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Human leukocyte antigen compatibility and incidence of donorspecific antibodies in pediatric liver transplant recipients

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World Journal of Gastroenterology 2024年第33期30卷 3837-3845页

作者： Melina U Melere Flavia H Feier Jorge Neumann Antônio N Kalil Juliana de M Montagner Luiza S Nader Carolina S da Silva Marco Aurélio F Junior Gabriela P Coral Guilherme P Bobsin Cristina T Ferreira Department of hepatology and Liver Transplantation Santa Casa de Porto AlegrePorto Alegre 90050170Rio Grande do SulBrazil Department of Hepato-biliary-pancreatic Surgery and Liver Transplantation Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil postgraduation program in medicine:hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90050-170Rio Grande do SulBrazil Laboratory of Transplantation Immunology Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Rio Grande do SulBrazil

BACKGROUND Antibody-mediated rejection following liver transplantation(LT)has been increasingly recognized,particularly with respect to the emergence of de novo donor-specific antibodies(DSAs)and their impact on graft *** substantial evidence for adult populations exists,research focusing on pediatric LT outcomes remains *** To investigate the prevalence of human leukocyte antigen(HLA)mismatches and DSA and evaluate their association with rejection episodes after pediatric *** A cohort of pediatric LT recipients underwent HLA testing at Santa Casa de Porto Alegre,Brazil,between December 2013 and December *** patients who survived for>30 days after LT with at least one DSA analysis were *** classes I and II and cross-matches were *** presence of de novo DSA(dnDSA)was evaluated at least 3 months after LT using the Luminex®single antigen bead method,with a positive reaction threshold set at 1000 *** episodes were confirmed by liver *** Overall,67 transplanted children were analyzed;61 received grafts from living donors,85%of whom were related to ***-transplant DSA(class I or II)was detected in 28.3%of patients,and dnDSA was detected in 48.4%.The median time to DSA detection after LT was 19.7[interquartile range(IQR):4.3-35.6]*** rejection occurred in 13 patients at follow-up,with C4d positivity observed in 5/13 Liver *** median time to rejection was 7.8(IQR:5.7-12.8)*** presence of dnDSA was significantly associated with rejection(36%vs 3%,P<0.001).The rejection-free survival rates at 12 and 24 months were 76%vs 100%and 58%vs 95%for patients with dnDSA anti-DQ vs those without,*** Our findings highlight the importance of incorporating DSA assessment into pre-and post-transplantation protocols for pediatric LT *** implications may include immunosuppression minimization strategies based on this analysis in pediatric LT recip

关键词： Human leukocyte antigens Donor-specific antibodies Liver transplantation Pediatric Rejection

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Liver volumetric and anatomic assessment in living donor liver transplantation: The role of modern imaging and artificial intelligence

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World Journal of Transplantation 2023年第6期13卷 290-298页

作者： Mayara Machry Luis Fernando Ferreira Angelica Maria Lucchese Antonio Nocchi Kalil Flavia Heinz Feier Department of Hepato-Biliary-Pancreatic Surgery and Liver Transplantation Irmandade Santa Casa de Misericórdia de Porto AlegrePorto Alegre 90020-090Brazil postgraduation program in medicine:hepatology Federal University of Health Sciences of Porto AlegrePorto Alegre 90050-170Brazil

The shortage of deceased donor organs has prompted the development of alternative liver grafts for ***-donor liver transplantation(LDLT)has emerged as a viable option,expanding the donor pool and enabling timely transplantation with favorable graft function and improved long-term *** accurate evaluation of the donor liver’s volumetry(LV)and anatomical study is crucial to ensure adequate future liver remnant,graft volume and precise liver ***,ensuring donor safety and an appropriate graftto-recipient weight *** LV(MLV)using computed tomography has traditionally been considered the gold standard for assessing liver ***,the method has been limited by cost,subjectivity,and *** LV techniques employing advanced segmentation algorithms offer improved reproducibility,reduced variability,and enhanced efficiency compared to manual ***,the accuracy of automated LV requires further *** study provides a comprehensive review of traditional and emerging LV methods,including semi-automated image processing,automated LV techniques,and machine learning-based ***,the study discusses the respective strengths and weaknesses of each of the aforementioned *** use of artificial intelligence(AI)technologies,including machine learning and deep learning,is expected to become a routine part of surgical planning in the near *** implementation of AI is expected to enable faster and more accurate image study interpretations,improve workflow efficiency,and enhance the safety,speed,and cost-effectiveness of the *** preoperative assessment of the liver plays a crucial role in ensuring safe donor selection and improved outcomes in *** has inherent limitations that have led to the adoption of semi-automated and automated software ***,AI has tremendous potential for LV and segmentation;however,its widespread use is hindered

