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Prognostic value of ultrasound in early arterial complications post liver transplant

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World Journal of Gastrointestinal Surgery 2024年第1期16卷 13-20页

作者： Ning-Bo Zhao Yi Chen Rui Xia Jian-Bo Tang Dong Zhao Department of Ultrasound National Clinical Research Centre for Infectious DiseaseShenzhen Third People's HospitalThe Second Affiliated Hospital of Southern University of Science and TechnologyNational Clinical Research Center for Infectious DiseaseShenzhen 518112Guangdong ProvinceChina Department of Thyroid and Hernia Surgery The Second Affiliated HospitalGuangzhou Medical UniversityGuangzhou 510000Guangdong ProvinceChina Department of Biomedical Engineering Southern University of Science and TechnologyShenzhen 51800Guangdong ProvinceChina Department of Liver Surgery and Organ Transplantation center Shenzhen Third People's HospitalThe Second Affiliated Hospital of Southern University of Science and TechnologyNational Clinical Research Center for Infectious DiseaseShenzhen 518112Guangdong ProvinceChina

Liver transplantation is the primary therapeutic intervention for end-stage liver disease.However,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.The clinical manifestations associated with early arterial complications following liver transplantation are often non-specific.Without timely intervention,these complications can result in graft fai-lure or patient mortality.Therefore,early diagnosis and the formulation of an op-timal treatment plan are imperative.Ultrasound examination remains the pre-dominant imaging modality for detecting complications post liver transplan-tation.This article comprehensively reviews common causes and clinical present-ations of early hepatic artery complications in the post-transplantation period and delineates abnormal sonographic findings for accurate diagnosis of these con-ditions.Overall,ultrasound offers the advantages of convenience,safety,effect-iveness,and non-invasiveness.It enables real-time,dynamic,and precise evalua-tion,making it the preferred diagnostic method for post-liver transplantation assessments.INTRODUCTION Liver transplantation stands as the primary therapeutic approach for end-stage liver disease.Continuous advancements in surgical techniques and the application of novel immunosuppressive agents contribute to ongoing improvements in the success rate and overall survival in patients undergoing liver transplantation procedures.Despite these advan-cements,vascular complications,particularly those involving the hepatic artery,pose significant risks to patients.During the early stages following liver transplantation(within the first 30 d),proper hepatic artery function is crucial for hepatic arterial blood flow.During later stages,collateral circulation,including arteries such as the phrenic artery,right gastric artery,and gastroduodenal artery,becomes important for maintaining hepatic blood supply.It is now understood that the establishment of effective collateral circulation is pivotal for determining the

关键词： Liver transplantation Vascular complication Arterial complication Ultrasound

Endoscopic resection for calcifying fibrous tumors of the gastrointestinal tract

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World Journal of Clinical Oncology 2024年第2期15卷 282-289页

作者： Zi-Han Geng Yan Zhu Pei-Yao Fu Yi-Fan Qu Shi-Yao Chen Yun-Shi Zhong Yi-Qun Zhang Wei-Feng Chen Wen-Zheng Qin Jian-Wei Hu Ming-Yan Cai Li-Qing Yao Quan-Lin Li Ping-Hong Zhou Endoscopy center and Endoscopy Research Institute Zhongshan HospitalFudan UniversityShanghai 200032China Shanghai Collaborative Innovation center of Endoscopy Shanghai 200032China

BACKGROUND Calcifying fibrous tumors(CFTs)are rare mesenchymal lesions that can occur in various sites throughout the body,including the tubular gastrointestinal(GI)tract.AIM To analyze the clinical findings of 36 patients with GI tract CFTs to provide guidance for diagnosis and treatment.METHODS This retrospective study included 36 patients diagnosed with CFTs of the GI tract.We collected demographic and clinical information and conducted regular follow-ups to assess for local recurrence.RESULTS The stomach was the most commonly involved site,accounting for 72.2%of the 36 CFTs.Endoscopic mucosal resection(n=1,2.8%),endoscopic submucosal dissection(n=14,38.9%),endoscopic full-thickness resection(n=16,44.4%),and submucosal tunneling endoscopic resection(n=5,13.9%)were used to resect calcifying fibrous tumors.Overall,34(94.4%)CFTs underwent complete endoscopic resections with a mean procedure time of 39.8±29.8 min.The average maximum diameter of the tumors was 10.6±4.3 cm.No complications,such as bleeding or perforation,occurred during an average hospital stay of 2.9±1.2 d.In addition,two patients developed new growth of CFTs near the primary tumor sites,and none of the patients developed distant metastases during the follow-up period.CONCLUSION GI tract CFTs are rare and typically benign tumors that can be effectively managed with endoscopic procedures.

