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Role of inflammation and infection in the pathogenesis of human acute liver failure: clinical implications for monitoring and therapy

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World Journal of Gastroenterology 2016年第26期22卷 5958-5970页

作者： Mhairi C Donnelly Peter C Hayes Kenneth J Simpson department of Hepatology and Scottish Liver transplant Unit Royal Infirmary of Edinburgh

Acute liver failure is a rare and devastating clinical condition. At present, emergency liver transplantation is the only life-saving therapy in advanced cases, yet the feasibility of transplantation is affected by the presence of systemic inflammation, infection and resultant multiorgan failure. The importance of immune dysregulation and acquisition of infection in the pathogenesis of acute liver failure and its associated complications is now recognised. In this review we discuss current thinking regarding the role of infection and inflammation in the pathogenesis of and outcome in human acute liver failure, the implications for the management of such patients and suggest directions for future research.

关键词： Inflammation Neuroinflammation Acute liver failure Biomarker Infection

Older candidates for kidney transplantation:Who to refer and what to expect?

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World Journal of transplantation 2016年第4期6卷 650-657页

作者： Beatrice P Concepcion Rachel C Forbes Heidi M Schaefer department of Medicine Division of Nephrology and Hypertension Vanderbilt University Medical Center Division of kidney and pancreas transplantation Vanderbilt University Medical Center

The number of older end-stage renal disease patients being referred for kidney transplantation continues to increase. This rise is occurring alongside the continually increasing prevalence of older end-stage renal disease patients. Although older kidney transplant recipients have decreased patient and graft survival compared to younger patients, transplantation in this patient population is pursued due to the survival advantage that it confers over remaining on the deceased donor waiting list. The upper limit of age and the extent of comorbidity and frailty at which transplantation ceases to be advantageous is not known. transplant physicians are therefore faced with the challenge of determining who among older patients are appropriate candidates for kidney transplantation. This is usually achieved by means of an organ systemsbased medical evaluation with particular focus given to cardiovascular health. More recently, global measures of health such as functional status and frailty are increasingly being recognized as potential tools in risk stratifying kidney transplant candidates. For those candidates who are deemed eligible, living donor transplantation should be pursued. This may mean accepting a kidney from an older living donor. In the absence of any living donor, the choice to accept lesser quality kidneys should be made while taking into account the organ shortage and expected waiting times on the deceased donor list. Appropriate counseling of patients should be a cornerstone in the evaluation process and includes a discussion regarding expected outcomes, expected waiting times in the setting of the new kidney Allocation System, benefits of living donor transplantation and the acceptance of lesser quality kidneys.

关键词： kidney transplant outcomes Frailty Elderly Expanded criteria donor Quality of life

Nationwide trends and predictors of inpatient mortality in 83884 transjugular intrahepatic portosystemic shunt

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World Journal of Gastroenterology 2016年第25期22卷 5780-5789页

作者： Edward Wolfgang Lee Andrew Kuei Sammy Saab Ronald W Busuttil Francisco Durazo Steven-Huy Han Mohamed M El-Kabany Justin P Mc Williams Stephen T Kee department of Radiology Division of Interventional Radiology Ronald Reagan Medical Center at UCLA David Geffen School of Medicine at UCLA department of Medicine Division of Hepatology Pfleger Liver Institute University of California at Los Angeles Dumont-UCLA transplant Center Pfleger Liver Institute Division of Liver and Pancreas Transplantation Department of Surgery David Geffen School of Medicine at University of California Los Angeles

AIM: To evaluate and validate the national trends and predictors of in-patient mortality of transjugular intrahepatic portosystemic shunt (TIPS) in 15 ***: Using the National Inpatient Sample which is a part of Health Cost and Utilization Project, we identified a discharge-weighted national estimate of 83884 TIPS procedures performed in the United States from 1998 to 2012 using international classification of diseases-9 procedural code 39.1. The demographic, hospital and co-morbility data were analyzed using a multivariant analysis. Using multi-nominal logistic regression analysis, we determined predictive factors related to increases in-hospital mortality. Comorbidity measures are in accordance to the Comorbidity Software designed by the Agency for Healthcare Research and ***: Overall, 12.3% of patients died during hospitalization with downward trend in-hospital mortality with the mean length of stay of 10.8 ± 13.1 d. Notable, African American patients (OR = 1.809 vs Caucasian patients, P kidney failure (OR = 4.359), hepatic encephalopathy (OR = 2.217) and esophageal variceal bleeding (OR = 2.187) were at considerably higher odds of in-hospital death compared with ascites (OR = 0.136, P < 0.001). Comorbidity measures with the highest odds of in-hospital death were fluid and electrolyte disorders (OR = 2.823), coagulopathy (OR = 2.016), and lymphoma (OR = 1.842).CONCLUSION: The overall mortality of the TIPS procedure is stea

关键词： Transjugular intrahepatic portosystemic shunt Mortality Inpatient United States National Inpatient Sample database Health Cost and Utilization Project

Surgical closure of large splenorenal shunt may accelerate recovery from hepato-pulmonary syndrome in liver transplant patients

