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Peculiar characteristics of portal-hepatic hemodynamics of alcoholic cirrhosis

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World Journal of Gastroenterology 2014年第25期20卷 8005-8010页

作者： Massimo Bolognesi Alberto Verardo marco di Pascoli Department of Medicine University of PaduaAzienda Ospedaliera Università di Padova35128 PadovaItaly

Alcohol-related cirrhosis is a consequence of heavy and prolonged drinking. Similarly to patients with cirrhosis of other etiologies, patients with alcoholic cirrhosis develop portal hypertension and the hepatic, splanchnic and systemic hemodynamic alterations that follow. However, in alcoholic cirrhosis, some specific features can be observed. Compared to viral cirrhosis, in alcohol-related cirrhosis sinusoidal pressure is generally higher, hepatic venous pressure gradient reflects portal pressure better, the portal flow perfusing the liver is reduced despite an increase in liver weight, the prevalence of reversal portal blood flow is higher, a patent paraumbilical vein is a more common finding and signs of hyperdynamic circulations, such as an increased cardiac output and decreased systemic vascular resistance, are more pronounced. Moreover, alcohol consumption can acutely increase portal pressure and portal-collateral blood flow. Alcoholic cardiomyopathy, another pathological consequence of prolonged alcohol misuse, may contribute to the hemodynamic changes occurring in alcohol-related cirrhosis. The aim of this review was to assess the portal-hepatic changes thatoccur in alcohol-related cirrhosis, focusing on the differences observed in comparison with patients with viral cirrhosis. The knowledge of the specific characteristics of this pathological condition can be helpful in the management of portal hypertension and its complications in patients with alcohol-related cirrhosis.

关键词： Alcohol-related cirrhosis Portal hypertension Splanchnic flow Hyperdynamic circulatory syndrome Alcohol-related cardiomyopathy

Whole-eye transplantation: Current challenges and future perspectives

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World Journal of Transplantation 2024年第2期14卷 28-39页

作者： Anna Scarabosio Pier Luigi Surico Vlad Tereshenko Rohan Bir Singh Carlo Salati Leopoldo Spadea Glenda Caputo Pier Camillo Parodi Caterina Gagliano Jonathan M Winograd marco Zeppieri Department of Plastic Surgery University Hospital of UdineUdine 33100Italy Department of Plastic Surgery Massachusetts General HospitalHarvard Medical SchoolBostonMA 02114United States Schepens Eye Research Institute of Mass Eye and Ear Harvard Medical SchoolBostonMA 02114United States Department of Ophthalmology University Hospital of UdineUdine 33100Italy Eye Clinic Policlinico Umberto I"Sapienza"University of RomeRome 00142Italy Department of Medicine and Surgery University of Enna"Kore"Enna 94100Italy Eye Clinic Catania University San marco Hospital Viale Carlo Azeglio Ciampi 95121 CataniaItaly

Whole-eye transplantation emerges as a frontier in ophthalmology,promising a transformative approach to irreversible *** advancements,formidable challenges *** of donor eye viability post-enucleation necessitates meticulous surgical techniques to optimize retinal integrity and ganglion cell *** the inhibitory milieu of the central nervous system for successful optic nerve regeneration remains elusive,prompting the exploration of neurotrophic support and immunomodulatory *** tolerance,paramount for graft acceptance,confronts the distinc-tive immunogenicity of ocular tissues,driving research into targeted immunosup-pression *** and legal considerations underscore the necessity for stringent standards and ethical *** collaboration and ongoing research endeavors are imperative to navigate these ***,stem cell therapies,and precision immunomodulation represent promising avenues in this ***,the aim of this review is to critically assess the current landscape of whole-eye transplantation,elucidating the challenges and advancements while delineating future directions for research and clinical *** concerted efforts,whole-eye transplantation stands to revolu-tionize ophthalmic care,offering hope for restored vision and enhanced quality of life for those afflicted with blindness.

关键词： Eye Transplantation Optic nerve Nerve regeneration Immunological tolerance

Clinical role of non-invasive assessment of portal hypertension

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World Journal of Gastroenterology 2017年第1期23卷 1-10页

作者： Massimo Bolognesi marco di Pascoli David Sacerdoti Department of Medicine University of PadovaI-35128 PadovaItaly

