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palliative long-term abdominal drains vs large volume paracenteses for the management of refractory ascites in end-stage liver disease

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World Journal of Hepatology 2024年第3期16卷 428-438页

作者： Senamjit Kaur Rodrigo V Motta Bryony Chapman Victoria Wharton Jane D Collier Francesca Saffioti Oxford Liver Unit Department of Gastroenterology and HepatologyOxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom Oxford Liver Unit and Translational Gastroenterology Unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom

BACKGROUND Long-term abdominal drains(LTAD)are a cost-effective palliative measure to manage malignant ascites in the community,but their use in patients with end-stage chronic liver disease and refractory ascites is not routine practice.The safety and cost-effectiveness of LTAD are currently being studied in this setting,with preliminary positive results.We hypothesised that palliative LTAD are as effective and safe as repeat palliative large volume paracentesis(LVP)in patients with cirrhosis and refractory ascites and may offer advantages in patients’quality of life.AIM To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver disease.METHODS A retrospective,observational cohort study comparing the effectiveness and safety outcomes of palliative LTAD and regular palliative LVP as a treatment for refractory ascites in consecutive patients with end-stage chronic liver disease followed-up at our United Kingdom tertiary centre between 2018 and 2022 was conducted.Fisher’s exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables,respectively.Kaplan-Meier survival estimates were generated to stratify time-related outcomes according to the type of drain.RESULTS Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular LVP.The baseline characteristics were similar between the groups.Prophylactic antibiotics were more frequently prescribed in patients with LTAD(P=0.012),while the incidence of peritonitis did not differ between the two groups(P=0.46).The incidence of acute kidney injury(P=0.014)and ascites/drain-related hospital admissions(P=0.004)were significantly higher in the LVP group.The overall survival was similar in the two groups(log-rank P=0.26),but the endpoint-free survival was significantly shorter in the LVP group(P=0.003,P<0.001,P=0.018 for first ascites/drain-related admission,acute kidney injury and drain-related complications,respectively).CONCLUSION

关键词： Decompensated liver cirrhosis Indwelling abdominal catheter Rocket drain palliative care Safety Quality of life

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Rationale for integration of palliative care in the medical intensive care:A narrative literature review

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World Journal of Critical care Medicine 2022年第6期11卷 342-348页

作者： Nishkarsh Gupta Raghav Gupta Anju Gupta department of Anesthesiology All India Institute of Medical SciencesDelhi 110029India department of Onco-Anesthesiology and palliative Medicine All India Institute of Medical SciencesDelhi 110029India department of Anesthesiology Pain Medicine and Critical CareAll India Institute of Medical SciencesDelhi 110029India

Despite the remarkable technological advancement in the arena of critical care expertise,the mortality of critically ill patients remains high.When the organ functions de-teriorate,goals of care are not fulfilled and life-sustaining treatment becomes a burden on the patient and caregivers,then it is the responsibility of the physician to provide a dignified end to life,control the symptoms of the patient and provide psychological support to the family members.palliative care is the best way forward for these patients.It is a multidimensional specialty which emphasizes patient and family-based care and aims to improve the quality of life of patients and their caregivers.Although intensive care and palliative care may seem to be at two opposite ends of the spectrum,it is necessary to amalgamate the postulates of palliative care in intensive care units to provide holistic care and best benefit patients admitted to intensive care units.This review aims to highlight the need for an alliance of palliative care with intensive care in the present era,the barriers to it,and models proposed for their integration and various ethical issues.

关键词： Intensive care palliative care Support Barriers Holistic care End of life

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Autologous mesenchymal stem cells offer a new paradigm for salivary gland regeneration

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International Journal of Oral Science 2023年第2期15卷 185-203页

作者： Milos Marinkovic Olivia N.Tran Hanzhou Wang Parveez Abdul-Azees David D.Dean Xiao-Dong Chen Chih-Ko Yeh department of Comprehensive Dentistry University of Texas Health Science Center at San AntonioTXUSA Research Service South Texas Veterans Health Care SystemTXUSA department of Biomedical Engineering University of Texas at San AntonioTXUSA Geriatric Research Education and Clinical CenterSouth Texas Veterans Health Care SystemTXUSA

Salivary gland(SG)dysfunction,due to radiotherapy,disease,or aging,is a clinical manifestation that has the potential to cause severe oral and/or systemic diseases and compromise quality of life.Currently,the standard-of-care for this condition remains palliative.A variety of approaches have been employed to restore saliva production,but they have largely failed due to damage to both secretory cells and the extracellular matrix(niche).

