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severe liver trauma with complex portal and common bile duct avulsion:A case report and review of the literature

World Journal of Clinical Cases 2023年第16期11卷 3837-3846页

作者： Bianca Mitricof Alin Kraft Florentina Anton Alexandru Barcu Darina Barzan Carmen Haiducu Vladislav Brasoveanu Irinel Popescu Cosmin Alec Moldovan Florin Botea Medicine Doctoral School Titu Maiorescu University of BucharestBucharest 040441Romania Department of General Surgery Regina Maria Military Emergency HospitalBrasov 500007Romania Faculty of Medicine Carol Davila University of Medicine and PharmacyBucharest 050474Romania Dan Setlacec Center for General Surgery and Liver Transplant Fundeni Clinical InstituteBucharest 022328Romania Department of Medical-Surgical and Prophylactic Disciplines Faculty of MedicineTitu Maiorescu University of BucharestBucharest 031593Romania Department of General Surgery Witting Clinical HospitalBucharest 010243Romania

BACKGROUND Given its size and location,the liver is the third most injured organ by abdominal trauma.Thanks to recent advances,it is unanimously accepted that the nonoperative management is the current mainstay of treatment for hemodynamically stable patients.However,those patients with hemodynamic instability that generally present with severe liver trauma associated with major vascular lesions will require surgical management.Moreover,an associated injury of the main bile ducts makes surgery compulsory even in the case of hemodynamic stability,thereby imposing therapeutic challenges in the tertiary referral hepato-biliopancreatic centers’setting.CASE SUMMARY We present the case of a 38-year-old male patient with The American Association for the Surgery of Trauma grade V liver injury and an associated right branch of portal vein and common bile duct avulsion,due to a crush polytrauma.The patient was referred to the nearest emergency hospital and because of the hemorrhagic shock,damage control surgery was performed by means of ligation of the right portal vein branch and right hepatic artery,and hemostatic packing.Afterwards,the patient was referred immediately to our tertiary hepato-bilio-pancreatic center.We performed depacking,a right hepatectomy and Roux-en-Y hepaticojejunostomy.On the 9th postoperative day,the patient developed a high output anastomotic bile leak that required a redo of the cholangiojejunostomy.The postoperative period was marked by a surgical incision site of incomplete evisceration that was managed non-operatively by negative wound pressure.The follow-up was optimal,with no complications at 55 mo.CONCLUSION In conclusion,the current case clearly supports that a favorable outcome in severe liver trauma with associated vascular and biliary injuries is achieved thru proper therapeutic management,conducted in a tertiary referral hepato-bilio-pancreatic center,where a stepwise and complex surgical approach is mandatory.

关键词： severe Liver Trauma Avulsion Right portal vein Common bile duct Case report

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Liver chemistries in severe or non-severe cases of COVID-19:A systematic review and meta-analysis

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World Journal of Hepatology 2022年第12期14卷 2012-2024页

作者： Xuan Dong Dan-Yi Zeng Qing-Qing Xing Mei-Zhu Hong Jin-Shui Pan Department of Hepatology The First Affiliated Hospital of Fujian Medical UniversityFuzhou 350005Fujian ProvinceChina Department of Traditional Chinese Medicine Mengchao Hepatobiliary Hospital of Fujian Medical UniversityFuzhou 350005Fujian ProvinceChina