关键词： Liver transplantation Living-donor Diagnostic imaging Artificial intelligence Machine learning Deep learning

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Co-nanoencapsulated meloxicam and curcumin improves cognitive impairment induced by amyloid-beta through modulation of cyclooxygenase-2 in mice

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Neural Regeneration Research 2021年第4期16卷 780-786页

作者： Maria Eduarda Ziani Gutierrez Anne Suély Pinto Savall Edina da Luz Abreu Kelly Ayumi Nakama Renata Bem Dos Santos Marina Costa Monteiro Guedes Daiana SilvaÁvila Cristiane Luchese Sandra Elisa Haas Caroline Brandão Quines Simone Pinton postgraduation program in Biochemistry Federal University of Pampa(UNIPAMPA)UruguaianaRSBrazil postgraduation program in Pharmaceutical Science Federal University of Pampa(UNIPAMPA)UruguaianaRSBrazil postgraduation program in Biochemistry and Bioprospecting Federal University of Pelotas(UFPEL)Capão do LeãoRSBrazil

Alzheimer’s disease is a progressive brain disorder and complex mechanisms are involved in the physiopathology of Alzheimer’s ***,there is data suggesting that inflammation plays a role in its development and ***,some non-steroidal antiinflammatory drugs,such as meloxicam,which act by inhibiting cyclooxygenase-2 have been used as neuroprotective agents in different neurodegenerative disease *** purpose of this study was to investigate the effects of co-nanoencapsulated curcumin and meloxicam in lipid core nanocapsules(LCN)on cognitive impairment induced by amyloid-beta peptide injection in *** were prepared by the nanoprecipitation *** Swiss mice received a single intracerebroventricular injection of amyloid-beta peptide aggregates(fragment 25–35,3 nmol/3μL)or vehicle and were subsequently treated with curcumin-loaded LCN(10 mg/kg)or meloxicam-loaded LCN(5 mg/kg)or meloxicam+curcumin-co-loaded LCN(5 and 10 mg/kg,respectively).Treatments were given on alternate days for 12 days(i.e.,six doses,once every 48 hours,by intragastric gavage).Our data showed that amyloid-beta peptide infusion caused long-term memory deficits in the inhibitory avoidance and object recognition tests in *** the inhibitory avoidance test,both meloxicam and curcumin formulations(oil or co-loaded LCN)improved amyloid-beta-induced memory impairment in ***,only meloxicam and curcumin-co-loaded LCN attenuated non-aversive memory impairment in the object recognition ***,the beneficial effects of meloxicam and curcuminco-loaded LCN could be explained by the anti-inflammatory properties of these drugs through cortical cyclooxygenase-2 *** study suggests that the neuroprotective potential of meloxicam and curcumin co-nanoencapsulation is associated with cortical cyclooxygenase-2 *** study was approved by the Committee on Care and Use of Experimental Animal Resources,the Federal University of Pampa,Brazil(app

关键词： Alzheimer’s disease curcumin cyclooxygenase-2 lipid core nanocapsules meloxicam memory rats inflammation

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SimTCM: A human patient simulator with application to diagnostic accuracy studies of Chinese medicine

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Journal of Integrative medicine 2015年第1期13卷 9-19页

作者： Arthur de Sá Ferreira Antonio Guilherme Pacheco postgraduation program in Rehabilitation Science Augusto Motta University Center program of Scientific Computing

OBJECTIVE： The aim of this work is to develop and implement the SimTCM, an advanced computationa model that incorporates relevant aspects from traditional Chinese medicine （TCM） theory as well as advanced statistical and epidemiological techniques for simulation and analysis of human patients. METHODS： SimTCM presents five major attributes for simulation： representation of true and false profiles for any single pattern; variable count of manifestations for each manifestation profile; empirical distributions of patterns and manifestations in a disease-specific population; incorporation of uncertainty in clinical data; and the combination of the four examinations. The proposed model is strengthened by following international standards for reporting diagnostic accuracy studies, and incorporates these standards in its treatment of study population, sample size calculation, data collection of manifestation profiles, exclusion criteria and missing data handling, reference standards, randomization and blinding and test reproducibility. RESULTS： Simulations using data from patients diagnosed with hypertension and post-stroke sensory- motor impairments yielded no significant differences between expected and simulated frequencies of patterns （P = 0.22 or higher）. Time for convergence of simulations varied from 9.90 s （9.80, 10.27） to 28.31 s （26.33, 29.52）. The ratio iteration profile necessary for convergence varied between 1：1 and 5：1. CONCLUSION： This model is directly connected to forthcoming models in a large project to design and implement the Suite TCM： ProntTCM, SciTCM, DiagTCM, StudentTCM, Research TCM, HerbsTCM, AcuTCM, and DataTCM. It is expected that the continuity of the SuiteTCM project enhances the evidence-based practice of Chinese medicine.