关键词： salivary clinical diseases

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Management of parenteral nutrition in critically ill patients

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World Journal of Critical care Medicine 2017年第1期6卷 13-20页

作者： Paolo Cotogni department of Anesthesia and Intensive care Pain Management and Palliative Care S. Giovanni Battista Hospital University of Turin

Artificial nutrition(AN) is necessary to meet the nutritional requirements of critically ill patients at nutrition risk because undernutrition determines a poorer prognosis in these patients. There is debate over which route of delivery of AN provides better outcomes and lesser complications. This review describes the management of parenteral nutrition(PN) in critically ill patients. The first aim is to discuss what should be done in order that the PN is safe. The second aim is to dispel "myths" about PN-related complications and show how prevention and monitoring are able to reach the goal of "near zero" PN complications. Finally, in this review is discussed the controversial issue of the route for delivering AN in critically ill patients. The fighting against PN complications should consider:(1) an appropriate blood glucose control;(2) the use of olive oil- and fish oil-based lipid emulsions alternative to soybean oil-based ones;(3) the adoption of insertion and care bundles for central venous access devices; and(4) the implementation of a policy of targeting "near zero" catheter-related bloodstream infections. Adopting all these strategies, the goal of "near zero" PN complications is achievable. If accurately managed, PN can be safely provided for most critically ill patients without expecting a relevant incidence of PN-related complications. Moreover, the use of protocols for the management of nutritional support and the presence of nutrition support teams may decrease PN-related complications. In conclusion, the key messages about the management of PN in critically ill patients are two. First, the dangers of PN-related complications have been exaggerated because complications are uncommon; moreover, infectious complications, as mechanical complications, are more properly catheter-related and not PN-related complications. Second, when enteral nutrition is not feasible or tolerated, PN is as effective and safe as enteral nutrition.

关键词： Enteral nutrition Intensive care Nutritional support Vascular access Artificial nutrition

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Long-term survivor of metastatic squamous-cell head and neck carcinoma with occult primary after cetuximab-based chemotherapy:A case report

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World Journal of Clinical Cases 2021年第24期9卷 7092-7098页

作者： Christina Große-Thie Claudia Maletzki Christian Junghanss Kathie Schmidt department of Medicine Clinic III-HematologyOncologyPalliative MedicineRostock University Medical CenterRostock 18057Germany

BACKGROUND Cancer of unknown primary(CUP)is a histological proven malignant tumor whose origin cannot be detected despite careful examination.Most cervical lymph node metastases in CUP(80%)will originate from head and neck sites,and 15%show infiltration of squamous carcinoma cells.The survival rates of CUP are poor:The 5-year-survival rate ranges from 10%to 15%.First-line treatment recommendation for advanced,inoperable squamous cell carcinoma of head/neck(HNSCC)was cetuximab plus platinum-fluorouracil chemotherapy until recently,when checkpoint inhibitors proved clinically beneficial therapies.CASE SUMMARY Here,we report a case of a 42-year-old female patient with cervical and abdominal lymph node and distant bone metastases of an occult primary of the head and neck(squamous cell carcinoma,human papillomavirus positive).The cancer was diagnosed during pregnancy 10 years ago,and after giving birth,the patient was treated with cetuximab plus platinum-fluorouracil chemotherapy achieving complete remission(CR).CR lasted 26 mo when new metastases(abdominal lymph node,lumbar vertebral body)emerged.Both manifestations were irradiated.From then on,the patient has not received any further treatment,and her disease has remained controlled.Ten years after the initial cancer diagnosis,the patient is still alive and in good health,representing an exceptional case of HNSCC.CONCLUSION This case illustrates the exceptional clinical course and benefits of combined therapy approaches in advanced metastatic HNSCC with occult primary.

