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Systematic review and meta-analysis of the impact of deviations from a clinical pathway on outcomes following pancreatoduodenectomy

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World Journal of Clinical Cases 2021年第13期9卷 3024-3037页

作者： Monish Karunakaran Pavan Kumar Jonnada savio george barreto Department of Gastrointestinal Surgery Gastrointestinal Oncologyand Bariatric SurgeryMedanta Institute of Digestive and Hepatobiliary SciencesGurgaon 122001HaryanaIndia Department of Liver Transplantation and Regenerative Medicine Medanta-The MedicityGurgaon 122001HaryanaIndia Surgical Oncology Kidwai Memorial Institute of OncologyBengaluru 560029KarnatakaIndia Division of Surgery and Perioperative Medicine Flinders Medical CenterBedford Park 5042South AustraliaAustralia College of Medicine and Public Health Flinders UniversityBedford Park 5042South AustraliaAustralia

BACKGROUND Enhanced recovery after surgery is steadily gaining importance in patients undergoing pancreatic surgery,including pancreatoduodenectomy(PD).While clinical pathways targeting enhanced-recovery can achieve their intended outcome in reducing length of stay,compliance to these pathways,and their relevance is poorly *** aim of this systematic review was to assess the impact of deviations from/non-compliance to a clinical pathway on post-PD *** To assess the impact of deviations from/non-compliance to a clinical pathway on post-PD *** A systematic review of major reference databases was undertaken,according to preferred reporting items for systematic reviews and meta-analysis guidelines,between January 2000 and November 2020 relating to compliance with clinical pathways and its impact on outcomes in patients undergoing PD.A meta-analysis was performed using fixed-effects or random-effects *** Eleven studies including 1852 patients were *** overall compliance to all components of the clinical pathway was 65.7%[interquartile range(IQR):62.7%-72.3%]with median compliance to post-operative parameters of the clinical pathway being 44%(IQR:34.5%-52.25%).Meta-analysis using a fixed-effects model showed that≥50%compliance to a clinical pathway predicted significantly fewer post-operative complications[pooled odds ratio(OR):9.46,95%confidence interval(CI):5.00-17.90;P<0.00001]and a significantly shorter length of hospital stay[pooled mean difference(MD):4.32,95%CI:-3.88 to-4.75;P<0.0001].At 100%compliance which was associated with significantly fewer post-operative complications(pooled OR:11.25,95%CI:4.71-26.84;P<0.00001)and shorter hospital stay(pooled MD of 4.66,95%CI:2.81-6.51;P<0.00001).CONCLUSION Compliance to post-PD clinical pathways remains *** are associated with an increased risk of complications and length of hospital *** the relevance of deviations to clinical pathways post-

关键词： Outcomes Morbidity Mortality Quality Surgery Recovery

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Borderline resectable pancreatic tumors:Is there a need for further refinement of this stage?

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Hepatobiliary & Pancreatic Diseases International 2011年第3期10卷 319-324页

作者： Shailesh V Shrikhande Supreeta Arya savio george barreto Sachin Ingle Melroy A D'Souza Rohini Hawaldar Parul J Shukla Department of Hepato-Pancreato-Biliary Surgical Oncology Department of Radiology Tata Memorial Hospital Department of Surgery Royal Adelaide Hospital Clinical Research Secretariat

BACKGROUND:The ideal treatment of patients with 'borderline resectable pancreatic tumors (BRTs)' needs to be *** protocols advise neoadjuvant chemo(radio)therapy,although some patients may appear to have BRT on preoperative imaging and a complete resection may be achieved without the need for vascular *** aim of the present study was to identify specific findings on preoperative imaging that could help predict in which patients with BRT a complete resection,with or without vascular resection (VR),could be ***:Twelve patients with BRTs were *** location,maximum degree of circumferential contact (CC),length of contact of the tumor with major vessels (LC),and luminal narrowing of vessels at the point of contact with the tumor (venous deformity,VD) were graded on preoperatively acquired multidetector computed tomography (MDCT) images and then compared with the intraoperative findings and need for ***:A complete resection (R0) was achieved in 10 patients with 2 having microscopic positive margins (R1) on histopathology at the uncinate *** of the 10 patients required VR (40%).In 3 of the 4 patients whose tumors required VRs,CC was ≥grade III and VD was grade *** did not influence the need for ***:It is possible to achieve a complete resection at the first instance in patients found to have BRTs on preoperative *** MDCT-based grading systems and our proposed criteria may help identify such patients,thus avoiding any delay in curative resections in such patients.

