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Impact of multidrug resistance on the management of bacterial infections in cirrhosis

World Journal of Clinical Cases 2023年第3期11卷 534-544页

作者： Carlos Terra Ângelo Zambam de Mattos Marcelo Souza Chagas Andre Torres denusa Wiltgen Barbara Muniz Souza Renata Mello Perez Gastroenterology-Liver Unit State University of Rio de JaneiroRio de Janeiro 20551-030Rio de JaneiroBrazil Liver Unit Casa de Saúde São José-Rede Santa CatarinaRio de Janeiro 22271-080Rio de JaneiroBrazil Alliance of Brazilian Centers for Cirrhosis Car The ABC GroupRio de Janeiro 20551-030Rio de JaneiroBrazil Liver Unit Federal Hospital of LagoaRio de Janeiro 22470-050Rio de JaneiroBrazil Graduate Program in Medicine:Hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil Gastroenterology and Hepatology Unit Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil Internal Medicine Federal Hospital of LagoaRio de Janeiro 22470-050Rio de JaneiroBrazil department of Internal Medicine Federal University of Health Sciences of Porto AlegrePorto Alegre 90020-090Brazil Hepatology Division Federal University of Rio de JaneiroRio de Janeiro 21941-617Rio de JaneiroBrazil IDOR D’Or Institute for Research and EducationRio de Janeiro 22281-100Rio de JaneiroBrazil

Patients with cirrhosis have an increased risk of infection and differently from other complications,that over the years are improving in their outcomes,infections in cirrhotic patients are still a major cause of hospitalization and death(up to 50%in-hospital mortality).Infections by multidrug-resistant organisms(MDRO)have become a major challenge in the management of cirrhotic patients with significant prognostic and cost-related *** one third of cirrhotic patients with bacterial infections is infected with MDR bacteria and their prevalence has increased in recent *** infections have a worse prognosis compared to infections by non-resistant bacteria because they are associated with lower rate of infection *** adequate management of cirrhotic patients with infections caused by MDR bacteria depends on the knowledge of some epidemiological aspects,such as the type of infection(spontaneous bacterial peritonitis,pneumonia,urinary tract infection and spontaneous bacteremia),bacteriological profile of antibiotic resistance at each health care unit and site of infection acquisition(community acquired,healthcare associated or nosocomial).Furthermore,regional variations in the prevalence of MDR infections determine that the choice of empirical antibiotic therapy must be adapted to the local microbiological *** treatment is the most effective measure to treat infections caused by ***,optimizing antibiotic prescribing is critical to effectively treat these *** of risk factors for multidrug resistance is essential to define the best antibiotic treatment strategy in each case and the choice of an effective empirical antibiotic therapy and its early administration is cardinal to reduce *** the other hand,the supply of new agents to treat these infections is very ***,specific protocols that include preventive measures must be implemented in order to limit the negative impact of this sev

关键词： Cirrhosis Infection Multidrug-resistance Bacterial Antibiotics Microbiota

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Influence of proton pump inhibitors in the development of spontaneous bacterial peritonitis

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World Journal of Hepatology 2017年第35期9卷 1278-1285页

作者： Suelen A S Miozzo Jorge A John Marcelo C Appel-da-Silva Isabella A Dossin Cristiane V Tovo Angelo A Mattos Graduate Program in Medicine HepatologyUniversidade Federal de Ciências da Saúde de Porto AlegrePorto Alegre CEP 90430-080Brazil

