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Extracellular sulfatase-2 is overexpressed in rheumatoid arthritis and mediates the TNF-α-induced inflammatory activation of synovial fibroblasts

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Cellular & Molecular Immunology 2022年第10期19卷 1185-1195页

作者： Ruby J.Siegel Anil K.Singh Paul M.Panipinto Farheen S.shaikh Judy Vinh Sang U.Han H.Mark Kenney Edward M.Schwarz Cynthia S.Crowson Sadik A.Khuder Basil S.Khuder David A.Fox Salahuddin ahmed Department of Pharmaceutical Sciences Washington State University College of Pharmacy and Pharmaceutical SciencesSpokaneWAUSA Department of Pathology and Laboratory Medicine University of Rochester Medical CenterRochesterNYUSA Center for Musculoskeletal Research University of Rochester Medical CenterRochesterNYUSA Department of Quantitative Health Sciences and Division of Rheumatology Mayo ClinicRochesterMNUSA Department of Medicine and Public Health University of ToledoToledoOHUSA Department of Pathology and Laboratory Medicine Phoenix Children’s HospitalPhoenixAZUSA Department of Medicine Division of Rheumatology and Clinical Autoimmunity Center of ExcellenceUniversity of Michigan Medical SystemAnn ArborMIUSA Division of Rheumatology University of Washington School of MedicineSeattleWAUSA

Extracellular sulfatase-2(Sulf-2)influences receptor-ligand binding and subsequent signaling by chemokines and growth factors,yet Sulf-2 remains unexplored in inflammatory cytokine signaling in the context of rheumatoid arthritis(RA).In the present study,we characterized Sulf-2 expression in RA and investigated its potential role in TNF-α-induced synovial inflammation using primary human RA synovial fibroblasts(RASFs).Sulf-2 expression was significantly higher in serum and synovial tissues from patients with RA and in synovium and serum from hTNFtg *** sequencing analysis of TNF-α-stimulated RASFs showed that Sulf-2 siRNA modulated~2500 genes compared to scrambled *** Pathway Analysis of RNA sequencing data identified Sulf-2 as a primary target in fibroblasts and macrophages in *** blot,ELISA,and qRT‒PCR analyses confirmed that Sulf-2 knockdown reduced the TNF-α-induced expression of ICAM1,VCAM1,CAD11,PDPN,CCL5,CX3CL1,CXCL10,and *** studies identified the protein kinase C-delta(PKCδ)and c-Jun N-terminal kinase(JNK)pathways as key in the TNF-α-mediated induction of proteins related to cellular adhesion and *** of Sulf-2 abrogated TNF-α-induced RASF ***-2 knockdown with siRNA and inhibition by OKN-007 suppressed the TNF-α-induced phosphorylation of PKCδand JNK,thereby suppressing the nuclear translocation and DNA binding activity of the transcription factors AP-1 and NF-κBp65 in human ***,Sulf-2 expression positively correlated with the expression of TNF receptor 1,and coimmunoprecipitation assays demonstrated the binding of these two proteins,suggesting they exhibit crosstalk in TNF-α*** study identified a novel role of Sulf-2 in TNF-αsignaling and the activation of RA synoviocytes,providing the rationale for evaluating the therapeutic targeting of Sulf-2 in preclinical models of RA.

关键词： Sulfatase-2 TNF-α Rheumatoid arthritis Synovial fibroblasts Signal transduction

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Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery

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World Journal of Orthopedics 2024年第2期15卷 163-169页

作者： Ashish Mishra ahmed Barakat Jitendra Mangwani Jakub Kazda Sagar Tiwatane Sana Mohammed Aamir shaikh Linzy Houchen-Wolloff Vipul Kaushik Department of Trauma and Orthopedics University Hospitals LeicesterLeicester LE15WWUnited Kingdom Department of Trauma and Orthopedics Leicester University Hospitals-NHS TrustLeicester LE15WWLeicestershireUnited Kingdom Academic Team of Musculoskeletal Surgery University Hospitals of Leicester NHS TrustLeicester LE39QPUnited Kingdom Department of Anaesthesia York&Scarborough Teaching Hospitals NHS Foundation TrustNorth Yorkshire YO318HEUnited Kingdom Department of Anaesthesia Royal Free London NHS TrustLondon NW32QGUnited Kingdom Department of Trauma&Orthopaedics Breach Candy Hospital TrustMumbai 400026India Department of Physiotherapy University Hospitals of Leicester NHS TrustLeicester LE39QPUnited Kingdom Department of Anasthesia University Hospitals of Leicester NHS TrustLeicester LE15WWUnited Kingdom

BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical *** is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of *** is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle *** To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle *** Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was *** tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h *** plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation *** All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for *** was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 *** was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h *** This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle *** choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.

