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clinical course and Outcome Patterns of Acute-on-chronic Liver Failure:A Multicenter Retrospective Cohort Study

Journal of clinical and Translational Hepatology 2021年第5期9卷 626-634页

作者： Man-Man Xu Ming Kong Peng-Fei Yu Ying-Ying Cao Fang Liu Bing Zhu Yi-Zhi Zhang Wang Lu Huai-Bin Zou Bin-Wei Duan Shao-Li You Shao-Jie Xin Tao Han Zhong-Ping Duan Yu Chen Fourth Department of Liver Disease(Difficult&Complicated Liver Diseases and Artificial Liver Center) Beijing You’an Hospital Affiliated to Capital Medical UniversityBeijingChina Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research BeijingChina Department of Hepatology The Third Central Clinical College of Tianjin Medical UniversityTianjinChina Liver Failure Treatment and Research Center The Fifth Medical Center of Chinese PLA General HospitalBeijingChina Department of General Surgery Beijing You’an Hospital Affiliated to Capital Medical UniversityBeijingChina

Background and Aims:Acute-on-chronic liver failure(ACLF)is acute decompensation of liver function in the setting of chronic liver disease,and characterized by high short-term *** this study,we sought to investigate the clinical course of patients at specific time points,and to propose dynamic prognostic ***:We assessed the clinical course of 453 patients with ACLF during a 12-week follow-up period in this retrospective multicenter *** clinical course of patients was defined as disease recovery,improvement,worsening or steady patterns based on the variation tendency in prothrombin activity(PTA)and total bilirubin(TB)at different time ***:Resolution of PTA was observed in 231 patients(51%)at 12 weeks after the diagnosis of *** the remaining patients,66(14.6%)showed improvement and 156(34.4%)showed a steady or worsening *** patients with resolved PTA,the clinical course of TB exhibited resolved pattern in 95.2%,improved in 3.9%,and steady or worse in 0.8%.Correspondingly,in patients with improved PTA,these values for TB were 28.8%,27.3%,and 43.9%,*** patients with steady or worsening PTA,these values for TB were 5.7%,32.3%,and 65.6%,*** prognostic criteria were developed by combining the clinical course of PTA/TB and the clinical outcomes at 4 and 12 weeks after diagnosis in ACLF ***:We propose the following dynamic prognostic criteria:rapid progression,slow progression,rapid recovery,slow recovery,and slow persistence,which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy.

关键词： Acute-on-chronic liver failure clinical course Outcome patterns Retrospective cohort study

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clinical course of Lung Cancer Patients with Subcutaneously Implanted Central Venous Access Device Ports from the Time of Receiving Chemotherapy to the Endpoint of Cancer

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Journal of Cancer Therapy 2016年第7期7卷 519-529页

作者： Tomonori Hirashima Teppei Tsumori Kenichi Sakai Makoto Fujishima Yukie Yamakawa Noriko Ryouta Masumi Sandoh Takayuki Shiroyama Motohiro Tamiya Naoko Morishita Hidekazu Suzuki Norio Okamoto Sho Goya Hironori Shigeoka Departments of Thoracic Malignancy Osaka Prefectural Medical Center for Respiratory and Allergic Diseases Osaka Japan Departments of Palliative Medicine Osaka Prefectural Medical Center for Respiratory and Allergic Diseases Osaka Japan Tsumori Clinic Osaka Japan Departments of Gastroenterological and Breast Surgery Osaka Prefectural Medical Center for Respiratory and Allergic Diseases Osaka Japan Departments of Nursing Osaka Prefectural Medical Center for Respiratory and Allergic Diseases Osaka Japan Departments of Pharmacy Osaka Prefectural Medical Center for Respiratory and Allergic Diseases Osaka Japan

Background: As the prognosis of lung cancer (LC) patients improves, subcutaneously implanted central venous access device ports (CV-ports) have frequently been used for continuing chemotherapy (CC) or palliative care (PC). In this study, we examined the clinical course of LC patients with subcutaneously implanted CV-ports from the time of receiving chemotherapy to the endpoint of cancer. Materials and Methods: We retrospectively reviewed the clinical data and treatment history of LC patients with subcutaneously implanted CV-ports between June 2008 and November 2013 using clinical records and a pharmacy database. Results: Of the 132 LC patients with subcutaneously implanted CV-ports, 79 (59.8%) had CV-ports for CC (the CC group) and 53 (40.2%) had CV-ports for PC (the PC group). After CV-port implantation, LC patients in the CC group received a median of two regimens with a median of 6 cycles. The median survival time of patients in the CC and PC groups was 457 and 44 days, respectively. In the CC group, the median survival time of small cell and non-small cell LC patients was 342 (95% confidence interval, 235 - 627) and 563 (95% confidence interval, 368 - 728) days, respectively. Nine patients (6.8%) had their CV-ports removed due to complications. Forty (30.3%) of the 132 enrolled patients were referred for at-home PC. The at-home death rate observed among these 40 patients was 30.0% (N = 12). Conclusion: CV-ports may contribute to seamless oncological care.

