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Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant:What is the evidence?

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World Journal of Gastroenterology 2023年第20期29卷 3066-3083页

作者： Manuel Durán Rafael calleja Angus Hann George Clarke Ruben Ciria Anisa Nutu Rebeca Sanabria-Mateos maría Dolores Ayllón Pedro lópez-Cillero Hynek Mergental Javier Briceño M Thamara P R Perera Department of liver Transplantation Reina Sofía University HospitalCórdoba 14004Spain The liver Unit Queen Elizabeth Hospital BirminghamBirmingham B152THUnited Kingdom Centre for liver and Gastrointestinal Research Institute of Immunology and ImmunotherapyUniversity of BirminghamBirmingham B152THUnited Kingdom

The widespread uptake of different machine perfusion(MP)strategies for liver transplant has been driven by an effort to minimize graft *** to the cholangiocytes during the liver donation,preservation,or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary *** problem continues to trouble clinicians,and may have catastrophic consequences for the graft and *** injury,as a result of compromised hepatic artery flow,is a well-known cause of biliary strictures,sepsis,and graft ***,very similar lesions can appear with a patent hepatic artery and these are known as ischemic type biliary lesions(ITBl)that are attributed to microcirculatory dysfunction rather than main hepatic arterial *** the warm and cold ischemic period duration appear to influence the onset of *** of the commonly used MP techniques deliver oxygen to the graft cells,and therefore may minimize the cholangiocyte injury and subsequently reduce the incidence of *** clinical experience and published evidence grows for these modalities,the impact they have on ITBl rates is important to *** this review,the evidence for the three commonly used MP strategies(abdominal normothermic regional perfusion[A-NRP],hypothermic oxygenated perfusion[HOPE],and normothermic machine perfusion[NMP])for ITBl prevention has been critically *** with ITBl definitions used in trials,coupled with variations in techniques of MP,make interpretation ***,the evidence suggests that both HOPE and A-NRP prevent ITBl in donated after circulatory death grafts compared to cold *** evidence for ITBl prevention in donor after brain death grafts with any MP technique is weak.

关键词： liver transplant Ischemic type biliary lesions Hypothermic oxygenated machine perfusion Normothermic machine perfusion Abdominal normothermic regional perfusion Donation after circulatory death

Machine learning in liver surgery:Benefits and pitfalls

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World Journal of Clinical Cases 2024年第12期12卷 2134-2137页

作者： Rafael calleja Manuel Durán maría Dolores Ayllón Ruben Ciria Javier Briceño Hepatobiliary Surgery and liver Transplantation Unit Hospital Universitario Reina SofíaMaimonides Biomedical Research Institute of CordobaCórdoba 14004Spain

The application of machine learning(Ml)algorithms in various fields of hepatology is an issue of ***,we must be cautious with the *** this letter,based on a published Ml prediction model for acute kidney injury after liver surgery,we discuss some limitations of Ml models and how they may be addressed in the *** the future faces significant challenges,it also holds a great potential.

关键词： Machine learning liver surgery Artificial intelligence Random forest Prediction model

Artificial intelligence and liver transplantation:looking for the best donor-recipient pairing

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Hepatobiliary & Pancreatic Diseases International 2022年第4期21卷 347-353页

作者： Javier Briceno Rafael calleja César Hervás Unit of liver Transplantation Department of General SurgeryHospital Universitario Reina SofíaCórdobaSpain Maimónides Institute of Biomedical Research of Córdoba(IMIBIC) CórdobaSpain Department of Computer Sciences and Numerical Analysis Universidad de CórdobaCórdobaSpain

Decision-making based on artificial intelligence(AI)methodology is increasingly present in all areas of modern *** recent years,models based on deep-learning have begun to be used in organ *** into account the huge number of factors and variables involved in donor-recipient(DR)matching,AI models may be well suited to improve organ ***-based models should provide two solutions:complement decision-making with current metrics based on logistic regression and improve their *** of classifiers could be used to address this ***,not all of them are really useful for D-R ***,in the decision to assign a given donor to a candidate in waiting list,a multitude of variables are handled,including donor,recipient,logistic and perioperative *** these last two,some of them can be inferred indirectly from the team’s previous *** groups of AI models have been used in the D-R matching:artificial neural networks(ANN)and random forest(RF).The former mimics the functional architecture of neurons,with input layers and output *** algorithms can be uni-or *** general,ANNs can be used with large databases,where their generalizability is ***,they are models that are very sensitive to the quality of the databases and,in essence,they are black-box models in which all variables are ***,these models do not allow to know safely the weight of each *** the other hand,RF builds decision trees and works well with small *** addition,they can select top variables as with logistic ***,they are not useful with large databases,due to the extreme number of decision trees that they would generate,making them *** ANN and RF allow a successful donor allocation in over 80%of D-R pairing,a number much higher than that obtained with the best statistical metrics such as model for end-stage liver disease,balance of risk

