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Hepatolithiasis:Epidemiology,presentation,classification and management of a complex disease

World Journal of Gastroenterology 2024年第13期30卷 1836-1850页

作者： Rodrigo V.Motta Francesca Saffioti vasileios k mavroeidis Translational Gastroenterology and Liver Unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit Royal Free Hospital and University College LondonLondon NW32QGUnited Kingdom Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom Department of Gastrointestinal Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic *** disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary *** the last century,owing to migration,its global incidence has *** main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic *** classifications have aimed at providing useful insight of clinically relevant aspects and guidance for *** management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious *** comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.

关键词： Cholelithiasis Intrahepatic stones Cholangiocarcinoma Biliary parasites Recurrent pyogenic cholangitis Oriental cholangiohepatitis Hepatectomy Cholangioscopy Liver transplant Paediatric

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Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

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World Journal of Diabetes 2024年第4期15卷 598-605页

作者： vasileios k mavroeidis Jennifer knapton Francesca Saffioti Daniel L Morganstein Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Gastrointestinal Surgery Southmead HospitalNorth Bristol NHS TrustBristol BS105NBUnited Kingdom Department of Academic Surgery Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health University College LondonLondon NW32PFUnited Kingdom Department of Endocrinology Chelsea and Westminster Hospital NHS Foundation TrustLondon SW109NHUnited Kingdom Department of Gastrointestinal Unit Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic *** centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved *** this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic *** 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and *** preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative *** incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe *** involvement of a specialist diabetes team is essential to ensure a holistic *** the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve *** various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required *** need for perioperative support of diabetic

关键词： Pancreatectomy Pancreatoduodenectomy Whipple’s Pancreatitis Diabetes specialist Type 3c pancreatogenic diabetes mellitus

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Role of routine lymph node dissection alongside resection ofintrahepatic cholangiocarcinoma: Systematic review and metaanalysis

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World Journal of Gastrointestinal Oncology 2023年第11期15卷 2017-2032页

作者： Mo Atif Aditya Borakati vasileios k mavroeidis Department of Colorectal Surgery University Hospitals Birmingham NHS Foundation TrustBirmingham B152GWUnited Kingdom Department of HPB and Liver Transplantation Surgery Royal Free Hospital NHS Foundation TrustLondon NW32QGUnited Kingdom Department of HPB Surgery University Hospitals Bristol and Weston NHS Foundation TrustBristol Royal InfirmaryBristol BS28HWUnited Kingdom Department of Academic Surgery Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

BACkGROUND The global incidence of intrahepatic cholangiocarcinoma(ICCA)is *** to often delayed presentation,only a narrow spectrum of the disease is usually surgically *** more accurately stage the disease,reduce recurrence,and improve overall survival,surgical teams are increasingly performing intraoperative lymph node dissection(LND)as *** procedure has its associated morbidity,while there is no consensus or formal guidelines on its role in this ***,there is a need to better delineate the evidence for performing LND alongside surgical resection of the *** To perform a systematic review and meta-analysis on the role of LND in improving prognostication and survival post-resection of *** We performed a systematic literature search using Pubmed,Medline,Embase,and the Cochrane Library,for all studies involving LND,ICCA,and surgical resection using several keywords,Medical Subject Headings(MeSH)tags,and appropriate *** clinical studies comparing curative intent resection of ICCA with LND vs resection without LND were included,while single-arm case series,studies with insufficient data,and duplicates were *** included all English-language studies from the different academic databases up till early December *** primary outcome measures were set for overall survival(OS)and disease-free survival(DFS).RESULTS This systematic review and meta-analysis included 15 studies that fulfilled the selection criteria comprising 11413 patients with surgically-resectable ICCA,of whom 6424(56.3%)underwent hepatectomy with LND while the remainder underwent hepatectomy *** patients who underwent LND,on average,27.7%of the resected lymph nodes were positive for metastatic ***,the results showed that performing LND did not significantly improve OS or ***,the effect of LND on OS showed a degree of variability by geographical region,in Eastern and Western *** LND is increasingly being perform