AIM To investigate whether the use of proton pump inhibitors(PPIs) increases the incidence of spontaneous bacterial peritonitis(SBP) in patients with cirrhosis and *** An historical cohort study was carried out in cirrhotic outpatients with ascites followed in a specialized clinic at a tertiary hospital in Southern Brazil. Patient charts were reviewed to collect information on the variables of interest as the use of PPIs. Primary outcome was defined as development of SBP during the study period. SBP was diagnosed based on ascitic fluid polymorphonuclear cell count ≥ 250 cells/mm3 without evidence of an intraabdominal, surgically treatable source of *** Of 738 cirrhotic patients, 582(58.2% male) were enrolled, with mean age of 53.6 ± 12 years. Hepatitis C virus infection(36.2%) and alcohol abuse(25.6%) were the main etiologies of cirrhosis. The presence of ascites was detected in 299(51.4%) patients during the development of the study. Nineteen patients with previous diagnosis of SBP undergoing secondary prophylaxis and 22 patients with insufficient PPI data were further excluded. Of 258 patients with ascites, 151 used PPIs, and 34 developed SBP(22.5%). Among 107 non-users of PPIs, 23 developed SBP(21.5%)(HR = 1.44, 95%CI: 0.85-2.47, P = 0.176). The median follow-up time of patients using PPI was 27 mo vs 32 mo for non-users. Univariate analysis of the risk factors associated with the development of SBP revealed a significant association of SPB with the severity of liver disease according to the Child-Turcotte-Pugh(CTP) score. Multivariate analysis confirmed that CTP score was the only independent variable influencing the occurrence of SBP. Survival at 60 mo(Kaplan-Meier analysis) was similar in users and non-users of PPI, independently of the presence of SBP(58.4% vs 62.7% respectively, P = 0.66). For patients with SBP, survival at 60 mo was 55.1%, vs 61.7% in patients without SBP(P = 0.34). CONCLUSION In conclusion, the rate of SBP was not

关键词： Cirrhosis Bacterial infection Spontaneous bacterial peritonitis Proton pump inhibitors Ascites

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Testosterone replacement maintains smooth muscle content in the corpus cavernosum of orchiectomized rats

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Asian Journal of Urology 2017年第4期4卷 223-229页

作者： Graziele Halmenschlager Ernani Luis Rhoden Gabriela Almeida Motta Lucas Sagrillo Fagundes Jorge Luiz Medeiros Jr Rosalva Meurer Claudia Ramos Rhoden Centro Universitario Ritter dos Reis(UniRitter)and Universidade Federal de Cieˆncias da Sau´de de porto alegre(UFCSPA)e PPG Cieˆncias da Sau´de Porto AlegreRSBrazil department of Urology at Universidade Federal de Cieˆncias da Sau´de de porto alegre(UFCSPA) Urologist at Irmandade Santa Casa de Miserico´rdia de Porto Alegre(ISCMPA)and Hospital Moinhos de Vento de Porto Alegre(HMV)Porto AlegreRSBrazil Universidade Federal de Cieˆncias da Sau´de de porto alegre(UFCSPA)e PPG Cieˆncias da Sau´de-porto alegre RSBrazil INRS Institut Armand Frappier(Universit.du Que´bec)and BioMed Research Center Laval QuebecCanada Laboratory of Morphometry Metabolismand Cardiovascular DiseaseBiomedical CenterInstitute of BiologyState University of Rio de JaneiroRio de JaneiroBrazil Laboratory of Multidisciplinary of Sciences Biomedical CenterMedical School of Valenc¸aValenc¸a/Rio de JaneiroBrazil

Objective:To evaluate the effects of testosterone(T)on the maintenance of corpus cavernosum(CC)structure and ***:Animals were divided into three groups:sham operation group(n Z 8)underwent sham operation;Orchiectomized(Orchiec)t oily vehicle group(n Z 8)underwent bilateral orchiectomy and received a single dose of oily vehicle by intramuscular injection(i.m.)30 days after orchiectomy;and Orchiec t T group(n Z 8)underwent bilateral orchiectomy and received a single dose of T undecanoate 100 mg/kg i.m.30 days after the *** were euthanized 60 days after the beginning of the experiment with an anesthetic overdose of ketamine and *** samples and penile tissue were collected on euthanasia.

关键词： Testosterone replacement Histomorphometry Androgen deprivation Hypogonadism Corpus cavernosum

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Hepatotoxicity Induced by Biological Agents: Clinical Features and Current Controversies

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Journal of Clinical and Translational Hepatology 2022年第3期10卷 486-495页

作者： Nelia Hernandez Fernando Bessone hospital de clinicas Universidad de la RepublicaMontevideoUruguay hospital Provincial del Centenario University of Rosario School of MedicineRosarioArgentina