关键词： Donor-recipient matching Artificial intelligence Deep learning Artificial neural networks Random forest liver transplantation outcome

Dental anomalies in first-degree relatives of transposed canine probands

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International Journal of Oral Science 2015年第3期7卷 169-173页

作者： Adriana Bartolo Neville calleja Fraser McDonald Simon Camilleri Broadstreet Dental Centre Department of Public Health Medical School University of Malta Dental Institute Department of Orthodontics Kings College London

The aim of this study was to investigate and compare the inheritance pattern and prevalence of inheritable dental anomalies in a sample of patients with maxillary canine—first premolar transposition and their first-degree relatives with a sample of palatally displaced canine families. Thirty-five consecutive maxillary canine—first premolar transposition probands and 111 first-degree relatives were matched to 35 consecutive palatally displaced canine probands and 115 first-degree relatives. These were assessed for palatally displaced canines and incisor-premolar hypodontia. Parental age at birth of the proband was also noted. The results revealed that（i） there is no difference in the overall prevalence of palatally displaced canine or incisor-premolar hypodontia between the groups of relatives;（ii） first-degree relatives of bilateral palatally displaced canine probands have a higher prevalence of palatally displaced canine and incisor-premolar hypodontia than those with unilateral palatally displaced canine; and（iii） maternal age at birth of the maxillary canine—first premolar transposition probands was significantly higher than that of the palatally displaced canine *** results suggest that maxillary canine—first premolar transposition and palatally displaced canine are unlikely to be different genetic entities and also indicate environmental or epigenetic influences on dental development.

关键词： ectopic epigenomics genetics hypodontia orthodontics tooth eruption

loss of efficacy and safety of the switch from infliximab original to infliximab biosimilar(CT-P13)in patients with inflammatory bowel disease

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World Journal of Gastroenterology 2018年第46期24卷 5288-5296页

作者： maría Fernanda Guerra Veloz Federico Argüelles-Arias luisa Castro laria Belén Maldonado Pérez Antonio Benítez Roldan Raúl Perea Amarillo Vicente Merino Bohórquez Miguel Angel calleja Angel Caunedo Alvarez Angel Vilches Arenas Department of Gastroenterology University Hospital Virgen MacarenaSeville 41007Spain Pharmacy Unit University Hospital Virgen MacarenaSeville 41007Spain Preventive Medicine and Public Health University Hospital Virgen MacarenaSeville 41007Spain

BACKGROUND Infliximab original has changed the natural history of inflammatory bowel diseases(IBD) over the past two decades. However, the recent expiration of its patent has allowed the entry of the first Infliximab biosimilar into the European and Spanish markets. Currently switching drugs data in IBD are limited. AIM To compare the efficacy of infliximab biosimilar, CT-P13, against infliximab original, analyzing the loss of response of both at the 12 mo follow-up in patients with *** An observational study of two cohorts has been conducted. One retrospective cohort that included patients with IBD treated with Infliximab original, and a prospective cohort of patients who were switching from infliximab original to infliximab biosimilar(CT-P13). We had analyzed the overall efficacy and loss of efficacy in patients in remission at the end of one year after treatment with the original drug compared to the results of the year of treatment with the ***98 patients(CD 67, CU 31) were included in both cohorts. The overall efficacy for infliximab original per year of treatment was 71% vs 68.2% for infliximab biosimilar(P = 0.80). The loss of overall efficacy at 12 mo for infliximab original was 6.6% vs 14.5% for infliximab biosimilar(P = 0.806). The loss of efficacy in patients who were in basal remission was 16.3% for infliximab original vs 27.1% for infliximab biosimilar. Adverse events were 9.2% for infliximab original vs 11.2% for infliximab biosimilar. CONClUSION The overall efficacy and loss of treatment response with infliximab biosimilar(CT-P13) is similar to that observed with infliximab original in patients who were switching at the 12 mo follow-up. There is no difference in the rate of adverse events.

关键词： Crohn’s disease Ulcerative colitis CT-P13 Inflammatory bowel disease Biosimilar agent Infliximab original Efficacy

Tenofovir vs lamivudine plus adefovir in chronic hepatitis B:TENOSIMP-B study

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World Journal of Gastroenterology 2017年第41期23卷 7459-7469页