关键词： Endoscopic resection Calcifying fibrous tumor Gastrointestinal tract

Liver transplantation as an alternative for the treatment of intrahepatic cholangiocarcinoma: Past, present, and future directions

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Hepatobiliary & Pancreatic diseases International 2024年第2期23卷 129-138页

作者： Sudha Kodali Ashton A Connor Souhail Thabet Elizabeth W Brombosz R Mark Ghobrial Sherrie and Alan Conover center for Liver disease and Transplantation Houston Methodist HospitalHoustonTX 77030USA JC Walter Jr Transplant center Houston Methodist HospitalHoustonTX 77030USA Department of Medicine Weill Cornell Medical CollegeNew YorkNYUSA Department of Surgery Houston Methodist HospitalHoustonTX 77030USA Department of Surgery Weill Cornell Medical CollegeNew YorkNYUSA School of Medicine New Giza UniversityGizaEgypt

Intrahepatic cholangiocarcinoma(iCCA)is a rare biliary tract cancer with high mortality rate.Complete resection of the iCCA lesion is the first choice of treatment,with good prognosis after margin-negative resection.Unfortunately,only 12%-40% of patients are eligible for resection at presentation due to cirrhosis,portal hypertension,or large tumor size.Liver transplantation(LT)offers margin-negative iCCA extirpation for patients with unresectable tumors.Initially,iCCA was a contraindication for LT until size-based selection criteria were introduced to identify patients with satisfied post-LT outcomes.Recent studies have shown that tumor biology-based selection can yield high post-LT survival in patients with locally advanced iCCA.Another selection criterion is the tumor response to neoadjuvant therapy.Patients with response to neoadjuvant therapy have better outcomes after LT compared with those without tumor response to neoadjuvant therapy.Another index that helps predict the treatment outcome is the biomarker.Improved survival outcomes have also opened the door for living donor LT for iCCA.Patients undergoing LT for iCCA now have statistically similar survival rates as patients undergoing resection.The combination of surgery and locoregional and systemic therapies improves the prognosis of iCCA patients.

关键词： Liver transplantation Cholangiocarcinoma Hepatectomy Transplant oncology Liver neoplasm

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Current understanding of ELF4 deficiency:a novel inborn error of immunity

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World Journal of Pediatrics 2024年第5期20卷 444-450页

作者： Hong-Qiang Du Xiao-Dong Zhao Department of Rheumatology&Immunology National Clinical Research Center for Child Health and DisordersMinistry of Education Key Laboratory of Child Development and DisordersChongqing Key Laboratory of Child Rare Diseases in Infection and ImmunityChildren’s Hospital of Chongqing Medical UniversityZhongshan Er Road 136Yuzhong DistrictChongqingChina

Background ELF4 deficiency has been recently recognized as a novel disorder within the spectrum of inborn errors of immunity(IEIs),specifically categorized as a“disease of immune dysregulation.”Cases of this condition,reported by our team and others,are very limited worldwide.As such,our current knowledge of this new disease remains preliminary.This review aims to provide a brief overview of the clinical manifestations,pathogenesis,and treatment strategies for this novel IEI.Data sources A comprehensive review was conducted after an extensive literature search in the PubMed/Medline database and websites concerning transcriptional factor ELF4 and reports concerning patients with ELF4 deficiency.Our search strategy was“ELF4 OR ETS-related transcription factor Elf-4 OR EL4-like factor 4 OR myeloid Elf-1-like factor”as of the time of manuscript submission.Results The current signature manifestations of ELF4 deficiency disorder are recurrent and prolonged oral ulcer,abdominal pain,and diarrhea in pediatric males.In some cases,immunodeficiency and autoimmunity can also be prominent.Targeted Sanger sequencing or whole exome sequencing can be used to detect variation in ELF4 gene.Western blotting for ELF4 expression of the patient’s cells can confirm the pathogenic effect of the variant.To fully confirm the pathogenicity of the variant,further functional test is strongly advised.Glucocorticoid and biologics are the mainstream management of ELF4 deficiency disorder.Conclusions Pediatric males presenting with recurring ulcerations in digestive tract epithelium with or without recurrent fever should be suspected of DEX.When atypical presentations are prominent,variations in ELF4 gene should be carefully evaluated functionally due to the complex nature of ELF4 function.Experience of treating DEX includes use of glucocorticoid and biologics and more precise treatment needs more patients to identify and further mechanistic study.