关键词： Cholangiocarcinoma Periductal-infiltrating Mass-forming Lymphadenectomy Lymph node metastasis Hepatectomy

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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

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Stereotactic radiotherapy for intrahepatic cholangiocarcinoma

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World Journal of Gastrointestinal Oncology 2022年第8期14卷 1478-1489页

作者： Aditya Borakati Farid Froghi Ricky H Bhogal vasileios k mavroeidis Department of Surgery The Royal London HospitalBarts Health NHS TrustLondon E11FRUnited Kingdom 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

Intrahepatic cholangiocarcinoma(iCCA)is an aggressive malignancy with an increasing incidence worldwide and poor prognosis,despite several advances and continuous efforts to develop effective *** surgical resection is the mainstay of treatment and offers a potentially curative option,but is only possible in less than a third of patients,owing to advanced *** is a well-established treatment in the adjuvant and palliative setting,however,confers limited *** radiotherapy is challenging due to local *** recent advances in stereotactic ablative radiotherapy(SABR),it is now possible to focus ablative beams of radiotherapy precisely aimed at tumours to minimise damage to surrounding *** review details the history,technical background and application of SABR to iCCA,with directions for future research suggested.

关键词： Cholangiocarcinoma Intrahepatic Stereotactic ablative radiotherapy Stereotactic body radiotherapy Radiotherapy Liver cancer Hepatectomy

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Review of incidence and outcomes of treatment of cholangiocarcinoma in patients with primary sclerosing cholangitis

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World Journal of Gastrointestinal Oncology 2021年第10期13卷 1336-1366页

作者： Francesca Saffioti vasileios k mavroeidis Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustOxford OX39DUOxfordshireUnited Kingdom UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit Royal Free HospitalUniversity College LondonLondon NW32QGUnited Kingdom Department of Surgery The Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom

Primary sclerosing cholangitis(PSC)is a premalignant condition and a welldocumented risk factor for cholangiocarcinoma(CCA)which is the most common malignancy in this setting and the leading cause of deaths in the recent years,with an increasing ***-associated CCA has a geographical distribution that follows the incidence of PSC,with an observed ascending gradient from the Eastern to the Western and from the Southern to the Northern *** may arise at any location along the biliary tree but is most common in the perihilar *** with PSC and intrahepatic or perihilar CCA are typically not suitable for liver resection,which is otherwise the treatment of choice with curative intent in patients with resectable tumours,providing a radical resection with clear margins can be *** largely relates to the commonly advanced stage of liver disease at presentation,which allows consideration for liver resection only for a very limited number of suitable patients with *** the other hand,remarkable progress has been reached in the last decades with the implementation of a protocol combining neoadjuvant chemoradiation and orthotopic liver transplantation(OLT)for the treatment of perihilar CCA,within specific *** results have been achieved particularly for PSC patients with this cancer,who seem to benefit the most from this treatment,having converted this into an accepted indication for transplantation and the standard of care in several experienced *** CCA as an indication for OLT remains controversial and has not been accepted given disappointing previous ***,as recent studies have shown favourable outcomes in early intrahepatic CCA,it may be that under defined criteria,OLT may play a more prominent role in the *** CCA in the context of PSC requires aggressive surgical treatment with curative intent,when *** review provides insight about particular features of CCA in the setting of

关键词： Cholangiocarcinoma Primary sclerosing cholangitis Liver resection Liver transplantation Neoadjuvant therapy Adjuvant therapy

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Surgical ampullectomy:A comprehensive review

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World Journal of Gastrointestinal Surgery 2021年第11期13卷 1338-1350页