BACKGROUND Coronavirus disease(COVID-19)patients exhibit different patterns of liver impairment,according to growing evidence.AIM In this study,we sought to provide a comprehensive analysis of liver test parameters in patients with severe and non-severe COVID-19.METHODS We performed a meta-analysis of published liver manifestations and described the liver damage in COVID-19.We searched PubMed,Google Scholar,Embase,Cochrane Library,medRxiv,bioRxiv,and three Chinese electronic databases through April 18,2020,in accordance with the Preferred Reporting Items for Meta-Analyses.We analyzed pooled data on liver chemistries stratified by COVID-19 severity using a fixed or random-effects model.RESULTS A meta-analysis of 56 studies,including 11052 patients,found that the pooled mean alanine aminotransferase(ALT)in severe COVID-19 cases was 35.9 IU/L whereas in non-severe COVID-19 cases was 27.3 IU/L.Average aspa-rtate aminotransferase(AST)levels were 44.3 IU/L in severe cases compared to 27.9 IU/L in non-severe cases.In addition,AST levels are often higher than ALT levels regardless of disease severity.The severe cases tended to have a higher gammaglutamyltransferase level but a lower albumin level than the non-severe cases.CONCLUSION severe COVID-19 was more likely to be associated with abnormal liver test results.Monitoring liver chemistry closely can help detect disease progression early.

关键词： Systematic reviews and Meta-Analyses COVID-19 SARS-CoV-2 Meta-analysis Liver chemistries severe

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severe acute respiratory syndrome coronavirus protein 6 mediates ubiquitin-dependent proteosomal degradation of N-Myc(and STAT) interactor

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Virologica Sinica 2015年第2期30卷 153-161页

作者： Weijia Cheng Shiyou Chen Ruiling Li Yu Chen Min Wang Deyin Guo School of Basic Medical Sciences Wuhan University College of Life Sciences Wuhan University

severe acute respiratory syndrome coronavirus(SARS-Co V) encodes eight accessory proteins, the functions of which are not yet fully understood. SARS-Co V protein 6(P6) is one of the previously studied accessory proteins that have been documented to enhance viral replication and suppress host interferon(IFN) signaling pathways. Through yeast two-hybrid screening, we identified eight potential cellular P6-interacting proteins from a human spleen c DNA library. For further investigation, we targeted the IFN signaling pathway-mediating protein, N-Myc(and STAT) interactor(Nmi). Its interaction with P6 was confirmed within cells. The results showed that P6 can promote the ubiquitin-dependent proteosomal degradation of Nmi. This study revealed a new mechanism of SARS-Co V P6 in limiting the IFN signaling to promote SARS-Co V survival in host cells.

关键词： severe acute respiratory syndrome coronavirus(SARS-Co V) P6 N-Myc(and STAT) interactor(Nmi) interferon(IFN) signaling pathway ubiquitination proteosomal degradation

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Abdominal paracentesis drainage ameliorates severe acute pancreatitis in rats by regulating the polarization of peritoneal macrophages

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World Journal of Gastroenterology 2018年第45期24卷 5131-5143页

作者： Ruo-Hong Liu Yi Wen Hong-Yu Sun Chun-Yu Liu Yu-Fan Zhang Yi Yang Qi-Lin Huang Jia-Jia Tang Can-Chen Huang Li-Jun Tang PLA Center of General Surgery and Pancreatic Injury and Repair Key Laboratory of Sichuan Province Chengdu Military General HospitalChengdu 610083Sichuan ProvinceChina Third Military Medical University(Army Medical University) Chongqing 400037China Jiaotong Hospital Affiliated with the Sichuan Provincial People’s Hospital Chengdu 611730Sichuan ProvinceChina Department of Ultrasound Chinese Academy of Medical Sciences and Peking Union Medical College HospitalBeijing 100032China

