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Don’t forget emergency surgery! Lessons to learn from elective indocyanine green-guided gastrointestinal interventions

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World Journal of Gastrointestinal Surgery 2024年第2期16卷 270-275页

作者： Davina Perini Jacopo Martellucci Department of Emergency Emergency and Minimally Invasive Surgery UnitCareggi University HospitalFirenze 50041Italy

Fluorescence-based imaging has found application in several fields of elective surgery,but there is still a lack of evidence in the literature about its use in the emergency *** trials have consistently shown that indocyanine green(ICG)-guided surgery can dramatically reduce the risk of postoperative complic-ations,length of in-hospital stay and total healthcare costs in the elective *** is well-known that emergency surgery has a higher complication rate than its elective counterpart,therefore an impelling need for research studies to explore,validate and develop this issue has been *** present editorial aims to provide a critical overview of currently available applications and pitfalls of ICG fluorescence in abdominal ***,we evidenced how the experience of ICG-fluorescence in elective surgery might be of great help in implementing its use in acute *** the first paragraph we analyzed the tips and tricks of ICG-guided cancer surgery that might be exploited in acute *** then deepened the two most described topics in ICG-guided emergency surgery:Acute cholecystitis and intestinal ischemia,focusing on both the advantages and limitations of green-fluorescence application in these two *** emergency situations,ICG fluorescence demonstrates a promising role in preventing undue intestinal resections or their entity,facilitating the detection of intestinal ischemic zones,identifying biliary tree anatomy,reducing post-operative complications,and mitigating high mortality *** need to improve its application still exists,therefore we strongly believe that the elective and routinary use of the dye is the best way to acquire the necessary skills for emer-gency procedures.

关键词： Indocyanine green Fluorescence Navigation surgery Angiography Emergency surgery Decision-making

Approaching the Sarcopenic Patient with Nonalcoholic Steatohepatitis-related Cirrhosis

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Journal of Clinical and Translational Hepatology 2024年第3期12卷 278-286页

作者： Paolo Gallo Valentina Flagiello Andrea Falcomatà Giulia Di Pasquale Giorgio D’Avanzo Francesca Terracciani Antonio Picardi Umberto Vespasiani-Gentilucci Operative Research unit of Clinical Medicine and Hepatology Fondazione Policlinico Universitario Campus Bio-MedicoVia Alvaro del PortilloRomaItaly Research unit of Hepatology Department of Medicine and SurgeryUniversitàCampus Bio-Medico di RomaVia Alvaro del PortilloRomaItaly

Sarcopenia is a well-known complication of chronic liver disease(CLD),and it is almost always observed in patients with cirrhosis,at least in those with decompensated *** nonalcoholic fatty liver disease(NAFLD),recently renamed metabolic dysfunction-associated steatotic liver disease(MASLD),is becoming the leading cause of end-stage liver disease,a new scenario characterized by the frequent coexistence of NAFLD,obesity,and sarcopenia is *** it is not yet resolved whether the bidirectional relationship between sarcopenia and NAFLD subtends causal determinants,it is clear that the interaction of these two conditions is associated with an increased risk of poor ***,during the course of CLD,deregulation of the liver-muscle-adipose tissue axis has been ***,owing to the lack of properly designed studies,specific therapeutic guidelines for patients with sarcopenia in the context of NAFLD-related CLD have not yet been *** aimed to induce the loss of fat mass together with the maintenance of lean body mass seem most *** can be achieved by properly designed diets integrated with specific nutritional supplementations and accompanied by adequate physical *** studies aiming to add to the knowledge of the correct assessment and approach to sarcopenia in the context of NAFLD-related CLD are eagerly awaited.