关键词： Lower limb surgery Tourniquet time Tourniquet pressure Tourniquet site Post-operative pain Pain scores

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Rational drug design,synthesis,and biological evaluation of novel N-(2-arylaminophenyl)-2,3-diphenylquinoxaline-6-sulfonamides as potential antimalarial,antifungal,and antibacterial agents

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Digital Chinese Medicine 2021年第4期4卷 290-304页

作者： ahmed Hassen Shntaif Sharuk Khan Ganesh Tapadiya Anand Chettupalli Shweta Saboo Mohd Sayeed shaikh Falak Siddiqui Ramkoteswra Rao Amara College of Science for Women Babylon UniversityHillaBabil 00964Iraq MUPs College of Pharmacy(B Pharm) WashimMaharashtra 444506India Shreeyash Institute of Pharmaceutical Education and Research AurangabadMaharashtra 431010India Department of Pharmaceutical Sciences Center for NanomedicineAnurag UniversityHyderabad 501301India Government College of Pharmacy KaradMaharashtra 415124India Department of Pharmacy Shri Jagdishprasad Jhabarmal Tibrewala UniversityVidya NagariRajasthan 333001India

Objective Sulfanilamide,sulfadiazine,and dapsone were the first sulfonamides to be used to treat malaria by disrupting the folate biosynthesis process,which is essential for parasite ***,we aimed to synthesize novel N-(2-arylaminophenyl)-2,3-diphenylquinoxaline-6-sulfonamide derivatives through a rational drug design *** All compounds were synthesized by the conventional method,and the products were characterized by spectral analysis(1 H NMR and mass spectrometry).The progression of the reaction was monitored using thin-layer chromatography(TLC).All the derivatives were analyzed for their effective binding mode in the allosteric site of the plasmodium cysteine protease *** and antifungal activities were determined using the broth dilution *** S6(N-(2-thiazol-4 yl)-acetyl-aminophenyl)-2,3-diphenylquinoxaline-6-sulfonamide and S9(N-(1 H-benzo[d]imidazol-2-yl)aminophenyl)-2,3-diphenylquinoxaline-6-sulfonamide formed five hydrogen bonds;S8(N-(2-1 H-imidazol-2 yl)aminophenyl)-2,3-diphenylquinoxaline-6-sulfonamide and S10(N-(1 H-benzo[d]imidazol-5-yl)aminophenyl)-2,3-diphenylquinoxaline-6-sulfonamide formed four hydrogen bonds with the allosteric site of the *** the docking scores and formation of hydrogen bonds with the target enzyme,the novel derivatives were processed for wet lab *** the newly synthesized derivatives were subjected to in vitro antimalarial,antifungal,and antibacterial *** the derivatives exhibited sufficient sensitivity to the Plasmodium falciparum strain compared to the ***,compounds S9 and S10 showed the most potent dual antimicrobial and antimalarial *** also exhibited powerful molecular interactions in molecular docking *** Based on the above results,it was concluded that N-(2-arylaminophenyl)-2,3-diphenylquinoxaline-6-sulfonamide derivatives have excellent biological potential to act as antimalarial,antifungal,

关键词： Sulfonamides Antimalarials Antifungal Antibacterial Plasmodium cysteine protease falcipain-2 2,3-Diphenylquinoxaline-6-sulfonamide Plasmodium falciparum

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Evaluating the Optimum Transplanting Time for Different Coarse Rice Genotypes under Semi-Arid Conditions of Faisalabad

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Agricultural Sciences 2018年第1期9卷 69-77页

