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Update on the association of hepatitis B with intrahepatic cholangiocarcinoma:Is there new evidence?

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World Journal of Gastroenterology 2021年第27期27卷 4252-4275页

作者： Nikolaos Fragkou Lazaros Sideras Panteleimon Panas Christos emmanouilides emmanouil sinakos Fourth Department of Internal Medicine Aristotle University of ThessalonikiThessaloniki 54642Greece Department of Oncology Interbalkan Medical CenterThessaloniki 57001Greece

Intrahepatic cholangiocarcinoma(iCCA)is a subgroup of cholangiocarcinoma that accounts for about 10%-20%of the total *** with hepatitis B virus(HBV)is one of the most important predisposing factors leading to the formation of *** has been recently estimated based on abundant epidemiological data that the association between HBV infection and iCCA is strong with an odds ratio of about *** HBV-associated mechanisms that lead to iCCA are under intense *** diagnosis of iCCA in the context of chronic liver disease is challenging and often requires histological confirmation to distinguish from hepatocellular *** is currently unclear whether antiviral treatment for HBV can decrease the incidence of *** terms of management,surgical resection remains the mainstay of *** is a need for effective treatment modalities beyond resection in both first-and second-line *** this review,we summarize the epidemiological evidence that links the two entities,discuss the pathogenesis of HBV-associated iCCA,and present the available data on the diagnosis and management of this cancer.

关键词： Cholangiocarcinoma Hepatitis B Intrahepatic Hepatocellular carcinoma Resection Chemotherapy

Update on inflammatory bowel disease in patients with primary sclerosing cholangitis

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World Journal of Hepatology 2014年第4期6卷 178-187页

作者： Christos Tsaitas Anysia Semertzidou emmanouil sinakos 4th Internal Medicine Unit University Hospital of Thessaloniki

Patients with primary sclerosing cholangitis(PSC) complicated by inflammatory bowel disease(IBD) represent a distinct subset of patients with unique characteristics,which have serious clinical *** aim of this literature review was to shed light to the obscure clinical and molecular aspects of the two diseases combined utilizing current data available and putting issues of diagnosis and treatment into *** prevalence of IBD,mainly ulcerative colitis in PSC patients is estimated to be 21%-80%,dependent on screening programs and ***-associated colitis is likely to be extensive,characterized by rectal sparing,backwash ileitis,and generally mild *** is also more likely to progress to colorectal malignancy,making it imperative for clinicians to maintain a high level of suspicion when tackling PSC *** is no optimal surveillance strategy but current guidelines advocate that colonoscopy is necessary at the time of PSC diagnosis with annual endoscopic *** biopsies have been criticized and a shift towards targeted biopsies using chromoendoscopy,laser endomicroscopy and narrow-band imaging has been *** directed towards genetic mutations instead of histological abnormalities hold promise for easier,more accurate diagnosis of dysplastic *** measures against colorectal cancer have been sought in these *** acid seemed promising at first but subsequent studies yielded conflicting results showing anticarcinogenic effects in low doses(8-15 mg/kg per day) and carcinogenic properties in high doses(15-30 mg/kg per day).

关键词： Primary sclerosing cholangitis Inflammatory bowel disease Ulcerative colitis Crohn’s disease

Role of immunotherapy in downsizing hepatocellular carcinoma prior to liver transplantation

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World Journal of Transplantation 2022年第11期12卷 331-346页

作者： Konstantinos Ouranos Anthi Chatziioannou Ioannis Goulis emmanouil sinakos 4th Medical Department Hippokratio HospitalAristotle University of ThessalonikiThessaloniki 54642Greece

Hepatocellular carcinoma(HCC)is an aggressive primary liver neoplasm that,according to tumor stage,can be treated with resection,transplantation,locoregional treatment options,or systemic *** interventions only in early-stage disease can offer complete tumor regression,systemic therapy in advanced disease can significantly prolong overall survival,according to published clinical *** emergence of immunotherapy in the field of cancer therapy has had a positive impact on patients with HCC,resulting in atezolizumab–bevacizumab currently being the first-line option for treatment of advanced *** light of this,application of immunotherapy in the preoperative process could increase the number of patients fulfilling the criteria for liver transplantation(LT).Implementation of this approach is faced with challenges regarding the safety of immunotherapy and the possibly increased risk of rejection in the perioperative *** reports and clinical trials assessing the safety profile and effectiveness of neoadjuvant immunotherapy,highlight important aspects regarding this newly evolving approach to HCC *** studies need to be conducted in order to reach a consensus regarding the optimal way to administer immunotherapy prior to *** this review,we summarize the role,safety profile and future considerations regarding the use of neoadjuvant immunotherapy prior to LT in patients with HCC.

