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Inferior outcomes of liver transplantation for hepatocellular carcinoma during early-COVID-19 pandemic in the United States

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World Journal of Hepatology 2023年第4期15卷 554-563页

作者： Inkyu S lee Kenji Okumura Ryosuke Misawa Hiroshi Sogawa Gregory Veillette devon John Thomas Diflo Seigo Nishida Abhay Dhand Department of Surgery Westchester Medical CenterValhallaNY 10595United States Department of Medicine Westchester Medical CenterValhallaNY 10595United States

BACKGROUND Early in the coronavirus disease 2019(COVID-19)pandemic,there was a significant impact on routine medical care in the United States,including in fields of transplantation and *** To analyze the impact and outcomes of early COVID-19 pandemic on liver transplantation(LT)for hepatocellular carcinoma(HCC)in the United *** WHO declared COVID-19 as a pandemic on March 11,*** retrospectively analyzed data from the United Network for Organ Sharing(UNOS)database regarding adult LT with confirmed HCC on explant in 2019 and *** defined pre-COVID period from March 11 to September 11,2019,and early-COVID period as from March 11 to September 11,*** Overall,23.5%fewer LT for HCC were performed during the COVID period(518 vs 675,P<0.05).This decrease was most pronounced in the months of March-April 2020 with a rebound in numbers seen from May-July *** LT recipients for HCC,concurrent diagnosis of non-alcoholic steatohepatitis significantly increased(23 vs 16%)and alcoholic liver disease(ALD)significantly decreased(18 vs 22%)during the COVID *** age,gender,BMI,and MELD score were statistically similar between two groups,while waiting list time decreased during the COVID period(279 days vs 300 days,P=0.041).Among pathological characteristics of HCC,vascular invasion was more prominent during COVID period(P<0.01),while other features were the *** the donor age and other characteristics remained same,the distance between donor and recipient hospitals was significantly increased(P<0.01)and donor risk index was significantly higher(1.68 vs 1.59,P<0.01)during COVID *** outcomes,90-day overall and graft survival were the same,but 180-day overall and graft were significantly inferior during COVID period(94.7 vs 97.0%,P=0.048).On multivariable Coxhazard regression analysis,COVID period emerged as a significant risk factor of post-transplant mortality(Hazard ratio 1.85;95%CI:1.28-2.68,P=0.001).CONCLUSION Durin

关键词： Liver transplantation Hepatocellular carcinoma COVID-19 Mortality Graft failure United Network for Organ Sharing database

Trends and outcomes of liver transplantation among older recipients in the United States

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World Journal of Transplantation 2022年第8期12卷 259-267页

作者： Kenji Okumura Joon Sub lee Abhay Dhand Hiroshi Sogawa Gregory Veillette devon John Ryosuke Misawa Roxana Bodin David C Wolf Thomas Diflo Seigo Nishida Department of Surgery Westchester Medical Center/New York Medical CollegeValhallaNY 10595United States

BACKGROUND The average age of recipients and donors of liver transplantation(LT)is *** there has been a change in the indications for LT over the years,data regarding the trends and outcomes of LT in the older population is *** To assess the clinical characteristics,age-related trends,and outcomes of LT among the older population in the United *** We analyzed data from the United Network for Organ Sharing database between *** sample was split into younger group(18-64 years old)and older group(≥65 years old).RESULTS Between 1987-2019,155758 LT were performed in the United *** this period there was a rise in median age of the recipients and percentage of LT recipients who were older than 65 years increased(P<0.05)with the highest incidence of LT among older population seen in 2019(1920,23%).Common primary etiologies of liver disease leading to LT in older patients when compared to the younger group,were non-alcoholic steatohepatitis(16.4%vs 5.9%),hepatocellular carcinoma(14.9%vs 6.9%),acute liver failure(2.5%vs 5.2%),hepatitis C cirrhosis(HCV)(19.2%vs 25.6%)and acute alcoholic hepatitis(0.13%vs 0.35%).In older recipient group female sex and Asian race were higher,while model for end-stage liver disease(MELD)score and rates of preoperative mechanical ventilation were lower(P<0.01).Median age of donor,female sex,body mass index(BMI),donor HCV positive status,and donor risk index(DRI)were significantly higher in older group(P<0.01).In univariable analysis,there was no difference in post-transplant length of hospitalization,one-year,three-year and five-year graft survivals between the two *** multivariable Cox-Hazard regression analysis,older group had an increased risk of graft failure during the five-year post-transplant period(hazard ratio:1.27,P<0.001).Other risk factors for graft failure among recipients were male sex,African American race,re-transplantation,presence of diabetes,mechanical ventilation at th

关键词： Liver transplant Elderly Outcomes Hepatocellular carcinoma Nonalcohol steatohepatitis

Global health education in U.K. universities

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Global Health Journal 2021年第3期5卷 155-162页

作者： Adrienne lee Matthew Quinn Anaesthetic Department University Hospitals Plymouth NHS TrustPlymouthDevon PL68DHUnited Kingdom Universities Allied for Essential Medicines Akazienstrafie 3ABerlin 10823Germany Weston Education Center King’s College LondonLondon SE59RJUnited Kingdom Department of Ageing and Health Guy’s and St Thomas’NHS Foundation TrustLondon SE19RTUnited Kingdom