作者： Muhammad Ahtisham Tahir Muhammad Ahmad Arain Saba Durrani Abdul Shakoor Ahtsham Bilal Nasir Ali Muhammad Ishfaq Umer Farooq Siraj ahmed Muhammad irfan Department of Agronomy University of Agriculture Faisalabad Pakistan Department of Botany University of Agriculture Faisalabad Pakistan Department of Plant Breeding and Genetics University of Agriculture Faisalabad Pakistan Department of Plant Breeding and Genetics Bahauddin Zakariya University Multan Pakistan

Continuously changing climate and availability of different rice genotypes make it necessary to find optimum time of sowing as well as suitable variety for cultivation to get maximum productivity under a specific set of climatic conditions. A field study was carried out to search out the suitable rice transplanting time for four different coarse genotypes under the semi-arid environment of Faisalabad. The experiment was conducted at Agronomic Research Area, University of Agriculture, Faisalabad and was laid out in randomized complete block design (RCBD) with split plot arrangement keeping transplanting time in main plots while rice genotypes in subplots. Variability among treatments was measured by Fisher’s ANOVA (P ≤ 5%) and LSD test was applied to compare the differences among treatments’ means. The ANOVA indicated statistically significant differences among genotypes as well as transplanting dates irrespective of all studied traits while interactive effects of both were found to be non-significant. NIBGE-1 performed best with maximum paddy yield of 6.05 t/ha while KSK-434 performed poor with paddy yield of 2.78 t/ha. Increased paddy yield and yield related parameters of all rice genotypes were recorded where transplantation was done on 25th of June. Generally, paddy yield decreased with delaying the transplanting time. The results suggested that NIBGE-1 can perform better under the semi-arid conditions of Faisalabad and last week of June might be the optimum time for nursery transplantation. It can also be further elucidated that late transplanting causes yield reduction which could not be recommended among farmers.

关键词： Coarse Rice Genotypes Transplanting Time Paddy Yield Semi-Arid

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Exploring the current provision of pancreatic transplantations in lowand middle-income countries:Current landscape,challenges,future prospects

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World Journal of Gastrointestinal Pathophysiology 2024年第6期15卷 1-10页

作者： Hareesha Rishab Bharadwaj Joecelyn Kirani Tan Syed Hasham Ali Muhammad Hamza Shah Aderinto Nicholas Khabab Abbasher Hussien Mohamed ahmed Khansa irfan Priyal Dalal Aashna Mehta Wireko Andrew Awuah Arkadeep Dhali Faculty of Biology Medicine and Health University of ManchesterManchester M139PLUnited Kingdom Faculty of Medicine University of St AndrewsSt Andrews KY169AJUnited Kingdom Faculty of Medicine Dow Medical CollegeKarachi 74200Pakistan School of Medicine Queen's University BelfastBelfast BT71NNUnited Kingdom Department of Medicine and Surgery Ladoke Akintola University of TechnologyOgbomosho 210214OyoNigeria Faculty of Medicine University of KhartoumKhartoum 0000Sudan School of Medicine University of Central LancashirePreston PR21SGUnited Kingdom Faculty of Medicine and Surgery University of DebrecenDebrecen 4032Hungary Faculty of Medicine and Surgery Sumy State UniversitySumy 40007Ukraine Department of Gastroenterology Sheffield Teaching Hospitals NHS Foundation TrustRoyal Hallamshire HospitalSheffield S102JFUnited Kingdom School of Medicine and Population Health University of SheffieldSheffield S102HQUnited Kingdom Deanery of Clinical Sciences The University of EdinburghEdinburgh EH164SBUnited Kingdom Leeds Institute of Health Sciences University of LeedsLeeds LS29LNUnited Kingdom

This comprehensive review addresses the global health challenge of disparities in pancreas transplant access,particularly in low-and middle-income countries(LMICs)compared to high-income *** advancements in surgical techniques and immunosuppression for procedures like simultaneous pancreas-kidney,pancreas-after-kidney,and pancreas-transplant alone,LMICs face significant challenges,including limited infrastructure,financial constraints,and a shortage of skilled medical *** after brain death remains constrained by sociocultural ***-specific analyses highlight progress in Latin America,Asia,Russia,and South Africa,showcasing the regional disparities in access and *** prospects involve minimally invasive surgeries,telemedicine for enhanced post-operative care,international collaborations with organizations like the European Union of Medical Specialists,and robust funding networks to improve organ *** conclusion,the review underscores the importance of multifaceted strategies to address economic,sociocultural,and infrastructural barriers,aiming to improve accessibility,quality,and effectiveness of pancreas transplantation services in LMICs.