关键词： Hepatocellular carcinoma Immunotherapy Tumor downsizing Liver transplantation Neoadjuvant Rejection

Anticholinergic syndrome induced by toxic plants

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World Journal of Emergency Medicine 2017年第4期8卷 297-301页

作者： Stergios Soulaidopoulos emmanouil sinakos Despoina Dimopoulou Christos Vettas Evangelos Cholongitas Alexandros Garyfallos Fourth Department of Internal Medicine Hippokration University Hospital Medical School Aristotle University ofThessaloniki Thessaloniki Greece

Plant intoxication constitutes an issue of greatinterest in the literature, concerning both human andanimal poisoning. Different herbs may produce multipleeffects from human organ systems, depending on specifi cingredients and metabolites that they contain. These effectsmay vary from gastroenteritis, hepatotoxicity, peripheralneuropathy, psychosis, rhabdomyolysis and blood countabnormalities to cardiotoxicity and multisystemic organfailure.

关键词： Anticholinergic syndrome toxic plants

Treating nonalcoholic steatohepatitis with antidiabetic drugs： Will GLP-1 agonists end the struggle？

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World Journal of Hepatology 2018年第11期10卷 790-794页

作者： Maria Kalogirou emmanouil sinakos 4th Department of Internal Medicine Hippocrates Hospital Aristotle University of Thessaloniki Thessaloniki 54642 Greece

Nonalcoholic fatty liver disease(NAFLD) is highly associated with insulin resistance(IR), type 2 diabetes mellitus and metabolic syndrome, being characterized as the hepatic component of metabolic syndrome. Despite its high prevalence, no pharmacological treatment has been established, as of yet. A growing body of evidence, however, shows that reducing IR can result in improvement of the biochemical and histological features of nonalcoholic steatohepatitis(NASH)-the aggressive form of NAFLD that can lead to cirrhosis and hepatocellular carcinoma. Unfortunately, the several trials that have assessed the effect of various antidiabetic agents to date have failed to establish an effective and safe treatment regimen for patients with NAFLD. Glucagon-like peptide-1(commonly known as GLP-1) agonists are a novel class of antidiabetic drugs that improve insulin sensitivity and promote weight loss. They also appear to have a direct effect on the lipid metabolism of hepatocytes, reducing hepatic steatosis. Several trials have demonstrated that GLP-1 agonists can reduce aminotransferase levels and improve liver histology in patients with NAFLD, suggesting that these agents could serve as an alternative treatment option for these patients. This manuscript discusses the role and potential mechanisms of GLP-1 agonists in the treatment of NASH.

关键词： Nonalcoholic steatohepatitis Cirrhosis Glucagon-like peptide-1 receptor agonists Nonalcoholic fatty liver disease

Liver disease in patients with transfusion-dependentβ-thalassemia:The emerging role of metabolism dysfunction-associated steatotic liver disease

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World Journal of Hepatology 2024年第5期16卷 671-677页

作者： Nikolaos Fragkou Efthimia Vlachaki Ioannis Goulis emmanouil sinakos 4^(th)Department of Internal Medicine Hippokratio HospitalAristotle University of ThessalonikiThessaloniki 54642Greece 2^(nd)Department of Internal Medicine Hippokratio HospitalAristotle University of ThessalonikiThessaloniki 54642Greece