关键词： clinical course At-Home Death Rate Implanted Central Venous Access Device Port Lung Cancer Seamless Oncological Care

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clinical presentation and outcomes of chronic dialysis patients with COVID-19:A single center experience from Greece

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World Journal of Nephrology 2022年第2期11卷 58-72页

作者： Dimitra Bacharaki Minas Karagiannis Aggeliki Sardeli Panagiotis Giannakopoulos Nikolaos Renatos Tziolos Vasiliki Zoi Nikitas Piliouras Nikolaos-Achilleas Arkoudis Nikolaos Oikonomopoulos Kimon Tzannis Dimitra Kavatha Anastasia Antoniadou Demetrios Vlahakos Sophia Lionaki Nephrology Unit Department of Internal Medicine"Attikon"University HospitalChaidari 12462Greece Medical School National and Kapodistrian University of AthensAthens 15772Greece Department of Internal Medicine "Attikon"University HospitalChaidari 12462Greece Department of Radiology "Attikon"University HospitalChaidari 12462Greece

BACKGROUND Coronavirus disease 2019(COVID-19)is still a menacing pandemic,especially in vulnerable *** and mortality from COVID-19 in maintenance hemodialysis(MHD)patients are considered worse than those in the general population,but vary across continents and countries in *** To describe the clinical course and outcomes of hospitalized MHD patients with COVID-19 in a retrospective observational single center study in *** We correlated clinical,laboratory,and radiological data with the clinical outcomes of MHD patients hospitalized with COVID-19 during the *** diagnosis was confirmed by real-time polymerase chain *** was determined as survivors vs non-survivors and“progressors”(those requiring oxygen supplementation because of COVID-19 pneumonia worsening)vs“non-progressors”.RESULTS We studied 32 patients(17 males),with a median age of 75.5(IQR:58.5-82)years *** those,12 were diagnosed upon screening and 20 with related *** to the World Health Organization(WHO)score,the severity on admission was mild disease in 16,moderate in 13,and severe in 3 *** computed tomography(CT)showed 1-10%infiltrates in 24 ***“progressors”were recorded among included *** case fatality rate was 5/32(15.6%).Three deaths occurred among“progressors”and two in“non-progressors”,irrespective of co-morbidities and *** of mortality on admission included frailty index,chest CT findings,WHO severity score,and thereafter the increasing values of serum LDH and D-dimers and decreasing serum *** of becoming a“progressor”included increasing number of neutrophils and neutrophils/lymphocytes *** Patients on MHD seem to be at higher risk of COVID-19 mortality,distinct from the general *** laboratory parameters on admission and during follow-up may be helpful in risk stratification and management of patients.

关键词： COVID-19 SARS-CoV-2 Dialysis Greece clinical course Outcome

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Enlarged pancreas: not always a cancer

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Hepatobiliary & Pancreatic Diseases International 2015年第1期14卷 107-108页

作者： Lucia Calculli Davide Festi Raffaele Pezzilli Departments of Radiology Sant'Orsola-Malpighi Hospital Digestive Diseases Sant'Orsola-Malpighi Hospital Internal Medicine Sant'Orsola-Malpighi Hospital

Pancreatic fat accumulation has been described with various terms including pancreatic lipomatosis, pancreatic steatosis, fatty replacement, fatty infiltration, fatty pancreas, lipomatous pseudohypertrophy and nonalcoholic fatty pancreas disease. It has been reported to be associated with type 2 diabetes mellitus, acute pancreatitis, pancreatic cancer and the formation of pancreatic fistula. The real incidence of this condition is still unknown. We report a case of pancreatic steatosis in a non-obese female patient initially diagnosed with a mass in the head of the pancreas. Magnetic resonance imaging（MRI） was carried out to define the characteristics of the pancreatic mass. MRI confirmed the diagnosis of fat pancreas. Enlarged pancreas is not always a cancer, but pancreatic steatosis is characterized by pancreatic enlargement. MRI could give a definite diagnosis of pancreatic steatosis or cancer.

