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Liver surgery in cirrhosis and portal hypertension

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World Journal of Gastroenterology 2016年第9期22卷 2725-2735页

作者： Christina Hackl Hans J Schlitt Philipp Renner sven A Lang Department of Surgery University Medical Center Regensburg

The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary ormetastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome. The Barcelona Clinic Liver Cancer classification recommends to restrict curative liver resections for hepatocellular carcinoma in cirrhotic patients to early tumor stages in patients with Child A cirrhosis not showing portal hypertension. However, during the last two decades, relevant improvements in preoperative diagnostic, perioperative hepatologic and intensive care management as well as in surgical techniques during hepatic resections have rendered even extended liver resections in higher-degree cirrhotic patients with portal hypertension possible. However, there are few standard indications for hepatic resections in cirrhotic patients and risk stratifications have to be performed in an interdisciplinary setting for each individual patient. We here review the indications, the preoperative risk-stratifications, the morbidity and the mortality of extended resections for primary and metastatic lesions in cirrhotic livers. Furthermore, we provide a review of literature on perioperative management in cirrhotic patients needing extrahepatic abdominal surgery and an overview of surgical options in the treatment of hepatic cirrhosis.

关键词： Liver resection Hepatocellular carcinoma Liver metastases Portal hypertension Cholangiocellular carcinoma Cirrhosis

Brain natriuretic peptide is a potent vasodilator in aged human microcircula- tion and shows a blunted response in heart failure patients

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Journal of Geriatric Cardiology 2014年第1期11卷 50-56页

作者： Marie-Louise Edvinsson Erik Uddman Lars Edvinsson sven E. Andersson Department of Emergency and Internal Medicine Institute of Clinical Sciences Lund University Lund University Hospital SE- 221 85 Lund Sweden

Background Brain natriuretic peptide （BNP） is normally present in low levels in the circulation, but it is elevated in parallel with the degree of congestion in heart failure subjects （CHF）. BNP has natriuretic effects and is a potent vasodilator. It is suggested that BNP could be a therapeutic alternative in CHF. However, we postulated that the high levels of circulating BNP in CHF may downregulate the response of microvascular natriuretic receptors. This was tested by comparing 15 CHF patients （BNP 〉 3000 ng/L） with 10 matched, healthy controls. Methods Cutaneous microvascular blood flow in the forearm was measured by laser Doppler Flowmetry. Local heating （＋44°C, 10 min） was used to evoke a maximum local dilator response. Results Non-invasive iontophoretic administration of either BNP or acetylcholine （ACh）, a known endothelium-dependent dilator, elicited an increase in local flow. The nitric oxide synthase inhibitor, l-N-Arginine- methyl-ester （L-NAME）, blocked the BNP response （in controls）. Interestingly, responses to BNP in CHF patients were reduced to about one third of those seen in healthy controls （increase in flow： 251% in CHF vs. 908% in controls; P 〈 0.001）. In contrast, the vasodilator responses to ACh and to local heating were only somewhat attenuated in CHF patients. Thus, dilator capacity and nitric oxide signalling were not af- fected to the same extent as BNP-mediated dilation, indicating a specific downregulation of the latter response. Conclusions The findings show for the first time that microvascular responses to BNP are markedly reduced in CHF patients. This is consistent with the hypothesis of BNP receptor function is downregulated in CHF.

关键词： Heart failure Cutaneous microcirculation Endothelial responses Acetylcholine, Brain natriuretic peptide Nitric oxide

Rotational Spectra and Molecular Structures of Ethylanilines

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Chinese Journal of Chemical Physics 2020年第1期33卷 119-124,I0034-I0076页

作者： Juan Wang sven Herbers Philipp Buschmann Kevin Lengsfeld Jens-Uwe Grabow Gang Feng Qian Gou School of Chemistry and Chemical Engineering Chongqing UniversityChongqing 401331China Institut fur Physikalische Chemie und Elektrochemie Leibniz Universitat HannoverCallinstraBe 3A30167 HannoverGermany

The molecular structures of three ethylanilines,ortho-,meta-and para-ethylaniline,have been obtained by means of Fourier-transform microwave *** spectra of all three molecules display the nuclear quadrupole hyperfine structures arising from the 14N *** of the determined structures allows a direct study of the influence of the position of the ethyl substituent on the structure of the amino group communicated through the phenyl ring.