关键词： NAFLD MASLD Cirrhosis Sarcopenia Sarcopenic obesity

Beyond total mesorectal excision: The emerging role of minimally invasive surgery for locally advanced rectal cancer

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World Journal of Gastrointestinal Surgery 2024年第8期16卷 2382-2385页

作者： Davina Perini Francesca Cammelli Maximilian Scheiterle Jacopo Martellucci Annamaria Di Bella Carlo Bergamini Paolo Prosperi Alessio Giordano Department of Emergency and Acceptance Emergency Surgery UnitCareggi University HospitalFirenze 50137Italy

Multivisceral resection and/or pelvic exenteration represents the only potential curative treatment for locally advanced rectal cancer(LARC);however,it poses significant technical challenges,which account for the high risk of morbidity and mortality associated with the *** complete histopathologic resection is the most important determinant of patient outcomes,LARC often requires an extended resection beyond the total mesorectal excision plane to obtain clear re-section *** an era when laparoscopic surgery and robot-assisted surgery are becoming commonplace,the optimal approach to extensive pelvic inter-ventions remains ***,acceptance of the suitability of mini-mally invasive surgery is slowly gaining ***,there is still a lack of evidence in the literature about minimally invasive approaches in multiple and extensive surgical resections,highlighting the need for research studies to explore,validate,and develop this *** editorial aims to provide a critical overview of the currently available applications and challenges of minimally invasive abdo-minopelvic surgery for ***,we discuss recent developments in the field of robotic surgery for LARC,with a specific focus on new innovations and emerging frontiers.

关键词： Robotic surgery Pelvic exenteration Multivisceral resection Rectal cancer Total mesorectal excision

Gut microbiota predicts the diagnosis of ulcerative colitis in Saudi children

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World Journal of Clinical Pediatrics 2024年第1期13卷 118-124页

作者： Mohammad El Mouzan Ahmed Al Sarkhy Asaad Assiri Department of Pediatrics Gastroenterology UnitKing Saud UniversityRiyadh 11461Saudi Arabia

BACKGROUND Ulcerative colitis(UC)is an immune-mediated chronic inflammatory condition with a worldwide *** the etiology of this disease is still unknown,the understanding of the role of the microbiota is becoming increasingly *** To investigate the predictive power of the gut microbiota for the diagnosis of UC in a cohort of newly diagnosed treatment-naïve Saudi children with *** The study population included 20 children with a confirmed diagnosis of UC and 20 healthy *** DNA was extracted and sequenced,and shotgun metagenomic analysis was performed for bacteria and *** and bioinformatics demonstrated significant dysbiosis in the form of reduced alpha diversity,beta diversity,and significant difference of abundance of taxa between children with UC and control *** receiver operating characteristic curve,a probability curve,was used to determine the difference between the UC and control *** area under the curve(AUC)represents the degree of separability between the UC group and the control *** AUC was calculated for all identified bacterial species and for bacterial species identified by the random forest classification algorithm as important potential biomarkers of UC.A similar method of AUC calculation for all bacteriophages and important species was *** The median age and range were 14(0.5-21)and 12.9(6.8-16.3)years for children with UC and controls,respectively,and 40%and 35%were male for children with UC and controls,*** AUC for all identified bacterial species was 89.5%.However,when using the bacterial species identified as important by random forest classification algorithm analysis, the accuracy increased to 97.6%. Similarly, the AUC for all theidentified bacteriophages was 87.4%, but this value increased to 94.5% when the important bacteriophagebiomarkers were *** very high to excellent AUCs of fecal bacterial and viral species sugge

关键词： Ulcerative colitis Microbiota Area under the curve Children Saudi Arabia

Impact of apolipoprotein E isoforms on sporadic Alzheimer's disease:beyond the role of amyloid beta

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Neural Regeneration Research 2024年第1期19卷 80-83页

作者： Madia Lozupone Francesco Panza Neurodegenerative Disease unit Department of Basic MedicineNeuroscienceand Sense OrgansUniversity of Bari Aldo MoroBariItaly unit of Research Methodology and Data Sciences for Population Health National Institute of Gastroenterology“Saverio de Bellis”Research HospitalCastellana GrotteBariItaly