Measurement of portal pressure is pivotal in the evaluation of patients with liver cirrhosis. The measurement of the hepatic venous pressure gradient represents the reference method by which portal pressure is estimated. However, it is an invasive procedure that requires significant hospital resources, including experienced staff, and is associated with considerable cost. Non-invasive methods that can be reliably used to estimate the presence and the degree of portal hypertension are urgently needed in clinical practice. Biochemical and morphological parameters have been proposed for this purpose, but have shown disappointing results overall. Splanchnic Doppler ultrasonography and the analysis of microbubble contrast agent kinetics with contrast-enhanced ultrasonography have shown better accuracy for the evaluation of patients with portal hypertension. A key advancement in the non-invasive evaluation of portal hypertension has been the introduction in clinical practice of methods able to measure stiffness in the liver, as well as stiffness/congestion in the spleen. According to the data published to date, it appears to be possible to rule out clinically significant portal hypertension in patients with cirrhosis (i.e., hepatic venous pressure gradient ≥ 10 mmHg) with a level of clinically-acceptable accuracy by combining measurements of liver stiffness and spleen stiffness along with Doppler ultrasound evaluation. It is probable that the combination of these methods may also allow for the identification of patients with the most serious degree of portal hypertension, and ongoing research is helping to ensure progress in this field.

关键词： Portal hypertension Splenic stiffness Liver stiffness Splenic arterial resistance indices Sonography Doppler ultrasound Cirrhosis Transient elastography Esophageal varices

Evolutionary fingerprint, phylogenetic and forest structure of tropical montane Atlantic cloud forests along an elevation gradient

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Journal of Mountain Science 2024年第4期21卷 1259-1271页

作者： Ravi Fernandes MARIANO Vanessa Leite REZENDE Cléber Rodrigo de SOUZA Patrícia Vieira POMPEU Rubens Manoel dos SANTOS Carolina Njaime MENDES Aloysio Souza de MOURA Felipe Santana MACHADO Warley Augusto Caldas CARVALHO marco Aurélio Leite FONTES Department of Forest Sciences Federal University of LavrasLavras 37200-900Brazil 2Environmental Defence Association of Minas Gerais Belo Horizonte 30360-110Brazil Department of Ecology and Conservation Federal University of LavrasLavras 37200-900Brazil Department of Forest Sciences State University of Mato Grosso do SulAquidauana 79200-000Brazil Agência Zetta Federal University of LavrasLavras 37200-900Brazil. Department of Natural Sciences Federal University of São João del-ReiSão João del-Rei 36307-352Brazil.

Environmental conditions can change markedly over geographical distances along elevation gradients,making them natural laboratories to study the processes that structure *** work aimed to assess the influences of elevation on Tropical Montane Cloud Forest plant communities in the Brazilian Atlantic Forest,a historically neglected *** evaluated the phylogenetic structure,forest structure(tree basal area and tree density)and species richness along an elevation gradient,as well as the evolutionary fingerprints of elevation-success on phylogenetic lineages from the tree *** do so,we assessed nine communities along an elevation gradient from 1210 to 2310 m *** large elevation *** relationships between elevation and phylogenetic structure,forest structure and species richness were investigated through Linear *** occurrence of evolutionary fingerprint on phylogenetic lineages was investigated by quantifying the extent of phylogenetic signal of elevation-success using a genus-level molecular *** results showed decreased species richness at higher elevations and independence between forest structure,phylogenetic structure and *** also verified that there is a phylogenetic signal associated with elevation-success by *** concluded that the elevation is associated with species richness and the occurrence of phylogenetic lineages in the tree communities evaluated in Mantiqueira *** the other hand,elevation is not associated with forest structure or phylogenetic ***,closely related taxa tend to have their higher ecological success in similar ***,we highlight the fragility of the tropical montane cloud forests in the Mantiqueira Range in face of environmental changes(*** warming)due to the occurrence of exclusive phylogenetic lineages evolutionarily adapted to environmental conditions(*** temperature)associated with each elevation range.

关键词： Atlantic Forest Cloud forest Conservation Community ecology Montane forests Phylogenetic diversity Phylogenetic signal

Primary liver transplantation vs transplant after Kasai portoenterostomy in children with biliary atresia: A retrospective Brazilian single-center cohort

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World Journal of Transplantation 2024年第1期14卷 112-119页

作者： Melina Utz Melere Valberto Sanha marco Farina Carolina Soares da Silva Luiza Nader Cristine Trein Angelica Maria Lucchese Cristina Ferreira Antonio Nocchi Kalil Flavia Heinz Feier Department of Hepatology and Liver Transplantation Santa Casa de Porto AlegrePorto Alegre 90050170Brazil Department of Hepato-biliary-pancreatic Surgery and Liver Transplantation Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Brazil Department of Surgical Oncology Santa Rita Hospital/Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90050-170Rio Grande do SulBrazil