关键词： ELF4 transcription factor Immune dysregulation Inborn errors of immunity Mechanism Recurrent infections

Perioperative complication incidence and risk factors for retroperitoneal neuroblastoma in children:analysis of 571 patients

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World Journal of Pediatrics 2024年第3期20卷 250-258页

作者： Min He Jia-Bin Cai Xuan Wu Yin-Bing Tang Jin-Yan Wang Jun-Qin Mao Ji-Jun Chen Li-Feng Zhang Zhong-Hai Guan Jie-Ni Xiong Wan-Xin Peng Jin-Hu Wang Ting Tao Pediatric Cancer Research center National Clinical Research Center for Child HealthHangzhouChina Department of Surgical Oncology Children's HospitalZhejiang University School of MedicineHangzhouChina Cancer center Zhejiang UniversityNo.3333 Binsheng RodeHangzhouChina

Background Surgery plays an important role in the treatment of neuroblastoma.Perioperative complications may impact the course of neuroblastoma treatment.To date,comprehensive analyses of complications and risk factors have been lacking.Methods Patients with retroperitoneal neuroblastoma undergoing tumor resection were retrospectively analyzed between 2014 and 2021.The data collected included clinical characteristics,operative details,operative complications and postopera-tive outcomes.Risk factors for perioperative complications of retroperitoneal neuroblastoma were analyzed.Results A total of 571 patients were enrolled in this study.Perioperative complications were observed in 255(44.7%)patients.Lymphatic leakage(28.4%),diarrhea(13.5%),and injury(vascular,nerve and organ;7.5%)were the most frequent compli-cations.There were three operation-related deaths(0.53%):massive hemorrhage(n=1),biliary tract perforation(n=1)and intestinal necrosis(n=1).The presence of image-defined risk factors(IDRFs)[odds ratio(OR)=2.09,P<0.01],high stage of the International Neuroblastoma Risk Group staging system(INRGSS)(OR=0.454,P=0.04),retroperitoneal lymph node metastasis(OR=2.433,P=0.026),superior mesenteric artery encasement(OR=3.346,P=0.003),and inferior mesenteric artery encasement(OR=2.218,P=0.019)were identified as independent risk factors for perioperative complications.Conclusions Despite the high incidence of perioperative complications,the associated mortality rate was quite low.Perio-perative complications of retroperitoneal neuroblastoma were associated with IDRFs,INRGSS,retroperitoneal lymph node metastasis and vascular encasement.Patients with high-risk factors should receive more serious attention during surgery but should not discourage the determination to pursue total resection of neuroblastoma.

关键词： Complication Neuroblastoma Risk factors Surgery

Insights into the Impact of Bifidobacterium bifidum， B. breve， and B. longum on the Immune Response Against Salmonella Infection in Neonatal Rats

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Food Science and Human Wellness 2024年

作者： Chunxiu Lin Yugui Lin Min Guo Rui Xiao Shunhe Wang Yonghua Zhou Jianxin Zhao Hao Zhang Wei Chen Gang Wang State Key Laboratory of Food Science and Resources Jiangnan University School of Food Science and Technology Jiangnan University Microbiology Laboratory zhongshan Bo'ai hospital Southern Medical University Key Laboratory of National Health Commission on Parasitic disease Control and Prevention Jiangsu Provincial Key Laboratory on Parasite and Vector Control Technology Jiangsu Institute of Parasitic diseases National Engineering Research center for Functional Food Jiangnan University (Yangzhou) Institute of Food Biotechnology Jiangnan University Wuxi Translational Medicine Research center and Jiangsu Translational Medicine Research Institute Wuxi Branch