关键词： medicine, Chinese traditional evidence-based medicine computer-assisted decision making rehabilitation medicine (TCM)

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Effect of silymarin on biochemical indicators in patients with liver disease: systematic review with meta-analysis

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World Journal of Gastroenterology 2017年第27期23卷 5004-5017页

作者： Camila Ribeiro de Avelar Emile Miranda Pereira Priscila Ribas de Farias Costa Rosangela Passos de Jesus Lucivalda Pereira Magalhaes de Oliveira postgraduation program Federal University of Bahia Departament of Science Nutrition Federal University of Bahia

To evaluate the effect of silymarin on the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyl transpeptidase (γGT) in patients with liver diseases. METHODSA systematic review with meta-analysis of ramdomized and controlled clinical trials was performed, evaluating the effects of sylimarin in patients with hepatic diseases, published by January 31, 2016. Clinical trials were sought on the basis of The Cochrane Central Register of Controlled Trials in the Cochrane Library, PubMed/Medline, Scopus, Web of Science, Lilacs and Clinical Trials. The trials with adult and elderly patients of both sexes, with Liver Diseases who took oral silymarin supplementation, as extract or isolated, as well as Silymarin combined with other nutrients, were included. The trials should provide information about the intervention, such as dosages and detailing of the product used, besides the mean and standard deviation of serum levels of ALT, AST and γGT of the baseline and at the end of the intervention. RESULTSAn amount of 10904 publications were identified. From those, only 17 were included in the systematic review and 6 in the meta-analysis, according to the used selection criteria. In this meta-analysis, the results indicated a reduction of 0.26 IU/mL (95%CI: -0.46-0.07, P = 0.007) at the level of ALT and 0.53 IU/mL (95%CI: -0.74-0.32, P = 0.000) at the serum levels of AST after using the silymarin, both, statistically significant, but with no clinical relevance. There was no significant change in the γGT levels. Subgroup analyzes were also performed for the biochemical markers in relation to the type of intervention, whether silymarin isolated or associated with other nutrients and the time of intervention (whether ≥ 6 mo or < 6 mo). Significant differences were not found. The evaluated studies presented a high degree of heterogeneity and low methodological quality in the carried out analysis. CONCLUSIONSilymarin minimally reduced, but w

关键词： Systematic review Liver diseases Milk thistle Silymarin Meta-analysis

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Effect of soy protein supplementation in patients with chronic hepatitis C:A randomized clinical trial

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World Journal of Gastroenterology 2012年第18期18卷 2203-2211页

作者： Lucivalda PM Oliveira Rosangela P de Jesus Ramona SSB Boulhosa Carlos Mauricio C Mendes Maria Cecilia Gnoatto Denise C Lemaire Maria Betania P Toralles Lourianne N Cavalcante Andre C Lyra Luiz GC Lyra Postgraduate Course in medicine and Health and Nutrition Science Department Federal University of BahiaBahia 40110-150Brazil Nutrition Science Department Federal University of BahiaBahia 40110-150Brazil Postgraduate Course in medicine and Health Federal University of BahiaBahia 40110-150Brazil the medicine and Health postgraduation program Federal University of BahiaBahia 40110-150Brazil the Radiology Service Prof.Edgard Santos University HospitalFederal University of BahiaBahia 40110-150Brazil Laboratory of Immunology Health Science InstituteFederal University of BahiaBahia 40110-150Brazil Pediatric Department Federal University of BahiaBahia 40110-150Brazil Department of medicine Division of Gastroenterology and HepatologyFederal University of Bahia and Gastro-hepatology UnitHospital S o Rafael of BahiaBahia 40110-150Brazil the medicine and Health postgraduation program Federal University of Bahia and Gastro-hepatology UnitHospital S o Rafael of BahiaBahia 40110-150Brazil

