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Feasibility and safety of autologous bone marrow mononuclear cell transplantation in patients with advanced chronic liver disease

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World Journal of Gastroenterology 2007年第7期13卷 1067-1073页

作者： Andre Castro lyra Milena Botelho Pereira Soares luiz Flavio Maia da Silva Marcos Fraga Fortes André Goyanna Pinheiro Silva Augusto César de Andrade Mota Sheilla A Oliveira eduardo lorens braga Wilson Andrade de Carvalho Bernd Genser Ricardo Ribeiro dos Santos luiz Guilherme Costa lyra Hos-pital Sao Rafael Salvador Bahia Brazil Centro de Pesquisas Goncalo Moniz Fundacao Oswaldo Cruz Salvador Bahia Brazil BGStats Consulting Graz Austria

AIM： To evaluate the safety and feasibility of bone marrow cell （BMC） transplantation in patients with chronic liver disease on the waiting list for liver transplantation. METHODS： Ten patients （eight males） with chronic liver disease were enrolled to receive infusion of autologous bone marrow-derived cells. Seven patients were classified as Child-Pugh B and three as Child-Pugh C. Baseline assessment included complete clinical and laboratory evaluation and abdominal MRI. Approximately 50 mL of bone marrow aspirate was prepared by centrifugation in a ficoll-hypaque gradient. At least of 100 millions of mononuclear-enriched BMCs were infused into the hepatic artery using the routine technique for arterial chemoembolization for liver tumors. Patients were followed up for adverse events up to 4 mo. RESULTS： The median age of the patients was 52 years （range 24-70 years）. All patients were discharged 48 h after BMC infusion. Two patients complained ofmild pain at the bone marrow needle puncture site. No other complications or specific side effects related to the procedure were observed. Bilirubin levels were lower at 1 （2.19 ± 0.9） and 4 mo （2.10 ± 1.0） after cell transplantation that baseline levels （238 ± 1.2）. Albumin levels 4 mo after BMC infusion （3.73 ± 0.5） were higher than baseline levels （3.47 ± 0.5）. International normalized ratio （INR） decreased from 1.48 （SD = 0.23） to 1.43 （SD = 0.23） one month after cell transplantation. CONCLUSION： BMC infusion into hepatic artery of patients with advanced chronic liver disease is safe and feasible. In addition, a decrease in mean serum bilirubin and INR levels and an increase in albumin levels are observed. Our data warrant further studies in order to evaluate the effect of BMC transplantation in patients with advanced chronic liver disease.

关键词： Bone marrow Cell transplantation Liverfailure Stem cell Cirrhosis

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Sleeve Gastrectomy with Duodenal Transit Bipartition (S-DTB): Preliminary Results and Technical Aspects of Its Metabolic Structure

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Surgical Science 2024年第4期15卷 244-264页

作者： Paulo Reis Esselin de Melo Ricardo Zorron Victor Ramos Mussa Dib Carlos Augusto Scussel Madalosso Rui Ribeiro Thonya Cruz braga Paula Volpe Carlos eduardo Domene Paulo Reis Institute Goiania GO Brazil Alfredo Nasser University Center (UNIFAN) Goiania GO Brazil Department of Bariatric and Metabolic Surgery CUF Descobertas Hospital Lisbon Portugal Victor Dib Institute Manaus AM Brazil Gastrobese Clinic Passo Fundo RS Brazil Lusiadas Amadora Hospital Lisbon Portugal Clianest Group Renaissance Hospital Goiania GO Brazil Integrated Center for Advanced Medicine (CIMAMED) Sao Paulo Brazil

