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Platelets in liver disease, cancer and regeneration

World Journal of Gastroenterology 2017年第18期23卷 3228-3239页

作者： Tomohiro Kurokawa Nobuhiro Ohkohchi department of surgery Division of Gastroenterological and Hepatobiliary Surgery and Organ Transplantation Faculty of Medicine University of Tsukuba

Although viral hepatitis treatments have evolved over the years, the resultant liver cirrhosis still does not completely heal. Platelets contain proteins required for hemostasis, as well as many growth factors required for organ development, tissue regeneration and repair. Thrombocytopenia, which is frequently observed in patients with chronic liver disease(CLD) and cirrhosis, can manifest from decreased thrombopoietin production and accelerated platelet destruction caused by hypersplenism; however, the relationship between thrombocytopenia and hepatic pathogenesis, as well as the role of platelets in CLD, is poorly understood. In this paper, experimental evidence of platelets improving liver fibrosis and accelerating liver regeneration is summarized and addressed based on studies conducted in our laboratory and current progress reports from other investigators. In addition, we describe our current perspective based on the results of these studies. Platelets improve liver fibrosis by inactivating hepatic stellate cells, which decreases collagen production. The regenerative effect of platelets in the liver involves a direct effect on hepatocytes, a cooperative effect with liver sinusoidal endothelial cells, and a collaborative effect with Kupffer cells. Based on these observations, we ascertained the direct effect of platelet transfusion on improving several indicators of liver function in patients with CLD and liver cirrhosis. However, unlike the results of our previous clinical study, the smaller incremental changes in liver function in patients with CLD who received eltrombopag for 6 mo were due to patient selection from a heterogeneous population. We highlight the current knowledge concerning the role of platelets in CLD and cancer and anticipate a novel application of platelet-based clinical therapies to treat liver disease.

关键词：血小板肝肝硬化肝新生癌症 Thrombopoietin Thrombopoietin 收缩筋 Eltrombopag

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Enhanced recovery after surgery in emergency colorectal surgery:Review of literature and current practices

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World Journal of Gastrointestinal surgery 2019年第2期11卷 41-52页

作者： Varut Lohsiriwat Romyen Jitmungngan Division of Colon and Rectal surgery Department of Surgery Faculty of Medicine Siriraj Hospital Mahidol University

Enhanced recovery after surgery(ERAS), a multidisciplinary program designed to minimize stress response to surgery and promote the recovery of organ function, has become a standard of perioperative care for elective colorectal surgery. In an elective setting, ERAS program has consistently been shown to decrease postoperative complication, reduce length of hospital stay, shorten convalescence, and lower healthcare cost. Recently, there is emerging evidence that ERAS program can be safely and effectively applied to patients with emergency colorectal conditions such as acute colonic obstruction and intraabdominal infection. This review comprehensively covers the concept and application of ERAS program for emergency colorectal surgery. The outcomes of ERAS program for this emergency surgery are summarized as follows:(1) The ERAS program was associated with a lower rate of overall complication and shorter length of hospital stay – without increased risks of readmission,reoperation and death after emergency colorectal surgery; and(2) Compliance with an ERAS program in emergency setting appeared to be lower than that in an elective basis. Moreover, scientific evidence of each ERAS item used in emergency colorectal operation is shown. Perspectives of ERAS pathway in emergency colorectal surgery are addressed. Finally, evidence-based ERAS protocol for emergency colorectal surgery is presented.

关键词： Enhanced recovery after surgery Emergency Colon Rectum surgery Intraabdominal infection Colonic obstruction Diverticulitis Review Guideline

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Insight into appropriate medication prescribing for elderly in the COVID-19 era

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World Journal of Clinical Cases 2022年第32期10卷 12056-12058页

作者： Amr S Omar Rasha Kaddoura department of Cardiothoracic surgery Hamad Medical CoporationDoha 3050Qatar department of Critical Care Medicine Beni Suef Faculty of MedicineBeni Suef 62511Egypt department of Medicine Weill Cornell Medical Center in QatarDoha 3050Qatar department of Pharmacy Heart HospitalHamad Medical CorporationDoha 3050Qatar

Coronavirus disease 2019(COVID-19)complicates clinical management in elderly population.There is an additional need to properly treat and monitor elderly COVID-19 patients.This paper discusses the inappropriate medication prescribing in the elderly and suggests an updated valid assessment tool considering COVID-19 and its treatment.