AIM To investigate the role of peritoneal macrophage(PM) polarization in the therapeutic effect of abdominal paracentesis drainage(APD) on severe acute pancreatitis(SAP).METHODS SAP was induced by 5% Na-taurocholate retrograde injection in Sprague-Dawley rats. APD was performed by inserting a drainage tube with a vacuum ball into the lower right abdomen of the rats immediately after the induction of SAP. To verify the effect of APD on macrophages, PMs were isolated and cultured in an environment, with the peritoneal inflammatory environment simulated by the addition of peritoneal lavage in complete RPMI 1640 medium. Hematoxylin and eosin staining was performed. The levels of pancreatitis biomarkers amylase and lipase as well as the levels of inflammatory mediators in the blood and peritoneal lavage were determined. The polarization phenotypes of the PMs were identified by detecting the marker expression of M1/M2 macrophages via flow cytometry, qPCR and immunohistochemical staining. The protein expression in macrophages that had infiltrated the pancreas was determined by Western blot.RESULTS APD treatment significantly reduced the histopathological scores and levels of amylase, lipase, tumor necrosis factor-α and interleukin(IL)-1β, indicating that APD ameliorates the severity of SAP. Importantly, we found that APD treatment polarized PMs towards the M2 phenotype, as evidenced by the reduced number of M1 macrophages and the reduced levels of proinflammatory mediators, such as IL-1β and L-selectin, as well as the increased number of M2 macrophages and increased levels of anti-inflammatory mediators, such as IL-4 and IL-10. Furthermore, in an in vitro study wherein peritoneal lavage from the APD group was added to the cultured PMs to simulate the peritoneal inflammatory environment, PMs also exhibited a dominant M2 phenotype, resulting in a significantly lower level of inflammation. Finally, APD treatment increased the proportion of M2 macrophages and upregulated the expression of the anti-inflammatory protein Arg-1

关键词： Abdominal paracentesis drainage Peritoneal macrophages Polarization severe acute pancreatitis

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Risk factors for progression to acute-on-chronic liver failure during severe acute exacerbation of chronic hepatitis B virus infection

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World Journal of Gastroenterology 2019年第19期25卷 2327-2337页

作者： Ling Yuan Bai-Mei Zeng Lu-Lu Liu Yi Ren Yan-Qing Yang Jun Chu Ying Li Fang-Wan Yang Yi-Huai He Shi-De Lin Department of Infectious Diseases Affiliated Hospital of Zunyi Medical University Department of Gastroenterology Jiangsu Province Hospital Pukou Branch Department of Respiratory Medicine the Fifth People’s Hospital of Chongqing

BACKGROUND Acute exacerbation in patients with chronic hepatitis B virus(HBV) infection results in different severities of liver injury. The risk factors related to progression to hepatic decompensation(HD) and acute-on-chronic liver failure(ACLF) in patients with severe acute exacerbation(SAE) of chronic HBV infection remain unknown.AIM To identify risk factors related to progression to HD and ACLF in compensated patients with SAE of chronic HBV infection.METHODS The baseline characteristics of 164 patients with SAE of chronic HBV infection were retrospectively reviewed. Independent risk factors associated with progression to HD and ACLF were identified. The predictive values of our previously established prediction model in patients with acute exacerbation(AE model) and the model for end-stage liver disease(MELD) score in predicting the development of ACLF were evaluated.RESULTS Among 164 patients with SAE, 83(50.6%) had compensated liver cirrhosis(LC),43 had progression to HD without ACLF, and 29 had progression to ACLF within 28 d after admission. Independent risk factors associated with progression to HD were LC and low alanine aminotransferase. Independent risk factors for progression to ACLF were LC, high MELD score, high aspartate aminotransferase(AST) levels, and low prothrombin activity(PTA). The area under the receiver operating characteristic of the AE model [0.844, 95%confidence interval(CI): 0.779-0.896] was significantly higher than that of MELD score(0.690, 95%CI: 0.613-0.760, P < 0.05) in predicting the development of ACLF.CONCLUSION In patients with SAE of chronic HBV infection, LC is an independent risk factor for progression to both HD and ACLF. High MELD score, high AST, and low PTA are associated with progression to ACLF. The AE model is a better predictor of ACLF development in patients with SAE than MELD score.