关键词： Pancreatic transplantation Diabetes mellitus Global health Low-and middle-income countries Transplant surgery

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Vildagliptin vs sulfonylurea in Indian Muslim diabetes patients fasting during Ramadan

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World Journal of Diabetes 2013年第6期4卷 358-364页

作者： Abhijit Shete Aheson shaikh K Javeed Nayeem Lily Rodrigues Mohamed Sheikamunadeen Sadiq Ali Parag Shah Rajiv Khanna Sarfaraj Majid Sabeer A Rasheed Shehla shaikh Tawfiqur Rahman Medical Department Novartis Pharma AGCH-4002 BaselSwitzerland Diabetes Care Centre Bibi Ayesha Mili Hospital Suraksha Multi Speciality Hospital irfan Cardiac and Diabetic Clinic Gujarat Endocrine Centre Khanna Clinic Gole DarwazaRadhey lalChowkLucknow 226003India B P Poddar Hospital Dr.Rasheed’s Diabetes Speciality Centre KGN Diabetes & Endocrinology Center GD Diabetic Institute

AIM:To compare the use of vildagliptin and sulfonylurea with or without metformin in Indian Muslim patients with type 2 diabetes mellitus,fasting during ***:This was a 4-wk,multicenter,non-interventional,open-label,observational *** of hypoglycemic events(HEs),adverse events,and changes in glycosylated hemoglobin A1c(HbA1c),fasting plasma glucose,postprandial plasma glucose and body weight were measured pre-and ***:Totally,97 patients were recruited and all completed the study(vildagliptin group,n=55;sulfonylurea group,n=42).HEs were reported in low frequencies in both the vildagliptin and the sulfonylurea groups[0 vs 2(4.8%)patients,respectively].Interestingly,HbA1c reduced by-0.43%(-4.71 mmol/mol)in the vildagliptin group[8.75%(72.10 mmol/mol)to8.32%(67.38 mmol/mol),P=0.009]while in the sulfonylurea group there was a small increase by 0.01%[0.08 mmol/mol;8.64%(70.92 mmol/mol)to 8.65%(71.00 mmol/mol),P=0.958].Higher percentage of vildagliptin-treated patients achieved HbA1c<7.0%(<53 mmol/mol)compared with sulfonylurea(16.4%vs4.8%).Mean decrease in the body weight was 1.2 kg and 0.03 kg,respectively(P<0.001).Both treatment groups were well tolerated during ***:Vildagliptin is an attractive treatment option for Indian patients with type 2 diabetes mellitus who are fasting during Ramadan.

关键词： Dipeptidyl-peptidase 4 inhibitors Fasting hypoglycemia Sulfonylurea Type 2 diabetes mellitus Vildagliptin

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Incidence and predictors of hypocalcemia in end-stage renal disease patients on denosumab therapy: A systematic review and metaanalysis

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World Journal of Meta-Analysis 2024年第3期12卷 68-78页

作者： Abdul Hannan Siddiqui Misbah shaikh Afia Salman Muhammad ahmed Ali Fahim Fizzah Batool Tahreem Mari Sarah Musani Muneeb Fareed Rooma Rehan Amna Hassni Urooj Nizami Ayesha Amir Abdul Moeed Salim R Surani Department of Internal Medicine Dow University of Health SciencesKarachi 74200SindhPakistan Department of Medicine&Pharmacology Texas A&M UniversityCollege StationTX 77843United States