关键词： Atrial fibrillation Beta blockers COVID-19 Elderly

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Liver resection versus radiofrequency ablation in the treatment of cirrhotic patients with hepatocellular carcinoma

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Hepatobiliary & Pancreatic Diseases International 2013年第3期12卷 270-277页

作者： Amilcare Parisi Jacopo Desiderio Stefano Trastulli Elisa Castellani Rosario Pasquale Roberto Cirocchi Carlo Boselli Giuseppe Noya department of Digestive surgery and Liver Unit St. Maria Hospital department of General and Oncologic surgery University of Perugia St. Maria della Misericordia Hospital department of General and Urgent surgery University of Perugia

BACKGROUND: Hepatocellular carcinoma is the most common type of primary liver tumor and its incidence is increasing worldwide. The study aimed to compare patients subjected to liver resection or radiofrequency ablation. METHODS: One hundred and forty cirrhotic patients in stage A or B of Child-Pugh with single nodular or multinodular hepatocellular carcinoma were included in this retrospective study. Among them, 87 underwent surgical resection, and 53 underwent percutaneous radiofrequency ablation. Patient charac-teristics, survival, and recurrence-free survival were analyzed. RESULTS: Recurrence-free survival was longer in the resection group in comparison to the radiofrequency group with a median recurrence-free time of 36 versus 26 months, respectively (P=0.01, HR=1.52, 95% CI: 1.05-2.25). In the resection group, median survival was 46 months, with the 1-, 3- and 5-year survival rates of 89.7%, 72.4% and 40.2%. In the radiofrequency group, median survival was 32 months, with the 1-, 3- and 5-year survival rates of 83.0%, 43.4% and 22.6% (Psurgery.

关键词： hepatocellular carcinoma liver resection radiofrequency ablation

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Aspects of Urolithiasis in Chadian Children: About of 191 Cases Collected at the Mother and Child University Hospital of N’Djamena (Chad)

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Open Journal of Urology 2022年第10期12卷 519-526页

作者： Moussa Adam Adami Amine Mahamat Mahamat Ali Ngaringuem Olivier Djibrine Abakar Mahamat Nour Faculty of Human Health Sciences/University of N’djamena N’djamena Chad department of pediatric surgery Mother and Child University Hospital N’djamena Chad Général surgery Mother and Child University Hospital N’djamena Chad Urological surgery National Reference University Hospital Center N’djamena Chad

Introduction: Urolithiasis in children is not sufficiently documented in Chad. Objectives: The aim of this work was to report the epidemiological, clinical and therapeutic aspects of urolithiasis in children in our environment. Patients and methods: This was a descriptive retrospective study of patients aged 0 - 15 years treated for urolithiasis between January 2015 and July 2020. The variables studied were age, gender, clinical, paraclinical and therapeutic aspects. Results: Among the 191 children, there were 164 boys (85.9%) and 19 girls (9.9%). The sex ratio was 8.63. The average age was 5.86 years with extremes (1 and 15 years). The symptomatology was dominated by dysuria. The ASP-ultrasound pair allowed the diagnosis in 183 cases (95.8%). The site of the calculus was bladder in 128 cases (67%). The average calculation size was 2.81mm. A supporting cause was found in only 1 case (posterior urethral valve). Treatment was surgical and dominated by cystolithotomy. The postoperative course was marked by 5 cases of parietal infections (2.6%) and 3 cases of vesico-cutaneous fistulas (1.6%). No case of death has been reported. Conclusion: Lithiasis is more common in boys in the lower urinary tract. Open surgery remains the only one practiced. Etiological research must be carried out to develop prevention strategies.

关键词： Urolithiasis Child Kidney Bladder Chad

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Primary intestinal extranodal natural killer/T-cell lymphoma, nasal type: A case report

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World Journal of Clinical Cases 2020年第1期8卷 234-241页

作者： Bao-Long Dong Xiao-Hua Dong Hui-Qi Zhao Peng Gao Xiao-Jun Yang department of General surgery Gansu Provincial Hospital

BACKGROUND Primary intestinal extranodal natural killer/T-cell lymphoma,nasal type(PIENKTCL)is a rare non-Hodgkin’s lymphoma(NHL)subtype,and its prognosis is extremely poor.Clinical characteristics of the disease are not obvious and easily misdiagnosed.In this case report,we describe a patient with PI-ENKTCL who presented with intermittent hematochezia.The advantages of positron emission tomography/computed tomography(PET-CT)as a useful diagnostic tool and the role of surgery as an important therapy are highlighted.CASE SUMMARY A 45-year-old man,hospitalized due to intermittent hematochezia,underwent gastroscopy,colonoscopy,biopsy and CT,but no cause was found.Hence,we carried out a multidisciplinary team(MDT)discussion on the causes and treatment of this patient,and it was decided to perform PET-CT imaging with a MDT discussion of the results.PET-CT demonstrated a diagnosis of lymphoma and it was decided to surgically resect the lesion,and a R0 resection was successfully performed.Postoperative pathology showed negative resection margins,and examination of the lesion confirmed the diagnosis of PI-ENKTCL.After surgery,the patient underwent a follow-up period of 6 mo and received 6 cycles of gemcitabine,oxaliplatin and L-asparaginase.No recurrence or metastasis occurred.CONCLUSION PI-ENKTCL is rare,and MDT discussion is required during diagnosis.PET-CT can be performed for imaging diagnosis.Treatment is based on surgical resection,and the best treatment regimen is determined according to postoperative pathological results to improve prognosis and to extend survival in patients.