The impact of apolipoprotein E(ApoE)isoforms on sporadic Alzheimer's disease has long been studied;however,the influences of apolipoprotein E gene(APOE)on healthy and pathological human brains are not fully *** exists as three common isoforms(ApoE2,ApoE3,and ApoE4),which differ in two amino acid ***,ApoE binds cholesterol and phospholipids and ApoE isoforms display diffe rent affinities for their receptors,lipids transport and distribution in the brain and *** role of ApoE in the human depends on ApoE isoforms,brain regions,aging,and neural *** E4 is the strongest genetic risk factor for sporadic Alzheimer's disease,considering its role in influencing amyloid-beta *** exact mechanisms by which APOE gene variants may increase or decrease Alzheimer's disease risk are not fully understood,but APOE was also known to affect directly and indirectly tau-mediated neurodegeneration,lipids metabolism,neurovascular unit,and microglial *** with the biological function of ApoE,ApoE4 isoform significantly alte red signaling pathways associated with cholesterol homeostasis,transport,and ***,the rare protective APOE variants confirm that ApoE plays an important role in Alzheimer's disease *** objectives of the present mini-review were to describe classical and new roles of various ApoE isoforms in Alzheimer's disease pathophysiology beyond the deposition of amyloid-beta and to establish a functional link between APOE,brain function,and memory,from a molecular to a clinical *** genotype also exerted a heterogeneous effect on clinical Alzheimer's disease phenotype and its *** only in learning and memory but also in neuro psychiatric symptoms that occur in a premorbid *** rifying the relationships between Alzheimer's disease-related pathology with neuropsychiatric symptoms,particularly suicidal ideation in Alzheimer's disease patients,may be useful for elucid

关键词： Alzheimer's disease amyloid-beta apolipoprotein E dementia glymphatic transport lipids neuropsychiatric symptoms neurovascular unit tau protein

Reproductive ecology of the black rat (Rattus rattus) in Madagascar: the influence of density-dependent and -independent effects

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Integrative Zoology 2024年第1期19卷 66-86页

作者： Kathryn SCOBIE Soanandrasana RAHELINIRINA Voahangy SOARIMALALA Fehivola Mandanirina ANDRIAMIARIMANANA Corinne RAHAINGOSOAMAMITIANA Toky RANDRIAMORIA Soloandry RAHAJANDRAIBE Xavier LAMBIN Minoarisoa RAJERISON Sandra TELFER School of Biological Sciences University of AberdeenAberdeenUK Plague unit Institut Pasteur de MadagascarAntananarivoMadagascar Association Vahatra AntananarivoMadagascar

The black rat(Rattus rattus)poses a severe threat to food security and public health in Madagascar,where it is a major cause of pre-and post-harvest crop losses and an important reservoir for many zoonotic diseases,including ***,ecologically based rodent management(EBRM)strategies have been developed using ecologi-cal information to inform decisions on where and when to target *** could deliver improved health and well-being outcomes in Madagascar if adapted to the local ecological *** data collected from removal studies,we explored spatio-temporal patterns in the breeding activity of the black rat(***)in domestic and agricultural habitats across Madagascar and investigated to what extent these trends are influenced by rainfall and rat *** identified clear spatio-temporal variation in the seasonality of *** *** was highly seasonal both inside and outside of houses,but seasonal trends varied between these two ***-sonal trends were explained,in part,by variation in rainfall;however,the effect of rainfall on reproductive rates did itself vary by season and habitat type.A decline in breeding intensity with increasing rat density was recorded outside of *** has important implications for control,as populations may compensate for removal through increased *** recommend that sustained control initiated before the main breeding season,combined with improved hygiene and adequate rodent-proofing in homes and grain stores,could curtail population growth and reduce pre-and post-harvest losses provided that these measures overcome the compensatory response of rodent populations.

关键词： Madagascar Rattus rattus reproductive ecology rodent control

A comparison of model choice strategies for logistic regression

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Journal of Data and Information Science 2024年第1期9卷 37-52页

作者： Markku Karhunen Built Environment Solutions unit Finnish Environment Institute(Syke)Latokartanonkaari 1100790 HelsinkiFinland

Purpose:The purpose of this study is to develop and compare model choice strategies in context of logistic *** choice means the choice of the covariates to be included in the ***/methodology/approach:The study is based on Monte Carlo *** methods are compared in terms of three measures of accuracy:specificity and two kinds of sensitivity.A loss function combining sensitivity and specificity is introduced and used for a final ***:The choice of method depends on how much the users emphasize sensitivity against *** also depends on the sample *** a typical logistic regression setting with a moderate sample size and a small to moderate effect size,either BIC,BICc or Lasso seems to be *** limitations:Numerical simulations cannot cover the whole range of data-generating processes occurring with real-world ***,more simulations are *** implications:Researchers can refer to these results if they believe that their data-generating process is somewhat similar to some of the scenarios presented in this ***,they could run their own simulations and calculate the loss ***/value:This is a systematic comparison of model choice algorithms and heuristics in context of logistic *** distinction between two types of sensitivity and a comparison based on a loss function are methodological novelties.