Infants exhibit diminished susceptibility to external infections， a phenomenon closely linked to the pervasive presence of the bifidobacterial community within their intestinal tract. Nonetheless， a significant knowledge gap remains concerning the distinct species of bifidobacteria initiating anti-infection immune responses during the early developmental stages. In this study， the impact of early intervention with Bifidobacterium bifidum (B. bifidum)， B. breve， and B. longum on neonatal rats infected with Salmonella enterica serovar Typhimurium (S. typhimurium) SL1344 were compared. The study encompasses various immunity levels， including gut immunity， central immunity (thymus)， peripheral immunity (spleen)， and brain immunity. Following Salmonella infection， significant alterations in neonatal rats were observed in growth and developmental levels， immune markers， cytokine levels， balance of T lymphocyte subpopulations， intestinal barrier function， and blood-brain barrier integrity. Compared with B. breve and B. longum， B. bifidum demonstrated more pronounced efficacy in regulating these physiological processes. By conducting multi-level analyses of gut microbiota， bifidobacterial community， colonic content metabolomics， and serum metabolomics， the significance of B. bifidum's role is underscored， and the immune-enhancing function of messenger metabolites is unveiled. Among these metabolites， γ-L-Glutamyl-L-glutamic acid and Orotic acid were found to be shared by all three species， while Hippuric acid and 1a，1b-dihomo Prostaglandin F2α were unique to B. bifidum， and DL-Arginine was specific to B. longum. Overall， this study has provided novel insights into the intervention and immunomodulation by Bifidobacterium in early-life infections， emphasizing the significant role of B. bifidum.

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Hepatopancreatoduodenectomy for advanced biliary malignancies

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Chinese Medical Journal 2022年第23期135卷 2851-2858页

作者： Xiangsong Wu Maolan Li Wenguang Wu Xu’an Wang Huaifeng Li Runfa Bao Yijun Shu Jun Shen Jun Gu Xuefeng Wang Wei Gong Shuyou Peng Yingbin Liu Department of General Surgery Xinhua HospitalAffiliated to Shanghai Jiao Tong University School of MedicineShanghai 200092China Department of biliary-Pancreatic Surgery Renji Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghai 200092China State Key Laboratory of Oncogenes and Related Genes Shanghai 200092China Shanghai Key Laboratory of biliary tract disease Research Shanghai 200092China Shanghai Research center of biliary tract disease Shanghai 200092China Department of General Surgery The Second Affiliated Hospital of Zhejiang University School of MedicineHangzhouZhejing 310009China

Background:Hepatopancreatoduodenectomy(HPD)has been considered the only curative treatment for metastatic cholangiocarcinoma and some locally advanced gallbladder cancers(GBCs).However,HPD has not yet been included in treatment guidelines as a standard surgical procedure in consideration of its morbidity and mortality rates.The aim of this study was to evaluate the safety and effectiveness of HPD in treating biliary malignancies.Methods:The medical records of 57 patients with advanced biliary cancer undergoing HPD from January 2009 to December 2019 were retrospectively retrieved.A case-control analysis was conducted at our department.Patients with advanced GBC who underwent HPD(HPD-GBC group)were compared with a control group(None-HPD-GBC group).Baseline characteristics,preoperative treatments,tumor pathologic features,operative results,and prognosis were assessed.Results:Thirteen patients with cholangiocarcinoma and 44 patients with GBC underwent HPD at our department.Significant postoperative complications(grade III or greater)and postoperative pancreatic fistula were observed in 24(42.1%)and 15(26.3%)patients,respectively.One postoperative death occurred in the present study.Overall survival(OS)was longer in patients with advanced cholangiocarcinoma than in those with GBC(median survival time[MST],31 months vs.11 months;Pcenter.For patients with advanced GBC without an N2 or T4 tumor,HPD can be a preferable treatment option.

关键词： Hepatectomy Hepatopancreatoduodenectomy Gallbladder cancer Cholangiocarcinoma

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Preoperative lymphocyte to C-reactive protein ratio as a new prognostic indicator in patients with resectable gallbladder cancer

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Hepatobiliary & Pancreatic diseases International 2022年第3期21卷 267-272页

作者： Wen-Yan Yao Xiang-Song Wu Shi-Lei Liu Zi-You Wu Ping Dong Wei Gong Department of General Surgery Xinhua HospitalAffiliated to Shanghai Jiao Tong University School of MedicineShanghai 200092China Shanghai Key Laboratory of biliary tract disease Research Shanghai 200092China