关键词： Squamous cell carcinoma of the head and neck Cancer of unknown primary Long-term survival Cetuximab Metastases Case report

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Characteristics and Social Support Needs Predicting Anticipatory Grief in the Spouses of Patients with Cancer at the End of Life

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International Journal of Clinical Medicine 2022年第3期13卷 98-120页

作者： Kanako Amano Kanako Ichikura Kazuho Hisamura Hiroki Sakurai Ryota Yanaizumi Saori Takahashi Yuko Shimizu Kazuhiro Kawada Osamu Takahashi Eisuke Matsushima Takashi Takeuchi Hidehiko Takahashi Liaison Psychiatry and Psycho-oncology Unit Department of Psychiatry and Behavioral Sciences Graduate School of Medical and Dental Sciences Tokyo Medical and Dental University Tokyo Japan palliative care Ward Heiwa Hospital Yokohama Japan department of Health Science Kitasato University School of Allied Health Sciences Sagamihara Japan department of Medical Oncology Kanazawa Medical University Ishikawa Japan department of palliative Medicine Toranomon Hospital Tokyo Japan department of palliative care Cancer Institute Hospital of Japanese Foundation for Cancer Research (JFCR) Tokyo Japan department of Anesthesiology Yokohama City University Medical Center Yokohama Japan department of Anesthesiology Seirei Yokohama Hospital Yokohama Japan Yuu Home care Clinic Yokohama Japan department of Psychiatry and Behavioral Sciences Graduate School of Medical and Dental Sciences Tokyo Medical and Dental Uni-versity Tokyo Japan

Background: Medical staff provide care to spouses of terminal cancer patients through trial and error by meeting their various support needs and spousal factors regarding their anticipatory grief. Studies on the association between spousal characteristics and anticipatory grief have been inconclusive;additionally, there has been insufficient research on support needs for anticipatory grief of spouses. This study aimed to explore the spousal characteristics and social support needs predicting anticipatory grief in spouses of patients with cancer at the end of life. Methods: This was a cross-sectional study. Eligible spouses (n = 102) completed a self-report questionnaire in two hospitals with palliative care units in Japan. The questionnaire included demographic information, a tool assessing social support needs of spouses, and the Anticipatory Grief Scale for Family caregivers. Results: Simple regression analyses indicated that patient age, chemotherapy, no treatment, ECOG PS3, children aged under 20 years, total score of “social support needs regarding the disease and treatment of the patients” and subscale scores (“medical condition and cure,” “daily life and social support,” and “intimacy and employment”), and total score of “social support needs of the spouses” and subscale scores (“family psychological issues and social support” and “intimacy, employment, and society”) were significant variables (all p p Conclusions: Patients having no experience of “chemotherapy” and higher “social support needs of the spouses” in Model 1, and greater spousal needs of “family psychological issues and social support” in Model 2 were significant predictors of severe anticipatory grief. Medical staff should pay attention to these risk factors that predict anticipatory grief among spouses.

关键词： Cancer Spouse Spousal Characteristics Social Support Needs Anticipatory Grief

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Ectopic expression of clusterin/apolipoprotein J or Bcl-2 decreases the sensitivity of HaCaT cells to toxic effects of ropivacaine

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Cell Research 2004年第5期14卷 415-422页

作者： Evangelos KONTARGIRIS Evangelos KOLETTAS Athina VADALOUCA Ioannis P. TROUGAKOS Efstathios S. GONOS Vasiliki KALFAKAKOU Laboratory of Experimental Physiology University of Ioannina Medical School 45110 Ioannina Greece department of Anesthesia Pain Relief and palliative care University Clinic Areteion Hospital Athens Laboratory of Molecular and Cellular Aging Institute of Biological Research and Biotechnology National Hellenic Research Foundation 11635 Athens

