ClinicsKansas CityMO 64108 United States Division of Clinical Genetics Department of PediatricsChildren's Mercy Hospitals and Clinics and University of MissouriKansas City School of MedicineKansas CityMO 64108United States

Juvenile polyps are relatively common findings in children,while juvenile polyposis syndrome(JPS) is a rare hereditary syndrome entailing an increased risk of colorectal *** in BMPR1A or SMAD4 are found in roughly half of patients diagnosed with *** in PTEN gene are also found in patients with juvenile polyps and in Bannayan-Riley-Ruvalcaba syndrome and Cowden *** previous reports have described microdeletions in chromosome 10q23 encompassing both PTEN and BMPR1A causing aggressive polyposis and malignancy in *** reports have also described extra-intestinal findings in most cases including cardiac anomalies,developmental delay and *** this report we describe a boy with a 5.75 Mb deletion of chromosome 10q23 and a 1.03 Mb deletion within chromosome band 1p31.3who displayed aggressive juvenile polyposis and multiple extra-intestinal anomalies including macrocephaly,developmental delay,short stature,hypothyroidism,atrial septal defect,ventricular septal defect and *** required colectomy at six years of age,and early colectomy was a common outcome in other children with similar *** to the aggressive polyposis and reports of dysplasia and even malignancy at a young age,we propose aggressive gastrointestinal surveillance in children with 10q23 microdeletions encompassing the BMPR1A and PTEN genes to include both the upper and lower gastrointestinal tracts,and also include a flowchart for an effective genetic testing strategy in children with juvenile polyposis.

关键词： Polyposis Genetics Cancer Endoscopy pediatric

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Active travel and sustainable transport

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Communications in Transportation Research 2022年第1期2卷 56-57页

作者： Maria attard Institute for Climate Change and Sustainable Development University of Malta MsidaMSD2080Malta

So far we have plenty of evidence that show how active travel,defined broadly here as walking and cycling,and encompassing multimodality with public transport and the use of a variety of micromobility options,affect positively the environment and public health,reduce car congestion in urban roads,and is the most effective solution towards ***,in many parts of the world and in many cities we still see a gap in the transport policies that prioritize active travel,with most policies still focusing on the car and its supporting infrastructures of more and wider roads,more parking and so *** the decarbonisation discourse is riddled with references to the electric,maybe shared,autonomous car as being the sustainable solution for the future.

关键词： travel transport plenty

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