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World Journal of Emergency Medicine 2020年第1期11卷 60-63页

作者： Yan-jun Shi Patrick Mckiernan Kyle Soltys George Mazariegos Wei-lin Wang department of Hepatobiliary&pancreas Surgery the Second Affi liated Hospital of Zhejiang University School of MedicineHangzhou 310009China Thomas E.Starzl transplantation Institute Hillman Center for Pediatric TransplantationDepartment of Transplant SurgeryChildren's Hospital of Pittsburgh of the University of Pittsburgh Medical CenterPittsburghPAUSA

Dear editor,Hepatopulmonary syndrome(HPS)is not uncommon in the setting of liver disease,especially in liver cirrhosis *** prevalence of HPS in liver cirrhosis patients varies from 4%to 47%.[1-3]About the definition of HPS,it is a pulmonary vascular disorder with evidence of intrapulmonary arterial venous shunt.[4]Pulmonary dyspnea and polycythemia are common presentations of ***,cyanosis and clubbed fingers were present in most of all *** nevi is another common clinical feature of patients with HPS.

关键词： patients shunt liver

Restrictive versus liberal fluid therapy for major abdominal surgery: is the evidence strong?

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Hepatobiliary Surgery and Nutrition 2018年第3期7卷 225-226页

作者： Yudong Qiu Xiaopeng Yan department of Hepatobiliary and pancreas Surgery Drum Tower HospitalMedical School of Nanjing UniversityNanjing 210008China

We have read with great interest the original study by Myles et al. (1), in which the authors claimed a restrictive fluid regimen during and up to 24 hours after major abdominal surgery was associated with higher rate of acute kidney injury. This international, randomized, assessor-blinded trail compared the following outcomes between restrictive and liberal intravenous-fluid regimen: disability-free survival at 1 year, acute kidney injury at 30 days, renal-replacement therapy at 90 days, septic complications, surgical-site infection, and death. The perioperative fluid management is of great clinical significance, the results demonstrated by Myles et al. provide high-level evidence with dedicate design and adequate case volume, serving as potential reference to guidelines of surgical patient care. Shortly after its online publication, the article has drawn tremendous attention and caused extensive discussion among surgeons world-wide.

关键词： fluid acute trail

Medical treatment for gastro-entero-pancreatic neuroendocrine tumours

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World Journal of Gastrointestinal Oncology 2016年第4期8卷 389-401页

作者： Rossana Berardi Francesca Morgese Mariangela Torniai Agnese Savini Stefano Partelli Silvia Rinaldi Miriam Caramanti Consuelo Ferrini Massimo Falconi Stefano Cascinu department of Medical Oncology Università Politecnica delle Marche Chirurgia del pancreas Ospedale San Raffaele IRCCS Università Vita e Salute

Gastro-entero-pancreatic neuroendocrine neoplasms(GEPNENs) represents a various family of rare tumours. Surgery is the first choice in GEP-NENs patients with localized disease whilst in the metastatic setting many other treatment options are available. Somatostatin analogues are indicated for symptoms control in functioning tumours. Furthermore they may be effective to inhibit tumour progression. GEP-NENs pathogenesis has been extensively studied in the last years therefore several driver mutations pathway genes have been identified as crucial factors in their tumourigenesis. GEP-NENs can over-express vascular endothelial growth factor(VEGF), basic-fibroblastic growth factor, transforming growth factor(TGF-α and-β), platelet derived growth factor(PDGF), insulin-like growth factor-1(IGF-1) and their receptors PDGF receptor, IGF-1 receptor, epidermal growth factor receptor, VEGF receptor, and c-kit(stem cell factor receptor) that can be considered as potential targets. The availability of new targeted agents, such as everolimus and sunitinib that are effective in advanced and metastatic pancreatic neuroendocrine tumours, has provided new treatment opportunities. Many trials combing new drugs are ongoing.

关键词： Neuroendocrine neoplasms of the gastro-entero-pancreatic system Chemotherapy Targeted agents Somatostatin analogues Everolimus Sunitinib

New era for pancreatic endoscopic ultrasound: From imaging to molecular pathology of pancreatic cancer

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World Journal of Gastrointestinal Oncology 2019年第11期11卷 933-945页

作者： Livia Archibugi Sabrina Gloria Giulia Testoni Miriam Redegalli Maria Chiara Petrone Michele Reni Massimo Falconi Claudio Doglioni Gabriele Capurso Paolo Giorgio Arcidiacono Paolo Giorgio Arcidiacono Pancreato-Biliary Endoscopy and EUS DivisionPancreas Translational and Clinical Research CenterIRCCS San Raffaele Scientific InstituteMilan 20132Italy Pathology department Pancreas Translational and Clinical Research CenterIRCCS San Raffaele Scientific InstituteMilan 20132Italy department of Medical Oncology Pancreas Translational and Clinical Research CenterIRCCS San Raffaele Scientific InstituteMilan 20132Italy Pancreatic Surgery department Pancreas Translational and Clinical Research CenterIRCCS San Raffaele Scientific InstituteMilan 20132Italy