作者： Darren L Scroggie vasileios k mavroeidis Department of Population Health Sciences Bristol Centre for Surgical ResearchBristol Medical SchoolBristol BS82PSUnited Kingdom Department of HPB Surgery University Hospitals Bristol and Weston NHS Foundation TrustBristol Royal InfirmaryBristol BS28HWUnited Kingdom Department of Surgery The Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Tumours of the ampulla of Vater are relatively uncommon lesions of the digestive *** are typically diagnosed at an earlier stage than other types of tumours in this region,due to their tendency to invoke symptoms by obstructing the bile duct or pancreatic ***,many are potentially curable by *** ampullectomy(SA)(or transduodenal ampullectomy)for an ampullary tumour was first described in 1899,but was soon surpassed by pancreatoduodenectomy(PD),which offered a more extensive resection resulting in a lower risk of *** innovation in endoscopic techniques over recent decades has led to the popularization of endoscopic papillectomy(EP),particularly for adenomas and even early *** vast majority of resectable ampullary tumours are now treated using either PD or ***,SA continues to play a role in specific *** authors have suggested specific indications for SA based on their own data,practices,or interpretations of the ***,certain issues have attracted controversy,such as its use for early ampullary ***,there has been a lack of clarity regarding indications for SA,and no evidence-based consensus guidelines have been *** studies reporting SA have employed observational designs,and have been heterogeneous in their ***,characteristics of patients and their tumours have differed substantially across treatment ***,meaningful comparisons of clinical outcomes between SA,PD and EP have been ***,it appears that suitably selected cases of ampullary tumours subjected to SA may benefit from favourable peri-operative and long-term outcomes with very low mortality and significantly long survival,hence its role in this setting warrants further clarification,while it can also be useful in the management of specific benign *** the commissioning of a randomised controlled trial seems unlikely,well-designed obse

关键词： Ampulla of Vater Ampullary tumours Surgical ampullectomy Transduodenal ampullectomy Endoscopic papillectomy Pancreatoduodenectomy

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Modeling and optimization of non-isothermal convective drying process of Lavandula×allardii

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Information Processing in Agriculture 2024年第1期11卷 1-13页

作者： vasileios Chasiotis konstantinos-Stefanos Nikas Andronikos Filios Laboratory of Thermo Fluid Systems(LTFS) Department of Mechanical EngineeringUniversity of West AtticaAncient Olive Grove CampusThivon Str.250GR12244 EgaleoGreece

Non-isothermal convective drying schemes were examined for Lavandula×allardii leaves and *** process parameters were optimized using response surface methodology(RSM)to ensure the peak operational *** effects of temperature increase rate(2–4°C/h)and the airflow velocity(1–3 m/s)on the essential oil yield,drying duration and consumption,were investigated.A face-centered central composite design was deployed and the experimental data was adapted to the most suitable polynomial models,as determined by the regression *** of variance was applied to assess the effects of the process variables,their interactions and the statistical significance of the examined *** factors of temperature increase rate and airflow velocity had a significant impact on the drying *** velocity had a greater effect on leaves’essential oil yield and inflorescences’process energy consumption,whereas the rates of temperature increase had a greater influence on the inflorescences’essential oil yield and leaves’energy *** minimum drying duration and energy consumption were obtained for the maximum temperature increasing rate at 3 and 1 m/s airflow velocities respectively;and the highest essential oil yield was obtained for the least rate of temperature increase and airflow velocity for both leaves and *** optimization was performed for minimizing drying duration and energy consumption by maximizing the essential oil *** rate of temperature increases of 4°C/h and the airflow velocity of 1 m/s,were proposed as the optimum non-isothermal drying conditions for both leaves and inflorescences of Lavandula×*** values of essential oil content have been 1.387/3.05 mL/g,4.21/4.18 h drying time and 0.809/0.732 kWh energy consumption at the optimum operation point for leaves and inflorescences,*** resulted optimized non-stationary temperature scheme considerably improved the drying

关键词： Convective drying Non-isothermal drying Lavender Essential oil Process optimization

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Oxidative dissolution of Cr(OH)_(3) and mixed Fe-Cr(Ⅲ)phases by aqueous Mn(Ⅲ)-pyrophosphate complex

