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Protein-S-100-beta is increased in patients with decompensated cirrhosis admitted to ICU

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Journal of Intensive Medicine 2024年第2期4卷 222-230页

作者： Nicolas Weiss Simona Tripon Maxime Mallet Françoise Imbert-Bismut Mehdi Sakka Dominique Bonnefont-Rousselot Philippe Sultanik Sarah Mouri Marika Rudler Dominique Thabut Sorbonne Université AP-HP.Sorbonne UniversitéHôpital de la Pitié-SalpêtrièreDépartement de NeurologieUnitéde Médecine Intensive RéanimationàOrientation NeurologiqueParisFrance Brain Liver Pitié-Salpêtrière(BLIPS)Study Group INSERM UMR_S 938Centre de recherche Saint-AntoineMaladies métaboliquesBiliaires et Fibro-Inflammatoire du FoieInstitute of Cardiometabolism and Nutrition(ICAN)ParisFrance Groupe de Recherche Clinique en Reanimation et Soins intensifs du Patient en Insuffisance Respiratoire aigue(GRC-ReSPIRe)Sorbonne Université ParisFrance Assistance Publique-hôpitaux de Paris AP-HP.Sorbonne UniversitéHôpital de la Pitié-SalpêtrièreService d'hépato-GastroentérologieUnitéde Soins Intensifs d'HépatologieParisFrance Assistance Publique-hôpitaux de Paris AP-HP.Sorbonne UniversitéService de Biochimie MétaboliqueHôpitaux Universitaires Pitié-Salpêtrière-Charles FoixDMU BioGeMParis F-75013France UniversitéParis Cité UFR de PharmacieCNRSInsermUTCBSParisFrance

Background hepatic encephalopathy(he)is highly prevalent in patients with liver *** pathophysiology of he is centered on the synergic role of hyperammonemia and systemic ***,some data suggest altered functioning of the blood–brain barrier(BBB).Assessing BBB function is challenging in clinical practice and at the ***-S-100 Beta(PS100-Beta)could be a useful peripheral marker of BBB permeability in *** study aimed to assess plasmatic PS100-Beta levels in a prospective cohort of patients admitted to the intensive care unit(ICU)with decompensated cirrhosis with and without overt *** We retrospectively evaluated a prospective cohort of cirrhotic patients admitted to the ICU from October 2013 to September 2015 that had an available plasmatic PS100-Beta *** with previous neurological impairment or limitation of intensive or resuscitative measures were *** he was defined as West-haven grades 2 to *** patients were compared to a control cohort of outpatient clinic cirrhotic and non-cirrhotic patients explored for isolated elevation of liver *** ICU discharge,the patients were followed for at least 3 months for the occurrence of overt *** outcomes(liver transplantation or death)were *** ability of PS100-Beta–in combination with other factors–to predict overt he was evaluated in a multivariate analysis using logistic *** ratios were used to determine the effects and calculate odds ratios(OR).Survival analysis was performed by using the Kaplan–Meier method and survival between groups was compared using a Log-rank *** A total of 194 ICU patients and 207 outpatients were included in the *** levels of plasmatic PS100-Beta were detected in the ICU decompensated cirrhotic patients compared with the outpatients([0.15±0.01]mg/L vs.[0.08±0]mg/L,Pents with overt he had higher levels of PS100-Beta([0.19±0.03]mg/L)compared with the

关键词： Cirrhosis hepatic encephalopathy Blood-brain barrier PS100-Beta Liver disease

Visceral Leishmaniasis at the National Reference University hospital Center of N’Djamena (Chad): epidemiological, Clinical, Diagnostic, Therapeutic and Prognostic Aspects

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Advances in Infectious Diseases 2024年第2期14卷 478-486页

作者： Joseph Mad-Toïngué Mahamat Ali Ahmat Oumaïma Mahamat Djarma Alifa Adjibera Philippe Ali Mahamat Moussa Ngakoutou Rangar Choua Ouchemi Mahamat Ali Bolti Djiddi Ali Sougoudi Mamissou Didi Mahamat Doungous Atim service des Maladies Infectieuses CHU de Référence Nationale N’Djamena Chad service de gastroentérologie et Médecine Interne CHU de Référence Nationale N’Djamena Chad service de Pneumologie et Phtisiologie CHU de Référence Nationale N’Djamena Chad service de Chirurgie viscérale CHU de Référence Nationale N’Djamena Chad service de Médecine CHU de la Renaissance N’Djamena Chad