作者： Manuel Rodríguez Juan Manuel Pascasio Enrique Fraga Javier Fuentes martín Prieto Gloria Sánchez-Antolín Jose luis calleja Esther Molina maría luisa García-Buey maría Angeles Blanco Javier Salmerón maría lucía Bonet Jose Antonio Pons Jose Manuel González Miguel Angel Casado Francisco Jorquera 无 Division of Gastroenterology and Hepatology.Hospital Universitario Central de Asturias Unit for the Clinical Management of Digestive Diseases IBISHospital Universitario Virgen del Rocío liver Transplantation and Hepatology Unit Gastroenterology ServiceHospital Universitario Reina Sofía Digestive Medicine Service Hospital Universitario Miguel Servet Hepatology Unit Digestive Medicine ServiceHospital Universitari i Politècnic La Fe Hepatology Unit Hospital Universitario Rio Hortega liver Unit Hospital Universitario Puerta de Hierro de MajadahondaUniversidad Autónoma de Madrid Digestive Medicine Service Hospital Clínico de Santiago de Compostela liver Unit Hospital Universitario de La Princesa Digestive Medicine Service Hospital General Universitario Gregorio Maranon Digestive Medicine Unit Complejo Hospitalario de Granada Digestive Medicine Service Hospital Universitario Son Espases Hepatology Unit IMIB Hospital Universitario Virgen de la Arrixaca Digestive Medicine Service Hospital Clínico Universitario de Valladolid Pharmacoeconomics and Outcomes Research Iberia Division of Gastroenterology and Hepatology Complejo Asistencial Universitario de León the TENOSIMP-B Research Group

AIM To demonstrate the non-inferiority(15% non-inferiority limit) of monotherapy with tenofovir disoproxil fumarate(TDF) vs the combination of lamivudine(lAM) plus adefovir dipivoxil(ADV) in the maintenance of virologic response in patients with chronic hepatitis B(CHB) and prior failure with *** This study was a Phase IV prospective, randomized, open, controlled study with 2 parallel groups(TDF and lAM+ADV) of adult patients with hepatitis B e antigen(HBe Ag)-negative CHB, prior failure with lAM, on treatment with lAM+ADV for at least 6 mo, without prior resistance to ADV and with an undetectable viral load at the start of the study, in 14 Spanish hospitals. The follow-up time for each patient was 48 wk after randomization, with quarterly visits in which the viral load, biochemical and serological parameters, adverse effects, adherence to treatment and consumption of hospital resources were *** Forty-six patients were evaluated [median age: 55.4 years(30.2-75.2); 84.8% male], including 22 patients with TDF and 24 with lAM+ADV. During study development, hepatitis B virus DNA(HBV-DNA) remained undetectable, all patients remained HBe Ag negative, and hepatitis B surface antigen(HBs Ag) positive. Alanine aminotransferase(AlT) values at the end of the study were similar in the 2 groups(25.1± 7.65, TDF vs 24.22 ± 8.38, lAM+ADV, P = 0.646). No significant changes were observed in creatinine or serum phosphorus values in either group. No significant differences between the 2 groups were noted in the identification of adverse effects(AEs)(53.8%, TDF vs 37.5%, lAM+ADV, P = 0.170), and none of the AEs which occurred were serious. Treatment adherence was 95.5% and 83.3% in the TDF and the lAM+ADV groups, respectively(P = 0.488). The costs associated with hospital resource consumption were significantly lower with the TDF treatment than the lAM+ADV treatment(€4943 ± 1059 vs €5811 ± 1538, respectively, P lUSION TDF monotherapy proved to be safe

关键词： Tenofovir lamivudine+Adefovir Efficacy Safety Adherence Costs Hepatitis B

Photovoltaic-based DC microgrid with partial shading and fault tolerance

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Journal of Modern Power Systems and Clean Energy 2019年第2期7卷 340-349页

作者： Carlos CORREA-BETANZO Hugo calleja Carlos AGUIlAR Adolfo R.lOpez-NUNEZ Elías RODRIGUEZ Electronics Department National Center for Research and Development of Technology62490 CuernavacaMorelosMexico Electronics Department Technological Institute of Celaya38010 CelayaGuanajuatoMexico

Partial shading is a common problem that affects bus regulation in DC microgrids with several photovoltaic(PV) modules as energy sources, as a result of reduced solar irradiance reaching the *** problem can be mitigated by incorporating batteries, but if they are not included, appropriate control strategies must be used. This paper presents a new approach in a PV-based DC microgrid, which provides a high-quality bus voltage regulation in islanding mode, without being affected by partial shading or problems associated with PV module connection and disconnection. The solution proposed herein ensures a proper voltage regulation without being affected by problems such as failures in PV modules or mismatch between them. Besides, it can help to prevent PV partial shade stress by disconnecting the affected modules. A further advantage of the approach is the flexibility to connect more PV modules. The advantages of this approach were verified in a 200 W prototype.