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Journal of Environmental Sciences 2024年第5期139卷 105-113页

作者： Mismel Ruiz-Garcia Jordan Stanberry Giovanna Ballerini Ribeiro vasileios Anagnostopoulos Department of Chemistry University of Central FloridaOrlando FL 32816USA

The key role of manganese(Mn)in the biogeochemical cycle of trace elements has been of great interest in recent ***,the redox properties of aqueous Mn(Ⅲ)have been studied to a lesser ***(Ⅲ)is not stable in solution by ***,when complexed with inorganic ligands,it has shown potential to oxidize and reduce trace *** the present study,we are exploring the redox characteristics of the complex Mn(Ⅲ)-Pyrophosphate(Mn(Ⅲ)-PP).This complex is stable over a wide range of pH values but requires the ratio of Mn:PP to be less than 1:***,the redox reaction of chromium(Cr(Ⅲ))and Mn(Ⅲ)-PP is investigated.A solid,Cr(OH)_(3),is used as a source of Cr(Ⅲ).For this reaction,environmentally relevant parameters,such as pH,ionic strength,ratio Mn(Ⅲ)/Cr(Ⅲ),and excess of ligand,were *** showed that Mn(Ⅲ)can effectively oxidize Cr(Ⅲ)to Cr(Ⅵ),taking about 15 days for the reaction to *** reaction occurs only under acidic conditions(pH4),and with a low excess of *** initial Mn(Ⅲ)concentration decreases as the Cr(Ⅵ)is produced,and Cr(Ⅵ)can be adsorbed back into the Cr(OH)_(3)surface,limiting the mobility of this toxic *** this adsorption,significant amounts of Cr(VI)are release in the aqueous *** study shows the importance of a mobile species(Mn-PP complex)in the oxidation of Cr(Ⅲ)and the release of Cr(Ⅵ)to the environment.

关键词： Chromium Manganese Pyrophosphate complex Sorption Ionic strength Redox

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Management of autoimmune hepatitis induced by hepatitis delta virus

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World Journal of Gastroenterology 2024年第8期30卷 799-805页

作者： Eleni Gigi vasileios Lagopoulos Aris Liakos Hepatology Unit The Second Internal Medicine DepartmentAristotle University Medical SchoolHippokrateio General HospitalThessaloniki 54642Greece Department of Surgical AHEPA General Hospital of ThessalonikiThessaloniki 54636Greece Clinical Research and Evidence-Based Medicine Unit Second Medical DepartmentHippokratio General HospitalAristotle University ThessalonikiThessaloniki 54642Greece

Approximately 12-72 million people worldwide are co-infected with hepatitis B virus(HBV)and hepatitis delta virus(HDV).This concurrent infection can lead to several severe outcomes with hepatic disease,such as cirrhosis,fulminant hepatitis,and hepatocellular carcinoma,being the most *** the past few decades,a correlation between viral hepatitis and autoimmune diseases has been ***,autoantibodies have been detected in the serum of patients co-infected with HBV/HDV,and autoimmune features have been ***,to date,very few cases of clinically significant autoimmune hepatitis(AIH)have been reported in patients with HDV infection,mainly in those who have received treatment with pegylated ***,there are some patients with HBV infection and AIH in whom HDV infection is unearthed after receiving treatment with ***,several questions remain unanswered with the challenge to distinguish whether it is autoimmune or“autoimmune-like”hepatitis being the most ***,it remains uncertain whether autoimmunity is induced by HBV or delta ***,we investigated whether the cause of AIH lies in the previous treatment of HDV with pegylated *** pressing issues should be elucidated to clarify whether new antiviral treatments for HDV,such as Bulevirtide or immu-nosuppressive drugs,are more appropriate for the management of patients with HDV and AIH.

关键词： Autoimmune hepatitis Hepatitis delta virus Bulevirtide Prednisolone

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