BACKGROUND Biliary atresia(BA)is the most common indication for pediatric liver transplantation,although portoenterostomy is usually performed ***,due to the high failure rate of portoenterostomy,liver transplantation has been advocated as the primary procedure for patients with *** is still unclear if a previous portoenterostomy has a negative impact on liver transplantation *** To investigate the effect of prior portoenterostomy in infants un-dergoing liver transplantation for *** This was a retrospective cohort study of 42 pediatric patients with BA who underwent primary liver transplantation from 2013 to 2023 at a single tertiary center in *** with BA were divided into two groups:Those undergoing primary liver transplantation without portoenterostomy and those undergoing liver transplantation with prior *** variables were compared using the Student’s t-test or the Kruskal-Wallis test,and categorical variables were compared using theχ2 or Fisher’s exact test,as *** Cox regression analysis was performed to determine risk factors for portal vein *** and graft survival analyses were conducted with the Kaplan–Meier product-limit estimator,and patient subgroups were compared using the two-sided log-rank *** Forty-two patients were included in the study(25[60%]girls),23 undergoing liver transplantation without prior portoenterostomy,and 19 undergoing liver transplantation with prior *** with prior portoenterostomy were older(12 vs 8 months;P=0.02)at the time of liver transplantation and had lower Pediatric End-Stage Liver disease scores(13.2 vs 21.4;P=0.01).The majority of the patients(35/42,83%)underwent livingdonor liver *** group of patients without prior portoenterostomy appeared to have a higher incidence of portal vein thrombosis(39 vs 11%),but this result did not reach statistical *** portoenterostomy

关键词： Hepatic portoenterostomy Biliary atresia Liver transplantation Patient outcome assessment Portal vein Survival

具有Ruddlesden-Popper结构的杂化非本征铁电体(Ca_(1-x)Sm_(x))_(3)Ti_(2)O_(7)陶瓷的制备及其物理性能

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天津师范大学学报（自然科学版） 2024年第2期44卷 19-25页

作者： marco Antonio López-Aguila 柳志旭王守宇黄聪刘卫芳天津大学理学院天津300350 天津师范大学物理与材料科学学院天津300387

为探究稀土离子掺杂对Ca_(3)Ti_(2)O_(7)物理性能的调控,采用固相反应法制备了Sm^(3+)掺杂的(Ca_(1-x)Sm_(x))_(3)Ti_(2)O_(7)(x=0,0.02,0.04)陶瓷样品,通过XRD、XPS、紫外-可见光吸收光谱以及第一性原理计算等方法对样品的晶体结构、... 详细信息

为探究稀土离子掺杂对Ca_(3)Ti_(2)O_(7)物理性能的调控,采用固相反应法制备了Sm^(3+)掺杂的(Ca_(1-x)Sm_(x))_(3)Ti_(2)O_(7)(x=0,0.02,0.04)陶瓷样品,通过XRD、XPS、紫外-可见光吸收光谱以及第一性原理计算等方法对样品的晶体结构、光学性能、电学性能和磁学性能进行分析.结果表明:随着Sm^(3+)含量的增加,(Ca_(1-x)Sm_(x))_(3)Ti_(2)O_(7)的晶胞参数逐渐增大.Sm^(3+)掺杂导致氧空位减少,因此样品的漏电流随着Sm^(3+)掺杂量的增加而减小.同时,随着Sm^(3+)掺杂量的增加,样品的光学带隙呈现增大趋势.此外,第一性原理研究表明,Sm^(3+)掺杂可在体系中诱导出磁性能,进一步丰富了该材料的物理性能.

关键词： (Ca_(1-x)Sm_(x))_(3)Ti_(2)O_(7)陶瓷铁电性氧空位光学带隙第一性原理

A Structured Method of Teaching Epidural Block reduces the incidence of accidental dural puncture in inexperienced trainees.

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Open Journal of Anesthesiology 2024年第4期14卷 131-135页

作者： marco Scorzoni Gianluigi Gonnella Emanuele Capogna Marina Campione Gaetano Draisci Matteo Velardo Giorgio Capogna Department of Anesthesiology Fondazione Policlinico Gemelli IRCCS Rome Italy Department of Economics and Law Enna Kore University Enna Italy European School of Obstetric Anesthesia Rome Italy

Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the construction of a 3D epidural module by trainees and practical training by using an epidural simulator with and without the CompuFlo™ Epidural instrument. In this study we report the retrospective analysis of the accidental dural puncture rate of inexperienced trainees during their 6 months clinical practice rotation in obstetrics before and after the introduction of the SETM in our Institution. Method: We evaluated the incidence of accidental dural puncture before the introduction of the SETM methodology and afterwards by analyzing our departmental database from February 2019 to January 2023. All epidural blocks were executed by trainees who had never previously performed an epidural block and were about to begin their obstetrics rotation. Results: We analyzed 7415 epidurals: 3703 were performed before the introduction of the SETM methodology (control group) and 3712 afterwards (study group). The incidence of accidental dural puncture was 0.37% for the control group and 0.13% for the study group (pdid not. Conclusions: After the introduction of the structured teaching method, we observed a significant reduction of accidental dural puncture during the training period. We hope that our observation will encourage a constructive discussion among experts about the need to use standardized and validated tools as a valuable aid in teaching epidural anesthesia.