关键词： pancreatic steatosis magnetic resonance image computer tomography IgG4 differential diagnosis clinical course

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Nontumoral Portal Vein Thrombosis:A Challenging Consequence of Liver Cirrhosis

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Journal of clinical and Translational Hepatology 2020年第4期8卷 432-444页

作者： Manus Rugivarodom Phunchai Charatcharoenwitthaya Division of Gastroenterology Department of MedicineFaculty of MedicineSiriraj HospitalMahidol UniversityBangkokThailand

Nontumoral portal vein thrombosis (PVT) is an increasingly recognized complication in patients with cirrhosis. Substantial evidence shows that portal flow stasis, complex thrombophilic disorders, and exogenous factors leading to endothelial dys-function have emerged as key factors in the pathogenesis of PVT. The contribution of PVT to hepatic decompensation and mortality in cirrhosis is debatable;however, the presence of an advanced PVT increases operative complexity and decreases survival after transplantation. The therapeutic decision for PVT is often determined by the duration and extent of thrombosis, the presence of symptoms, and liver transplant eligibility. Evidence from several cohorts has demonstrated that anti-coagulation treatment with vitamin K antagonist or low mo-lecular weight heparin can achieve recanalization of the portal vein, which is associated with a reduction in portal hyper-tension-related events and improved survival in cirrhotic patients with PVT. Consequently, interest in direct oral anti-coagulants for PVT is increasing, but clinical data in cirrhosis are limited. Although the most feared consequence of anti-coagulation is bleeding, most studies indicate that anticoagu-lation therapy for PVT in cirrhosis appears relatively safe. Interestingly, the data showed that transjugular intrahepatic portosystemic shunt represents an effective adjunctive ther-apy for PVT in cirrhotic patients with symptomatic portal hypertension if anticoagulation is ineffective. Insufficient evi-dence regarding the optimal timing, modality, and duration of therapy makes nontumoral PVT a challenging consequence of cirrhosis. In this review, we summarize the current literature and provide a potential algorithm for the management of PVT in patients with cirrhosis.

关键词： Portal vein thrombosis Liver cirrhosis clinical course Anticoagulation Transjugular intrahepatic portosystemic shunt

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Risk factors and prognostic value of acute severe lower gastrointestinal bleeding in Crohn’s disease

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World Journal of Gastroenterology 2021年第19期27卷 2353-2365页

作者： Jiyoung Yoon Dae Sung Kim Ye-Jee Kim Jin Wook Lee Seung Wook Hong Ha Won Hwang Sung Wook Hwang Sang Hyoung Park Dong-Hoon Yang Byong Duk Ye Jeong-Sik Byeon Seung-Jae Myung Suk-Kyun Yang Department of Gastroenterology Asan Medical CenterUniversity of Ulsan College of MedicineSeoul 05505South Korea Department of clinical Epidemiology and Biostatistics Asan Medical CenterUniversity of Ulsan College of MedicineSeoul 05505South Korea

BACKGROUND Acute severe lower gastrointestinal bleeding(LGIB)is an uncommon but challenging complication of Crohn’s disease(CD).AIM To identify the predictors of acute severe LGIB and to evaluate the impact of acute severe LGIB on the subsequent clinical course in CD *** A retrospective inception cohort study was conducted in 75 CD patients with acute severe LGIB and 1359 CD patients without acute severe LGIB who were diagnosed between February 1991 and November 2019 at Asan Medical Center,a tertiary university hospital in *** analysis with Cox proportional hazard regression was performed to identify the risk factors for acute severe LGIB.A matched analysis using 72 patients with bleeding and 267 matched patients without within the cohort was also conducted to investigate whether acute severe LGIB is a predictor of clinical outcomes of *** Multivariable Cox regression analysis revealed that early use of thiopurines[hazard ratio(HR):0.23,95%confidence interval(CI):0.12-0.48;P<0.001]and female sex(HR:0.51,95%CI:0.27-0.94;P=0.031)were significantly associated with a lower risk of acute severe *** cumulative risks of behavioral progression and intestinal resection were not significantly different between the two matched groups(P=0.139 and P=0.769,respectively).The hospitalization rate was higher in the bleeding group than in the matched non-bleeding group(22.1/100 vs 13.2/100 patient-years;P=0.012).However,if hospitalizations due to bleeding episodes were excluded from the analysis,the hospitalization rate was not significantly different between the bleeding group and the matched nonbleeding group(14.5/100 vs 13.2/100 patient-years;P=0.631).CONCLUSION Early use of thiopurines may reduce the risk of acute severe *** of acute severe LGIB may not have a significant prognostic value in patients with CD.