关键词： Model choice Logistic regression Logit regression Monte Carlo simulations Sensitivity Specificity

Characteristics and Risk Factors for Pediatric Sepsis

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Current Medical Science 2024年第3期44卷 648-656页

作者： Yong-bing ZHU Tong-lin LIU Qi DAI Shu-fan LIU Peng XIONG Hao HUANG Yi YUAN Tian-nan ZHANG Yu CHEN Department of Pediatric Intensive Care unit Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuhan430030China

Objective Sepsis is considered a major cause of health loss in children and had high mortality and ***,there is no reliable model for predicting the prognosis of pediatric patients with *** study aimed to analyze the clinical characteristics of sepsis in children and assess the risk factors associated with poor prognosis in pediatric sepsis patients to identify timely interventions and improve their *** This study analyzed the clinical indicators and laboratory results of septic patients hospitalized in the Pediatric Intensive Care unit of Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,China,from January 1,2019,to December 31,*** factors for sepsis were identified by logistic regression *** A total of 355 children with sepsis were enrolled,with 333 children(93.8%)in the good prognosis group,and 22 children(6.2%)in the poor prognosis *** them,there were 255 patients(71.8%)in the sepsis group,and 100 patients(28.2%)in the severe sepsis *** length of hospital stay in the poor prognosis group was longer than that in the good prognosis group(P0.05),and the platelet(PLT),albumin(ALB),and hemoglobin(Hb)levels were lower in the poor prognosis group(P<0.01).The IL-8 levels in the severe sepsis group were higher than those in the sepsis group(P<0.05).Multiple logistic regression analysis suggested that lower Hb levels,ALB levels,peak PLT counts,and higher IL-1βlevels were independent risk factors for poor prognosis in children with *** Lower Hb,ALB,and PLT counts and elevated IL-1βare independent risk factors for poor prognosis in children with sepsis.

关键词： pediatric sepsis inflammation severity prognosis risk factors

Calcineurin inhibitors-related posterior reversible encephalopathy syndrome in liver transplant recipients: Three case reports and review of literature

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World Journal of Hepatology 2024年第9期16卷 1297-1307页

作者： Yu Gong Department of Intensive Care unit Fudan University Affiliated Zhongshan HospitalShanghai 200032China

BACKGROUND Posterior reversible encephalopathy syndrome(PRES),characterized by acute neurological deterioration and extensive white matter lesions on T2-fluid attenuated inversion recovery magnetic resonance imaging(MRI),is increasingly associated with calcineurin inhibitors(CNI)-related *** diagnosis is crucial,as early intervention,including the modification or discontinuation of CNI therapy,strict blood pressure management,corticosteroid treatment,and supportive care can significantly improve patient outcomes and *** growing clinical recognition of CNI-related PRES underscores the importance of identifying and managing this condition in patients presenting with acute neurological *** SUMMARY This report describes three cases of liver transplant recipients who developed *** first case involves a 60-year-old woman who experienced seizures,aphasia,and hemiplegia on postoperative day(POD)9,with MRI revealing ischemic foci followed by extensive white matter *** replacing tacrolimus,her symptoms improved,and no significant MRI abnormalities were observed after three years of *** second case concerns a 54-year-old woman with autoimmune hepatitis who developed headaches,seizures,and extensive white matter demyelination on MRI on *** the switch to rapamycin and the initiation of corticosteroids,her symptoms resolved,and she was discharged on *** third case details a 60-year-old woman with hepatocellular carcinoma who developed PRES,evidenced by brain MRI abnormal-ities on *** to rapamycin and corticosteroid therapy led to her full recovery,and she was discharged on *** cases highlight the critical importance of early diagnosis,CNI modification,and stringent management in improving outcomes for liver transplant recipients with CNI related *** Clinical manifestations,combined with characteristic MRI findings,are crucial in diagnosing PRES among organ transplan

关键词： Posterior reversible encephalopathy syndrome Calcineurin inhibitors Liver transplantation Prognosis Case report