关键词： teaching epidural Anesthesia obstetrical Anesthesia Anesthesia

Splanchnic vasodilation and hyperdynamic circulatory syndrome in cirrhosis

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World Journal of Gastroenterology 2014年第10期20卷 2555-2563页

作者： Massimo Bolognesi marco di Pascoli Alberto Verardo Angelo Gatta Department of Internal Medicine-diMED University of Padua Azienda Ospedaliera Università di Padova 35128 Padova Italy

Portal hypertension is a clinical syndrome which leads to several clinical complications, such as the formation and rupture of esophageal and/or gastric varices, ascites, hepatic encephalopathy and hepato-renal syndrome. In cirrhosis, the primary cause of the increase in portal pressure is the enhanced resistance to portal outflow. However, also an increase in splanchnic blood flow worsens and maintains portal hypertension. The vasodilatation of arterial splanchnic vessels and the opening of collateral circulation are the determinants of the increased splanchnic blood flow. Several vasoactive systems/substances, such as nitric oxide, cyclooxygenase-derivatives, carbon monoxide and endogenous cannabinoids are activated in portal hypertension and are responsible for the marked splanchnic vasodilatation. Moreover, an impaired reactivity to vasoconstrictor systems, such as the sympathetic nervous system, vasopressin, angiotensin II and endothelin-1, plays a role in this process. The opening of collateral circulation occurs through the reperfusion and dilatation of preexisting vessels, but also through the generation of new vessels. Splanchnic vasodilatation leads to the onset of the hyperdynamic circulatory syndrome, a syndrome which occurs in patients with portal hypertension and is characterized by increased cardiac output and heart rate, and decreased systemic vascular resistance with low arterial blood pressure. Understanding the pathophysiology of splanchnic vasodilatation and hyperdynamic circulatory syndrome is mandatory for the prevention and treatment of portal hypertension and its severe complications.

关键词： Portal hypertension Splanchnic flow Splenic circulation Nitric oxide Autonomic dysfunction Cirrhosis Hyperdynamic circulatory syndrome

Adherence to Pharmacotherapy in Post-Menopausal Women with Hypertension or Metabolic Syndrome: Real World Experience

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International Journal of Clinical Medicine 2024年第3期15卷 145-154页

作者： Maria Maiello Francesca Amati Vincenzo Ezio Santobuono Andrea Igoren Guaricci Cinzia Forleo marco Matteo Ciccone Pasquale Palmiero Department of Cardiology ASL BR SSN3 Brindisi Italy Cardiovascular diseases Section Interdisciplinary Department of Medicine (DIM) University of Bari “Aldo Moro” Bari Italy

Background: Adherence to medications is dependent upon a variety of factors, including individual characteristics of the patient, interactions with health care providers, and medication complexity. Even though several studies were conducted to test intervention strategies, results are uncertain. Aim: The aim of the study is to assess if a tailored combined intervention strategy improves medication adherence in a large population of post-menopausal women affected by hypertension or metabolic syndrome. Methods: We enrolled 6833 patients aged 50 to 69 years, 85.7% with hypertension, and 14.3% with metabolic syndrome. A network between patients, general practitioners, and cardiologists was established. Interventions included education, adequate information to patients, a simplified scheme of treatment, and periodic adherence assessment. These were either delivered as healthcare provider supports or using modern technology. Medication adherence was estimated by the proportion of days covered for all classes of drugs after the index date. Results: Non-adherent hypertensive women were 297 (5%), and those with metabolic syndrome were 73 (7.4%) (p Conclusions: The rate of non-adherence in both settings of postmenopausal women was 7.7%, much lower than that described in the literature. This rate was increased in patients with metabolic syndrome;probably it is related to the complexity of the therapeutic scheme or to a poor consciousness of the disease. Therefore, implementing a tailored combined intervention can improve significantly patients’ adherence to medical therapy.

关键词： Adherence Cardiovascular Prevention Postmenopausal Women Hypertensive Metabolic Syndrome