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Non-selective beta-blockers in cirrhosis:Current concepts and controversies

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World Journal of Pharmacology 2016年第1期5卷 15-31页

作者： Neil Rajoriya Dhiraj Tripathi Department of Hepatology the New Queen Elizabeth Hospital

Non-selective beta-blockers(NSBBs) have been at the forefront in the management of portal hypertension in liver cirrhosis for the last three decades, a trusty component in the armamentarium of the Hepatologist. The role of beta-blockers has been cemented for years in cardiac disease including angina, hypertension and in heart failure, however NSBBs with their non-selective effects on β1 and β2 receptors have led to them fondly being termed "the hepatologist's aspirin". NSBBs' role in reduction of portal pressure in the setting of primary and secondary prophylaxis for variceal haemorrhage has been well established. NSBBs include propranolol, nadolol and carvedilol- with the latter having been shown to be effective in patients who often fail to demonstrate a haemodynamic response to propranolol. Recent observational studies however have served for the Hepatology community to question the beneficial role of NSBBs in portal hypertension, especially in advanced cases with refractory ascites. The deleterious effect in patients with refractory ascites in a few studies led to a U-turn in clinical practice, with some in the Hepatology community withdrawing their usage in patients with advanced cirrhosis. This also led to the "window hypothesis" suggesting there may be only be a finite time frame when NSBBs have a beneficial effect in portal hypertension. The window hypothesis proposed the window for the benefits of NSBBs is closed in early portal hypertension, opening as portal hypertension progresses with it closing in advanced liver disease. The window was proposed to close in conditions such as refractory ascites or spontaneous bacterial peritonitis when patients may not necessarily mount a compensatory haemodynamic response when on NSBBs. Some centres however have continued the practice of NSBBs in advanced cirrhosis with published data challenging the scepticisms of other groups who stop NSBBs. Thus the debate, like the window hypothesis has opened, with more questions

关键词： Variceal haemorrhage Non-selective betablockers Portal hypertension Liver cirrhosis

Assessment of myocardial viability using a minimally invasive laser Doppler flowmetry on pig model

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Journal of Innovative Optical Health Sciences 2021年第2期4卷 51-57页

作者： Karina Litvinova Berthold Stegemann Francisco Leyva Aston Medical School Aston University Aston TriangleB47ETBirminghamUK Cardiology Department Queen Elizabeth Hospital Mindelsohn WayB152THBirminghamUK

Background:The intra-operative real-time assessment of tissue viability can potentially improve therapy delivery and clinical outcome in cardiovascular *** ablation therapy for the treatment of supraventricular or ventricular arrhythmia continues to be done without being able to assess if the intended lesion and lesion size have been ***,we report a method for continuous measurements of cardiac muscle microcirculation to provide an instrument for real-time ablation ***:We performed two acute open chest animal studies to assess the ability to perform real-time monitoring of creation and size of ablation lesion using a standard RF irrigated *** ablation and laser Doppler were applied to different endocardial areas of alive open-chest ***:We performed two experiments at three different RF ablation energy setting and different ablation ***-fusion signals before and after ablation were found extensively and distinctively *** in-creasing the ablation energy and time,the perfusion signal was ***:In vivo assessing the local microcirculation during RF ablation by laser Doppler can potentially be useful to differentiate between viable and nonviable ablated beating heart in real time.

关键词： Beating heart RF ablation perfusion real-time monitoring myocardial microcirculation

Late post liver transplant protein losing enteropathy: Rare complication of incisional hernia

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World Journal of Gastroenterology 2013年第27期19卷 4409-4412页

作者： Jonathan D Evans M Thamara PR Perera CY Pal James Neuberger Darius F Mirza The Liver Unit The Queen Elizabeth Hospital

Development of oedema and hypoproteinaemia in a liver transplant recipient may be the first signs of graft dysfunction and should prompt a full assessment. We report the novel case of a patient who, years after liver transplantation developed a functional blind loop in an incisional hernia, which manifested as oedema and hypoproteinaemia secondary to protein losing enteropathy. After numerous investigations, the diagnosis was made by flurodeoxyglucose positron emmision tomography (FDG-PET) imaging. Surgical repair of the incisional hernia was followed several months later by resolution of the protein loss, and confirmed at a post operative FDG-PET scan at one year.

关键词： Protein losing enteropathies Bacterial overgrowth Hypoproteinaemia Incarcerated hernia Liver transplantation.