Novel biological agents including cytokines and recombinant fusion proteins are increasingly prescribed for cancer,rheumatologic,autoimmune,and inflammatory diseases,and are currently being evaluated in hepatocellular carcinoma(HCC).They are classified by their mechanism of action and include tumor necrosis factor-alpha(TNF-α)antagonists,T cell mediated antitumor inhibitors,interleukin receptor antagonists,and immune checkpoint inhibitors(ICIs).Some ICIs cause frequent hepatotoxicity with a variable clinical,biochemical,and serological presentation,especially in patients receiving another immunomodulatory *** of the cases of liver damage induced by biological agents spontaneously regress after drug withdrawal,but the others require steroid ***,there are no widely accepted recommendation for the use of corticosteroids in these patients,even though international cancer societies have their own *** drug-induced autoimmune hepatitis(DIAIH)from classic AIH is challenging for pathologists,but liver biopsy is valuable,particularly in cases with unclear clinical ***,novel histological patterns have been described in liver damage induced by these agents(i.e.,endothelitis,ring granuloma and secundary sclerosing cholangitis associated with lymphocytic infiltration of cytotoxic CD8+T cells).Here,we describe the clinical and biochemical characteristics of patients with hepatotoxicity induced by TNF-αantagonists and *** issues involved in the administration of corticosteroid therapy,and hepatitis B virus(HBV)reactivation induced by immunosuppressive therapy are also discussed.

关键词： Hepatotoxicity Checkpoint inhibitors Biologics Autoimmune hepatitis Drug-induced liver injury

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Antioxidant and anti-inflammatory action of melatonin in an experimental model of secondary biliary cirrhosis induced by bile duct ligation

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World Journal of Gastroenterology 2016年第40期22卷 8918-8928页

作者： Josieli Raskopf Colares Elizângela Goncalves Schemitt Renata Minuzzo Hartmann Francielli Licks Mariana do Couto Soares Adriane Dal Bosco Norma Possa Marroni Graduate Program in Medical Sciences Universidade Federal do Rio Grande do Sul Porto Alegre 90040-060 Brazil Laboratory of Experimental Hepatology and Gastroenterology Hospital de Clínicas de Porto Alegre Porto Alegre 90035-903 Brazil Laboratory of Oxidative Stress and Antioxidants Universidade Luterana do Brasil Canoas 92425-900 Brazil Graduate Program in Physiology Universidade Federal do Rio Grande do Sul Porto Alegre 90050-170 Brazil

AIM To evaluate the effects of melatonin(Mel) on oxidative stress in an experimental model of bile duct ligation(BDL).METHODS Male Wistar rats(n = 32, weight ± 300 g) were allocated across four groups: CO(sham BDL), BDL(BDL surgery), CO + Mel(sham BDL and Mel administration) and BDL + Mel(BDL surgery and Mel administration). Mel was administered intraperitoneally for 2 wk, starting on postoperative day 15, at a dose of 20 mg/*** Mel was effective at the different standards, reestablishing normal liver enzyme levels, reducing the hepatosomatic and splenosomatic indices, restoring lipoperoxidation and antioxidant enzyme concentrations, reducing fibrosis and inflammation, and thereby reducing liver tissue injury in the treated *** The results of this study suggest a protective effect of Mel when administered to rats with secondary biliary cirrhosis induced by BDL.

关键词： Antioxidant Cirrhosis Fibrosis Melatonin Oxidative stress

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Advances in surgical techniques for gastric cancer:Indocyanine green and near-infrared fluorescence *** it ready for prime time?

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Chinese Journal of Cancer Research 2022年第6期34卷 587-591页

作者： Erica Sakamoto Adriana Vaz Safatle-Ribeiro Ulysses Ribeiro Jr department of Gastroenterology Instituto do Cancer do Estado de Sao PauloHospital das ClinicasFaculdade de MedicinaUniversidade de Sao

Surgery is still the primary curative treatment for gastric cancer,which includes resection of the tumor with adequate margins and extended *** order to improve the operative results and the quality of life of patients,several endeavors have been made toward precision medicine through image-guided surgery,allowing access to real-time intraoperative anatomy and accurate tumor *** goal of the surgeon is to achieve a more precise,individualized,and less invasive surgery without compromising oncological efficiency and *** this perspective,we have demonstrated the role of indocyanine green(ICG)and near-infrared(NIR)fluorescence imaging method in gastric cancer *** technique may be used to improve localization of the tumor,detection of sentinel lymph nodes(SLN),real-time lymphatic mapping,and blood flow assessment(anastomosis perfusion).