关键词： Acute-on-chronic liver failure Chronic hepatitis B Hepatic decompensation Liver cirrhosis Risk factors severe acute exacerbation

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severe congenital hemolytic anemia caused by a novel compound heterozygous PKLR gene mutation in a Chinese boy

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Chinese Medical Journal 2019年第1期132卷 92-95页

作者： Peng-Peng Liu Hu-Qing Ding Shen-Zhen Huang Sheng-Yong Yang Ting Liu Department of Hematology Hematologic Research LaboratoryWest China Hospital of Sichuan University.ChengduSichuan 610041China Sichuan Hua Xi Kindstar Medical Diagnostic Centre ChengduSichuan 610000China State Key Laboratory of Cancer Biotherapy Sichuan UniversityChengduSichuan 610041China

To the Editor:Congenital hemolytic anemia (CHA) can be caused by the defect of any component in red blood cell (RBC),including hemoglobinopathies,membrane and cytoskeleton defects,and metabolic enzymopathies etc.And it is characterized by early present normocytic/macrocytic anemia,reticulocytosis,and elevated unconju-gated bilirubin.

关键词： Chinese boy PKLR gene mutation severe congenital hemolytic anemia

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Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study

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World Journal of Pediatrics 2020年第3期16卷 251-259页

作者： Dan Sun Hui Li Xiao-Xia Lu Han Xiao Jie Ren Fu-Rong Zhang Zhi-Sheng Liu Department of Neurology Wuhan Children's HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430015China Department of Hematology Wuhan Children's HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430015China Department of Intensive Care Unit Wuhan Children's HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430015China Department of Respiratory Wuhan Children's HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan 430015China Institute of Maternal and Child Health Wuhan Children's HospitalTongji Medical CollegeHuazhong University and TechnologyWuhan 430015China

Background An outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was first detected in Wuhan,Hubei,China.People of all ages are susceptible to SARS-CoV-2 infection.No information on severe pediatric patients with COVID-19 has been reported.We aimed to describe the clinical features of severe pediatric patients with COVID-19.Methods We included eight severe or critically ill patients with COVID-19 who were treated at the Intensive Care Unit (ICU),Wuhan Children's Hospital from January 24 to February 24.We collected information including demographic data,symptoms,imaging data,laboratory findings,treatments and clinical outcomes of the patients with severe COVID-19.Results The onset age of the eight patients ranged from 2 months to 15 years;six were boys.The most common symptoms were polypnea (8/8),followed by fever (6/8) and cough (6/8).Chest imaging showed multiple patch-like shadows in seven patients and ground-glass opacity in six.Laboratory findings revealed normal or increased whole blood counts (7/8),increased C-reactive protein,procalcitonin and lactate dehydrogenase (6/8),and abnormal liver function (4/8).Other findings included decreased CD16 + CD56 (4/8) and Th/Ts*(1/8),increased CD3 (2/8),CD4 (4/8) and CD8 (1/8),IL-6 (2/8),IL-10 (5/8) and IFN-γ (2/8).Treatment modalities were focused on symptomatic and respiratory support.Two critically ill patients underwent invasive mechanical ventilation.Up to February 24,2020,three patients remained under treatment in ICU,the other five recovered and were discharged home.Conclusions In this series of severe pediatric patients in Wuhan,polypnea was the most common symptom,followed by fever and cough.Common imaging changes included multiple patch-like shadows and ground-glass opacity;and a cytokine storm was found in these patients,which appeared more serious in critically ill patients.

关键词： Children COVID-19 Novel coronavirus 2019-nCoV severe Critical ill Wuhan

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LAMC1, LAMA2 and LAMA3 gene polymorphisms and the risk for severe pelvic organ prolapse

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Science Bulletin 2019年第7期64卷 466-468页

作者： Lei Li Jia Kang Ye Zhang Meng Mao Yuxiang Yang Jinghe Lang Zhijing Sun Juan Chen Lan Zhu Department of Obstetrics and Gynecology Peking Union Medical College Hospital Chinese Academy of Medical Sciences & Peking Union Medical College

Pelvic organ prolapse (POP) is the descent of the pelvic organs,including bladder, uterus, vagina and rectum, resulting in pelvic discomfort, urinary and fecal incontinence and sexual dysfunction(1)The prevalence of symptomatic POP in China is 9.56%according to a cross-sectional study involving 54,000 adult women in six provinces in the mainland of China (unpublished data). The etiology of this disorder is multifactorial, including race, age, body mass index(BMI), parity and menopause (1)The loss of the integrity of vaginal connective tissue has been demonstrated to weaken the pelvic floor support and promote the development of POP.