Advances in antithrombin therapy for ST-elevation myocardial infarction

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Chinese Medical Journal 2003年第11期116卷 1760-1763页

作者： Wai-hong Chen Chu-Pak Lau Department of Medicine Queen Mary Hospital Hong Kong ChinaDepartment of Medicine Queen Mary Hospital Hong Kong China

Thrombin is a pivotal molecule in acute myocardial infarction ( Ml) because of its extensive procoagulant and prothrombotic actions. Antithrombin therapy is an important component of the pharmacotherapy for acute Ml. The standard agent used in clinical practice, unfractionated heparin (UFH), is associated with the disadvantages of variable anticoagulant effect, inability to inhibit clot-bound thrombin, neutralization by platelet factor 4, and the propensity to cause thrombocytopenic complications. Novel thrombin inhibitors have been developed to overcome these disadvantages. Although possessing the property of inhibiting both fluid-phase and clot-bound thrombin, the direct thrombin inhibitor hirudin has been shown to give marginal benefits over UFH as adjunct to fibrinolysis in ST-elevation Ml. Bivalirudin, another direct thrombin inhibitor, is able to reduce reinfarction in patients treated with streptokinase and is a new anticoagulant treatment option in this setting. The pharmacokinetic characteristics of better availability, longer half-life, and dose-independent clearance together with the ability of inhibiting both thrombin generation and activity make the low-molecular-weight heparins (LMWHs) an attractive alternative to UFH. The favorable benefit/risk profile of the LMWHs as adjunct to different generations of fibrinolytic agents is setting the stage for larger clinical trials to confirm their role as the antithrombin agent of choice for STEMI.

关键词： thrombin antithrombotic therapy myocardial infarction

Acetic acid chromoendoscopy: Improving neoplasia detection in Barrett's esophagus

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World Journal of Gastroenterology 2016年第25期22卷 5753-5760页

作者： Fergus JQ Chedgy Sharmila Subramaniam Kesavan Kandiah Sreedhari Thayalasekaran Pradeep Bhandari Department of Gastroenterology Queen Alexandra Hospital

Barrett’s esophagus (BE) is an important condition given its significant premalignant potential and dismal five-year survival outcomes of advanced esophageal adenocarcinoma. It is therefore suggested that patients with a diagnosis of BE undergo regular surveillance in order to pick up dysplasia at an earlier stage to improve survival. Current “gold-standard” surveillance protocols suggest targeted biopsy of visible lesions followed by four quadrant random biopsies every 2 cm. However, this method of Barrett’s surveillance is fraught with poor endoscopist compliance as the procedures are time consuming and poorly tolerated by patients. There are also significant miss-rates with this technique for the detection of neoplasia as only 13% of early neoplastic lesions appear as visible nodules. Despite improvements in endoscope resolution these problems persist. Chromoendoscopy is an extremely useful adjunct to enhance mucosal visualization and characterization of Barrett’s mucosa. Acetic acid chromoendoscopy (AAC) is a simple, non-proprietary technique that can significantly improve neoplasia detection rates. This topic highlight summarizes the current evidence base behind AAC for the detection of neoplasia in BE and provides an insight into the direction of travel for further research in this area.

关键词： Barrett’ s esophagus Acetic acid Esophageal adenocarcinoma Chromoendoscopy Dysplasia

Nutrition in alcohol-related liver disease:Physiopathology and management

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World Journal of Gastroenterology 2020年第22期26卷 2916-2930页

作者： Umair Kamran Jennifer Towey Amardeep Khanna Abhishek Chauhan Neil Rajoriya Andrew Holt The Liver Unit Queen Elizabeth Hospital BirminghamBirmingham B152GWUnited Kingdom Department of Dietetics Queen Elizabeth Hospital BirminghamBirmingham B152GWUnited Kingdom Centre for Liver Research Institute of Immunology and Inflammationand National Institute for Health Research(NIHR)Birmingham Biomedical Research CentreThe Medical SchoolUniversity of BirminghamBirmingham B152TTUnited Kingdom

Malnutrition encompassing both macro-and micro-nutrient deficiency,remains one of the most frequent complications of alcohol-related liver disease(ArLD).Protein-energy malnutrition can cause significant complications including sarcopenia,frailty and immunodepression in cirrhotic *** reduces patient’s survival and negatively affects the quality of life of individuals with ***,nutritional deficit increases the likelihood of hepatic decompensation in *** recognition of at-risk individuals,early diagnosis and treatment of malnutrition remains a key component of ArLD *** this review,we describe the pathophysiology of malnutrition in ArLD,review the screening tools available for nutritional assessment and discuss nutritional management strategies relevant to the different stages of ArLD,ranging from acute alcoholic hepatitis through to decompensated end stage liver disease.

