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Pathogen detection in patients with perihilar cholangiocarcinoma:Implications for targeted perioperative antibiotic therapy

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国际肝胆胰疾病杂志:英文版 2023年第5期22卷 512-518页

作者： Felix Dondorf Maximilian Graf Aladdin Ali Deeb Oliver Rohland Philipp Felgendreff Michael Ardelt utz settmacher Falk Rauchfuss Department of General Visceral and Vascular SurgeryJena University HospitalJena 07747Germany Research Program"Else Kröner-Forschungskolleg AntiAge" Jena University HospitalJena 07747Germany

Background:Cholestasis should be relieved by biliary drainage prior to major liver *** condition is often associated with bacterial colonization of the otherwise sterile biliary *** reduces the regenerative capacity of the remaining ***,targeted antibiotic therapy is a key feature in perioperative treatment in patients with perihilar cholangiocarcinoma(pCCC).Methods:Between December 1999 and December 2017,251 pCCC patients were treated in our *** total,115 patients underwent a microbiological *** addition to the characterization of the specific microorganisms and antibiotic resistance,we analyzed subgroups according to preoperative ***:Enterococci(87/254,34%)and Enterobacteria(65/254,26%)were the most frequently detected *** 43%(50/115)of patients,Enterococcus faecalis was found in the bile duct *** faecium(29/115)and Escherichia coli(29/115)were detected in 25%of *** patients with percutaneous transhepatic biliary drainage(3/8,38%)or stents(24/79,30%),Enterococcus faecium was diagnosed most frequently(P<0.05).Enterococcus faecium and Klebsiella oxytoca were significantly more frequently noted in the time period after 2012(P<0.05).With regard to fungal colonization,the focus was on various Candida strains,but these strains generally lacked ***:pCCC patients exhibit specific bacterial colonization features depending on the type of preoperative biliary ***,targeted antibiosis should be applied in this patient cohort to minimize the risk of biliary complications after major liver *** our cohort,the combination of meropenem and vancomycin represents an effective perioperative medical approach.

关键词： Perihilar cholangiocarcinoma Klatskin tumor Cholangitis Targeted antibiotic therapy Biliary drainage

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Adipose tissue induces a better liver regeneration after living liver donation in normal weight donors

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Hepatobiliary Surgery and Nutrition 2023年第3期12卷 341-350页

作者： Aladdin Ali Deeb utz settmacher Michael Ardelt Felix Dondorf Oliver Rohland Falk Rauchfuß Department of General Visceral and Vascular SurgeryJena University HospitalJenaGermany

Background:Extrahepatic body fat could be a relevant factor affecting liver regeneration after partial *** aim of this study was to evaluate the potential role of body fatty tissue in liver regeneration capacity after liver resection in a cohort of living ***:We observed liver regeneration in 120 patients:70 living donors who underwent right hepatectomy and 50 recipients who got a right graft *** volumetry and body fat analysis were performed based on the computed tomography images with volumetry *** gain of liver volume was calculated between three points in time considering the absolute and percentage values:before surgery and early(median 10 days,range 4-21 days)and late(median 27 weeks,range 18-40 weeks)after ***’s correlation was used to examine the potential correlation between adipose tissue and liver ***:Pearson’s correlation showed a significant correlation between the subcutaneous fat mass index(sFMI)and early(r=0.173,P=0.030),as well late(r=0.395,P=0.0004)percental liver volume gain in the whole *** stratification in donor’s and recipient’s collectives,the effect of extrahepatic adipose tissue appears in multiple regression only in the donor’s collective:early(β=0.219,T=2.137,P=0.036)and late(β=0.390,T=2.552,P=0.015)percental volume ***:Subcutaneous adipose tissue is a positive predictive factor to estimate the goodness of liver regeneration after partial hepatectomy in normosthenic donors.

关键词： Partial hepatectomy fat mass index living donation liver transplantation

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Individualized treatment of gastric cancer:Impact of molecular biology and pathohistological features

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World Journal of Gastrointestinal Oncology 2015年第11期7卷 292-302页

作者： Yves Dittmar utz settmacher Department of General Visceral and Vascular SurgeryUniversity Hospital Jena

Gastric cancer is one of the most common malignancies *** overall prognosis remains poor over the last decades even though improvements in surgical outcomes have been achieved.A better understanding of the molecular biology of gastric cancer and detection of eligible molecular targets might be of central interest to further improve clinical *** this intention,first steps have been made in the research of growth factor *** morphogens,cell cycle and nuclear factor-κB signaling,a remarkable count of target-specific agents have been developed,nevertheless the transfer into the field of clinical routine is still at the *** potential utility of epigenetic targets and the further evaluation of micro RNA signaling seem to have potential for the development of novel treatment strategies in the future.

关键词： Gastric cancer Molecular biology Targeted therapy

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Induction of chronic cholestasis without liver cirrhosis-Creation of an animal model

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World Journal of Gastroenterology 2017年第23期23卷 4191-4199页

作者： Felix Dondorf RenéFahrner Michael Ardelt Eleonora Patsenker Felix Stickel Uta Dahmen utz settmacher Falk Rauchfuβ Department of General Visceral and Vascular SurgeryJena University Hospital Division of Gastroenterology and Hepatology University Hospital Zürich