Obesity is a significant and escalating health issue both in Brazil and globally, with over 650 million overweight adults worldwide. The treatment of obesity can be performed clinically, endoscopically or surgically;surgical treatment proves to be safe and more effective in terms of weight loss and long-term maintenance. Objective: This study aimed to monitor the progress of weight loss and comorbidity control in patients undergoing sleeve gastrectomy with duodenal bipartition. Methods: This pilot project involved 8 patients divided into 2 arms. In the first arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenoileal transit bipartition (S-RYDITB), while in the second arm, patients underwent sleeve gastrectomy with Roux-en-Y duodenojejunal transit bipartition (S-RYDJTB). Both procedures involved Roux-en-Y reconstruction without duodenal exclusion. In S-RYDITB, the duodenal-ileal anastomosis was performed 300 cm from the ileocecal valve (ICV), creating a 250 cm common channel and a 50 cm alimentary channel. In S-RYDJTB, a biliopancreatic loop was created 200 cm from the angle of Treitz, with a 1 m alimentary channel. Results: Five patients underwent the procedures, with one undergoing S-RYDITB and four undergoing S-RYDJTB. No adverse events such as hospitalizations, readmissions, reoperations, fistulas, bleeding, pulmonary embolism, diarrhea, dumping syndrome, or hypoglycemia occurred during the study period. The mean length of hospital stay was 2 days. The average BMI decreased from 37.27 kg/m2 preoperatively to 29.48 kg/m2 after 6 months. The significant percentage of weight loss was 21.22%, with excess weight loss of 63.6%. Ninety-five percent remission of comorbidities, including hypercholesterolemia, hypertriglyceridemia, diabetes, hypertension, steatosis, and pre-diabetes. Two patients underwent sleeve gastrectomy with duodenal bipartition using a single anastomosis. Conclusion: Duodenal switch surgery has gained worldwide recog

关键词： Obesity Bariatric Surgery Metabolic Surgery Duodenal Switch

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Iron-Deficiency Anemia Management in Gynecological Surgery: A Review of Current Evidence and Best Practices

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Open Journal of Obstetrics and Gynecology 2024年第8期14卷 1223-1241页

作者： Aline Evangelista Santiago Artur Lima Sendin Víctor Nilo Nogueira Rogério Adão braga Admilson Lemos Costa Filho eduardo Batista Cândido Agnaldo Lopes Silva Filho Department of Gynecology and Obstetrics Faculty of Medicine Santo Amaro University (UNISA) So Paulo Brazil Department of Gynecology and Obstetrics Federal University of Minas Gerais (UFMG) Belo Horizonte Brazil Department of Gynecology and Obstetrics Faculty of Medicine So Paulo State University (UNESP) So Paulo Brazil

Purpose: Due to the high prevalence of iron deficiency anemia in women undergoing gynecological surgeries and its association with worse postoperative results, it is necessary to identify and treat anemia preoperatively. However, although anemia and iron deficiency are significant global health problems, there are still disparities in the recognition and implementation of “Patient Blood Management” (PBM) as a comprehensive approach to mitigating the risks associated with these diseases. The purpose of the study is to review best practices for the treatment of anemia based on the Enhanced Recovery After Surgery (ERAS) protocol and PBM recommendations. Methods: This study reviewed the literature on preoperative iron deficiency anemia in patients undergoing gynecological surgery. We identified references through searches in PubMed using relevant search terms. Results: Among the various strategies used in PBM, perhaps the most important is the early detection and management of anemia. In gynecological surgery, there are several approaches to reducing perioperative blood loss, highlighting the use of gonadotropin-releasing hormone (GnRH) agonists (aGnRh) and antifibrinolytics. Oral and intravenous iron supplementation can be performed in addition to blood transfusion to treat anemia. Conclusion: Addressing preoperative and postoperative anemia through systematic correction, following the guidelines of the ERAS protocol and PBM guidelines, is essential to improving perioperative outcomes in women undergoing gynecological surgery.

关键词： Anemia Gynecological Surgery Iron Supplementation Iron Deficiency

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Gastrointestinal symptoms in patients with COVID-19: Is there a relationship with mortality and new variations of SARS-CoV-2?

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World Journal of Gastroenterology 2021年第37期27卷 6345-6347页

作者： Igor braga Ribeiro Diogo Turiani Hourneaux de Moura eduardo Guimarães Hourneaux de Moura Departamento de Gastroenterologia Serviço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloSao Paulo 05403-010Brazil

Coronavirus disease 2019(COVID-19)is caused by the severe acute respiratory syndrome coronavirus 2(SARS-CoV-2).Although,respiratory symptoms are typical the digestive system is also a susceptible target with gastrointestinal symptoms present even in the absence of respiratory *** gastrointestinal symptoms of COVID-19 include diarrhea,abdominal pain,anorexia,and nausea among other *** questions that remain to be answered include:Do patients with gastrointestinal symptoms have a higher mortality?SARS-CoV-2 variants are already a global reality:Do these variants present with a greater prevalence of gastrointestinal symptoms?Do patients with these symptoms warrant more intensive care unit care?