关键词： Indocyanine green near-infrared fluorescence imaging gastric cancer lymphatic mapping

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Metabolic disease and the liver: A review

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World Journal of Hepatology 2024年第1期16卷 33-40页

作者： Márcia Vargas Sheila de Castro Cardoso Toniasso Patricia G Riedel Camila Pereira Baldin Francielle Lopes dos Reis Robson Martins Pereira Maria Carlota Borba Brum Dvora Joveleviths Mario Reis Alvares-da-Silva Program of Graduate Science in Gastroenterology and Hepatology Federal University of Rio Grande do SulPorto Alegre 90040-060Rio Grande do SulBrazil School of Medicine Federal University of Rio Grande do SulPorto Alegre 90040-060Brazil Program of Graduate Science in Gastroenterology and Hepatology Clinicas Hospital of Porto AlegrePorto Alegre 90410000Brazil Medicine Faculty Federal University of Rio Grande do Sul Federal University of Rio Grande do SulPorto Alegre 90040-060Brazil Division of Gastroenterology and Hepatology Clinicas Hospital of Porto AlegrePorto Alegre 90035007Brazil

Metabolic dysfunction-associated steatotic liver disease(MASLD)is the most common liver disease worldwide,with an estimated prevalence of 31%in Latin *** presence of metabolic comorbidities coexisting with liver disease varies substantially among *** is acknowledged that obesity is boosting the type 2 diabetes mellitus“epidemic,”and both conditions are significant contributors to the increasing number of patients with *** steatohepatitis represents a condition of chronic liver inflammation and is considered the most severe form of *** diagnosis is based on the presence of steatosis,noninvasive scores and altered liver *** scores of liver fibrosis,such as serum biomarkers,which should be used in primary care to rule out advanced fibrosis,are simple,inexpensive,and widely ***,guidelines from international hepatology societies recommend using noninvasive strategies to simplify case finding and management of high-risk patients with MASLD in clinical ***,there is no definite pharmacological treatment for the *** public health policies to treat patients with risk factors for MASLD prevention is essential.

关键词： Nonalcoholic fatty liver disease Primary care Metabolic risk Liver Metabolism

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Scaffold strategies combined withmesenchymal stem cells in vaginalconstruction: a review

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Cell Regeneration 2021年第1期10卷 269-279页

作者： Nicole Andréa Corbellini Henckes Dalana Faleiro Laura Chao Chuang Elizabeth Obino Cirne-Lima Programa de Pós-Graduação em Ciências da Saúde—Ginecologia e Obstetrícia Universidade Federal do Rio Grande do Sul(UFRGS)Porto AlegreBrazil Laboratório de Embriologia e Diferenciação Celular Centro de Pesquisa ExperimentalHospital de Clínicas de Porto AlegrePorto AlegreBrazil departamento de Patologia Clínica Veterinária Faculdade de VeterináriaUniversidade Federal do Rio Grande do Sul(UFRGS)Porto AlegreBrazil

Tissue engineering has provided new treatment alternatives for tissue reconstruction. Advances in the tissue engineeringfield have resulted in mechanical support and biological substitutes to restore, maintain or improve tissue/organs structuresand functions. The application of tissue engineering technology in the vaginal reconstruction treatment can not onlyprovide mechanical requirements, but also offer tissue repairing as an alternative to traditional approaches. In this review, wediscuss recent advances in cell-based therapy in combination with scaffolds strategies that can potentially be adopted forgynaecological transplantation.