关键词： Photovoltaic Microgrid Partial shading Fault Control strategy

Estimation of visceral fat is useful for the diagnosis of significant fibrosis in patients with non-alcoholic fatty liver disease

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World Journal of Gastroenterology 2020年第42期26卷 6658-6668页

作者： marta Hernández-Conde Elba llop Carlos Fernández Carrillo Beatriz Tormo Javier Abad luis Rodriguez Christie Perelló marta lópez Gomez Joséluis martínez-Porras Natalia Fernández Puga maria Trapero-marugan Enrique Fraga Carlos Ferre Aracil Joséluis calleja Panero Gastroenterology and Hepatology Department IDIPHISAHospital Universitario Puerta de Hierro-MajadahondaMadrid 28222Spain Centro de Investigación Biomédica en Red en elÁrea temática de Enfermedades Hepáticas Instituto de Salud Carlos IIIMadrid 28029Spain

BACKGROUND Obesity is a risk factor for non-alcoholic fatty liver disease(NAFlD),although obese patients with NAFlD do not always develop significant *** distribution of body fat could predict the risk of NAFlD *** To investigate the role of bioelectrical impedance-estimated visceral fat(VF)in assessing NAFlD *** In this cross-sectional study,patients with biopsy-proven NAFlD were prospectively *** patients underwent anthropometric evaluation,blood tests and bioelectrical impedance *** Between 2017 and 2020,119 patients were included[66.4%male,56 years(SD 10.7),62.2%obese,61.3%with metabolic syndrome].Sixty of them(50.4%)showed significant fibrosis(≥F2)in liver ***,VF and metabolic syndrome were associated with significant fibrosis(61 years vs 52 years,16.4 vs 13.1,73.3%vs 49.2%,respectively;Pll).In the multivariate analysis,VF and age were independently associated with significant fibrosis(VF,OR:1.11,95%CI:1.02-1.22,P=0.02;age,OR:1.08,95%CI:1.03-1.12,Pl including these variables showed and area under the receiver operating characteristic curve(AUROC)of 0.75,which was not inferior to transient elastography or NAFlD fibrosis score *** developed a nomogram including age and VF for assessing significant fibrosis in routine *** VF is a surrogate marker of liver fibrosis in patients with *** impedance analysis is an inexpensive and simple method that can be combined with age to guide patient referral when other resources may be unavailable.

关键词： Non-alcoholic fatty liver disease Visceral fat liver fibrosis Bioimpedanciometry Metabolic syndrome Obesity

Short-term outcomes of robotic liver resection: An initial singleinstitution experience

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World Journal of Hepatology 2022年第1期14卷 224-233页

作者： Manuel Durán Javier Briceño Ana Padial Ferdinando Massimiliano Anelli Juan Manuel Sánchez-Hidalgo maría Dolores Ayllón Rafael calleja-lozano Carmen García-Gaitan Unit of Hepatobiliary Surgery and liver Transplantation General and Digestive Surgery DepartmentReina Sofia University HospitalCordoba 14004Spain GC18 Translational Research in Surgery of Solid Organ Transplantation Maimonides Biomedical Research InstituteCórdoba 14004Spain GE09 Research in Peritoneal and Retroperitoneal Oncological Surgery Maimonides Biomedical Research InstituteCórdoba 14004Spain Department of Anesthesiology and Resuscitation Reina Sofia University HospitalCordoba 14004Spain

BACKGROUND liver surgery has traditionally been characterized by the complexity of its procedures and potentially high rates of morbidity and mortality in inexperienced *** robotic approach has gradually been introduced in liver surgery and has increased notably in recent ***,few centers currently perform robotic liver surgery and experiences in robot-assisted surgical procedures continue to be limited compared to the laparoscopic *** To analyze the outcomes and feasibility of an initial robotic liver program implemented in an experienced laparoscopic hepatobiliary *** A total of forty consecutive patients underwent robotic liver resection(da Vinci Xi,***,United States)between June 2019 and January *** were prospectively followed and retrospectively *** characteristics and perioperative and short-term outcomes were *** are expressed as mean and standard *** study was approved by the Institutional Review *** The mean age of patients was 59.55 years,of which 18(45%)were *** mean body mass index was 29.41 kg/m^(2).Nine patients(22.5%)were *** were divided by type of resection as follows:Ten segmentectomies,three wedge resections,ten left lateral sectionectomies,six bisegmentectomies(two VVI bisegmentectomies and four IVb-V bisegmentectomies),two right anterior sectionectomies,five left hepatectomies and two right *** lesions occurred in twenty-nine(72.5%)of the *** mean operative time was 258.11 min and two patients were transfused intraoperatively(5%).Inflow occlusion was used in thirty cases(75%)and the mean total clamping time was 32.62 *** was a single conversion due to uncontrollable *** postoperative complications(Clavien–Dindo>Ⅲb)occurred in three patients(7.5%)and mortality in one(2.5%).No patient required readmission to the *** mean hospital stay was 5.6 *** Althou

关键词： Robotics Hepatectomy Minimally invasive surgery liver surgery Da vinci