关键词： COVID-19 SARS-CoV-2 Gastrointestinal symptoms Intensive care unit Variant

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Angiotensin Ⅱ-derived reactive oxygen species underpinning the processing of the cardiovascular reflexes in the medulla oblongata

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Neuroscience Bulletin 2011年第4期27卷 269-274页

作者： Valdir A.braga eduardo Colombari Mariana G.Jovita 坎皮纳联邦大学制药技术实验室圣保罗州立大学生理学与病理学系

The brainstem is a major site in the central nervous system involved in the processing of the cardiovascular reflexes such as the baroreflex and the peripheral chemoreflex. The nucleus tractus solitarius and the rostral ventrolateral medulla are 2 important brainstem nuclei, and they play pivotal roles in autonomic cardiovascular regulation. Angiotensin II is one of the neurotransmitters involved in the processing of the known that one of the mechanisms by which angiotensin II exerts cardiovascular reflexes within the brainstem. It is well- its effect is via the activation of pathways that generate reactive oxygen species （ROS）. In the central nervous system, ROS are reported to be involved in several pathological dis- eases such as hypertension, heart failure and sleep apnea. However, little is known about the role of ROS in the processing of the cardiovascular reflexes within the brainstem. The present review mainly discussed some recent findings documenting a role for ROS in the processing of the baroreflex and the peripheral chemoreflex in the brainstem.

关键词： angiotensin Ⅱ superoxide, rostral ventrolateral medulla nucleus tractus solitarius baroreflex peripheralchemoreflex

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Role of pancreatography in the endoscopic management of encapsulated pancreatic collections-review and new proposed classification

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World Journal of Gastroenterology 2020年第45期26卷 7104-7117页

作者： Igor Mendonca Proença Marcos eduardo Lera dos Santos Diogo Turiani Hourneaux de Moura Igor braga Ribeiro Sergio Eiji Matuguma Spencer Cheng Thomas R McCarty Epifanio Silvino do Monte Junior Paulo Sakai eduardo Guimaraes Hourneaux de Moura Gastrointestinal Endoscopy Unit Department of GastroenterologyHospital das ClinicasUniversity of Sao PauloSao Paulo 05403000Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s Hospital-Harvard Medical SchoolBostonMA 02115United States

Pancreatic fluids collections are local complications related to acute or chronic pancreatitis and may require intervention when symptomatic and/or *** the last decade,endoscopic management of these collections via endoscopic ultrasound-guided transmural drainage has become the gold standard treatment for encapsulated pancreatic collections with high clinical success and lower morbidity compared to traditional surgery and percutaneous *** understanding of anatomic landmarks,including assessment of the main pancreatic duct and any associated lesions–such as disruptions and strictures-are key to achieving clinical success,reducing the need for reintervention or recurrence,especially in cases with suspected disconnected pancreatic duct ***,proper review of imaging and anatomic landmarks,including collection location,are pivotal to determine type and size of pancreatic stenting as well as approach using long-term transmural indwelling plastic *** to adequately assess the main pancreatic duct may be performed by two methods:Either non-invasively using magnetic resonance cholangiopancreatography or endoscopically via retrograde *** the critical need to understand anatomy via pancrea tography and assess the main pancreatic duct,a standardized approach or uniform assessment strategy has not been described in the ***,the aim of this review was to clarify the role of pancreatography in the endoscopic management of encapsulated pancreatic collections and to propose a new classification system to aid in proper assessment and endoscopic treatment.