Introduction: leishmaniasis is a group of parasitic diseases caused by a parasite of the genus Leishmania transmitted by the bite of an infected vector called a sandfly. There are four forms. Visceral leishmaniasis is the most severe form. The aim of our work is to study the epidemiological, clinical, diagnostic, therapeutic and prognostic aspects of the disease in the Infectious Diseases Department of the Centre hospitalier Universitaire de Référence Nationale in N'Djaména. Methodology: Patients were recruited on the basis of clinical signs suggestive of visceral leishmaniasis, i.e. prolonged fever, splenomegaly and altered general condition. Biological confirmation was performed with a rapid diagnostic test using recombinant K39 parasite antigen, which is known to have good specificity and sensitivity. epidata version 3.1 software was used to process patient data. Results: From 05/04/21 to 15/12/23, 153 positive cases were managed. The mean age of patients was 18 years, with a sex ratio of 9.2. Of these patients, 103 (67.3%) had recently stayed at gold mining sites. Patients testing positive were treated with sodium stibogluconate combined with paromomycin for 17 days. The mortality rate was 13.2%. Conclusion: Leishmaniasis is a serious and little-known disease in Chad. In order to respond to the disease, it is necessary to reinforce the capacities of health structures and to carry out appropriate actions in the outbreaks.

关键词： Visceral Leishmaniasis Gold Mining Sites Chad

A Cross-sectional Real-life Study of the Prevalence,Severity,and Determinants of Metabolic Dysfunction-associated Fatty Liver Disease in Type 2 Diabetes Patients

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Journal of Clinical and Translational hepatology 2023年第6期11卷 1377-1386页

作者： Quentin Binet Audrey Loumaye Michel P hermans Nicolas Lanthier service d’hépato-gastroentérologie Cliniques universitaires Saint-LucUCLouvainBrusselsBelgium service d’endocrinologie et Nutrition Cliniques universitaires Saint-LucUCLouvainBrusselsBelgium

Background and Aims:Most data on liver assessment in type 2 diabetes mellitus(T2DM)patients are from retrospective cohorts with selection *** aimed at appraising the feasibility,results,and benefits of an outpatient systematic noninvasive screening for metabolic dysfunction-associated fatty liver disease(MAFLD)severity and determinants in T2DM ***:We conducted a 50-week crosssectional study enrolling adult T2DM outpatients from a diabetes *** algorithm based on guidelines was applied using simple bioclinical scores and,if applicable,ultrasound and/or ***:Two hundred and thirteen patients were *** age and body mass index were 62 years and 31 kg/m^(2) and 29% of patients had abnormal transaminase *** acceptance rate of additional liver examinations was 92%.The prevalence of MAFLD,advanced fibrosis and cirrhosis was 87%,11%,and 4%,*** than half of the cases of advanced fibrosis had not been suspected and were detected by this *** was associated with poor glycemic control,elevated transaminases,low hDL-C and the absence of peripheral arterial *** fibrosis was linked to high waist circumference and excessive alcohol consumption,which should be interpreted with caution owing to the small number of patients reporting excessive ***:Simple bioclinical tools allowed routine triage of T2DM patients for MAFLD severity,with high adherence of high-risk patients to subsequent noninvasive exams.

关键词： Noninvasive tests MAFLD Outpatient Steatosis Fibrosis

Patient experience at endoscopy Centers in Three West African Countries during the COVID-19 Pandemic

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Open Journal of gastroenterology 2023年第4期13卷 161-169页

作者： Alice Nanelin Guingané euloge houndonougbo Jamila Abdouramane Soli Léonce Steve Zoungrana Sandrine Soudré Aboubacar Coulibaly Sosthène Somda Roger Sombié Appolinaire Sawadogo Alain Bougouma service d’hépato-gastroentérologie CHU Bogodogo Ouagadougou Burkina Faso service d’hépato-gastroentérologie Hopital saint jean de Dieu Tanguiéta Bénin service d’hépato-gastroentérologie Hopital général de référence de Niamey Niamey Niger service d’hépato-gastroentérologie CHU Ouahigouya Ouagadougou Burkina Faso service d’hépato-gastroentérologie CHU Tengandogo Tengandogo Burkina Faso service d’hépato-gastroentérologie CHU Yalgado Ouédraogo Ouagadougou Burkina Faso service d’hépato-gastroentérologie CHU Sourou Sanou Bobo-Dioulasso Burkina Faso