Local anesthetics inhibit cell proliferation and induce apoptosis in various cell types. Ropivacaine, a unique, novel tertiary amine-type anesthetic, was shown to inhibit the proliferation of several cell types including keratinocytes. We found that Ropivacaine could inhibit the proliferation and induce apoptosis in an immortalized human keratinocyte line, HaCaT, in a dose- and time-dependent manner and with the deprivation of serum. The dose-dependent induction of apoptosis by ropivacaine was demonstrated by DNA fragmentation analysis and the proteolytic cleavage of a caspase-3 substrate — poly (ADP-ribose) polymerase (PARP). In addition, ropivacaine downregulated the expression of clusterin/ apoliporotein J, a protein with anti-apoptotic properties, in a dose-dependent manner, which well correlated with the induction of apoptosis of HaCaT cells. To investigate the role of clusterin/apoliporotein J in ropivacaine-induced apoptosis, HaCaT cells overexpressing clusterin/apoliporotein J were generated and compared to cells expressing the well estab- lished anti-apoptotic Bcl-2 protein. Ectopic overexpression of the secreted form of clusterin/apoliporotein J or Bcl-2 decreased the sensitivity of HaCaT cells to toxic effects of ropivacaine as demonstrated by DNA fragmentation, the proteolytic cleavage of PARP and by a reduction in procaspase-3 expression. Furthermore, the downregulation of endogenous clusterin/apolipoprotein J levels by ropivacaine suggested that this might be one mechanism by which ropivacaine induced cell death in HaCaT cells. In conclusion, the ability of ropivacaine to induce antiproliferative responses and to suppress the expression of the anti-apoptotic protein clusterin/apolipoprotein J, combined with previ- ously reported anti-inflammatory activity and analgesic property of the drug, suggests that ropivacaine may have poten- tial utility in the local treatment of tumors.

关键词： keratinocytes ropivacaine clusterin/Apolipoprotein J Bcl-2 apoptosis.

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Having a Partner and Having Children:Comparisons of Adults with Congenital Heart Disease and the General Population:A 15-Year Case-Control Study

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Congenital Heart Disease 2023年第3期18卷 337-348页

作者： Siegfried Geyer Claudia Dellas Thomas Paul Matthias Müller Kambiz Norozi Medical Sociology Unit Hannover Medical SchoolHannover30625Germany department of Pediatric Cardiology Intensive Care Medicine and NeonatologyUniversity Medical Center GoettingenGoettingenGermany department of Pediatrics Western UniversityLondonOntarioCanada department of Pediatric Cardiology and Intensive care Medicine Hannover Medical SchoolHannoverGermany

Objectives:To examine whether patients with congenital heart disease(CHD)are less likely to have a partner or children than individuals from the general population.Methods:Longitudinal study with two assessments of the same patients(n=244)from a hospital population and controls(n=238)from the German Socio-Economic Panel(GSOEP)using parental education,patients age,and sex as matching criteria.The first patient study was conducted between 5/2003 and 6/2004,the second one between 5/2017 and 4/2019.Controls were drawn from GSOEP-surveys 2004 and 2018.CHD-severity was classified according to type of surgery:curative,reparative,or palliative.Living single was used as outcome measure,for offspring the outcome was having children or not.Results:Among women with CHD the rate of those living single was higher than among controls with the differences depending on disease complexity(curative:OR=5.5;reparative:OR=1.9;palliative:OR=2.7).No statistically significant differences between patients and controls emerged in the male study population.With respect to children a marked difference emerged between women with CHD and controls.Among patients the odds of having children were lower than among controls(curative:OR=0.3;reparative:OR=0.3;palliative:OR=0.2).The rate of patients with children with CHD(women:5.6%;men:4.9%)was higher than expected(1%)if compared with the general population.Conclusions:Using partnership and children as outcome criteria,patients with CHD are disadvantaged if compared to subjects from the general population.In female patients the social consequences of the disease turned out as more pervasive than in women.

关键词： Congenital heart disease children partnership panel study case-control study

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Liver transplantation in the era of non-alcoholic fatty liver disease/metabolic(dysfunction)associated fatty liver disease:the dilemma of the steatotic liver graft on transplantation and recipient survival

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Hepatobiliary Surgery and Nutrition 2022年第3期11卷 425-429页

作者： Seren M.Gedallovich Daniela P.Ladner Lisa B.VanWagner Division of palliative Medicine Department of MedicineUniversity of California San FranciscoSan FranciscoCAUSA Division of Organ Transplantation Department of SurgeryNorthwestern University Feinberg School of MedicineChicagoILUSA Division of Gastroenterology&Hepatology Department of MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA Division of Epidemiology Department of Preventive MedicineNorthwestern University Feinberg School of MedicineChicagoILUSA