In this Editorial,we highlight the possible role that metabolism dysfunction-associated steatotic liver disease(MASLD)may play in the future,regarding liver disease in patients with transfusion-dependent β-thalassemia(TDBT).MASLD is characterized by excessive accumulation of fat in the liver(hepatic steatosis),in the presence of cardiometabolic *** is a strong correlation between the occurrence of MASLD and insulin resistance,while its increased prevalence parallels the global epidemic of diabetes mellitus(DM)and *** with TDBT need regular transfusions for life to ensure their *** these transfusions,a large amount of iron is accumulated,which causes saturation of transferrin and leads to the circulation of free iron molecules,which cause damage to vital organs(primarily the liver and myocardium).Over the past,the main mechanisms for the development of liver disease in these patients have been the toxic effect of iron on the liver and chronic hepatitis C,for which modern and effective treatments have been found,resulting in successful *** advances in the treatment and monitoring of these patients have led to a reduction in deaths,and an increase in their life *** increased survival makes them vulnerable to the onset of diseases,which until recently were mainly related to the non-thalassemic general population,such as obesity and *** is insufficient data in the literature regarding the prevalence of MASLD in this population or on the risk factors for its ***,it was recently shown by a study of 45 heavily transfused patients with beta-thalassemia(Padeniya et al,BJH),that the presence of steatosis is a factor influencing the value of liver elastography and thus liver *** findings suggest that future research in the field of liver disease in patients with TDBT should be focused on the occurrence,the risk factors,and the effect of MASLD on these patients.

关键词： Metabolism dysfunction-associated steatotic liver disease Transfusion-dependent thalassemia Metabolic syndrome Hepatic steatosis Non-invasive markers Liver fibrosis

Liver Imaging Reporting and Data System criteria for the diagnosis of hepatocellular carcinoma in clinical practice: A pictorial minireview

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World Journal of Gastroenterology 2022年第32期28卷 4540-4556页

作者： Christina Liava emmanouil sinakos Elissavet Papadopoulou Lamprini Giannakopoulou Stamatia Potsi Anestis Moumtzouoglou Anthi Chatziioannou Loukas Stergioulas Lydia Kalogeropoulou Ioannis Dedes Evangelos Akriviadis Danai Chourmouzi 4^(th)Department of Internal Medicine Hippokratio HospitalAristotle University of ThessalonikiThessaloniki 54642Greece Department of Radiology Interbalkan Medical CenterThessaloniki 57001Greece

Hepatocellular carcinoma(HCC)is the sixth most common *** main risk factors associated with HCC development include hepatitis B virus,hepatitis C virus,alcohol consumption,aflatoxin B1,and nonalcoholic fatty liver ***,hepatocarcinogenesis is a complex multistep *** factors lead to hepatocyte malignant transformation and HCC *** and surveillance of HCC can be made with the use of liver ultrasound(US)every 6 ***,the sensitivity of this imaging method to detect HCC in a cirrhotic liver is limited,due to the abnormal liver *** tomography(CT)and magnetic resonance imaging(MRI)are considered to be most useful tools for at-risk patients or patients with inadequate *** biopsy is still used for diagnosis and prognosis of HCC in specific nodules that cannot be definitely characterized as HCC by *** the American College of Radiology designed the Liver Imaging Reporting and Data System(LI-RADS),which is a comprehensive system for standardized interpretation of CT and MRI liver examinations that was first proposed in *** 2018,it was integrated into the American Association for the Study of Liver Diseases guidance statement for ***-RADS is designed to ensure high sensitivity,precise categorization,and high positive predictive value for the diagnosis of HCC and is applied to“highrisk populations”according to specific *** importantly LI-RADS criteria achieved international collaboration and consensus among liver experts around the world on the best practices for caring for patients with or at risk for HCC.

关键词： Hepatocellular carcinoma Hepatocarcinogenesis Computed tomography Magnetic resonance imaging Liver Imaging Reporting and Data System

Effects of an active lifestyle on the physical frailty of liver transplant candidates

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World Journal of Transplantation 2022年第11期12卷 365-377页

作者： Ilias Marios Oikonomou emmanouil sinakos Nikolaos Antoniadis Ioannis Goulis Olga Giouleme Maria Anifanti Georgios Katsanos Konstantina-Eleni Karakasi Georgios Tsoulfas Evangelia Kouidi Department of Transplant Surgery Aristotle University of ThessalonikiThessaloniki 54642Greece The Fourth Department of Internal Medicine Aristotle University of ThessalonikiThessaloniki 54642Greece The Second Propaedeutic Department of Internal Medicine Aristotle University of ThessalonikiThessaloniki 54642Greece Laboratory of Sports Medicine Aristotle University of ThessalonikiThessaloniki 57001Greece

