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Lenvatinib as first-line therapy for recurrent hepatocellular carcinoma after liver transplantation:Is the current evidence applicable to these patients?

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World Journal of Transplantation 2020年第11期10卷 297-306页

作者： Federico Piñero Marcos Thompson Juan Ignacio Marín Marcelo Silva Hepatology and liver Transplant Unit Hospital Universitario AustralBuenos Aires B1629HJArgentina Hospital Universitario Austral Facultad de Ciencias BiomédicasUniversidad AustralBuenos Aires B1629HJArgentina Latin american liver research educational and awareness network(LALREAN) Buenos Aires B1629HJArgentina Hepatology and liver Transplantation Unit Hospital Pablo Tobón UribeMedellín 240Colombia

liver transplantation(LT)is one of the leading curative therapies for hepatocellular carcinoma(HCC).Despite recent optimization of transplant selection criteria,including alpha-feto protein,HCC recurrence after LT is still the leading cause of death in these *** the last decades,effective systemic treatments for HCC,including tyrosine kinase inhibitors and immunotherapy,have been *** describe the clinical scenario of a patient with recurrence of HCC five years after LT,who received lenvatinib as first-line systemic therapy to introduce systemic treatment options in this clinical *** this opinion review,we detail first and second-line systemic treatment options,focusing on those feasible for patients with recurrent HCC after *** trials have evaluated new drugs to treat HCC patients in first and secondline therapy,but patients with recurrent HCC after LT have been excluded from these ***,most of the evidence comes from observational retrospective *** tyrosine kinase inhibitors will remain the primary therapeutic approach in these patients,due to a relative contraindication for immunotherapy,may be clarified in the near future.

关键词： liver transplantation Recurrence Systemic therapies Hepatocellular carcinoma

Mindfulness training in medical education as a means to improve resilience,empathy,and mental health in the medical profession

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World Journal of Psychiatry 2024年第4期14卷 489-493页

作者： Edison Iglesias de Oliveira Vidal Luiz Fernando Alvarenga Ribeiro Marco Antonio de Carvalho-Filho Fernanda Bono Fukushima Internal Medicine Department Botucatu Medical SchoolSao Paulo State University(UNESP)Botucatu 18618-687SPBrazil Wenckebach Institute for Education and Training LEARN-Lifelong LearningEducation and Assessment Research NetworkUniversity Medical Center GroningenGroningen 9713AVGroningenNetherlands Assertiva Mindfulness Botucatu 18603-970SPBrazil Surgical Specialties and Anesthesiology Department Botucatu Medical SchoolSão Paulo State University(UNESP)Botucatu 18618-687SPBrazil

The high rates of depression,burnout,and increased risk of suicide among medical students,residents,and physicians in comparison with other careers signal a mental health crisis within our *** contend that this crisis coupled with the inadequate acquisition of interpersonal skills during medical education results from the interaction between a challenging environment and the mental capital of ***,we posit that mindfulness-based practices are instrumental for the development of major components of mental capital,such as resilience,flexibility of mind,and learning skills,while also serving as a pathway to enhance empathy,compassion,self-awareness,conflict resolution,and relational ***,the evidence base supporting the effectiveness of mindfulness-based interventions has been increasing over the years,and a growing number of medical schools have already integrated mindfulness into their *** we acknowledge that mindfulness is not a panacea for all educational and mental health problems in this field,we argue that there is currently an unprecedented opportunity to gather momentum,spread and study mindfulness-based programs in medical schools around the world as a way to address some longstanding shortcomings of the medical profession and the health and educational systems upon which it is rooted.