关键词： Primary intestinal extranodal natural killer/T-cell lymphoma Multidisciplinary team discussion Rare disease Case report

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Accessory navicular in children

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World Journal of Clinical Cases 2023年第35期11卷 8256-8262页

作者： Feng Xiang Zhi-Qing Liu Xi-Ping Zhang Yan-Jun Li Jie Wen department of Traumatic Orthopedics Zhuzhou Central HospitalThe Affiliated Zhuzhou Hospital of Xiangya Medical CollegeCentral South UniversityZhuzhou 412007Hunan ProvinceChina department of pediatric Orthopedics Hunan Provincial People’s HospitalThe First Affiliated Hospital of Hunan Normal UniversityChangsha 410013Hunan ProvinceChina

Accessory navicular(AN)is a developmental variation of the secondary ossification center of the navicular tuberosity.Ten percent of patients with AN will have pain symptoms that affect walking and life.As the AN changes the position of the posterior tibial tendon insertion,children with AN often have posterior tibial tendon function insufficiency and flexible flat foot.Surgical treatment is often required after failure of conservative treatment.This article reviewed the etiology,clinical manifestations,complications,and treatment methods of AN.

关键词： Accessory navicular Posterior tibial tendon Flexible flatfoot Kidner procedure Treatment

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Day-to-day blood pressure variability predicts poor outcomes following percutaneous coronary intervention:A retrospective study

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World Journal of Cardiology 2022年第5期14卷 307-318页

作者： Cody L Weisel Cornelius M Dyke Marilyn G Klug Thomas A Haldis Marc D Basson University of North Dakota School of Medicine and Health Sciences Grand ForksND 58201United States department of surgery University of North Dakota School of Medicine and Health SciencesGrand ForksND 58201United States department of surgery Sanford Medical CenterFargoND 58104United States Population Health University of North Dakota School of Medicine and Health SciencesGrand ForksND 58201United States department of Cardiology Sanford Medical CenterFargoND 58104United States department of surgery Pathology and Biomedical SciencesUniversity of North Dakota School of Medicine and Health SciencesGrand ForksND 58202United States

BACKGROUND For patients with cardiovascular disease,blood pressure variability(BPV),distinct from hypertension,is an important determinant of adverse cardiac events.Whether pre-operative BPV adversely affects outcomes after percutaneous coronary intervention(PCI)is to this point unclear.AIM To investigate the relationship between blood pressure variability and outcomes for patients post-PCI.METHODS Patients undergoing PCI in a single state in 2017 were studied(n=647).Systolic and diastolic BPV,defined as both the largest change and standard deviation for the 3-60 mo prior to PCI was calculated and patients with more than ten blood pressure measurements in that time were included for analysis(n=471).Adverse outcomes were identified up to a year following the procedure,including major adverse cardiac events(MACE),myocardial infarction,cerebrovascular accident,death,and all-cause hospitalization.RESULTS Visit-to-visit systolic BPV,as measured by both standard deviation and largest change,was higher in patients who had myocardial infarction,were readmitted,or died within one year following PCI.Systolic BPV,as measured by largest change or standard deviation,was higher in patients who had MACE,or readmissions(P<0.05).Diastolic BPV,as measured by largest change,was higher in patients with MACE and readmissions(P<0.05).CONCLUSION As BPV is easily measured and captured in the electronic medical record,these findings describe a novel method of identifying at-risk patients who undergo PCI.Aggressive risk modification for patients with elevated BPV and known coronary artery disease is indicated.

关键词： Blood pressure variability Percutaneous coronary intervention Angioplasty Major adverse cardiac events

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Liver transplantation and multivisceral transplantation in the management of patients with advanced neuroendocrine tumours

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World Journal of Gastroenterology 2018年第20期24卷 2152-2162页

作者： Ashley Kieran Clift Andrea Frilling department of surgery and Cancer Imperial College London

Orthotopic liver transplantation(OLT) represents a generally accepted albeit somewhat controversially discussed therapeutic strategy in highly selected patients with non-resectable hepatic metastases from neuroendocrine tumours(NET). Whilst there are some exclusion criteria, these are not universally followed, and the optimal set of inclusion parameters for deeming patients eligible has not yet been elucidated. This is due to heterogeneity in the study populations, as well differing approaches employed and also divergences in selection criteria between centres. Recent data have suggested that OLT may represent the most efficacious approach in terms of overall and disease-free survival to the management of NET metastatic to the liver when conducted in accordance with the modified Milan criteria. Therefore, a consensus set of selection criteria requires definition to facilitate stringent and fair allocation of deceased-donor organs, as well as consideration for living-donor organs. In the context of classically non-resectable metastatic tumour bulk, multivisceral transplantation with or without the liver may also be indicated, yet experience is very limited. In this review, we discuss the diagnostic work-up of patients in whom the aforementioned transplantation approaches are being considered, critically analyse the published experience and also anticipate future developments in this field, including a discussion of immediate and longer-term research priorities.