关键词： Endoscopic retrograde cholangiopancreatography Endoscopy Endoscopic ultrasound Pseudocyst Endosonography Pancreatic ducts

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Current role and future perspectives of cardiac rehabilitation in coronary heart disease

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World Journal of Cardiology 2021年第12期13卷 695-709页

作者： eduardo M Vilela Ricardo Ladeiras-Lopes Ana Joao Joana braga Susana Torres Sofia Viamonte José Ribeiro Madalena Teixeira José P Nunes Ricardo Fontes-Carvalho Department of Cardiology Centro Hospitalar de Vila Nova de Gaia/EspinhoVila Nova de Gaia 4434-502Portugal Department of Surgery and Physiology Cardiovascular Research Unit(UnIC)Faculty of MedicineUniversity of PortoPorto 4200-319Portugal Centro de Reabilitação do Norte Centro Hospitalar de Vila Nova de Gaia/EspinhoVila Nova de Gaia 4405-565Portugal Faculty of Medicine University of PortoPorto 4200-319Portugal

Ischaemic heart disease(IHD)is a major cause of morbidity and mortality *** there have been major advances in this field,these patients are still a higher risk *** such,strategies to mitigate risk and tailor secondary prevention measures are of the utmost *** rehabilitation(CR),encompassing several domains including exercise training,cardiovascular risk factor optimization,nutritional and psychological assessments,as well as other ancillary interventions has shown to be one of the pillars in the contemporary management of patients with ***,CR is associated with several benefits in this population,ranging from functional capacity to improvements in *** this,there are still several issues concerning the optimal application of CR which are still not fully ascertained,such as lack of referral and completion,as well as questions related to programme design(particularly among patients with multiple comorbidities).In this review,we aim at presenting a pragmatic overview on the current role of CR in the management of individuals with IHD,while also discussing some of the caveats in the current data,as well as future concepts which could help improve the uptake and personalization of this pivotal time-tested intervention.

关键词： Cardiac rehabilitation Secondary prevention Myocardial infarction Ischaemic heart disease Cardiovascular diseases

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Pancreatitis after endoscopic retrograde cholangiopancreatography:A narrative review

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World Journal of Gastroenterology 2021年第20期27卷 2495-2506页

作者： Igor braga Ribeiro Epifanio Silvino do Monte Junior Antonio Afonso Miranda Neto Igor Mendonça Proença Diogo Turiani Hourneaux de Moura Mauricio Kazuyoshi Minata Edson Ide Marcos eduardo Lera dos Santos Gustavo de Oliveira Luz Sergio Eiji Matuguma Spencer Cheng Renato Baracat eduardo Guimarães Hourneaux de Moura Department of Gastrointestinal Endoscopy Unit University of São Paulo School of MedicineSão Paulo 05403-010Brazil

Acute post-endoscopic retrograde cholangiopancreatography pancreatitis(PEP)is a feared and potentially fatal complication that can be as high as up to 30%in high-risk ***-examination measures,during the examination and after the examination are the key to technical and clinical success with a decrease in adverse *** studies have debated on the subject,however,numerous topics remain controversial,such as the effectiveness of prophylactic medications and the amylase dosage *** review was designed to provide an update on the current scientific evidence regarding PEP available in the literature.

关键词： Endoscopic retrograde cholangiopancreatography Pan-creatitis Postendoscopic retrograde cholangiopancreatography pancreatitis Adverse events Pancreatitis Prevention

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Peroral endoscopic myotomy vs laparoscopic myotomy and partial fundoplication for esophageal achalasia: A single-center randomized controlled trial

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World Journal of Gastroenterology 2022年第33期28卷 4875-4889页

作者： eduardo Turiani Hourneaux de Moura Jose Jukemura Igor braga Ribeiro Galileu Ferreira Ayala Farias Aureo Augusto de Almeida Delgado Lara Meireles Azeredo Coutinho Diogo Turiani Hourneaux de Moura Rubens Antonio Aissar Sallum Ary Nasi Sergio A Sanchez-Luna Paulo Sakai eduardo Guimaraes Hourneaux de Moura Departamento de Gastroenterologia Faculdade de MedicinaUniversidade de Sao PauloServico de Endoscopia Gastrointestinal do Hospital das Clinicas HCFMUSPSao Paulo 05403-010Brazil Division of Esophageal Surgery Hospital das ClinicasUniversity of Sao Paulo School of MedicineSao Paulo 05403-010Brazil Departamento de Gastroenterologia Faculdade de MedicinaUniversidade de Sao PauloHospital das ClinicasUniversity of Sao Paulo School of MedicineSao Paulo 05403-010Brazil Department of Internal Medicine The University of Alabama at Birmingham Heersink School of MedicineBasil I.Hirschowitz Endoscopic Center of ExcellenceDivision of Gastroenterology and HepatologyBirminghamAL 35233United States