关键词： Mindfulness Medical education Mental capital Mental health Medical students Resilience

Hepatocellular carcinoma in Latin America: Diagnosis and treatment challenges

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World Journal of Gastroenterology 2018年第37期24卷 4224-4229页

作者： Federico Pinro Jaime Poniachik Ezequiel Ridruejo Marcelo Silva Hospital Universitario Austral Facultad de Ciencias BiomédicasUniversidad AustralPilarBuenos Aires B1629HJArgentina american liver research educational and awareness network Buenos Aires B1629HJArgentina Hepatology Hospital Clínico Universidad de ChileSantiago de ChileRegión Metropolitana Santiago 46010Chile Santa María Santiago de ChileRegión Metropolitana Santiago 834-0518Chile Médica e Investigaciones Clínicas Norberto Quirno Ciudad de Buenos Aires C1425ASGArgentina

Latin America, a region with a population greater than 600000000 individuals, is well known due to its wide geographic, socio-cultural and economic heterogeneity. Access to health care remains as the main barrier that challenges routine screening, early diagnosis and proper treatment of hepatocellular carcinoma(HCC). Therefore, identification of population at risk, implementation of surveillance programs and access to curative treatments has been poorly obtained in the region. Different retrospective cohort studies from the region have shown flaws in the implementation process of routine surveillance and early HCC diagnosis. Furthermore, adherence to clinical practice guidelines recommendations assessed in two studies from Brazil and Argentina demonstrated that there is also room for improvement in this field, similarly than the one observed in Europe and the United States. In summary, Latin America shares difficulties in HCC decision-making processes similar to those from developed countries. However, a transversal limitation in the region is the poor access to health care with the consequent limitation to standard treatments for overall population. Specifically, universal health care access to the different World Health Organization levels is crucial, including improvement in research, education and continuous medical training in order to expand knowledge and generation of data promoting a continuous improvement in the care of HCC patients.

关键词： Latin America liver cancer Limitations Challenge

Hepatitis B in China: from Guideline to Practice

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Virologica Sinica 2008年第2期23卷 152-155页

作者： Ji-dong JIA liver research Center Beijing Friendship Hospital Capital Medical University Beijing 100050 China

Chronic hepatitis B infection is a very important health problem in China, which is carrying an enormous economic and social burdens. The major routs of chronic hepatitis B infection in China are mother-infant vertical transmission and early childhood horizontal transmission. After more than 10 years implementation of universal vaccination against hepatitis B in newborns and safety injection in health care settings, the prevalence of HBsAg in general population has decreased from 9.75% to around 7%. In China, patients with hepatitis are cared by either hepatologists or physicians of infectious diseases. The Chinese Society of Hepatology, and Chinese Society of Infectious Diseases jointly issued an evidence-based guideline on the prevention and treatment of chronic hepatitis B in 2005. This guideline concisely describes the virology, epidemiology, natural history and prevention, as well as diagnosis and management of chronic hepatitis B. It also highlights the importance of active viral replication in disease progression in chronic HBV infection and explicitly states the necessity of antiviral therapy in patient care. The cornerstone of anti-hepatitis B therapy is optimal use of interferons or nucleos(t)ide analogs in those patients with active viral replication and elevated serum transaminase levels. Through an independent continue medical educational agency, a panel of selected speakers were trained to give well-formatted talks on the key points of the guideline in over 60 major cities across China. This educational campaign among health care providers has greatly improved the awareness and the stand of care for antiviral therapy.

关键词： Hepatitis B China Epidemiology Prevention Treatment

Intermediate-advanced hepatocellular carcinoma in Argentina:Treatment and survival analysis

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World Journal of Gastroenterology 2019年第27期25卷 3607-3618页