Corona virus infection and the risk of contagiousness to medical personnel or patients during endoscopy necessitated further measures in the endoscopy rooms. The objective of this study was to assess the experience of patients in endoscopy rooms during the COVID-19 epidemic in West Africa. Patients and Methods: This was a multicenter cross-sectional study that took place over a period of 3 months (June to August 2020) in endoscopy centers in Burkina Faso, Benin and Niger. An online questionnaire was sent to patients who had performed upper digestive endoscopies, in 8 digestive endoscopy centers including private, public and religious structures. Depending on the choice of patients, questionnaires were either sent electronically or completed in the endoscopy room with the help of field investigators. The choice of centers was random from the list of centers and descriptive analyses were carried out. Results: A total of 294 patients responded to the online questionnaire. There were 37 lower and 257 upper gastrointestinal endoscopies. The female sex represented 52.1%. The wait times for obtaining an endoscopy appointment were considered satisfactory by 281 patients 95.6%. In the endoscopy departments, 112 patients, or 38.1%, were questioned about the risk factors for contamination of SARS-CoV-2. Among the risk factors found, 6 patients (2.0%) would have traveled abroad in the 2 weeks preceding the examination, 4 patients 1.4% had already been in contact with a subject at risk. The most frequent symptoms were chest pain (80 cases;27.2%), flu-like syndrome (29 cases;9.9%), cough (40 cases;13.6%), fever (46 cases;15.6%). In contrast, ageusia (7 cases;2.4%) and anosmia (5 cases;1.7%) were only found in very few patients. Twenty-two patients (7.5%) felt highly exposed to COVID-19 during the endoscopy examination and 144 patients (48.9%) rated the examination as satisfactory. Conclusion: Gastrointestinal symptoms initially described as rare are being reported with increasing

关键词： endoscopy COVID-19 Patients exposure Symptoms

Improving the prognosis before and after liver transplantation:Is muscle a game changer?

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World Journal of gastroenterology 2022年第40期28卷 5807-5817页

作者： Alexis Goffaux Alicia Delorme Géraldine Dahlqvist Nicolas Lanthier Laboratory of hepato-gastroenterology Institut de Recherche Expérimentale et CliniqueUniversitécatholique de LouvainBrussels 1200Belgium service d’hépato-gastroentérologie Cliniques universitaires Saint-LucUniversitécatholique de LouvainBrussels 1200Belgium

Liver transplantation(LT)is currently the only curative treatment option for selected patients with end stage liver disease or hepatocellular *** waiting list-mortality,post-transplant morbidity and mortality and refining the selection of the patients remain our current central *** this field,different concepts dealing with nutrition and the muscle such as sarcopenia,malnutrition,frailty or myosteatosis have emerged as possible game *** more than a decade,many prospective studies have demonstrated that sarcopenia and frailty are major predictive factors of mortality in the waiting list but also after *** is also a well-known risk factor for morbidity and *** composition is a newer concept giving insight on muscle quality which has also been shown to be linked to poorer *** of these terms has a precise definition as well as pathophysiological *** bidirectional liver-muscle axis makes sense in this *** the best,easy to use in clinical practice tools to assess muscle quality,quantity,and function in this specific population and developing quality prospective studies to identify interventional strategies that could improve these parameters as well as evaluate the effect on mortality are among the important challenges of today.

关键词： Muscle Liver Transplantation Sarcopenia Myosteatosis Frailty

hepatocellular carcinoma with portal invasion,still a place for liver surgery in the era of immunotherapy?

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hepatobiliary Surgery and Nutrition 2022年第5期11卷 782-784页

作者： héloïse Giudicelli Claire Goumard Manon Allaire service d’hépato-gastroentérologie Hôpital Universitaire Pitié-SalpêtrièreAP-HP Sorbonne UniversitéParisFrance service de Chirurgie hépatobiliopancréatique et Transplantation hépatique Hôpital Universitaire Pitié-SalpêtrièreAP-HP Sorbonne UniversitéParisFrance

hepatocellular carcinoma(hCC)is a leading cause of cancer death worldwide and is associated with a 5-year overall survival(OS)of 10-15%all stages ***,5-year OS reaches 50-70%when patients are in an early stage and can access curative treatments such as liver transplantation,liver resection(LR)or ***,LR is reserved to very selected patients with adequate performance status,preserved liver function,to be matched with grade of portal hypertension(PhT),sufficient volume of the future liver remnant and acceptable tumor burden(1,2).Worldwide,the definitions of“tumor burden”and vascular invasion vary as illustrated in Tables 1,2,and the impact of portal vein tumoral thrombosis(PVTT)on the choice for hCC treatment is not consensual(1,2).