BACKGROUND Denosumab inhibits the receptor activator of nuclear factor *** markedly increases bone mineral density and has been proven to reduce the risk of ***,numerous adverse effects,notably hypocalcemia,are prevalent in patients with end-stage renal disease(ESRD).AIM To analyze the incidence and predictors of hypocalcemia caused by denosumab compared to control in patients with *** We conducted this study in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses ***,Scopus,Cochrane Central,and EMBASE were systematically searched from inception through March *** original studies investigating the effects of denosumab on patients with ESRD compared to control were *** primary outcomes of our study were the incidence of mild,severe,and very severe *** outcomes included serum levels of intact parathyroid hormone,calcium,and *** results were pooled and analyzed using a random-effects *** Seven articles comprising 3240 patients were included in our *** treated with denosumab had a significantly increased incidence of mild hypocalcemia[risk ratio(RR):2.79;95%confidence interval(CI):0.99-7.91;P=0.05;I^(2)=37%]and of very severe hypocalcemia(RR:9.58;95%CI:1.58-57.98;P=0.01;I^(2)=49%).However,an increase in the occurrence of severe hypocalcemia was non-significant(RR:4.23;95%CI:0.47-38.34;P=0.20;I^(2)=96%).Alternatively,denosumab showed a significant decrease in serum intact parathyroid hormone[mean difference(MD):-433.20,95%CI:-775.12 to-91.28,I2=98%,P=0.01],while there was a non-significant decrease in phosphate(MD:-0.47,95%CI:-1.35 to 0.41,I^(2)=88%,P=0.30)and calcium levels(MD:-0.33,95%CI:-0.95 to 0.29,I^(2)=94%,P=0.29).CONCLUSION Our study demonstrated that denosumab is significantly associated with mild and very severe hypocalcemia in patients with ESRD making it necessary to detect and prevent this side effect of treatmen

关键词： Denosumab End-stage renal disease Hypocalcemia Parathyroid hormone Dialysis

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Automated Leukemia Screening and Sub-types Classification Using Deep Learning

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Computer Systems Science & Engineering 2023年第9期46卷 3541-3558页

作者： Chaudhary Hassan Abbas Gondal Muhammad irfan Sarmad Shafique Muhammad Salman Bashir Mansoor ahmed Osama M.Alshehri Hassan H.Almasoudi Samar M.Alqhtani Mohammed M.Jalal Malik A.Altayar Khalaf F.Alsharif Department of Computer Science COMSATS University Islamabad44000Pakistan Electrical Engineering Department College of EngineeringNajran UniversityNajran61441Saudi Arabia Control Automotive and Robotics LabNational Center of Robotics and Automation(NCRA HEC)MirpurPakistan Mirpur University of Science and Technology(MUST)MirpurPakistan Department of Computer Science Virtual University of PakistanLahore54000Pakistan Department of Clinical Laboratory Sciences College of Applied Medical SciencesNajran UniversityNajran61441Saudi Arabia Department of Information Systems College of Computer Science and Information SystemsNajran UniversityNajran61441Saudi Arabia Department of Medical Laboratory Technology Faculty of Applied Medical SciencesUniversity of TabukTabukSaudi Arabia Department of Clinical Laboratory Sciences College of Applied Medical SciencesTaif UniversityP.O.Box 11099Taif21944Saudi Arabia

Leukemia is a kind of blood cancer that damages the cells in the blood and bone marrow of the human *** produces cancerous blood cells that disturb the human’s immune system and significantly affect bone marrow’s production ability to effectively create different types of blood cells like red blood cells(RBCs)and white blood cells(WBC),and *** can be diagnosed manually by taking a complete blood count test of the patient’s blood,from which medical professionals can investigate the signs of leukemia ***,two other methods,microscopic inspection of blood smears and bone marrow aspiration,are also utilized while examining the patient for ***,all these methods are labor-intensive,slow,inaccurate,and require a lot of human experience and *** authors have proposed automated detection systems for leukemia diagnosis to overcome these *** have deployed digital image processing and machine learning algorithms to classify the cells into normal and blast ***,these systems are more efficient,reliable,and fast than previous manual diagnosing ***,more work is required to classify leukemia-affected cells due to the complex characteristics of blood images and leukemia cells having much intra-class variability and inter-class *** this paper,we have proposed a robust automated system to diagnose leukemia and its *** have classified ALL into its sub-types based on FAB classification,i.e.,L1,L2,and L3 types with better *** have achieved 96.06%accuracy for subtypes classification,which is better when compared with the state-of-the-art methodologies.