Liver transplantation remains the only curative therapy for end-stage liver disease and there is a well-established shortage of transplantable deceased donor organs to meet the growing demand of waitlisted patients.Steatotic liver grafts represent the most common type of so-called extended criteria donor(ECD)grafts aimed at ameliorating this disparity.However,steatotic grafts are associated with increased post-transplant complications and graft failure(1).Hepatic graft steatosis is strongly correlated with the high prevalence of non-alcoholic fatty liver disease(NAFLD)and metabolic(dysfunction)associated fatty liver disease(MAFLD)in the general population.NAFLD and MAFLD are related,but not equivalent,liver disorders that are linked with obesity and diabetes(2).Global prevalence of NAFLD is estimated at~25%and rising(3).Models predict that NAFLD prevalence will increase by 21%to affect 100.9 million persons worldwide by 2030(4).As more donors have NAFLD,the steatotic liver graft will continue to be a challenge for liver transplantation.But,promising efforts(e.g.,organ pump with defatting agents)are under way,aimed at expanding the donor pool in the coming years.Herein,we briefly summarize approaches for assessment of hepatic steatosis,describe recipient outcomes associated with the use of steatotic liver grafts,and highlight strategies that may be used to mitigate risk considering the ongoing NAFLD/MAFLD epidemic.

关键词： organs graft donor

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Clinical significance of glycemic parameters on venous thromboembolism risk prediction in gastrointestinal cancer

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World Journal of Gastroenterology 2017年第28期23卷 5187-5195页

作者： Fiorella Guadagni Silvia Riondino Vincenzo Formica Girolamo Del Monte Anna Maria Morelli Jessica Lucchetti Antonella Spila Roberta D’Alessandro David Della-Morte Patrizia Ferroni Mario Roselli San Raffaele Roma Open University Interinstitutional Multidisciplinary Biobank IRCCS San Raffaele Pisana department of Systems Medicine Medical Oncology UnitTor Vergata Clinical CenterUniversity of Rome Tor Vergata department of palliative care San Raffaele CassinoClinical Center department of Systems Medicine University of Rome Tor Vergata

AIM To investigate the possible predictive role of routinely used glycemic parameters for a first venous thromboembolism(VTE) episode in gastrointestinal(GI) cancer ambulatory patients-with or without clinically diagnosed type 2 diabetes(T2D) or obesity-treated with chemotherapy.METHODS Pre-treatment fasting blood glucose,insulin,glycated hemoglobin(Hb A1c) and homeostasis model of risk assessment(HOMA) were retrospectively evaluated in a cohort study of 342 GI cancer patients. Surgery was performed in 142(42%) patients with primary cancer,30(21%) and 112(79%) of whom received neoadjuvant and adjuvant therapies,respectively. Firstline chemotherapy was administered in 200(58%) patients with metastatic disease. The study outcome was defined as the occurrence of a first symptomatic or asymptomatic VTE episode during active treatment.RESULTS Impaired glucose tolerance(IGT) or T2 D were diagnosed in 30% of GI cancer patients,while overweight/obesity had an incidence of 41%. VTE occurred in 9.4% of patients(7% of non-diabetic non-obese),especially in those with a high ECOG score(P = 0.025). No significant association was found between VTE incidence and T2 D,obesity,different tumor types,metastatic disease,Khorana class of risk,or different anti-cancer drugs,although VTE rates were substantially higher in patients receiving bevacizumab(17% vs 8%,P = 0.044). Conversely,all glucose metabolic indexes were associated with increased VTE risk at ROC analysis. Multivariate Cox proportional analyses confirmed that HOMA index(HR = 4.13,95%CI: 1.63-10.5) or fasting blood glucose(HR = 3.56,95%CI: 1.51-8.39) were independent predictors of VTE occurrence during chemotherapy.CONCLUSION The results here reported demonstrate that evaluating glucose metabolic asset may allow for VTE risk stratification in GI cancer,helping to identify chemotherapy-treated patients who might benefit from thromboprophylaxis. Further multicenter prospective studies involving a larger number of patients are presently needed.

关键词：胃肠的癌症打 2 糖尿病静脉的 thromboembolism 化疗胰岛素抵抗

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