关键词： Malnutrition Sarcopenia Alcohol-related liver disease Nutritional assessment Nutrition support Micronutrients

Determining the role for uric acid in non-alcoholic steatohepatitis development and the utility of urate metabolites in diagnosis:An opinion review

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World Journal of Gastroenterology 2020年第15期26卷 1683-1690页

作者： Paul Brennan Kathleen Clare Jacob George John F Dillon Department of Molecular and Clinical Medicine University of DundeeNinewells Hospital and Medical SchoolDundee DD19SYUnited Kingdom Department of Neurology Queen Elizabeth HospitalGlasgow G514TFUnited Kingdom

There has long been a recognised association between non-alcoholic fatty liver disease(NAFLD)and the composite aspects of the metabolic *** of this association highlighted the supposed co-existence of elevated uric acid levels in those with *** is interest in exploitation of this as a putative diagnostic and prognostic biomarker in *** the increased economic and health burden associated with the NAFLD epidemic,improved methods of population-based,minimally-invasive methods and biomarkers are clearly highly sought and *** this opinion review we review the proposed role of uric acid in the pathogenesis of NAFLD and its potential utilisation in the diagnosis and monitoring of the disease process.

关键词： Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Uric acid Urate Non-invasive fibrosis markers Fatty liver index

Risk factors for hepatocellular carcinoma associated with hepatitis C genotype 3 infection:A systematic review

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World Journal of Gastrointestinal Oncology 2024年第4期16卷 1596-1612页

作者： Hamzah Z Farooq Michael James Jane Abbott Patrick Oyibo Pip Divall Naheed Choudhry Graham R Foster Blizard Institute Queen Mary University of LondonLondon E12ATUnited Kingdom School of Health and Psychological Sciences University of LondonLondon EC1V 0HBUnited Kingdom University hospitals of Leicester Library University Hospitals of Leicester NHS TrustLeicester LE39QPUnited Kingdom

BACKGROUND Hepatitis C virus(HCV)is a blood-borne virus which globally affects around 79 million people and is associated with high morbidity and *** infection leads to cirrhosis in a large proportion of patients and often causes hepatocellular carcinoma(HCC)in people with *** the 6 HCV genotypes(G1-G6),genotype-3 accounts for 17.9%of *** genotype-3 responds least well to directly-acting antivirals and patients with genotype-3 infection are at increased risk of HCC even if they do not have *** To systematically review and critically appraise all risk factors for HCC secondary to HCV-G3 in all ***,we studied possible risk factors for HCC due to HCV-G3 in the literature from 1946 to *** This systematic review aimed to synthesise existing and published studies of risk factors for HCC secondary to HCV genotype-3 and evaluate their strengths and *** searched Web of Science,Medline,EMBASE,and CENTRAL for publications reporting risk factors for HCC due to HCV genotype-3 in all settings,*** Four thousand one hundred and forty-four records were identified from the four databases with 260 records removed as *** thousand eight hundred and eighty-four records were screened with 3514 *** hundred and seventy-one full-texts were assessed for eligibility with seven studies included for *** the seven studies,three studies were retrospective case-control trials,two retrospective cohort studies,one a prospective cohort study and one a cross-sectional study *** were based in hospital settings with four in Pakistan,two in South Korea and one in the United *** total number of participants were 9621 of which 167 developed HCC(1.7%).All seven studies found cirrhosis to be a risk factor for HCC secondary to HCV genotype-3 followed by higher age(five-studies),with two studies each showing male sex,high alpha feto-protein,directly-acting antivirals trea

关键词： Hepatocellular carcinoma Hepatitis C Genotype 3 Systematic review Blood-borne viruses Liver cancer

Staphylococcus lugdunensis in children:A retrospective analysis

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Pediatric Investigation 2022年第3期6卷 163-170页

作者： Thomas Patrick Bowman Ashutosh Deshpande Alison Balfour Kathleen Harvey-Wood Department of Microbiology Queen Elizabeth University HospitalGlasgowUK

Importance:Staphylococcus lugdunensis(***)is a coagulase-negative staphylococcus(CoNS),found commonly as skin flora in *** most species of CoNS are clinically benign,*** can exhibit a similar virulence to that ***,there is scant data *** infection in the pediatric ***:To ascertain *** infection rates and sensitivity patterns in the pediatric ***:A retrospective analysis was undertaken of *** isolates across a 6-year period from 2015 to *** were collected from electronic patient notes and laboratory ***-assisted laser desorption ionization and time of flight mass spectrometry were used to identify ***:Ninety-six isolates *** were identified from 86 *** these,34 isolates were treated as an ***-three(67.6%)were found to have skin as the primary source of *** the observed number was small,central nervous system(CNS)sources *** infection appear to be a significant source:all three isolates cultured from cerebrospinal fluid were clinically managed as *** three were associated with ventriculoperitoneal(VP)shunt *** cases *** infective endocarditis were *** 18.6%*** isolates were resistant to ***:*** is an uncommon but significant cause of infection in the pediatric population and appears to be a rising cause of CNS infection,particularly when associated with VP *** is recommended locally as the first choice of antibiotic.

关键词： Children Infection Pediatrics Staphylococcus lugdunensis