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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 *** safety and cost-effectiveness of LTAD are currently being studied in this setting,with preliminary positive *** 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 *** To compare the effectiveness and safety of palliative LTAD and LVP in refractory ascites secondary to end-stage chronic liver *** 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 ***’s exact tests and the Mann-Whitney U test were used to compare qualitative and quantitative variables,***-Meier survival estimates were generated to stratify time-related outcomes according to the type of *** Thirty patients had a total of 35 indwelling abdominal drains and nineteen patients underwent regular *** baseline characteristics were similar between the *** 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 *** 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

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

New guidelines for screening,evaluation and management of hepatobiliary disease in cystic fibrosis

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Hepatobiliary Surgery and Nutrition 2024年第5期13卷 875-878页

作者： P.Aiden McCormick Emer Fitzpatrick liver unit St Vincent’s University HospitalDublinIreland Department of Medicine UCD School of MedicineUniversity College DublinDublinIreland Gastroenterology and liver Department Children’s Health IrelandCrumlinDublinIreland

The recently published guidelines on screening,monitoring and treatment update previous guidelines published 25 years ago(1,2).This update is timely as much has happened in the *** fibrosis(CF)modulator therapy has dramatically improved prognosis for patients with CF,although it is not yet clear whether liver disease is *** understanding of the pathophysiology of CF liver disease has also changed with the recognition of the importance of non-cirrhotic portal hypertension(3,4).Non-invasive tests for fibrosis and elastography have changed the practice of hepatology and reduced the need for liver *** guideline committee was made up of experts from North America and Europe and included adult and paediatric hepatologists and pulmonologists together with allied health practitioners and representatives of the CF community.A systematic literature search was performed and a vote of 80%was required to adopt a *** guidelines contain 7 recommendations for screening,13 for disease monitoring and 14 for treatment.

关键词： Cirrhosis oesophageal varices non-cirrhotic portal hypertension porto-sinusoidal vascular disease hepatobiliary

Acute liver failure:individualization of care and minimizing the need for liver transplantation

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Hepatobiliary Surgery and Nutrition 2024年第5期13卷 865-868页

作者： Philippe Ichaï Faouzi Saliba liver Intensive Care unit AP-HP Hôpital Paul-BrousseCentre Hépato-BiliaireVillejuifFrance UniversitéParis-Saclay and INSERM unit N°1193 VillejuifFrance

Acute liver failure(ALF)is a challenging condition that requires a rapid transfer and management in a specialized intensive care unit affiliated to a transplant *** outcome depends mainly on patient’s age,etiology of ALF,severity of the neurological damage at time of presentation,systemic and brain hemodynamic status and the possibility of a rapid access to liver transplantation(LT).Nevertheless,in recent years,the global survival rate improved and the number of patients with ALF who do not require LT have significantly *** 1998 and 2013,the gap of improvement was respectively 12%and 25%(1).

关键词： Acute liver failure(ALF) artificial liver support liver transplantation(LT)

Navigating the controversy regarding antibiotic prophylaxis in acute variceal bleeding

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World Journal of Gastroenterology 2024年第18期30卷 2485-2487页

作者： David Aguirre-Villarreal Ignacio García-Juárez Department of Gastroenterology and liver Transplant unit Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico City 14080Mexico

Antibiotic prophylaxis in patients with cirrhosis and acute variceal bleeding is part of the standard of care according to most clinical ***,with recent evidence arguing against antibiotic prophylaxis,the role of this... 详细信息

关键词： Cirrhosis Acute variceal bleeding Antibiotic prophylaxis Endoscopic band ligation Spontaneous bacterial peritonitis

Machine learning in liver surgery:Benefits and pitfalls

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World Journal of Clinical Cases 2024年第12期12卷 2134-2137页

作者： Rafael Calleja Manuel Durán María Dolores Ayllón Ruben Ciria Javier Briceño Hepatobiliary Surgery and liver Transplantation unit Hospital Universitario Reina SofíaMaimonides Biomedical Research Institute of CordobaCórdoba 14004Spain

The application of machine learning(ML)algorithms in various fields of hepatology is an issue of ***,we must be cautious with the *** this letter,based on a published ML prediction model for acute kidney injury after liver surgery,we discuss some limitations of ML models and how they may be addressed in the *** the future faces significant challenges,it also holds a great potential.