关键词： Gastrointestinal hemorrhage Lower gastrointestinal tract Crohn’s disease Risk factors Cohort studies clinical course

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clinical Observation and Proposed Classification of Vitiliginous Patches by a Wood’s Lamp

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Journal of Cosmetics, Dermatological Sciences and Applications 2020年第4期10卷 204-211页

作者： Yuka Kimura Atsushi Tanemura Yukiho Kurosaki Madoka Takafuji Kazunori Yokoi Eiji Kiyohara Noriko Arase Manabu Fujimoto Department of Dermatology Osaka University Graduate School of Medicine Suita Japan

Although vitiligo lesion especially in static state is characterized as sharply demarcated and complete depigmented macule, we encounter patients who have various manners of hypopigmented lesions. We examined the 81 lesions using the newly released Wood’s lamp (Woody®) and investigated whether or not vitiliginous lesions could be uniformly classified under Wood’s lamp illumination and also this classification helped to estimate the tendency of repigmentation after treatment. As result, the vitiliginous lesions were categorized into 4 types on intra- and peri-lesions prior to treatment by using the Wood’s lamp. The inside and border of the lesions were classified as follows: clear white, faint, multi-dot, and perifollicular for the inside, and sharp, blunt, confetti, and trichrome for the border. Suggestive residual pigmentation was detected in 73.6% of patients at the first visit and repigmentation was observed in 67.9% of patients at least 3 months after treatment. Lesions with the “clear white” inside pattern showed significantly lower repigmentation frequency in 38.5% of patients compared to others. The borders with 4 enlarged lesions were composed of 3 of confetti-type and one of sharp-type. This preliminary study demonstrated that detailed observation with a Wood’s lamp could be the basis to classify vitiliginous lesions and might be useful for predicting not only disease progression but also repigmentation prior to treatment.

关键词： Vitiligo Wood’s Lamp Classification Repigmentation clinical course

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clinical Characteristics and Treatment for Patients with Occult Chronic Hepatitis B

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国际感染病学（电子版） 2013年第1期2卷 25-28页

作者： Qing-wei Gao De-sheng Yuan Dalian Sixth People’s Hospital

Objective To observe the clinical manifestations and assess direct antiviral effect for patients with occult hepatitis B in *** The study includes 15 patients with occult hepatitis B and their medical history,family history,firstdiagnosis time,confirmed-diagnosis time,laboratory report,anti-viral therapy and outcomes were *** The average age of the patients is 38.67-year old(6 males and 9 females),2 with acute hepatitis B(2/15,13.3%),13 with no hepatitis history(13/15,86.6%),8 with family history(8/15,53.3%),6 with no family history(6/15,40%),1 with unknown family history(1/15,6.6%).Eight patients were treated with entecavir(0.5 mg/day,taken orally),with effective results and steady conditions;3 patients were treated with lamivudine(0.1 g/day,taken orally),2 of them were prescribed to take adefovir dipivoxil additionally due to drug-resistance,the other one was treated with lamivudine continuously without drug-resistance;4 cases refused anti-viral *** patient’s condition remained steady,1 patient died of cirrhosis with portal hypertension and liver failure 5 years after firstdiagnosis,1 patient progressed to hepatocellular carcinoma and accepted surgery operation treatment 5 years after first-diagnosis,the other 1 patient progressed to compensatory cirrhosis 2 years after first-diagnosis and is steady from then,which indicates that occult chronic hepatitis B can progress to cirrhosis and hepatocellular carcinoma without therapy in *** The clinical characteristics of 15 cases with occult chronic hepatitis B showed that these patients with short latency,younger age when being-struck,and light damage to liver *** efficacy and drugresistance of nucleos(t)ide-analogue(entecavir,lamivudine,adefovir dipivoxil)in treatment of patients with occult chronic hepatitis B are similar to chronic hepatitis B.

关键词： Occult Chronic hepatitis B clinical course Treatment

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