关键词： Rotational spectroscopy Molecular structure Supersonic expansion Quadrupole coupling effect

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Ecosystem ecology

Dual-sugar tests of small intestinal permeability are poor predictors of bacterial infections and mortality in cirrhosis: a prospective study

丛书名：生态前沿系列

2011年

作者： editor-in-chief sven Erik J?rgensen

Includes bibliographical references and index.

ISBN: (数字)9787030303561

ISBN: (纸本)9787894453723

Includes bibliographical references and index.

关键词： Ecological zones.

来源：畅想之星图书光盘版（南... 畅想之星图书光盘版（南... 评论

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World Journal of Gastroenterology 2016年第11期22卷 3275-3284页

作者： Anika Vogt Philipp A Reuken sven Stengel Andreas Stallmach Tony Bruns Department of Internal Medicine IV (Gastroenterology Hepatologyand Infectious Diseases)Jena University Hospital Center for Sepsis Control and Care Jena University Hospital

AIM: To prospectively analyze the impact of increased intestinal permeability (IP) on mortality and the occurrence of infections in patients with ***: IP was quantified using the lactulose/mannitol (L/M) test in 46 hospitalized patients with cirrhosis (25 Child-Pugh A/B, 21 Child-Pugh C) and in 16 healthy controls. Markers of inflammation [LPS-binding protein, Interleukin-6 (IL-6)] and enterocyte death [intestinal fatty-acid binding protein (I-FABP)] were determined in serum using enzyme-linked immunosorbent assays. Patients were followed for one year and assessed for survival, liver transplantation, the necessity of hospitalization and the occurrence of bacterial infections. The primary endpoint of the study was defined as differences in survival between patients with pathological and without pathological lactulose/mannitol ***: Thirty-nine (85%) patients with cirrhosis had a pathologically increased IP index (L/M ratio > 0.07) compared to 4 (25%) healthy controls (P < 0.0001). The IP index correlated with the Child-Pugh score (r = 0.484, P = 0.001) and with serum IL-6 (r = 0.342, P = 0.02). Within one year, nineteen (41%) patients developed a total of 33 episodes of hospitalization with bacterial or fungal infections. Although patients who developed spontaneous bacterial peritonitis (SBP) (n = 7) had a higher IP index than patients who did not (0.27 vs 0.14, P = 0.018), the baseline IP index did not predict time to infection, infection-free survival or overall survival, neither when assessed as linear variable, as tertiles, nor dichotomized using an established cut-off. In contrast, model for end-stage liver disease score, Child-Pugh score, the presence of ascites, serum IL-6 and I-FABP were univariate predictors of infection-free ***: Although increased IP is a frequent phenomenon in advanced cirrhosis and may predispose to SBP, it failed to predict infection-free and overall survival in this prospective coho

关键词： Intestinal permeability Liver cirrhosis Lactulose/mannitol ratio Spontaneous bacterial peritonitis Bacterial translocation

Effect of exogenous fibrolytic enzymes on performance and blood profile in early and mid-lactation Holstein cows

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Animal Nutrition 2015年第3期1卷 229-238页

作者： Anja Peters Ulrich Meyer sven Danicke Institute of Animal Nutrition Friedrich-Loeffler-Institute(FLI)Federal Research Institute for Animal Health