作者： Federico Pinero Sebastián Marciano Nora Fernández Jorge Silva Margarita Anders Alina Zerega Ezequiel Ridruejo Gustavo Romero Beatriz Ameigeiras Claudia D’Amico Luis Gaite Carla Bermúdez Virginia Reggiardo Luis Colombato Adrián Gadano Marcelo Silva Hospital Universitario Austral Facultad de Ciencias BiomédicasUniversidad AustralBuenos Aires B1629HJArgentina Latin american liver research educational and awareness network(LALREAN) Buenos Aires B1629HJArgentina Hospital Italiano de Buenos Cuidad Autónoma de Buenos AiresBuenos Aires C1424BYEArgentina Hospital Británico Cuidad Autonoma de Buenos AiresBuenos Aires C1280AEBArgentina Hospital G Rawson San Juan 5400Argentina Hospital Aleman Cuidad Autonoma de Buenos AiresBuenos Aires C1280AEBArgentina Sanatorio Allende from Córdoba Córdoba 5016Argentina Centro de Educación Médica e Investigaciones Clínicas“Norberto Quirno”(CEMIC) Ciudad de Buenos Aires 1431Argentina Hospital Udaondo Cuidad Autonoma de Buenos Aires C1264AAAArgentina Hospital Ramos Mejía Ciudad de Buenos Aires C1221ADCArgentina Centro Especialidades Medicas Ambulatorias(CEMA) Mar del PlataBuenos Aires 7600Argentina Clínica de Nefrología Santa Fe 3000Argentina Hospital del Centenario RosarioSanta Fe S2002KDTArgentina

BACKGROUND Hepatocellular carcinoma(HCC) represents the sixteenth most frequent cancer in Argentina. The rise of new therapeutic modalities in intermediate-advanced HCC opens up a new paradigm for the treatment of *** To describe real-life treatments performed in patients with intermediateadvanced HCC before the approval of new systemic *** This longitudinal observational cohort study was conducted between 2009 and2016 in 14 different regional hospitals from Argentina. Included subjects had intermediate-advanced Barcelona Clinic liver Cancer(BCLC) HCC stages(BCLC B to D). Primary end point analyzed was survival, which was assessed for each BCLC stage from the date of treatment until last patient follow-up or *** Meier survival curves and Cox regression analysis were performed, with hazard ratios(HR) calculations and 95% confidence intervals(95%CI).RESULTS From 327 HCC patients, 41% were BCLC stage B, 20% stage C and 39% stage *** median survival were 15 mo(IQR 5-26 mo), 5 mo(IQR 2-13 mo)and 3 mo(IQR 1-13 mo)(P < 0.0001), respectively. Among BCLC-B patients(n =135), 57% received TACE with a median number of 2 sessions(IQR 1-3 sessions).Survival was significantly better in BCLC-B patients treated with TACE HR =0.29(CI: 0.21-0.40) than those without TACE. After tumor reassessment by RECIST 1.1 criteria following the first TACE, patients with complete response achieved longer survival (HR = 0.15(CI: 0.04-0.56, P = 0.005))Eighty-two patients were treated with sorafenib, mostly BCLC-B and C(87.8%). However,12.2% were BCLC-D. Median survival with sorafenib was 4.5 mo(IQR 2.3-11.7 mo);which was lower among BCLC-D patients 3.2 mo(IQR 2.0-14.1 mo). A total of 36 BCLC-B patients presented tumor progression after TACE. In these patients,treatment with sorafenib presented better survival when compared to those patients who received sorafenib without prior TACE [HR = 0.26(CI: 0.09-0.71);P= 0.013].CONCLUSION In this real setting, our results we

关键词： Hepatocellular carcinoma Therapeutics Survival Real-life

Attitudes,awareness,and knowledge levels of the Turkish adult population toward organ donation:Study of a nationwide survey

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World Journal of Clinical Cases 2020年第11期8卷 2235-2245页

作者： Sami Akbulut Ali Ozer Ayse Gokce Khaled Demyati Hasan Saritas Sezai Yilmaz Department of Public Health Inonu University Faculty of MedicineMalatya 44280Turkey liver Transplant Institute Inonu UniversityMalatya 44280Turkey Department of Surgery An-Najah National University HospitalAn-Najah National UniversityNablus 11941Palestine Department of Surgical Nursing Inonu University Faculty of NursingMalatya 44280Turkey