关键词： treatment invasion matched

hepatitis C treatment in patients with substance use disorder:the faster the better

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hepatobiliary Surgery and Nutrition 2022年第1期11卷 129-131页

作者： Antonio Saviano Lucile heroin Pierre Mayer Thomas F.Baumert Institut de Recherche sur les Maladies et hépatiques(IVh) Inserm U1110StrasbourgFrance Institut hospitalo-Universitaire Service d’hépato-gastroentérologieHôpitaux Universitaires de StrasbourgStrasbourgFrance University of Strasbourg StrasbourgFrance Institut Universitaire de France(IUF) ParisFrance

hepatitis C virus(hCV)infection is a major cause of liver disease and hepatocellular carcinoma worldwide(1).hCV is a blood-borne infection and prevalence is particularly high in patients with a history of injective drug use or unsafe health care or sexual *** use disorder(SUD),and especially opioid misuse is a growing problem worldwide(2).This is particularly relevant in the United States(US)where opioid misuse has raised sharply in the last years(3,4),termed also opioid *** is associated with an increase incidence of hCV infections and reinfections and associated liver disease(2,4).Moreover,alcohol use disorder is frequent in patients with SUD(5),representing another major risk factor for chronic liver disease in this *** with SUD often experience poor access to health care resulting in higher mortality(5,6).Finally,SUD is associated with psychiatric conditions and social problems such as housing instability,unemployment,and reduced access to medical care(7)which could result in a reduced access and compliance to hCV treatment.

关键词： patients mortality faster

Incomplete Situs Inversus Revealed by Acute Pain of the Right hypochondrium

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Open Journal of gastroenterology 2022年第10期12卷 263-270页

作者： Alice Nanelin Guingané Julien Sawadogo Adjirata Koama Bénilde Marie-Ange Tiemtoré-Kambou Roger Sombié Alain Bougouma service d’hépato-gastroentérologie CHU Bogodogo Ouagadougou Burkina Faso service de chirurgie générale et digestive du ChU-YO Ouagadougou Burkina Faso service de radiologie CHU Bogodogo Ouagadougou Burkina Faso service d’hépato-gastroentérologie CHU-YO Ouagadougou Burkina Faso

Situs inversus is an abnormal placement of the thoracic and/or abdominal organs that are inverted right/left from normal. It is a rare congenital malformation often discovered in childhood. In adults, it can lead to misdiagnosis. Clinical case: A 35-year-old female patient, seen in a hepatogastroenterology consultation for acute spontaneous pain in the right hypochondrium. She had no particular clinical history. A diagnosis of hepatopathy was suspected. Abdominal and pelvic CT scans showed the left liver, stomach and spleen in the right hypochondrium, but with the heart in place, suggesting incomplete situs inversus. The evolution in our patient was spontaneously resolved with analgesics and antispasmodics, which leads us to believe that the volvulus was probably partial and without other complications. Conclusion: In developing countries, antenatal diagnosis of situs inversus is rare and is usually made during a pathology that leads the patient to a medical consultation. CT is one of the key paraclinical examinations for its diagnosis as genetic tests are not widely available.

关键词： Situs Inversus Abdominal Pain hypochondrium Abdominal CT Scan

Alfapump®implantable device in management of refractory ascites:An update

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World Journal of hepatology 2022年第7期14卷 1344-1356页

作者： Delphine Weil-Verhoeven Vincent Di Martino Guido Stirnimann Jean Paul Cervoni eric Nguyen-Khac Thierry Thévenot service d’hépatologie et Soins Intensifs Digestifs CHRU Jean MinjozBesançon 25030France eA 4266 ePILAB Universitéde Bourgogne Franche-ComtéBesançon 25030France Department of Visceral Surgery and Medicine Inselspital University Hospital and University of BernBern 3010Switzerland service d’hépato-gastroentérologie CHU Amiens-PicardieAmiens 80080France

Refractory ascites(RA)is a frequent and life-threatening complication of *** selected patients with RA,transjugular intrahepatic portosystemic shunt(TIPS)placement and liver transplantation(LT)are currently considered the best therapeutic alternatives to repeated large volume *** patients with a contraindication to TIPS or LT,the alfapump®system(Sequana Medical,Ghent,Belgium)has been developed to reduce the need for iterative paracentesis,and consequently to improve the quality of life and nutritional *** report here recent data on technical progress made since the first implantation,the efficacy and tolerance of the device,the position of the pump in the therapeutic arsenal for refractory ascites,and the grey areas that remain to be clarified regarding the optimal selection of patients who are potential candidates for this treatment.

关键词： Alfapump Refractory ascites Automated low flow ascites pump Cirrhosis Liver