Background:The coronavirus disease 2019(COVID-19)pandemic has led to a paradigm shift in global health,casting a previously niche academic discipline into a headline dominating field of ***,accurate information on the delivery of global health education(GHE)at a university level is *** study aims to assess current GIIE practices in ***,by identifying the availability of dedicated global health qualifications,as well as the breadth of inclusion of GHE topics across university course ***:Universities selected were the top 25 recipients of MRC funding in 2015-2016,as well as universities who were included in previous iterations of the“Global Health League Table”.We used the Consortium of Universities for Global Health“GHE Competencies Toolkit”to identify the presence of global health content across university global health and other course *** were additionally judged on opportunities available in global health and on the presence of sustainable ***:Our results showed that 20 universities(74%)offer a post-graduate global health related course,with 9(33%)offering an undergraduate global health related course.13(48%)were identified as centers of global health *** 12(44%)universities had registered sustainable partnerships with Tropical Health and Education *** London School of Hygiene and Tropical Medicine was identified as the top deliverer of GHE,with the Universities of Leicester and the Universities of Exeter joint *** were unable to standardize quality assessments in this iteration of the project,but the release of student feedback to future assessors would help to improve the reliability of this study ***,much of our data was based on information available online,and thus some aspects of degree courses not published publicly may not have been accounted for in our ***:Those institutions wishing to improve their delivery of G

关键词： Global health Postgraduate education U.K.

Pneumocystis jiroveci pneumonia and pneumomediastinum in an anti-TNFαnaive patient with ulcerative colitis

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World Journal of Gastroenterology 2009年第15期15卷 1897-1900页

作者： James C lee Deborah C Bell Richard M Guinness Tariq Ahmad Department of Gastroenterology Royal Devon and Exeter Hospital

We report the case of a 21-year-old man who was noted to have pneumomediastinum during an admission for an acute flare of ulcerative colitis. At that time, he was on maintenance treatment with azathioprine at a dose of 2.25 mg/kg per day, and had not received supplementary steroids for 9 mo. He had never received anti-tumor necrosis factor （TNF）α therapy. Shortly after apparently effective treatment with intravenous steroids and an increased dose of azathioprine, he developed worsening colitic and new respiratory symptoms, and was diagnosed with Pneumocystis jiroveci （carinii） pneumonia （PCP）. Pneumomediastinum is rare in immunocompetent hosts, but is a recognized complication of PCP in human immunodeficiency virus （HIV） patients, although our patient＇s HIV test was negative. Treatment of PCP with co-trimoxazole resulted in resolution of both respiratory and gastrointestinal symptoms, without the need to increase the steroid dose. There is increasing vigilance for opportunistic infections in patients with inflammatory bowel disease following the advent of anti-TNFα therapy. This case emphasizes the importance of considering the possibility of such infections in all patients with inflammatory bowel disease, irrespective of the immunosuppressants they receive, and highlights the potential of steroid-responsive opportunistic infections to mimic worsening colitic symptoms in patients with ulcerative colitis.

关键词： Pneumocystis jiroveci Ulcerative colitis Pneumomediastinum Azathioprine Corticosteroids

Exclusive cigar smoking in the United States and smoking-related diseases: A systematic review

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World Journal of Meta-Analysis 2020年第3期8卷 245-264页

作者： Peter N lee Janette S Hamling Alison J Thornton Department of Statistics P.N.Lee Statistics and Computing Ltd.SuttonSurrey SM25DAUnited Kingdom Department of Statistics RoeLee Statistics Ltd.Sutton SM25DAUnited Kingdom Independent Consultant OkehamptonDevon EX201SGUnited Kingdom

BACKGROUND Little information has been published on the risks of cigar *** 1990 cigar smoking has become more prevalent in the United *** To summarise the evidence from the United States relating exclusive cigar smoking to risk of the major smoking-related *** Literature searches detected studies carried out in the United States which estimated the risk of lung cancer,chronic obstructive pulmonary disease(COPD),heart disease,stroke or overall circulatory disease in exclusive cigar smokers as compared to those who had never smoked any tobacco *** were identified from reviews and detailed searches on *** each study,data were extracted onto a study database and a linked relative risk *** risks and 95%CIs were extracted,or estimated,relating to current,former or ever exclusive cigar smokers,and meta-analysed using standard *** analyses were conducted including or excluding results from studies that did not quite fit the full selection criteria(for example,a paper presenting combined results from five studies,where 86%of the population were in the United States).RESULTS The literature searches identified 17 relevant publications for lung cancer,four for COPD and 12 for heart disease,stroke and circulatory *** related to 11 studies for lung cancer,to four studies for COPD and to eight studies for heart disease,stroke or overall circulatory *** some studies provided results for more than one disease,the total number of studies considered was 13,with results from four of these used in sensitivity *** was evidence of significant heterogeneity in some of the meta-analyses so the random-effects estimates are summarized *** the results from the sensitivity analyses were generally very similar to those from the main analyses,and involved more data,only the sensitivity results are summarized *** lung cancer,relative risks(95%CI)for current,former and ever smokers

关键词： Tobacco products Cigar smoking Lung neoplasms Pulmonary disease Chronic obstructive Heart diseases Stroke Circulatory disease Systematic review Metaanalysis