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Liver transplantation in the management of cholangiocarcinoma:Evolution and contemporary advances

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World Journal of Gastroenterology 2023年第13期29卷 1969-1981页

作者： Aditya Borakati Farid Froghi ricky h bhogal Vasileios K Mavroeidis Department of hPB and Liver Transplantation Surgery Royal Free Hospital NHS Foundation TrustLondon NW32QGUnited Kingdom Department of Academic Surgery The Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Cholangiocarcinoma(CCA)is an aggressive malignancy arising from the biliary *** may occur at any location along the biliary tree with the perihilar area being the most *** is poor with 5-year overall survival at less than 10%,typically due to unresectable disease at *** surgical resection with clear margins offers a chance of cure in patients with resectable tumours,but is frequently not possible due to locally advanced *** the other hand,orthotopic liver transplantation(LT)allows for a radical and potentially curative resection for these patients,but has been historically controversial due to the limited supply of donor grafts and previously poor *** patients with perihilar CCA,within specific criteria and following the implementation of a protocol combining neoadjuvant chemoradiation and LT,excellent results have been achieved in the last decades,resulting in its increasing acceptance as an indication for LT and the standard of care in several centres with significant ***,in intrahepatic CCA,the role of LT remains controversial and owing to dismal previous results it is not an accepted ***,more recent studies have demonstrated favourable results with LT in early intrahepatic CCA,indicating that,under defined criteria,its role may increase in the *** review highlights the history and contemporary advances of LT in CCA,with particular focus on the improving outcomes of LT in intrahepatic and perihilar CCA and future perspectives.

关键词： Cholangiocarcinoma Klatskin tumor Liver transplantation Liver cancer Liver resection Neoadjuvant therapy

Mechanisms of autophagy activation in endothelial cell and their targeting during normothermic machine liver perfusion

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World Journal of Gastroenterology 2017年第48期23卷 8443-8451页

作者： Yuri L Boteon Richard Laing hynek Mergental Gary M Reynolds Darius F Mirza Simon C Afford ricky h bhogal The Liver Unit University Hospitals of BirminghamMindelsohn Way The Centre for Liver Research Institute for Biomedical ResearchUniversity of Birmingham

Ischaemia-reperfusion injury(IRI) is the leading cause of injury seen in the liver following transplantation. IRI also causes injury following liver surgery and haemodynamic shock. The first cells within the liver to be injured by IRI are the liver sinusoidal endothelial cells(LSEC). Recent evidence suggests that LSEC coordinate and regulates the livers response to a variety of injuries. It is becoming increasingly apparent that the cyto-protective cellular process of autophagy is a key regulator of IRI. In particular LSEC autophagy may be an essential gatekeeper to the development of IRI. The recent availability of liver perfusion devices has allowed for the therapeutic targeting of autophagy to reduce IRI. In particular normothermic machine liver perfusion(NMP-L) allow the delivery of pharmacological agents to donor livers whilst maintaining physiological temperature and hepatic flow rates. In this review we summarise the current understanding of endothelial autophagy and how this may be manipulated during NMP-L to reduce liver IRI.

关键词： Autophagy Liver transplant Ischaemiareperfusion injury Normothermic machine liver perfusion

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

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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

Postoperative day one serum alanine aminotransferase does not predict patient morbidity and mortality after elective liver resection in non-cirrhotic patients

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hepatobiliary & Pancreatic Diseases International 2016年第6期15卷 655-659页

作者： ricky harminder bhogal Amit Nair Davide Papis Zaed hamady Jawad Ahmad For Tai Lam Saboor Khan Gabriele Marangoni Department of hepato-pancreatico-biliary Surgery University Hospitals of Coventry and Warwickshire University of Birmingham Centre for Liver ResearchInstitute for Biomedical ResearchThe Medical School