关键词： Machine learning liver surgery Artificial intelligence Random forest Prediction model

Enhanced recovery for liver transplantation: recommendations from the 2022 International liver Transplantation Society Consensus Conference: towards better clinical care in transplant hepatology

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Hepatobiliary Surgery and Nutrition 2024年第3期13卷 512-515页

作者： Yu Jun Wong Noreen Singh Norberto Sanchez-Fernandez Aldo J.Montano-Loza Division of Gastroenterology and liver unit University of Alberta HospitalEdmontonCanada Division of Transplantation Department of SurgeryUniversity of Alberta HospitalEdmontonCanada

liver transplantation(LT)was first performed over six decades ago and is currently the standard of care for patients with end-stage liver disease and life-threatening *** have been significant advances in the area of LT;however,it remains a highly morbid,restrictive,expensive and resource-intensive intervention(1).Early recovery for LT(***)is a multimodal concept aimed at promoting faster recovery in patients undergoing *** development of a dedicated protocol for early recovery following LT has been challenging due to the complexity of developing a treatment approach,patient comorbidities associated with decompensated cirrhosis,and low case volume.

关键词： liver transplantation(LT) outcome recovery

Risk stratification prior to major hepatectomy

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Hepatobiliary Surgery and Nutrition 2024年第5期13卷 898-900页

作者： Daniel C.Osei-Bordom Robert P.Sutcliffe liver unit Queen Elizabeth HospitalBirminghamUK

Post-hepatectomy liver failure(PHLF)is an uncommon but potentially life-threatening complication after major hepatic *** mild cases of PHLF are self-limiting,clinically significant PHLF[International Study Group of liver Surgery(ISGLS)grades B or C]may be associated with multi-organ failure and sepsis and carries a high *** is no proven treatment for PHLF,and its management is essentially supportive,including timely diagnosis and treatment of septic or vascular complications and organ support for associated renal,respiratory or cardiovascular *** the absence of any evidence-based interventions that may improve PHLF outcomes,liver surgeons have focussed on preoperative risk assessment and development of risk mitigation *** dominant risk factors for PHLF are extent of resection and background liver function,which have been incorporated into several risk scores(1,2).Patients who undergo resection or four or more segments(i.e.,right hemihepatectomy or extended left/right hemihepatectomy)or those with underlying liver disease(e.g.,fibrosis,cirrhosis or chemotherapy-associated liver disease)are at particular risk of PHLF.

关键词： Prediction models liver resections post-hepatectomy liver failure(PHLF)

Multiomics analysis reveals metabolic subtypes and identifies diacylglycerol kinase α (DGKA) as a potential therapeutic target for intrahepatic cholangiocarcinoma

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Cancer Communications 2024年第2期44卷 226-250页

作者： Weiren Liu Huqiang Wang Qianfu Zhao Chenyang Tao Weifeng Qu Yushan Hou Run Huang Zimei Sun Guiqi Zhu Xifei Jiang Yuan Fang Jun Gao Xiaoling Wu Zhixiang Yang Rongyu Ping Jiafeng Chen Rui Yang Tianhao Chu Jian Zhou Jia Fan Zheng Tang Dong Yang Yinghong Shi Department of liver Surgery and Transplantation Liver Cancer InstituteZhongshan HospitalFudan UniversityKey Laboratory of Carcinogenesis and Cancer Invasion of Ministry of EducationShanghaiP.R.China Research unit of liver cancer Recurrence and Metastasis Chinese Academy of Medical SciencesBeijingP.R.China State Key Laboratory of Medical Proteomics Beijing Proteome Research CenterNational Center for Protein Sciences(Beijing)Beijing Institute of LifeomicsBeijingP.R.China