关键词： pancreatic head carcinoma pancreatic cancer pancreatic neoplasms resection

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Analysis of the delayed approach to the management of infected pancreatic necrosis

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World Journal of Gastroenterology 2011年第3期17卷 366-371页

作者： Nilesh Doctor Sujith Philip Vidhyachandra Gandhi Maharra Hussain savio G barreto Department of Gastrointestinal Surgery Jaslok Hospital and Research Center Department of Surgery Bhatia Hospital Department of General and Digestive Surgery Flinders Medical Center

AIM: To analyze outcomes of delayed single-stage necrosectomy after early conservative management of patients with infected pancreatic necrosis (IPN) associated with severe acute pancreatitis (SAP). METHODS: Between January 1998 and December 2009, data from patients with SAP who developed IPN and were managed by pancreatic necrosectomy were analyzed. RESULTS: Fifty-nine of 61 pancreatic necrosectomies were performed by open surgery and 2 laparoscopically. In 55 patients, single-stage necrosectomy could be performed (90.2%). Patients underwent surgery at a median of 29 d (range 13-46 d) after diagnosis of acute pancreatitis. Sepsis and multiple organ failure accounted for the 9.8% mortality rate. Pancreatic fistulae (50.8%) predominantly accounted for the morbidity. The median hospital stay was 23 d, and the median interval for return to regular activities was 110 ***: This series supports the concept of delayed single-stage open pancreatic necrosectomy for IPN. Advances in critical care, antibiotics and interventional radiology have played complementary role in improving the outcomes.

关键词： Necrosectomy Infected necrosis Pancreas Severe acute pancreatitis Inflammation

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Therapeutic potential of trehalose in neurodegenerative diseases:the knowns and unknowns

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Neural Regeneration Research 2021年第10期16卷 2026-2027页

作者： Masoomeh Khalifeh george E.barreto Amirhossein Sahebkar Department of Medical Biotechnology and Nanotechnology Faculty of MedicineMashhad University of Medical SciencesMashhadIran Department of Biological Sciences Health Research InstituteUniversity of LimerickLimerickIreland Applied Biomedical Research Center Biotechnology Research CenterPharmaceutical Technology InstituteMashhad University of Medical SciencesMashhadIran Polish Mother’s Memorial Hospital Research Institute(PMMHRI) LodzPoland School of Pharmacy Mashhad University of Medical Sciences MashhadIra

Neurodegenerative diseases(NDs)are a growing health problem associated with a high burden due to destructive and longterm clinical *** aggregations of misfolded proteins are the most common pathological hallmark of many late-onset NDs called proteinopathies including Parkinson’s disease(PD),Alzheimer’s disease(AD),tauopathies,amyotrophic lateral sclerosis(ALS),and polyglutamine(polyQ)expansion diseases such as Huntington’s disease(HD)and various spinocerebellar ataxias(SCA)such as SCA3(Renna et al.,2010).Misfolded proteins can be generated by posttranslational conjugation(e.g.,hyperphosphorylated tau in AD),or endoproteolytic cleavage(e.g.,amyloidβpeptides)or genetic mutations in specific proteins(such as HTT in HD,α-synuclein in PD,PrPC in prion disease and SOD1 and TDP-43 in ALS)leading to the formation of oligomers.

关键词： Huntington tau Alzheimer

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Neuroprotective effects of minocycline on focal cerebral ischemia injury: a systematic review

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Neural Regeneration Research 2020年第5期15卷 773-782页

作者： Yazdan Naderi Yunes Panahi george E. barreto Amirhosein Sahebkar Chemical Injuries Research Center Systems Biology and Poisonings InstituteBaqiyatallah University of Medical SciencesTehranIran Pharmacotherapy Department Faculty of PharmacyBaqiyatallah University of Medical SciencesTehranIran Department of Biological Sciences University of LimerickLimerickIreland Halal Research Center of IRI FDATehranIran Biotechnology Research Center Pharmaceutical Technology InstituteMashhad University of Medical SciencesMashhadIran Neurogenic Inflammation Research Center Mashhad University of Medical SciencesMashhadIran