关键词： Mesenchymal stem cells Scaffolds Tissue engineering Vaginal reconstruction

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Potential use of lactate for the treatment of neonatal hypoxic-ischemic encephalopathy

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Neural Regeneration Research 2022年第4期17卷 788-790页

作者： Isadora D’Ávila Tassinari Luciano Stürmer de Fraga Laboratory of Neurobiology and Metabolism(NeuroMet) Department of PhysiologyInstituto de Ciências Básicas da Saúde(ICBS)Federal University of Rio Grande do Sul(UFRGS) Post-Graduate Program in Physiology Instituto de Ciências Básicas da Saúde(ICBS)Federal University of Rio Grande do Sul(UFRGS) Unidade de Experimentação Animal Centro de Pesquisa ExperimentalHospital de Clínicas de Porto Alegre(HCPA)Porto AlegreBrazil

Function of lactate:Lactate is a three-carbon molecule produced by glycolytic metabolism that is a metabolic waste product with no known use in clinical ***,it is a metabolite that the body should quickly guarantee the ***,lactate is now recognized as a potential energy substrate,as well as an anti-inflammatory signaling *** actions were first reported in adult animal models with a brain injury,including a traumatic brain injury and cerebral ischemia,and have also been observed in human patients(Magistretti and Allaman,2018).Recently,however,two studies by independent research groups described promising n euro p rotective results from the use of lactate in animal models with neonatal hypoxia-ischemia(Roumes et al.,2021;Tassinari et al.,2020).

关键词： neonatal metabolism ischemia

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Hepatocellular carcinoma staging systems: Hong Kong liver cancer vs Barcelona clinic liver cancer in a Western population

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World Journal of Hepatology 2019年第9期11卷 678-688页

作者： Laura Bainy Rodrigues de Freitas Larisse Longo deivid Santos Ivana Grivicich Mário Reis Alvares-da-Silva Graduate Program in Gastroenterology and Hepatology Universidade Federal do Rio Grande do SulPorto AlegreRS 90035-003Brazil Experimental Hepatology and Gastroenterology Laboratory Center for Experimental ResearchHospital de Clínicas de Porto AlegrePorto AlegreRS 90035-003Brazil School of Medicine Universidade Federal do Rio Grande do SulPorto AlegreRS 90035-003Brazil Graduate Program in Health-Applied Cellular and Molecular Biology ULBRA.CanoasRS 92425-900Brazil department of Gastroenterology Hospital de Clínicas de Porto AlegrePorto AlegreRS 90035-003Brazil

BACKGROUND despite being the world’s most widely used system for staging and therapeutic guidance in hepatocellular carcinoma(HCC)treatment,the Barcelona clinic liver cancer(BCLC)system has limitations,especially regarding intermediate-grade(BCLC-B)*** recently proposed Hong Kong liver cancer(HKLC)staging system appears useful but requires validation in Western *** To evaluate the agreement between BCLC and HKLC staging on the management of HCC in a Western population,estimating the overall patient *** This was a retrospective study of HCC patients treated at a university hospital in southern Brazil between 2011 and ***,clinical,and laboratory data were *** staging was carried out according to the HKLC and BCLC systems to assess treatment *** survival was estimated based on the treatment proposed in each *** A total of 519 HCC patients were *** these,178(34.3%)were HKLC-I;95(18.3%)HKLC-IIA;47(9.1%)HKLC-IIB;29(5.6%)HKLC-IIIA;30(5.8%)HKLCIIIB;75(14.4%)HKLC-IV;and 65(12.5%)*** to the BCLC,25(4.9%)were BCLC-0;246(47.4%)BCLC-A;107(20.6%)BCLC-B;76(14.6%)BCLCC;and 65(12.5%)*** general agreement between the two systems was 80.0%-BCLC-0 and HKLC-I(100%);BCLC-A and HKLC-I/HKLC-II(96.7%);BCLC-B and HKLC-III(46.7%);BCLC-C and HKLC-IV(98.7%);BCLC-D and HKLC-V(41.5%).When sub-classifying BCLC-A,HKLC-IIB,HKLC-IIIA and HKLC-IIIB stages according to the up-to-7 in/out criterion,13.4,66.0,100 and 36.7%,respectively,of the cases were classified as up-to-7 *** In a Western population,the general agreement between the two systems was 80.0%,although in BCLC-B cases the agreement was low,suggesting that some individuals could be candidates for the curative treatment recommended by the *** authors suggest that the BCLC system should be routinely employed,although for BCLC-B cases it should be associated with the HKLC system.

关键词： Barcelona clinic liver cancer staging system Hepatocellular carcinoma Hong Kong liver cancer staging system

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