With recent advances in molecular pathology and the development of new chemotherapy regimens,the knowledge of the molecular alterations of pancreatic ductal adenocarcinoma(PDAC)is becoming appealing for stratifying patients for prognosis and response to a defined *** formalin-fixed,paraffinembedded samples are a useful source of genomic deoxyribonucleic acid;nevertheless,most studies employed formalin-fixed,paraffin-embedded samples deriving from surgical specimens,which are therefore representative of<20%of PDAC ***,the development of a reliable methodology for endoscopic ultrasound-guided tissue acquisition,stabilization,and analysis is crucial for the development of molecular markers for clinical use in order to achieve“personalized medicine”.With the development of new needles,this technique is able to retrieve a high quantity and quality of PDAC tissue that can be used not only for diagnosis but also for mutational and transcriptome evaluations and for the development of primary cell or tissue *** the present editorial,we discuss the current knowledge regarding the use of endoscopic ultrasound as a tool to obtain samples for molecular analyses,its possible pitfalls,and its use for the development of disease models such as xenografts or organoids.

关键词： Endoscopic ultrasound Pancreatic cancer Ribonucleic acid Deoxyribonucleic acid Mutation Molecular Organoid Profiling Personalized medicine

Effect of donor age on graft function and longterm survival of recipients undergoing living donor liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2015年第1期14卷 50-55页

作者： Kai Wang Wen-Tao Jiang Yong-Lin Deng Cheng Pan Zhong-Yang Shen department of transplant Surgery Tianjin First Center Hospital Key Laboratory of Organ Transplantation of Tianjin

BACKGROUND： Donor shortage is the biggest obstacle in organ transplantation. Living donor liver transplantation（LDLT） has been considered as a valuable approach to shortening waiting time. The objectives of this study were to investigate the feasibility of utilizing donors older than 50 years in LDLT and to evaluate the graft function and recipient ***： All LDLT cases（n=159） were divided into the older（donor age ≥50 years, n=10） and younger（donor age 〈50 years,n=149） donor groups. Donor graft and recipient condition pre-,intra- and post-operation were compared between the two *** particular, graft functions and recipient survivals were ***： The median donor age was 58.5（52.5-60.0） years in the older donor group and 25.0（23.0-32.0） in the younger donor group. There was no significant difference in cold ischemic time, anhepatic phase and operation time between the older and younger donor groups（P〉0.05）. However, the volume of red blood cell transfused in operation was greater in the older donor group than in the younger donor group（1900 vs 1200 m L, P=0.023）. The 1-, 3- and 5-year graft survival rates were 90%, 80% and 80% for the older donor group, and 92%, 87% and 87% for the younger donor group, respectively（P=0.459）.The 1-, 3- and 5-year survival rates were 100%, 90% and 90% for recipients with older grafts, and 93%, 87% and 87% for those with younger grafts, respectively（P=0.811）.CONCLUSION： It is safe for a LDLT recipient to receive liver from donors older than 50 years, and there is no significant adverse effect on graft function and long-term patients’ survival.

关键词： living donor liver transplantation donor age graft liver function long-term survival

Unusual complication in patient with Gardner's syndrome: Coexistence of triple gastrointestinal perforation and lower gastrointestinal bleeding: A case report and review of literature

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World Journal of Clinical Cases 2018年第10期6卷 393-397页

作者： Sami Akbulut Cemalettin Koc Abuzer Dirican department of Surgery and Liver transplant Institute Inonu University Faculty of Medicine

Gardner's syndrome(GS) is a rare syndrome with autosomal dominant inheritance, which is characterized by multiple intestinal polyps, dental anomalies, desmoid tumors, and soft tissue tumors. All gastrointestinal symptoms seen in GS are associated with the underlying familial adenomatosis polyposis and abdominal desmoid tumors, with the most common symptoms being anemia, lower gastrointestinal bleeding, abdominal pain, diarrhea, obstruction, and mucous defecation. To our best knowledge, no case of GS that has presented with gastrointestinal perforation and bleeding has ever been reported in the English language medical literature. A 37-year-old male who had been diagnosed with GS five years earlier was referred to our clinic for lower gastrointestinal bleeding. Despite the absence of a bleeding focus on conventional angiography, the patient was operated on with laparotomy, due to the persistence of both signs and symptoms of mild peritonitis. On the laparotomy, the patient was noted to have areas of perforation in the duodenum, splenic flexura, and midrectum. The third and fourth part of the duodenum, the proximal 15 cm segment of the jejunum, a 10 cm segment of the terminal ileum, the whole colon, and the upper and middle rectum were resected, and duodenojejunal side-to-side anastomosis and terminal ileostomy were performed. The histopathological analysis of the large mass measuring 30 cm × 20 cm was reported as a desmoid tumor. The pathological examination of the tumor foci detected in the colonic specimen revealed poorly differentiated adenosquamous carcinoma.

关键词： Gastrointestinal perforation Gastrointestinal bleeding Adenosquamous carcinoma Complications Gardner’s syndrome