关键词： POP LAMA2 and LAMA3 gene polymorphisms and the risk for severe pelvic organ prolapse LAMC1

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Determination of mechanical properties of pure zirconium processed by surface severe plastic deformation through nanoindentation

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Rare Metals 2019年第9期38卷 824-831页

作者： Yao-Mian Wang Wei Zhuang Huan-Ping Yang Cong-Hui Zhang School of Metallurgical Engineering Xi’an University of Architecture and Technology

Commercially pure zirconium was processed by the surface mechanical attrition treatment(SMAT),and the microstructure observation showed that a gradient structure was induced.Nanoindentation measurements were taken to obtain the load-displacement curves at different depths below the treated surface.Using dimensional analysis,the local yield stress,hardness,strain hardening exponent,and elastic modulus at the corresponding depths were derived.The results showed that the yield stress and hardness varied with depth,while the strain hardening exponent and elastic modulus were approximately invariable.The finite element method was used to simulate nanoindentation at different depths below the treated surface to verify the derivation of the local elastic-plastic constitutive relationship.Stressstrain curves were computed for the treated samples through the rule of mixtures,and they agreed well with the experimental results.The analysis showed that the surface and subsurface hardening layers as well as the transition layer shared a high load applied to the samples,even though their volume fraction was small.

关键词： Mechanical property severe plastic deformation Gradient microstructure Nanoindentation Finite element method

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Long-term outcomes after fractional flow reserve-guided percutaneous coronary intervention in patients with severe coronary stenosis

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Journal of Geriatric Cardiology 2019年第4期16卷 329-337页

作者： Ying-Hua ZHANG Jing LI Andreas J. Flammer Yoshiki Matsuo Moo-Sik Lee Ryan J. Lennon Malcolm R. Bell David R. Holmes John F. Bresnahan Charanjit S. Rihal Lilach O. Lerman Amir Lerman Division of Cardiology Xuanwu Hospital Capital Medical UniversityBeijingChina Division of Cardiovascular Diseases Mayo ClinicRochesterUSA Cardiovascular Center CardiologyUniversity Hospital ZurichSwitzerland Department of Preventive Medicine College of Medicine Konyang UniversityDaejeonSouth Korea Biomedical Statistics Mayo ClinicRochesterUSA Division of Nephrology and Hypertension Mayo ClinicRochesterUSA

Objective To explore the safety and efficacy of FFR-guided percutaneous coronary intervention (PCI) in vessels with severe diameter stenosis. Methods & Results Of 1090 patients undergoing fractional flow reserve (FFR) assessment from 2002 to 2009,we identified 167 patients in whom FFR was measured in at least one 70%–89% stenotic lesion. These patients were subdivided into an FFR-defer group (n = 49) if PCI was deferred (FFR > 0.80),and an FFR-perform group (n = 118) if PCI was performed (FFR ≤ 0.80). Comparatively,an additional 1176 patients undergoing PCI in at least one lesion with 70%–89% stenosis but without measurement of FFR served as a control (angiography- guided) group. Clinical outcomes were compared during a median follow-up of 49.0 months. The 5-year Kaplan-Meier estimated revascularization rates were 16% in the FFR-defer group and 33% in the FFR-perform group (P = 0.046). The incidence of major adverse cardiac events were comparable in these two groups (HR = 0.82,95% CI: 0.37–1.82,P = 0.63). The number of stents placed was significantly lower in the FFR-guided group (0.9 ± 0.8 vs. 1.4 ± 0.8,P severe stenosis is clinically safe and associated with fewer stents use. This study suggests that extending the use of FFR to more severe coronary lesions may be reasonable.

关键词： Fractional flow reserve Outcome Percutaneous coronary intervention severe stenosis Stent

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