The supplementation of exogenous fibrolytic enzymes(EFE) to dairy cows diets could be a strategy to improve fiber degradation in the rumen which is especially important for the early lactating cows characterized by a high milk energy output and an insufficient energy intake. The objective of this study was to examine the effects of a fibrolytic enzyme product(Roxazyme G2 Liquid, 3.8 and 3.9 mL/kg total mixed ration [TMR] DM) supplemented to a TMR on production performance and blood parameters of dairy cows during early(trial 1) and mid-lactation(trail 2). In addition, rumination activity was measured in trial 2. The nutrient digestibility of the experimental TMR was obtained by using wethers. In the digestibility trial, EFE was supplemented at a rate of 4.4 m L/kg Roxazyme G2 Liquid TMR-DM. The TMR contained 60% forage and 40% concentrate(DM basis). Twenty eight 50 ± 16 days in milk(DIM)and twenty six 136 ± 26 DIM Holstein cows were used in two 8-wk completely randomized trails,stratified by parity and milk yield level. One milliliter of the enzyme product contained primarily cellulase and xylanase activities(8,000 units endo-1,4-? glucanase, 18,000 units endo-1,3(4)-? glucanase and 26,000 units 1,4-? xylanase). No differences in digestibility of DM, OM, CP, NDF and ADF were observed(P >0.05) between the control and the EFE supplemented TMR. Addition of EFE to the TMR fed to early(trial 1) and mid-lactation cows(trial 2) did not affect daily dry matter intake(DMI), milk yield,4% fat-corrected milk, energy-corrected milk(ECM), concentration of milk fat, protein, fat-protein-quotients, somatic cell score, energy balance, and gross feed efficiency of early and mid-lactation cows(P >0.05). Mid-lactation cows(trial 2) fed with TMR enzyme showed a tendency of a slightly higher ECM yield(P = 0.09). The tested blood parameters were not affected by treatment in trials 1 and 2(P >0.05).Exogenous fibrolytic enzymes supplementation did not alter daily time spent ruminating in t

关键词： Fibrolytic enzymes Dairy cows Milk yield Feed efficiency

Changes of the liver metabolome following an intravenous lipopolysaccharide injection in Holstein cows supplemented with dietary carnitine

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Journal of Animal Science and Biotechnology 2023年第1期14卷 188-199页

作者： Wei Xu Sandra Grindler Akos Kenez sven Danicke Jana Frahm Korinna Huber Beijing Research Center of Intelligent Equipment for Agriculture Beijing 100097China. Department of Biosystems Biosystems Technology ClusterCampus GeelKleinhoefstraat 42440 Geel LeuvenKUBelgium. Institute of Animal Science Faculty of Agricultural SciencesUniversity of Hohenheim70599 StuttgartGermany. Department of Infectious Diseases and Public Health City University of Hong KongBlock 14/FTo Yuen Building31 To Yuen StreetKowloonHong Kong SARChina. Institute of Animal Nutrition Federal Research Institute for Animal Health(Friedrich-Loeffler-Institut)38116 BrunswickGermany.

Background:Carnitine facilitates the flux of long-chain fatty acids for hepatic mitochondrial beta-oxidation,which acts to ameliorate the negative energy balance commonly affecting high-yielding dairy *** triggered by lipopolysaccharide(LPS)load can however pose a challenge to the metabolic integrity via the expression of pro-inflammatory mediators,leading to immune system activation and respective metabolic *** effect of enhanced carnitine availability on hepatic metabolome profiles during an inflammatory challenge has not yet been determined in dairy ***,Holstein cows were supplemented with 25 g/d rumen-protected carnitine from 42d prepartum until 126 d postpartum(n=16)or assigned to the control group with no supplementation during the same period(n=14).We biopsied the liver of the cows before(100 d postpartum)and after(112 d postpartum)an intravenous injection of 0.5μg/kg *** samples were subjected to a targeted metabolomics analysis using the AbsoluteIDQ p180 Kit(Biocrates Life Sciences AG,Innsbruck,Austria).Results:Multivariate statistical analyses revealed that hepatic metabolome profiles changed in relation to both the carnitine supplementation and the LPS *** the metabolite profiles on 100 d,carnitine increased the concentration of short-and long-chain acyl-carnitines,which may be explained by an enhanced mitochondrial fatty acid shuttle and hence greater energy *** LPS injection affected hepatic metabolite profiles only in the carnitine supplemented group,particularly altering the concentration of biogenic ***:Our results point to interactions between an acute hepatic inflammatory response and biogenic amine metabolism,depending on energy availability.