To review the neuroprotective effects of minocycline in focal cerebral ischemia in animal *** searching in the databases of PubMed,ScienceDirect,and Scopus,and considering the inclusion and exclusion criteria of the *** were included if focal cerebral ischemia model was performed in mammals and including a control group that has been compared with a minocycline *** in languages other than English;duplicate data;in vitro studies and combination of minocycline with other neuroprotective agents were *** function of patients was assessed by National Institute of Health Stroke Scale,modified Rankin Scale,and modified Barthel *** effects were assessed by detecting the expression of inflammatory *** examined 35 papers concerning the protective effects of minocycline in focal cerebral ischemia in animal models and 6 clinical trials which had evaluated the neuroprotective effects of minocycline in ischemic *** studies revealed that minocycline increases the viability of neurons and decreases the infarct volume following cerebral *** mechanisms that were reported in these studies included anti-inflammatory,antioxidant,as well as anti-apoptotic *** also increases the neuronal regeneration following cerebral *** has considerable neuroprotective effects against cerebral ischemia-induced neuronal ***,larger clinical trials may be required before using minocycline as a neuroprotective drug in ischemic stroke.

关键词： ischemic stroke minocycline neuronal regeneration neuroprotection stroke

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Cell-type specificity of β-actin expression and its clinicopathological correlation in gastric adenocarcinoma

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World Journal of Gastroenterology 2014年第34期20卷 12202-12211页

作者： Shafqat A Khan Monica Tyagi Ajit K Sharma savio G barreto Bhawna Sirohi Mukta Ramadwar Shailesh V Shrikhande Sanjay Gupta Epigenetics and Chromatin Biology Group Cancer Research InstituteAdvanced Centre for Treatment Research and Education in CancerTata Memorial CentreKhargharNavi MumbaiMH 410210India Gastrointestinal and Hepato-Pancreato-Biliary Service Department of Surgical OncologyTata Memorial HospitalTata Memorial CentreMumbaiMH 400012India Medanta Institute of Hepatobiliary and Digestive Sciences MedantaThe MedicityGurgaonHaryana 122001India Medical Oncology-GI and Breast Unit Tata Memorial HospitalTata Memorial CentreMumbaiMH 400012India Department of Pathology Tata Memorial HospitalTata Memorial CentreMumbaiMH 400012India

AIM: To investigate cell type specific distribution of β-actin expression in gastric adenocarcinoma and its correlation with clinicopathological parameters.

关键词： Gastric cancer β-actin Immunohistochemistry Epithelial cells Inflammatory cells Tumor infiltrating immune cells Adjacent mucosa Resection margin

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Extended pancreatic resections and lymphadenectomy:An appraisal of the current evidence

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World Journal of Gastrointestinal Surgery 2010年第2期2卷 39-46页

作者： Shailesh V Shrikhande savio G barreto Department of Hepato-Pancreato Biliary Surgical Oncology Tata Memorial Hospital Department of General and Digestive Surgery Flinders Medical Centre and Flinders University

Surgery remains the mainstay of treatment for pancreatic ductal adenocarcinoma and complete removal of the cancer confers a definite survival advantage,especially in early ***,the majority of patients do not present with early disease,thus precluding the chance of a cure by standard pancreatoduodenectomy(PD),distal pancreatectomy or total *** this reason,pancreatic surgeons have attempted to push the limits of resection over the last three *** aim of these resections has been to determine whether obtaining a complete resection by extending the limits of conventional resection in patients with advanced disease will yield the results seen with PD alone in early *** article revisits the data from such studies in an attempt to determine if the available literature supports the performance of extended resections for pancreatic cancer in terms of improvement of survival.

关键词： Pancreas Cancer Vein Lymphadenectomy Artery Reconstruction

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Phytochemicals as inhibitors of tumor necrosis factor alpha and neuroinflammatory responses in neurodegenerative diseases

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Neural Regeneration Research 2022年第8期17卷 1675-1684页

作者： Fatemeh Zahedipour Seyede Atefe Hosseini Neil C.Henney george E.barreto Amirhossein Sahebkar Department of Medical Biotechnology School of MedicineMashhad University of Medical SciencesMashhadIran Student Research Committee Faculty of MedicineMashhad University of Medical SciencesMashhadIran Pharmacy&Biomolecular Sciences Liverpool John Moores UniversityLiverpoolUK Department of Biological Sciences University of LimerickLimerickIreland Health Research Institute University of LimerickLimerickIreland Applied Biomedical Research Center Mashhad University of Medical SciencesMashhadIran Biotechnology Research Center Pharmaceutical Technology InstituteMashhad University of Medical SciencesMashhadIran Polish Mother’s Memorial Hospital Research Institute(PMMHRI) LodzPoland School of Pharmacy Mashhad University of Medical SciencesMashhadIran