BACKGROUND The most important factors affecting attitudes on organ donation are socioeconomic, educational, cultural, and religious factors in many *** To evaluate the attitudes, awareness, and knowledge levels of the Turkish adult population toward organ *** This nationwide study surveyed 3000 adults(≥ 18 years) in Turkey. To ensure a representative sample, the Nomenclature of Territorial Units for Statistics-Ⅱ(modified for Turkey) was used. Turkey was divided into 26 regions based on social, economic, and geographic criteria as identified by the Turkish Statistical Institute. A stratified sampling method was used with an even distribution of adults across cities and towns based on population data. Data were collected by the PRP research and Consultancy Company using computer-assisted personal *** Out of 3000 individuals represented in the study population, 1465(48.8%) were male and 1535(51.2%) female. The results showed that most participants were under 45 years(59.0%) and married(72.1%), some had a bachelor’s degree or higher(21.9%), and very few(1.5%) had any direct experience with organ transplantation-whether in the family, or a family member on a transplantation waiting list. Most of the study population(88.3%) had not considered donating an organ, however, most(87.9%) said that they would accept an organ from a donor if they needed one. Among the individuals surveyed, 67% were willing to donate an organ to a close relative, while 26.8% would donate an organ to an unrelated person. Only 47.2% said they had adequate information about brain death, and 85.2% refused to consent to donating organs of family members declared brain dead. Only 33.9% thought they had adequate information about organ donation. The main source of information was the television. The two main reasons for refusing organ donation were that it was too soon to think about organ donation and the importance of retaining the integrity of the dead person’s bo

关键词： Organ donation Adult population Attitudes Knowledge levels awareness Barriers to the organ donation

Attitudes, knowledge levels and behaviors of Islamic religious officials about organ donation in Turkey: National survey study

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World Journal of Clinical Cases 2020年第9期8卷 1620-1631页

作者： Sami Akbulut Ali Ozer Betul Firinci Hasan Saritas Khaled Demyati Sezai Yilmaz Department of Public Health Inonu University Faculty of MedicineMalatya 44280Turkey liver Transplant Institute Inonu UniversityMalatya 44280Turkey Department of Surgical Nursing Inonu University Faculty of NursingMalatya 44280Turkey Department of Surgery An-Najah National University HospitalAn-Najah National UniversityNablus 11941Palestine

BACKGROUND The most important factors affecting the decision of organ donation are socioeconomic,educational,cultural,and religious *** To evaluate Islamic religious officials’attitudes and behaviors toward and level of knowledge on organ donation and *** This study surveyed 2350 Islamic religious officials in *** ensure a representative sample,we used and modified the Nomenclature of Territorial Units for *** on the Nomenclature of Territorial Units for Statistics-II,Turkey was divided into 26 *** number of Islamic religious officials in each city and town in each of the 26 regions was proportionate to the population.A stratified sampling method based on demographic factors,such as age,marital status,and educational level,was *** were collected by PRP research and Consultancy Company using computer-assisted personal *** Of the 2350 religious officials surveyed,59.9%were in the age group of 35-54 years;84.7%had either a bachelor’s or a master’s degree;99.7%never donated an organ;and 75.4%were not considering donating in the *** 22%of the religious officials said religious belief was their reason for not donating;45.3%did not indicate any *** 41.5%of participants considered cadaveric organ donation as the best source of organ transplantation,36.3%deemed living donor transplantation as the best ***,52.9%of participants considered donating an organ from a brain dead relative in case they were asked for permission;80.1%considered donating to a relative,if necessary;81.6%considered undergoing organ transplantation,if *** 83.7%of participants deemed organ donation as a proper human behavior;60.5%believed that it is allowed by Islam;55%said they preach for organ donation at their mosque;and 41.1%said their views of organ donation were influenced by their leaders in *** Religious officials are unsure whether or not organ donation is resp

关键词： Organ transplant Organ donation Islamic religious officials Religious beliefs Barriers to organ donation awareness