Background:Intrahepatic cholangiocarcinoma(iCCA)is a highly heteroge-neous and lethal hepatobiliary tumor with few therapeutic *** metabolic reprogramming of tumor cells plays an essential role in the develop-ment of tumors,while the metabolic molecular classification of iCCA is largely ***,we performed an integrated multiomics analysis and metabolic classification to depict differences in metabolic characteristics of iCCA patients,hoping to provide a novel perspective to understand and treat ***:We performed integrated multiomics analysis in 116 iCCA samples,including whole-exome sequencing,bulk RNA-sequencing and proteome *** on the non-negative matrix factorization method and the protein abundance of metabolic genes in human genome-scale metabolic models,the metabolic subtype of iCCA was *** and prognostic gene analy-ses were used to compare overall survival(OS)differences between metabolic *** proliferation analysis,5-ethynyl-2’-deoxyuridine(EdU)assay,colony formation assay,RNA-sequencing and Western blotting were performed to investigate the molecular mechanisms of diacylglycerol kinaseα(DGKA)in iCCA ***:Three metabolic subtypes(S1-S3)with subtype-specific biomarkers of iCCA were *** metabolic subtypes presented with distinct prog-noses,metabolic features,immune microenvironments,and genetic *** S2 subtype with the worst survival showed the activation of some special metabolic processes,immune-suppressed microenvironment and Kirsten ratsar-coma viral oncogene homolog(KRAS)/AT-rich interactive domain 1A(ARID1A)*** the S2 subtype-specific upregulated proteins,DGKA was further identified as a potential drug target for iCCA,which promoted cell proliferation by enhancing phosphatidic acid(PA)metabolism and activating mitogen-activated protein kinase(MAPK)***:Viamultiomics analyses,we identified three metabolic subtypes of iCCA,revealing

关键词： diacylglycerol kinaseα intrahepatic cholangiocarcinoma MAPK signaling metabolic classifi-cation multiomics analysis phosphatidic acid metabolism

Pancreatic neuroendocrine tumors:Are tumors smaller than 2 cm truly indolent?

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World Journal of Gastrointestinal Oncology 2024年第5期16卷 1756-1762页

作者： Sergio Hoyos Pablo Posada-Moreno Natalia Guzman-Arango Romario Chanci-Drago Jaime Chavez Alvaro Andrés-Duarte Santiago Salazar-Ochoa Hepatobilary and liver Transplant unit Hospital Pablo Tobon Uribe and Gastrohepathology Group Universidad de AntioquiaMedellin 050034AntioquiaColombia Department of General Surgery Universidad Pontificia BolivarianaMedellín 050034AntioquiaColombia

BACKGROUND Pancreatic neuroendocrine tumors(PNETs)are relatively rare but rank as the second most common pancreatic *** can be functional,causing early metabolic disturbances due to hormone secretion,or non-functional and diagnosed later based on tumor size-related *** diagnoses of PNETs under 2 cm in size have sparked debates about their management;some practitioners advocate for surgical removal and others suggest observation due to the tumors’lower potential for ***,it is unclear whether managing these small tumors expectantly is truly *** To evaluate poor prognostic factors in PNETs based on tumor size(>2 cm or7(95%CI:2.98–207.19,P=0.003),*** involvement and lymphovascular invasion were present in tumors smaller than 2 cm in diameter and those larger than 2 cm in *** recurrence rates between the two tumor groups were furthermore similar:18.2%for tumors smaller than 2 cm and 21.4%for tumors larger than 2 *** survival was additionally comparable between the two tumor *** Tumor size does not dictate prognosis;lymph node and lymphovascular involvement a

关键词： Neuroendocrine tumor Pancreatic neoplasm Pancreas Pancreatic neuroendocrine neoplasm Pancreatic neuroendocrine tumors