AIM To analyze time intervals of inflammation and regeneration in a cholestatic rat liver *** In 36 Lewis rats, divided into six groups of 6 animals(postoperative observation periods: 1, 2, 3, 4, 6, 8 wk), the main bile duct was ligated with two ligatures and observed for the periods mentioned above. For laboratory evaluation, cholestasis parameters(bilirubin, γ-GT), liver cell parameters(ASAT, ALAT) and liver synthesis parameters(quick, albumin) were determined. For histological analysis, HE, Ev G, ASDCL and HMGB-1 stainings were performed. Furthermore, we used the m RNA of IL-33, GADD45 a and p-21 for analyzing cellular stress and regeneration in cholestatic *** In chemical laboratory and histological evaluation, a distinction between acute and chronic cholestatic liver injury with identification of inflammation and regeneration could be demonstrated by an increase in cholestasis(bilirubin: 1-wk group, 156.83 ± 34.12 μmol/L, P = 0.004) and liver cell parameters(ASAT: 2-wk group, 2.1 ± 2.19 μmol/L.s, P = 0.03; ALAT: 2-wk group, 1.03 ± 0.38 μmol/L.s, P = 0.03) after bile duct ligation(BDL). Histological evaluation showed an increase of bile ducts per portal field(3-wk group, 48 ± 6.13, P = 0.004) during the first four weeks after bile duct ligation. In addition to inflammation, which is an expression of acute cholestasis, there was an increase of necrotic areas in the histological sections(2-wk group, 1.38% ± 2.28% per slide, P = 0.002). Furthermore, the inflammation could be verified by ASDCL(4-wk group, 22 ± 5.93 positive cells per portal field, P = 0.041) and HMGB-1 [2-wk group, 13 ± 8.18 positive cells per field of view(Fo V), P = 0.065] staining. Therefore, in summary of the laboratory evaluation and histological studies, acute cholestasis could be found during the first four weeks after bile duct ligation. Subsequently, the described parameters declined so that chronic cholestasis could be assumed. For quantification of secondary biliary cir

关键词： Rats Cholestasis Chronic cholestasis Rat liver model

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Role of NK, NKT cells and macrophages in liver transplantation

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World Journal of Gastroenterology 2016年第27期22卷 6135-6144页

作者： René Fahrner Felix Dondorf Michael Ardelt utz settmacher Falk Rauchfuss Department of General Visceral and Vascular Surgery Jena University Hospital

Liver transplantation has become the treatment of choice for acute or chronic liver disease. Because the liver acts as an innate immunity-dominant organ, there are immunological differences between the liver and other organs. The specific features of hepatic natural killer(NK), NKT and Kupffer cells and their role in the mechanism of liver transplant rejection, tolerance and hepatic ischemia-reperfusion injury are discussed in this review.

关键词： Liver transplantation Natural killer cells Kupffer cells Graft rejection Ischemia-reperfusion injury

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Successful living donor liver transplantation in a cystic fibrosis patient with combined hepatocellular carcinoma and cholangiocarcinoma

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Hepatoma Research 2015年第1期1卷 46-48页

作者： Falk Rauchfuß Felix Dondorf RenéFahrner Michael Ardelt Yves Dittmar utz settmacher Department of General Visceral and Vascular SurgeryJena University HospitalFriedrich-Schiller-University Jena07747 JenaGermany

Combined hepatocellular carcinoma(HCC)and cholangiocarcinoma(CC)is a rare tumor *** this report,we describe a case of a young patient who developed a liver tumor in a cirrhotic liver caused by cystic fi *** diagnostic fi ndings suggested that this tumor was an *** performed living donor liver *** examination of the tumor revealed combined HCC and CC as an incidental fi *** years after the transplantation,the patient is in good clinical condition and is disease-free.

关键词： Cholangiocarcinoma cystic fi brosis hepatocellular carcinoma liver transplantation liver tumor living donation

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Liver transplantation for hepatocellular carcinoma- factors influencing outcome and disease-free survival

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World Journal of Gastroenterology 2015年第42期21卷 12071-12082页

作者： René Fahrner Felix Dondorf Michael Ardelt Yves Dittmar utz settmacher Falk RauchfuB Department of General Visceral and Vascular Surgery Jena University Hospital

Hepatocellular carcinoma is one of the leading causes of cancer-related death worldwide. Liver transplantation can be a curative treatment in selected patients. However, there are several factors that influence disease-free survival after transplantation. This review addresses the pre-, intra- and postoperative factors that influence the risk of tumor recurrence after liver transplantation.

关键词： Hepatocellular carcinoma Survival Risk factor Diagnostics Recurrence Liver transplantation

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Current techniques for AB0-incompatible living donor liver transplantation

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World Journal of Transplantation 2016年第3期6卷 548-555页

作者： Silke Rummler Astrid Bauschke Erik B?rthel Heike Jütte Katrin Maier Patrice Ziehm Christina Malessa utz settmacher Institute of Transfusion Medicine University Hospital Jena Department of General Visceral and Vascular Surgery University Hospital Jena

For a long time, it was considered medical malpractice to neglect the blood group system during transplantation. Because there are far more patients waiting for organs than organs available, a variety of attempts have been made to transplant AB0-incompatible(AB0i) grafts. Improvements in AB0 i graft survival rates have been achieved with immunosuppression regimens and plasma treatment procedures. Nevertheless, some grafts are rejected early after AB0 i living donor liver transplantation(LDLT) due to antibody mediated rejection or later biliary complications that affect the quality of life. Therefore, the AB0 i LDLT is an option only for emergency situations, and it requires careful planning. This review compares the treatment possibilities and their effect on the patients' graft outcome from 2010 to the present. We compared 11 transplant center regimens and their outcomes. The best improvement, next to plasma treatment procedures, has been reached with the prophylactic use of rituximab more than one week before AB0 i LDLT. Unfortunately, no standardized treatment protocols are available. Each center treats its patients with its own scheme. Nevertheless, the transplant results are homogeneous. Due to refined treatment strategies, AB0 i LDLT is a feasible option today and almost free of severe complications.

关键词： Living-donor liver transplantation AB0-incompatible Rituximab Desensitization Iso-titer Biliary complications

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