AIM:To evaluate the effects of soy supplementation on insulin resistance,fatty liver and alanine aminotransferase(ALT) levels in non-diabetic patients with chronic hepatitis C(CHC).METHODS:In a prospective,randomized and singleblinded clinical trial,we compared patients with CHC who had casein as a supplement(n = 80)(control group),with patients who consumed a soy supplement diet(n = 80) [intervention group(IG)].Both groups received 32 g/d of protein for 12 ***:Patients' baseline features showed that 48.1% were overweight,43.7% had abdominal fat accumulation,34.7% had hepatic steatosis and 36.3% had an homeostasis model assessment index of insulin resistance(HOMA-IR) ≥ *** analysis showed that protein supplementation diet reduced hepatic steatosis in both groups;however,significant reductions in ALT levels occurred in the soy *** regression modeling indicated that in the presence of severe fibrosis(F3/F4),g glutamyl transferase elevation and high density lipoprotein(HDL) reduction,the intervention group had 75% less chance of developing hepatic steatosis(OR= 0.25;95% CI:0.06-0.82) and 55% less chance of presenting with an ALT level ≥ 1.5 × the upper limit of normal(ULN)(OR = 0.45,95% CI:0.22-0.89).Soy treatment did not have any effect on insulin resistance(OR = 1.92;95% CI:0.80-4.83),which might be attributed to the fact that the HOMAIR values at baseline in most of our patients were in the normal *** hepatic fibrosis,an ALT level > 1.5 × ULN and visceral fat were predictors of an HOMA-IR ≥ *** IG group had a reduced risk of an ALT level > 1.5 × *** HOMA-IR ≥ 3.0 and HDL < 35 mg/dL were also risk factors for increased ***:Soy supplementation decreased ALT levels and thus may improve liver inflammation in hepatitis C virus(HCV) patients;it also reduced hepatic steatosis in a subgroup of patients but did not change insulin *** should be considered in the nutritional care of HCV patients.

关键词： Chronic hepatitis C Soy supplementation Insulin resistance Hepatic steatosis Hepatitis C virus

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Chinese medicine Pattern Differentiation and Its Implications for Clinical Practice

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Chinese Journal of Integrative medicine 2011年第11期17卷 818-823页

作者： Arthur Sá Ferreira Agnaldo José Lopes Laboratory of Computational Modeling and Simulation in Rehabilitation program of Rehabilitation Science Augusto Motta University Laboratory of Cardiopulmonar Analysis Rehabilitation Science postgraduation program Augusto Motta University Laboratory of Respiratory Physiology State University of Rio de Janeiro

Chinese medicine practitioners apply the differentiation reasoning for decision-making. The wide scope of Chinese medicine intervention provides coverage of methods and techniques with applications to primary, secondary and tertiary levels of prevention. The rapid evolution of mathematical and computational techniques allowed the implementation of several models for pattern differentiation that were tested for several physiologic systems. Concurrently, it is argued that pattern differentiation might improve the efficacy of either traditional or conventional medical interventions. This article reviewed the influence of pattern differentiation into clinical practice organized by medical field： general pattern differentiation; genitourinary （recurrent cystitis）; cardiovascular （coronary heart disease; arterial hypertension; angina pectoris）; neurology （stroke）; surgery; metabolic （diabetes mellitus）; hepatic （cirrhosis）; gastrointestinal （chronic superficial gastritis）; orthopedic （low back pain; rheumatoid arthritis; cervical spondylosis; elbow arthritis）; oncology （gastric mucosal dysplasia; lung cancer）; gynecologic and obstetric manifestations （nausea and vomiting）. The reviewed studies presented achievements that have contributed to the integration of Chinese medicine and evidence-based medicine in the treatment of many mild and severe diseases. Target diseases considered as major public health problems were also investigated and the results are promising regarding the possibility to treat guided by pattern differentiation.

关键词： Chinese medicine-syndrome differentiation Chinese medicine preventive medicine rehabilitation "health care delivery"

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Pushing the limits of liver surgery for colorectal liver metastases:Current state and future directions

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World Journal of Gastrointestinal Surgery 2019年第2期11卷 34-40页

作者： Raphael LC Araujo Marcelo M Linhares Department of Digestive Surgery Escola Paulista de Medicina-UNIFESP Department of Oncology Americas Medical Service/Brazil United Health Group postgraduation program Barretos Cancer Hospital

Liver surgery for the treatment of colorectal liver metastases is the standard treatment in a dynamic surgical field with many variables that should be considered in a curative intent scenario. Hepatectomy for colorectal liver metastases has undergone constant changes over the last 30 years, including indications until the need for rescue procedures of recurrent and advanced diseases as well as minimally invasive surgery. These advancements in liver surgery have not only resulted from overall improvements in the surgical field but have also resulted from a better understanding of the biological behavior of the disease, liver regeneration, and homeostasis during and after *** in anesthesiology, intensive care medicine, radiology, and surgical devices have correlated with further advancements of hepatectomies. Moreover,changes are still forthcoming, and both fields of augmented reality and artificial intelligence will likely have future contributions in this field in regard to both diagnoses and the planning of procedures. The aim of this editorial is to emphasize several aspects that have contributed to the paradigm shifts in colorectal liver metastases surgery over the last three decades as well as to discuss the factors concerning patient selection and the technical aspects of liver surgery. Finally, this editorial will highlight the promising new features of this surgery for diagnoses and treatments in this field.