Inflammatory processes and proinflammatory cytokines have a key role in the cellular processes of neurodegenerative diseases and are linked to the pathogenesis of functional and mental health *** necrosis factor alpha has been reported to play a major role in the central nervous system in Alzheimer’s disease,Parkinson’s disease and amyotrophic lateral sclerosis and many other neurodegenerative ***,a potent proinflammatory/proapoptotic tumor necrosis factor alpha could be a strong candidate for targeted *** derivatives have now become promising candidates as therapeutic agents because of their antioxidant and chemical characteristics,and anti-inflammatory ***,phytochemicals including flavonoids,terpenoids,alkaloids,and lignans have generated interest as tumor necrosis factor alpha inhibitor candidates for a number of diseases involving inflammation within the nervous *** this review,we discuss how phytochemicals as tumor necrosis factor alpha inhibitors are a therapeutic strategy targeting neurodegeneration.

关键词： brain central nervous system cytokine herbal medicine inflammation neurodegenerative diseases phytochemicals tumor necrosis factor-alpha

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Surgery for gallbladder cancer:The need to generate greater evidence

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World Journal of Gastrointestinal Surgery 2009年第1期1卷 26-29页

作者： Shailesh V Shrikhande savio G barreto Department of Gastrointestinal Surgical Oncology Tata Memorial Hospital Department of General and Digestive Surgery Flinders Medical Centre

The outcomes for gallbladder cancer remain largely dismal to this ***,the low incidence of gallbladder cancer around the world coupled with an even lower number of patients amenable to surgery at the time of presentation,has precluded the generation of evidence-based guidelines for the management of this ***,while the incidence of the cancer may be decreasing in some parts of the world,in other countries such as India,Japan and Chile,gallbladder cancer continues to affect a sizeable population of *** such,there is a growing need to define what constitutes an adequate surgery for each stage of this cancer,based on sound *** editorial provides a broad overview of the existing problems in the management of gallbladder cancer and appeals for multi-institutional studies aimed at answering some of the pertinent questions on the surgical management of gallbladder cancer.

关键词： Treatment outcome Lymphadenectomy Incidence Survival rate

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Screening for colorectal neoplastic lesions following acute diverticulitis: Would a sigmoidoscopy suffice?

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World Journal of Surgical Procedures 2013年第2期3卷 13-17页

作者： Leong Ung Tiong Ryan Jalleh Edward J Travers Thomas Paxton Cecilia Innes-Wong savio G barreto Randall Williams Department of Surgery Modbury Hospital Modbury SA 5092 Australia

AIM: To investigate the yield of colorectal malignant or premalignant lesions during colonoscopy performed following an episode of acute ***: A prospectively maintained electronic database of a public teaching hospital(Modbury Hospital, South Australia) was searched for international classification of diseases codes for acute diverticulitis from July 2007 to June 2011. The electronic database and each patient's medical records were reviewed for demographic data, clinical presentation, investigation results, colonoscopy details and surgical ***: Two hundred and nineteen patients were diagnosed with acute diverticulitis with a median age of 60 years(range 24-93). One hundred and thirty-nine patients(63.5%) had follow-up screening colonoscopy, with the median interval between the episode of acute diverticulitis and colonoscopy being 8 wk(range: 1-66). Colonoscopy revealed polyps in 21 patients(15%) and no cases of colorectal cancer. Of the 21 patients with polyps, there were 14 patients(10%) with tubular/villous adenomas(13 in rectosigmoid region and 1 in descending colon). CONCLUSION: Detection of colorectal cancer in patients undergoing routine colonoscopy following acute diverticulitis is rare. However, colonic polyps in the left colon are noted. A flexible sigmoidoscopy is an adequate screening tool in such patients. A complete colonoscopy reserved for patients with family history of colorectal cancer or with polyps detected on flexible sigmoidoscopy to evaluate the rest of the colon.

关键词： Polyps Surgery Diverticulitis Colonoscopy Colorectal cancer

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