Farnesoid X receptor,the bile acid sensing nuclear receptor,in liver regeneration

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Acta Pharmaceutica Sinica B 2015年第2期5卷 93-98页

作者： Guodong Li Grace L.Guo Department of General Surgery the Fourth Hospital of Harbin Medical University Division of Biobank research Department of General Surgery the Fourth Hospital of Harbin Medical University Department of Pharmacology and Toxicology Ernest Mario School of Pharmacy Rutgers the State University of New Jersey

The liver is unique in regenerative potential, which could recover the lost mass and function after injury from ischemia and resection. The underlying molecular mechanisms of liver regeneration have been extensively studied in the past using the partial hepatectomy(PH) model in rodents, where 2/3 PH is carried out by removing two lobes. The whole process of liver regeneration is complicated, orchestrated event involving a network of connected interactions, which still remain fully elusive. Bile acids(BAs) are ligands of farnesoid X receptor(FXR), a nuclear receptor of ligand-activated transcription factor. FXR has been shown to be highly involved in liver regeneration. BAs and FXR not only interact with each other but also regulate various downstream targets independently during liver regeneration. Moreover, recent findings suggest that tissue-specific FXR also contributes to liver regeneration significantly. These novel findings suggest that FXR has much broader role than regulating BA, cholesterol, lipid and glucose metabolism. Therefore, these researches highlight FXR as an important pharmaceutical target for potentialuse of FXR ligands to regulate liver regeneration in clinic. This review focuses on the roles of BAs and FXR in liver regeneration and the current underlying molecular mechanisms which contribute to liver regeneration.

关键词： Farnesoid X receptor liver regeneration Bile acids Fibroblast growth factor 15 liver-intestine croass talk Transmembrane G protein coupled receptor 5

Helping the Consumers and Producers of Standards,Repositories and Policies to Enable FAIR Data

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Data Intelligence 2020年第1期2卷 151-157,312页

作者： Peter McQuilton Dominique Batista Oya Beyan Ramon Granell Simon Coles Massimiliano Izzo Allyson L.Lister Robert Pergl Philippe Rocca-Serra Ben Schaap Hugh Shanahan Milo Thurston Susanna-Assunta Sansone Oxford e-research Centre Department of Engineering SciencesUniversity of OxfordOxford OX13PJUK Fraunhofer Institute for Applied Information Technology(FIT) 53754 Sankt AugustinGermany School of Chemistry Faculty of Engineering and Physical SciencesUniversity of SouthamptonSO171BJUK Czech Technical University in Prague Faculty of Information Technology(FIT CTU)16000 Prague 6Czech Republic Wageningen University Wagengen 6700 HBThe Netherlands Royal Holloway University of LondonLondon Surrey TW200EXUK

Thousands of community-developed(meta)data guidelines,models,ontologies,schemas and formats have been created and implemented by several thousand data repositories and knowledge-bases,across all *** resources are necessary to meet government,funder and publisher expectations of greater transparency and access to and preservation of data related to research *** obligates researchers to ensure their data is FAIR,share their data using the appropriate standards,store their data in sustainable and community-adopted repositories,and to conform to funder and publisher data *** data sharing also plays a key role in enabling researchers to evaluate,re-analyse and reproduce each other’s *** can map the landscape of relationships between community-adopted standards and repositories,and the journal publisher and funder data policies that recommend their *** this paper,we show how the work of the GO-FAIR FAIR Standards,Repositories and Policies(StRePo)Implementation network serves as a central integration and cross-fertilisation point for the reuse of FAIR standards,repositories and data policies in *** to this effort,the FAIRsharing,an endorsed flagship resource of the research Data Alliance that maps the landscape of relationships between community-adopted standards and repositories,and the journal publisher and funder data policies that recommend their ***,we highlight a number of activities around FAIR tools,services and educational efforts to raise awareness and encourage participation.

关键词： Convergence Data repositories Data policies Data standards FAIR data FAIR enabling community standards