关键词： neuroendocrine transplantation metastases liver multivisceral

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Expert consensus on the monitoring and treatment of sepsis-induced immunosuppression

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Military Medical Research 2023年第3期10卷 281-298页

作者： Fei Pei Ren‑Qi Yao Chao Ren Soheyl Bahrami Timothy RBilliar Irshad HChaudry De‑Chang Chen Xu‑Lin Chen Na Cui Xiang‑Ming Fang Yan Kang Wei‑Qin Li Wen‑Xiong Li Hua‑Ping Liang Hong‑Yuan Lin Ke‑Xuan Liu Ben Lu Zhong‑Qiu Lu Marc Maegele Tian‑Qing Peng You Shang Lei Su Bing‑Wei Sun Chang‑Song Wang Jian Wang Jiang‑Huai Wang Ping Wang Jian‑Feng Xie Li‑Xin Xie Li‑Na Zhang Basilia Zingarelli Xiang‑Dong Guan Jian‑Feng Wu Yong‑Ming Yao department of Critical Care Medicine the First Affiliated Hospital of Sun Yat-Sen University58 Zhongshan Er RoadYuexiu DistrictGuangzhou 510080GuangdongChina Translational Medicine Research Center Medical Innovation Research Division and Fourth Medical Center of the Chinese PLA General Hospital28 Fuxing RoadHaidian DistrictBeijing 100853China department of Burn surgery the First Affiliated Hospital of Naval Medical UniversityShanghai 200433China Ludwig-Boltzmann Institute for Experimental and Clinical Traumatology 1200 ViennaAustria department of surgery University of Pittsburgh Medical CenterPittsburghPA 15213USA Center for Surgical Research and department of surgery University of Alabama at BirminghamBirminghamAL 35294USA department of Critical Care Medicine Ruijin HospitalShanghai Jiaotong UniversityShanghai 200025China department of Burns the First Affiliated Hospital of Anhui Medical UniversityHefei 230022China department of Critical Care Medicine Peking Union Medical College HospitalChinese Academy of Medical Science and Peking Union Medical CollegeBeijing 100730China department of Anesthesiology the First Affiliated HospitalZhejiang University School of MedicineHangzhou 31003China department of Critical Care Medicine West China Hospital of Sichuan UniversityChengdu 610041China department of Critical Care Medicine General Hospital of Eastern Theater Command of Chinese PLANanjing 210002China department of Surgical Intensive Critical Unit Beijing Chao‑Yang HospitalCapital Medical UniversityBeijing 100020China State Key Laboratory of Trauma Burns and Combined InjuryResearch Institute of SurgeryDaping HospitalArmy Medical UniversityChongqing 400042China department of Critical Care Medicine Fourth Medical Center of the Chinese PLA General HospitalBeijing 100048China department of Anesthesiology Nanfang HospitalSouthern Medical UniversityGuangzhou 510515China department of Critical Care Medicine and Hematology the Third Xiangya HospitalCentral South UniversityChangs

Emerged evidence has indicated that immunosuppression is involved in the occurrence and development of sepsis.To provide clinical practice recommendations on the immune function in sepsis,an expert consensus focusing on the monitoring and treatment of sepsis-induced immunosuppression was developed.Literature related to the immune monitoring and treatment of sepsis were retrieved from PubMed,Web of Science,and Chinese National Knowledge Infrastructure to design items and expert opinions were collected through an online questionnaire.Then,the Delphi method was used to form consensus opinions,and RAND appropriateness method was developed to provide consistency evaluation and recommendation levels for consensus opinions.This consensus achieved satisfactory results through two rounds of questionnaire survey,with 2 statements rated as perfect consistency,13 as very good consistency,and 9 as good consistency.After summarizing the results,a total of 14 strong recommended opinions,8 weak recommended opinions and 2 non-recommended opinions were produced.Finally,a face-to-face discussion of the consensus opinions was performed through an online meeting,and all judges unanimously agreed on the content of this consensus.In summary,this expert consensus provides a preliminary guidance for the monitoring and treatment of immunosuppression in patients with sepsis.

关键词： Sepsis Immune function monitoring Immunomodulatory therapy Immunosuppression

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