BACKGROUND Achalasia is a rare benign esophageal motor disorder characterized by incomplete relaxation of the lower esophageal sphincter(LES). The treatment of achalasia is not curative, but rather is aimed at reducing LES pressure. In patients who have failed noninvasive therapy, surgery should be considered. Myotomy with partial fundoplication has been considered the first-line treatment for non-advanced achalasia. Recently, peroral endoscopic myotomy(POEM), a technique that employs the principles of submucosal endoscopy to perform the equivalent of a surgical myotomy,has emerged as a promising minimally invasive technique for the management of this *** To compare POEM and laparoscopic myotomy and partial fundoplication(LM-PF) regarding their efficacy and outcomes for the treatment of *** Forty treatment-naive adult patients who had been diagnosed with achalasia based on clinical and manometric criteria(dysphagia score ≥ II and Eckardt score > 3) were randomized to undergo either LM-PF or POEM. The outcome measures were anesthesia time, procedure time, symptom improvement, reflux esophagitis(as determined with the Gastroesophageal Reflux Disease Questionnaire), barium column height at 1 and 5 min(on a barium esophagogram), pressure at the LES, the occurrence of adverse events(AEs), length of stay(LOS), and quality of life(QoL).RESULTS There were no statistically significant differences between the LM-PF and POEM groups regarding symptom improvement at 1, 6, and 12 mo of follow-up(P = 0.192, P = 0.242, and P = 0.242, respectively). However, the rates of reflux esophagitis at 1, 6, and 12 mo of follow-up were significantly higher in the POEM group(P = 0.014, P < 0.001, and P = 0.002, respectively). There were also no statistical differences regarding the manometry values, the occurrence of AEs, or LOS. Anesthesia time and procedure time were significantly shorter in the POEM group than in the LM-PF group(185.00 ± 56.89 and 95.70 ± 30.47 min v

关键词： Esophageal achalasia Gastroesophageal reflux Deglutition disorders Heller myotomy Fundoplication Randomized controlled trial

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Status of bariatric endoscopy–what does the surgeon need to know? A review

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World Journal of Gastrointestinal Surgery 2022年第2期14卷 185-199页

作者： Diogo Turiani Hourneaux de Moura Anna Carolina Batista Dantas Igor braga Ribeiro Thomas R McCarty Flávio Roberto Takeda Marco Aurelio Santo Sergio Carlos Nahas eduardo Guimarães Hourneaux de Moura Departamento de Gastroenterologia Faculdade de MedicinaUniversidade de Sao PauloServiço de Endoscopia Gastrointestinal do Hospital das Clínicas HCFMUSPSao Paulo 05403-010Brazil Departamento de Gastroenterologia Hospital das Clinicas HCFMUSPFaculdade de MedicinaUniversidade de Sao PauloUnidade de Cirurgia Bariátrica e MetabólicaDisciplina de Cirurgia do Aparelho Digestivo e ColoproctologiaSao Paulo 05403-010Brazil Division of Gastroenterology Hepatology and EndoscopyBrigham and Women’s HospitalBostonMA 021115United States

BACKGROUND Obesity is a chronic and multifactorial disease with a variety of potential treatment options ***,there are several multidisciplinary therapeutic options for its management,including conservative,endoscopic,and surgical *** To clarify indications,technical aspects,and outcomes of bariatric *** Narrative review of current literature based on electronic databases including MEDLINE(PubMed),Cochrane Library,and *** Bariatric endoscopy is in constant development and comprises primary and revisional treatment options as well as management of surgical *** devices act upon different mechanisms of action,which may be individualized to each *** favorable results for the endoscopic treatment of obesity,prospective randomized studies with long-term follow-up are required to fully validate primary and revisional endoscopic *** the management of bariatric surgery complications,endoscopic therapy may be considered the procedure of choice in a variety of ***,as there is no standardized algorithm,local experience should be considered in *** The treatment of patients with obesity is complex,and a multidisciplinary approach is *** endoscopy has shown impressive results both in the treatment of obesity and its surgical complications,and therefore,must be part of the armamentarium in the fight against this disease.

关键词： Endoscopy Gastrointestinal Surgery Obesity Bariatric Weight regain

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