ABSTRACT： Serum aminotransferases have been used as surrogate markers for liver ischemia-reperfusion injury that follows liver surgery. Some studies have suggested that rises in serum alanine aminotransferase （ALT） correlate with patient outcome after liver resection. We assessed whether postoperative day 1 （POD 1） ALT could be used to predict patient morbidity and mortality following liver resection. We reviewed our prospectively held database and included consecutive adult patients undergoing elective liver resection in our institution between January 2013 and December 2014. Primary outcome assessed was correlation of POD 1 ALT with patient＇s morbidity and mortality. We also assessed whether concurrent radiofrequency ablation, neoadjuvant chemotherapy and use of the Pringle maneuver significantly affected the level of POD 1 ALT. A total of 110 liver resections were included in the study. The overall in-hospital patient morbidity and mortality were 31.8% and 0.9%, respectively. The median level of POD 1 ALT was 275 IU/L. No correlation was found between POD 1 serum ALT levels and patient morbidity after elective liver resection, whilst correlation with mortality was not possible because ofthe low number of mortalities. Patients undergoing concurrent radiofrequency ablation were noted to have an increased level of POD 1 serum ALT but not those given neoadjuvant chemotherapy and those in whom the Pringle maneuver was used. Our study demonstrates POD 1 serum ALT does not correlate with patient morbidity after elective liver resection.

关键词： alanine aminotransferase hepatectomy reperfusion injury aminotransferases postoperative complications

Mechanical thrombectomy in patients with M1 occlusion and NIhSS score≤5:a single-centre experience

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Stroke & Vascular Neurology 2016年第4期1卷 165-171页

作者： P bhogal P Bucke O Ganslandt h Bazner h henkes M Aguilar Perez Neuroradiological Clinic NeurocenterKlinikum StuttgartStuttgartGermany Neurological Clinic NeurocenterKlinikum StuttgartStuttgartGermany Neurosurgical Clinic NeurocenterKlinikum StuttgartStuttgartGermany Medical Faculty University Duisburg-EssenStuttgartGermany

Background:The recent success of several mechanical thrombectomy trials has resulted in a significant change in management for patients presenting with ***,it is still unclear how to manage patients that present with stroke and low National Institutes of health Stroke Scale(NIhSS)≤*** sought to review our experience of mechanical thrombectomy in patients with low NIhSS and confirmed M1 ***:We retrospectively analysed our prospectively maintained database of all patients undergoing mechanical thrombectomy between January 2008 and August *** identified 41 patients with confirmed M1 occlusion and low NIhSS(≤5)on admission to our *** collected demographic,radiological,procedural and outcome ***:The mean age of patients was 72±14,with 20 male *** medical conditions were common with hypertension seen in∼80%.Just over 50%presented with NIhSS 4 or *** average ASPECTS score on admission was 8.8(range 6–10),and the average clot length 10 *** Thrombolysis in Cerebral Infarction(TICI)≥2b was obtained in 87.8%of patients.7 patients had haemorrhage on follow-up,2 of which were *** 40 patients with 90-day follow-up,75%had modified Rankin Scale(mRS)score 0–*** were 3 deaths at 90 ***:Mechanical thrombectomy in patients with low NIhSS and proximal large vessel occlusion is technically possible and carries a high degree of success with good safety *** with low NIhSS and confirmed occlusion should be considered for mechanical thrombectomy.

关键词： patients occlusion throm

Colonic tumour precipitating caecal volvulus within a diaphragmatic hernia

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World Journal of Gastrointestinal Surgery 2013年第9期5卷 256-258页

作者： ricky harminder bhogal Kambiz Maleki Rajan Patel Department of Gastroenterological Surgery Dudley Group of HospitalsRussell’s Hall Hospital Department of Radiology Dudley Group of HospitalsRussell’s Hall Hospital

An 85-year-old woman presented with sudden onset of generalised abdominal pain and absolute constipation for 4 *** examination she had a distended *** abdominal radiograph revealed a gas filled viscous within the left upper *** computed tomography suggested caecal volvulus herniated through a left diaphragmatic *** patient underwent reduction of the internal hernia,right hemicolectomy and mesh repair of the diaphragmatic *** recovery was *** revealed a Dukes’A colonic cancer within the *** of caecal volvulus through a diaphragmatic hernia is a very rare condition and may have been precipitated by the colonic tumour.