Background:Inflammation is often related to cancer,and several inflammatory scores have been established to predict the prognosis of various types of cancer.Our study aimed to determine the prognostic value of the preoperative lymphocyte to C-reactive protein ratio(LCR)for predicting postoperative outcomes in patients with resectable gallbladder cancer(GBC).Methods:A retrospective analysis of 104 GBC patients who received curative surgery at Xinhua hospital,Affiliated to Shanghai Jiao Tong University School of Medicine from January 2000 to December 2016 was performed.A time-dependent receiver operating characteristic curve was constructed to evaluate the accuracy of different markers.Univariate and multivariate Cox proportional hazard models were used to define factors associated with overall survival.Results:Among the assessed variables,the preoperative LCR showed the highest accuracy in predicting the overall survival of GBC patients(AUC:0.736).Decreased preoperative LCR was significantly associated with advanced tumor stage,including tumor invasion(P=0.018),lymph node metastasis(P=0.011)and TNM stage(P=0.022).A low preoperative LCR(cutoff threshold=145.5)was an independent risk factor for overall survival in patients with resectable GBC(P<0.001).Conclusions:The preoperative LCR is a novel and valuable prognostic indicator of postoperative survival in patients with resectable GBC.

关键词： Gallbladder neoplasms Inflammation Lymphocyte to C-reactive protein ratio Overall survival

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An RNA-RNA crosstalk network involving HMGB1 and RICTOR facilitates hepatocellular carcinoma tumorigenesis by promoting glutamine metabolism and impedes immunotherapy by PD-L1+ exosomes activity

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Signal Transduction and Targeted Therapy 2022年第1期7卷 282-294页

作者： Yanping Wei Xuewu Tang Yibin Ren Yun Yang Fengliang Song Jingbo Fu Shuowu Liu Miao Yu Jing Chen Suyang Wang Kecheng Zhang Yexiong Tan Zhipeng Han Lixjn Wei Baohua Zhang Zhangjun Cheng Liang Li Hongyang Wang International Co-operation Laboratory on Signal Transduction Eastern Hepato-Biliary Surgery InstituteSecond Military Medical UniversityShanghaiChina National center for Liver Cancer ShanghaiChina Hepato-Pancreato-biliary center Zhongda HospitalSchool of MedicineSoutheast UniversityNanjingChina The Third Department of Hepatic Surgery Eastern Hepatobiliary Surgery HospitalShanghaiChina School of Medicine Nantong UniversityNantongJiangsu ProvinceChina Department of biliary tract Surgery Eastern Hepatobiliary Surgery HospitalSecond Military Medical UniversityShanghaiChina Tumor Immunology and Gene Therapy center Eastern Hepato-Biliary Surgery InstituteSecond Military Medical UniversityShanghaiChina National Laboratory for Oncogenes and Related Genes Cancer InstituteRenJi HospitalShanghai Jiao Tong University200441 ShanghaiChina

Hepatocellular carcinoma(HCC)is the global leading cause of cancer-related deaths due to the deficiency of targets for precision therapy.A new modality of epigenetic regulation has emerged involving RNA-RNA crosstalk networks where two or more competing endogenous RNAs(ceRNAs)bind to the same microRNAs.However,the contribution of such mechanisms in HCC has not been well studied.Herein,potential HMGB1-driven RNA-RNA crosstalk networks were evaluated at different HCC stages,identifying the mT0RC2 component RICTOR as a potential HMGB1 ceRNA in HBV^(+)early stage HCC.Indeed,elevated HMGB1 mRNA was found to promote the expressio n of RICTOR mRNA through competitively bin ding with the miR-200 family,especially miR-429.Functio nal assays emplo ying overexpressi on or in terference strategies dem on strated that the HMGB1 and RICTOR 3zuntra nslated regions(UTR)epigenetically promoted the malignant proliferation,self-renewal,and tumorigenesis in HCC cells.Intriguingly,in terference agai nst HMGB1 and RICTOR in HCC cells promoted a stron ger an ti-PD-L1 immuno therapy resp on se,which appeared to associate with the production of PD-L1^(+)exosomes.Mechanistically,the HMGB1-driven RNA-RNA crosstalk network facilitated HCC cell glutamine metabolism via dual mechanisms,activating a positive feedback loop involving mT0RC2-AKT-C-MYC to upregulate glutamine synthetase(GS)expression,and inducing mTORCI signaling to derepress SIRT4 on glutamate dehydrogenase(GDH).Meanwhile,this crosstalk network could impede the efficacy of immunotherapy through mTORCI-P70S6K dependent PD-L1 production and PD-L1^(+)exosomes activity.In conclusion,our study highlights the non-coding regulatory role of HMGB1 with implicatio ns for RNA-based therapeutic targeting together with a predictio n of an ti-PD-L1 immuno therapy in HCC.

关键词： metabolism network crosstalk