关键词： Acyl-carnitines Inflammatory response Lipid metabolism Liver metabolome Mitochondrial function

Ultrasonography-triggered diagnosis of putrid,ulcero-phlegmonous,hemorrhagic appendicitis and periappendicitis with an atypical symptom pattern:a case report

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Journal of Medical Colleges of PLA(China) 2016年第3期31卷 168-172页

作者： Hagen Frickmann sven A.Jungblut Department of Tropical Medicine at the Bernhard Nocht Institute German Armed Forces Hospital of Hamburg Institute for Microbiology Virology and HygieneUniversity Medicine Rostock Practice Dr. Jungblut Frankfurt/Main

Background:Asymptomatic and oligosymptomatic appendicitis are rare and challenging diagnoses that should not be *** presentation:A young female patient presented with mild to moderate pain in the middle and lower abdomen,and the results of physical examination,including digital rectal examination,were otherwise *** demonstrated a marked increase of the outer appendiceal diameter up to 12.0mm and a trace of free liquid around the terminal *** surgical exploration and histological examination allowed for a final diagnosis of putrid,ulcero-phlegmonous,hemorrhagic appendicitis and ***:Ultrasonography is increasingly used for the diagnosis of appendiceal inflammation,particularly in military medical *** in the outer appendiceal diameter up to>6.0mm under compression have recently been demonstrated to be indicative of acute *** a minimum,in cases with doubtful physical examination results,ultrasonography should be considered as an element in the diagnosis of acute appendicitis.

关键词： Acute appendicitis Ultrasound Oligosymptomatic Surgery

Spatio-temporal Variability of Soil Water at Three Seasonal Floodplain Sites: A Case Study in Tarim Basin,Northwest China

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Chinese Geographical Science 2014年第6期24卷 647-657页

作者： sven GRASHEY-JANSEN Martin KUBA Bernd CYFFKA müt HALIK Tayierjiang AISHAN Institute of Geography University of Augsburg Augsburg 86135Germany Applied Physical Geography Catholic University of Eichstaett-Ingolstadt Eichstaett 85072Germany Key Laboratory of Oasis Ecology College of Resources and Environmental ScienceXinjiang University

The floodplain -egetation of the Tarim River in Northwest China is strongly influenced by irrigated agriculture. The abstrac- tion of river water disturbs; the natural dynamics of the floodplain ecosystem. The human impact on the hydrological system by bank dams and the irrigation of cotton plantings have caused adverse changes of the Tarim River and its floodplains, so the current stocks of the typical Tugai vegetation show significant signs of degradation. Field studies of soils and statistical analysis of soil moisture data have shown that the vitality of the Tugai vegetation is primarily determined by its position to the riverbank and the groundwater. There exist complex interactions between soil hydrological conditions and the vitality of the vegetation. But the availability of water is not only influenced by the groundwater level and seasonal flood events. The spatial distribution of stocks at different states of vitality seems also to be decisively influenced by physical soil properties. Our results show that the water supply of plant communities is strongly in- fluenced by the soil texture. Spatial differences of soil moisture and corresponding soil water tensions may be the decisive factors for the zonafion of vegetation. Physical soil properties control the water retention and rising of capillary water from deeper soil layers and the phreatic zone and may supply the root systems of the phreatophytic vegetation with water. Keywords： soil moisture;soil texture; soil water tensions; Tarim River; water retention

关键词： soil moisture soil texture soil water tensions Tarim River water retention