BACKGROUND Liver transplantation is the most important therapeutic intervention for end-stage liver disease(ELD).The prioritization of these patients is based on the model for end-stage liver disease(MELD),which can successfully predict short-term ***,despite its great validity and value,it cannot fully incorporate several comorbidities of liver disease,such as sarcopenia and physical frailty,variables that can sufficiently influence the survival of such ***,there is growing interest in the importance of physical frailty in regard to mortality in liver transplant candidates and recipients,as well as its role in improving their survival *** To evaluate the effects of an active lifestyle on physical frailty on liver transplant *** An observational study was performed within the facilities of the Department of Transplant Surgery of Aristotle University of *** liver transplant candidate patients from the waiting list of the department were included in the *** that were bedridden,had recent cardiovascular incidents,or had required inpatient treatment for more than 5 d in the last 6 mo were excluded from the *** following variables were evaluated:Activity level via the International Physical Activity Questionnaire(IPAQ);functional capacity via the 6-min walking test(6MWT)and cardiopulmonary exercise testing;and physical frailty via the Liver Frailty Index(LFI).RESULTS According to their responses in the IPAQ,patients were divided into the following two groups based on their activity level:Active group(A,10 patients);and sedentary group(S,10 patients).Comparing mean values of the recorded variables showed the following results:MELD(A:12.05±5.63 vs S:13.99±3.60;P>0.05);peak oxygen uptake(A:29.78±6.07 mL/kg/min vs S:18.11±3.39 mL/kg/min;P<0.001);anaerobic threshold(A:16.71±2.17 mL/kg/min vs S:13.96±1.45 mL/kg/min;P<0.01);6MWT(A:458.2±57.5 m vs S:324.7±55.8 m;P<0.001);and LFI(A:3.75±0.31 vs

关键词： Liver transplantation Frailty Six-minute walk test Cardiopulmonary exercise testing Exercise therapy Observational study

Outcome of patients with primary sclerosing cholangitis and ulcerative colitis undergoing colectomy

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2013年第3期4卷 61-68页

作者： Sombat Treeprasertsuk Einar Bjrnsson emmanouil sinakos Emma Weeding Keith D Lindor Division of Gastroenterology Department of MedicineFaculty of MedicineChulalongkorn UniversityBangkok 10330Thailand Department of Internal Medicine Section of Gastroenterology and HepatologyThe National University Hospital of IcelandIS121 ReykjavikIceland Division of Gastroenterology and Hepatology Mayo ClinicRochesterMN 55905United States Health Solutions Arizona State UniversityAZ 85004United States

AIM:To study the outcomes of primary sclerosing cholangitis(PSC) patients with ulcerative colitis(UC) undergoing ***:We identified 193 patients with PSC and UC undergoing colectomy at the Mayo Clinic(Rochester,MN,United States),between January 1,1995 and December 31,2008 using a computerized record ***-nine patients were excluded due to unclear diagnosis,liver transplantation prior to colectomy,age less than 18 years,inadequate follow-up data or known cases of *** retrospectively reviewed data from patient medical *** information,date of colectomy,preoperative and follow-up liver tests and pathological findings of the colon were *** Mayo risk score at baseline was calculated to obtain survival estimates for up to 4 years of *** primary endpoint was defined by the presence of all-cause mortality and/or liver decompensation requiring liver *** patients who did not have a clinical note on December 31,2008 were considered as patients with an incomplete follow-up unless they reached a study endpoint(death or underwent liver transplantation) prior to that *** study was approved by the Institutional Review Boards of the Mayo ***:Of the 2441 patients with PSC observed in this period,104 patients(4.3%) had UC and underwent colectomy and were *** median age was 43.2 years,and 67% were *** leading indications for colectomy were severe colonic inflammation(49%),the presence of colonic dysplasia during routine surveillance(42%) and bowel perforation(3%).Twenty-six patients were lost to follow-up after a median duration of 3.9 *** remaining 78 patients included 52 patients(66.7%) who were followed for a median duration of 5.5 years and 26 patients(33.3%) who developed primary endpoints including death(n = 13) or underwent liver transplantation(n = 13) with a median follow up of 2.6 *** the secondary endpoint,the liver complications within 1 mo follow

关键词： Prognosis Colectomy Primary sclerosing cholangitis Ulcerative colitis Outcomes