关键词： Healthcare cancer detection deep learning convolutional neural network

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Comparative Effects of Ballooning Intracervical Catheter and Prostaglandin Pessary on Cervical Ripening

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Open Journal of Obstetrics and Gynecology 2016年第9期6卷 525-533页

作者： Raheela Baloch Qamarunissa Muhabat Fakhrunissa Waheed Waqarunissa ahmed Department of Obstetrics & Gynecology Aga Khan Maternity & Child Care Hospital Hyderabad Sindh Pakistan Department of Obstetrics & Gynecology Indus Tando M. Khan Hyderabad Sindh Pakistan Department of Obstetrics & Gynecology Shaikh Zayed Hospital Larkana Sindh Pakistan

Labor is induced to stimulate the uterine contraction in effort to have vaginal birth. Induction may be advocated to reduce fetal or neonatal morbidity and mortality. Indication of labor needs to be considered when risk and benefits analysis indicates that delivering the baby is safe option for mother or both rather than continuing the pregnancy and when there are no clear indications for caesarean section and no contraindication for vaginal delivery.

关键词： Induction Foley’s Cather Prostaglandin

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National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

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World Journal of Gastroenterology 2024年第9期30卷 1018-1042页

作者： Faisal Saud Dar Zaigham Abbas irfan ahmed Muhammad Atique Usman Iqbal Aujla Muhammad Azeemuddin Zeba Aziz Abu Bakar Hafeez Bhatti Tariq Ali Bangash Amna Subhan Butt Osama Tariq Butt Abdul Wahab Dogar Javed Iqbal Farooqi Faisal Hanif Jahanzaib Haider Siraj Haider Syed Mujahid Hassan Adnan Abdul Jabbar Aman Nawaz Khan Muhammad Shoaib Khan Muhammad Yasir Khan Amer Latif Nasir Hassan Luck Ahmad Karim Malik Kamran Rashid Sohail Rashid Mohammad Salih Abdullah Saeed Amjad Salamat Ghias-un-Nabi Tayyab Aasim Yusuf Haseeb Haider Zia Ammara Naveed Department of Hepatopancreatic Biliary Surgery&Liver Transplant Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Hepatogastroenterology and Liver Transplantation Dr.Ziauddin University HospitalKarachi 75600SindhPakistan University of Aberdeen Aberdeen B243FXUnited Kingdom Department of Pathology Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Gastroenterology&Hepatology Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Radiology Aga Khan UniversityKarachi 74800Pakistan Department of Oncology Hameed Latif HospitalLahore 54000Pakistan Division of Hepatopancreatic Biliary Surgery&Liver Transplantation Shifa International HospitalIslamabad 44000Pakistan Department of Hepatopancreatic Biliary Surgery&Liver Transplant Shaikh Zayed Hospital and Post Graduate Medical InstituteLahore 54000Pakistan Department of Medicine Aga Khan University HospitalKarachi 74800Pakistan Department of Liver Transplant Pir Abdul Qadir Shah Jeelani Institute of Medical SciencesGambat 66020Pakistan Department of Medicine&Gastroenterology Lifecare Hospital and Research CentrePeshawar 25000Khyber PakhtunkhwaPakistan Department of Hepatopancreatobiliary&Liver Transplant Bahria International HospitalLahore 54000Pakistan Department of Surgery Hepatopancreatobiliary&Liver TransplantDow University of Health SciencesKarachi 74800Pakistan Department of Gastroenterology Hepatology&NutritionPir Abdul Qadir Shah Jeelani Institute of Medical SciencesGambat 66020Pakistan Department of Oncology Dr.Ziauddin HospitalKarachi 74800Pakistan Department of Radiology Rehman Medical InstitutePeshawar 25000Pakistan Army Liver Transplant Unit Pak Emirates Military HospitalRawalpindi 46000Pakistan Department of Gastroenterology Sindh Institute of Urology and TransplantationKarachi 75500Pakistan Rashid Nursing Home and Cancer Clinic Rashid Nursing Home and Cancer ClinicRawalpindi 46000Pakistan Department of Gastroentero

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the *** Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this *** effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these *** coordinated effort can minimise delays and give patients a chance for curative treatment and effective *** diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance *** cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for ***,histopathologic confirmation is not always required before *** ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for *** only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette *** patients with unresectable hCCA can be considered for liver *** chemotherapy should be offered to patients with a high risk of *** use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary *** with acute cholangitis can be drained with endoscopic or percutaneous biliary *** chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

关键词： Hilar cholangiocarcinoma Bismuth-Corlette classification Memorial Sloan Kettering Cancer Centre Staging Preoperative biliary drainage Portal vein embolisation Surgical resection Hepatectomy

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