关键词： Colonic cancer Caecal volvulus Bowel obstruction Diaphragmatic hernia Bowel ischaemia

Transcatheter aortic valve replacement in low-risk young population:A double edge sword?

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World Journal of Cardiology 2024年第4期16卷 177-180页

作者： Sukhdeep bhogal Akash Batta Department of Cardiology Sovah HealthMartinsvilleVA 24112United States Department of Cardiology Dayanand Medical College and HospitalLudhiana 141001India

Since the advent of transcatheter aortic valve replacement(TAVR)in 2002,it has now become the default interventional strategy for symptomatic patients presenting with severe aortic stenosis,particularly in intermediate to highsurgical risk *** 2019,the United States Food and Drug Administration approved TAVR in low-risk patients based on two randomized ***,these breakthrough trials excluded patients with certain unfavorable anatomies and odd *** currently there is no randomized study of TAVR in young patients,it may be preferred by the young population given the benefits of early discharge,shorter hospital stay,and expedite ***,it is important to ruminate various factors including lifetime expectancy,risk of pacemaker implantation,and the need for future valve or coronary interventions in young cohorts before considering TAVR in these ***,the data on long-term durability(>10 years)of TAVR is still unknown given most of the procedures were initially performed in the high or prohibitive surgical risk ***,this editorial aims to highlight the importance of considering an individualized approach in young patients with consideration of various factors including lifetime expectancy while choosing TAVR against surgical aortic valve replacement.

关键词： Transcatheter aortic valve replacement Surgical aortic valve replacement Pacemaker implantation Coronary re-access Structural deterioration

Action Recognition for Multiview Skeleton 3D Data Using NTURGB+D Dataset

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Computer Systems Science & Engineering 2023年第12期47卷 2759-2772页

作者： Rosepreet Kaur bhogal V.Devendran School of Electronics and Electrical Engineering Lovely Professional UniversityPhagwara144411India School of Computer Science Engineering Lovely Professional UniversityPhagwara144411India

human activity recognition is a recent area of research for *** recognition has many applications in smart homes to observe and track toddlers or oldsters for their safety,monitor indoor and outdoor activities,develop Tele immersion systems,or detect abnormal activity *** dimensions(3D)skeleton data is robust and somehow *** to this,it is one of the popular choices for human action *** paper proposed using a transversal tree from 3D skeleton data to represent videos in a *** proposed two neural networks:convolutional neural network recurrent neural network_1(CNN_RNN_1),used to find the optimal features and convolutional neural network recurrent neural network network_2(CNN_RNN_2),used to classify *** deep neural network-based model proposed CNN_RNN_1 and CNN_RNN_2 that uses a convolutional neural network(CNN),Long short-term memory(LSTM)and Bidirectional Long shortterm memory(BiLSTM)*** systemefficiently achieves the desired accuracy over state-of-the-art models,i.e.,88.89%.The performance of the proposed model compared with the existing state-of-the-art *** NTURGB+D dataset uses for analyzing experimental *** is one of the large benchmark datasets for human activity ***,the comparison results show that the proposed model outperformed the state-ofthe-art models.

关键词： Activity recognition multiview LSTM BiLSTM NTURGB+D

Responding to fire in an intensive care unit: Management and lessons learned

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World Journal of Emergency Medicine 2018年第2期9卷 154-156页

作者： Navneet Dhaliwal Ranjitpal Singh bhogal Ashok Kumar Anil Kumar Gupta Department of hospital Administration Postgraduate Institute of MedicalEducation and Research

healthcare institutions are vulnerable to disruptionfrom events such as earthquakes, fires, and floods, andthe damage incurred can endanger the lives of patientsin the hospital.[1] In this type of scenario hospital staffhave primary responsibility for the hospitalized patients＇safety, since patients are neither fit to respond to sucha disaster, nor do they know how to respond.[2,3] Thesituation becomes more difficult and challenging if thedisaster occurs in critical care areas such as intensivecare units （ICUs） and operating rooms.

关键词： Responding to fire an intensive care unit:Management lessons learned