关键词： Colorectal liver metastases Cancer Hepatectomy Liver Surgery Oncology

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Childhood trauma and factors associated with depression among inpatients with cardiovascular disease

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World Journal of Psychiatry 2017年第2期7卷 106-113页

作者： Felipe José Nascimento Barreto Frederico Duarte Garcia Paulo Henrique Teixeira Prado Paulo Marcos Brasil Rocha Nádia Souza Las Casas Felipe Barbosa Vallt Humberto Correa Maila Castro Lourenco Neves Department of Mental Health Federal University of Minas Gerais postgraduation program in Molecular medicine School of Medicine Federal University of Minas Gerais Molecular medicine National Institute of Science and Technology Avenida Alfredo Balena Federal University of Minas Gerais Hospital das Clínicas Federal University of Minas Gerais

AIM To identify factors associated with depressive symptoms among inpatients with cardiovascular disease(CVD). METHODS This is a cross-sectional study performed in a subsample of a large cross-sectional research that investigated affective disorders and suicide behaviour among inpatients hospitalized in non-surgical wards of the University Hospital of the Federal University of Minas Gerais from November 2013 to October 2015. Sociodemographic and clinical data were obtained through a structured interview and medical record review. Depression was assessed by the depression subscale of the Hospital Anxiety and Depression Scale, with scores ≥ 8 considered as positive screening for depression. We used the Fagestr?m Test for Nicotine Dependence to characterize nicotine dependence. For assessing resilience and early-life trauma, we used the raw scores of the Wagnild and Young Resilience Scale and Childhood Trauma Questionnaire, *** At endpoint, we included 137 subjects. Thirty-eight(27.7%) subjects presented depressive symptoms and nine(23.7%) of those were receiving antidepressant treatment during hospitalization. The female sex; a lower mean educational level; a greater prevalence of previous suicide attempts; a higher level of pain; a higher prevalence of family antecedents of mental disorders; a lower resilience score; and higher childhood trauma score were the factors significantly associated with screening positive for major depression(P < 0.05). Multivariate analysis demonstrated that the factors independently associated with the depressive symptoms were a higher childhood trauma severity(OR = 1.06; P = 0.004); moderate to severe nicotine dependence(OR = 8.58; P = 0.008); and the number of previous hospital admissions(OR = 1.11; P = 0.034). The obtained logistic model was considered valid, indicating that the three factors together distinguished between having or not depressive symptoms, and correctly classified 74.6% of individuals in the ***

关键词： Inpatients Depression Cardiovascular disease Depressive symptoms General hospital

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Pulse Waveform Analysis as A Bridge between Pulse Examination in Chinese medicine and Cardiology

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Chinese Journal of Integrative medicine 2013年第4期19卷 307-314页

作者： Arthur de Sa Ferreira Agnaldo Jose Lopes postgraduation program of Rehabilitation Science Augusto Motta University CenterRio de JaneiroRJBrazil Department of Physical Therapy Salgado de Oliveira UniversityNiteroiRJBrazil Laboratory of Respiratory Physiology University of the State of Rio de JaneiroRio de JaneiroRJBrazil

Pulse examination was probably the earliest attempt to distinguish between health and illnesses. Starting at the pre-Hippocratic era, Chinese medicine practitioners developed techniques for pulse examination and defined pulse images based on their perceptions of pulse waveforms at the radial artery. Pulse images were described using basic variables （frequency, rhythm, wideness, length, deepness, and qualities） developed under philosophical trends such as Taoism and Confucianism. Recent advances in biomedical instrumentation applied to cardiology opened possibilities to research on pulse examination based on ancient Chinese medical theories： the pulse wave analysis. Although strongly influenced by philosophy, some characteristics used to describe a pulse image are interpretable as parameters obtained by pulse waveform analysis such as pulse wave velocity and augmentation index. Those clinical parameters reflect concepts unique to Chinese medicine - such as yin- yang - while are based on wave reflection and resonance theories of fluids mechanics. Major limitations for integration of Chinese and Western pulse examination are related to quantitative description of pulse images and pattern differentiation based on pulse examination. Recent evidence suggests that wave reflection and resonance phenomena may bridge Chinese medicine and cardiologyto provide a more evidence-based medical practice.

关键词： blood circulation palpation diagnosis Chinese medicine pulse waveform

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