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Effects of excess high-normal alanine aminotransferase levels in relation to new-onset metabolic dysfunction-associated fatty liver disease:Clinical implications

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World Journal of Gastroenterology 2024年第27期30卷 3264-3267页

作者： Giovanna McGinty Robert Przemioslo Department of Gastroenterology North Bristol TrustSouthmead HospitalBristol BS105NBUnited Kingdom Department of Gastroenterology and Hepatology North Bristol TrustSouthmead HospitalBristol BS105NBUnited Kingdom

In this editorial,we comment on the article by Chen et al recently published in *** focus the debate on whether reducing the upper limit of normal of alanine aminotransferase(ALT)would effectively identify cases of fibrosis in metabolic-dysfunction associated fatty liver disease(MAFLD).This is important given the increasing prevalence of MAFLD and obesity ***,a suitable screening test to identify patients in the general population does not exist and most patients are screened after the finding of an abnormal *** authors of this paper challenge the idea of what a normal ALT is and whether that threshold should be lowered,particularly as their study found that 83.12%of their study population with a diagnosis of MAFLD had a normal *** main advantages of screening would be to identify patients and provide intervention early,the mainstay of this being changing modifiable risk factors and monitoring for liver ***,there is not enough suitable therapeutic options available as of yet although this is likely to change in the coming years with more targets for therapy being *** is one example of this which has demonstrated benefit with an acceptable side effect profile for those patients with MAFLD and obesity,although studies have not yet shown a significant improvement in fibrosis *** would also require a huge amount of resource if a reduced ALT level alone was used as criteria;it is more likely that current scoring systems such as fibrosis-4 may be amended to represent this additional ***,there is not a good argument to recommend wide-spread screening with a reduced ALT level as this is unlikely to be *** is compounded by the fact that there is a significant heterogeneity in what is considered a normal ALT between *** studies previously have suggested a more pragmatic approach in screening those over the age of 60,this is likely to change with the increasing inc

关键词： Alanine aminotransferase Metabolic-dysfunction associated fatty liver disease Metabolic syndrome Fibrosis Cirrhosis Semaglutide

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Using clinical cases to guide healthcare

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World Journal of Clinical Cases 2024年第9期12卷 1555-1559页

作者： Michael Colwill Samantha Baillie Richard Pollok Andrew Poullis Department of Gastroenterology St George's University Hospital NHS Foundation TrustLondon SW170QTUnited Kingdom

Evidence-based practice(EBP)has been the gold standard in healthcare for nearly three centuries and aims to assist physicians in providing the safest and most effective healthcare for their *** well-established hierarchy of evidence lists systematic reviews and meta-analyses at the top however these methodologies are not always appropriate or possible and in these instances case-control studies,case series and case reports are utilised to support ***-control studies allow simultaneous study of multiple risk factors and can be performed rapidly and relatively cheaply.A recent example was during the Coronavirus pandemic where case-control studies were used to assess the efficacy of personal protective equipment for healthcare *** series and case reports also play a role in EBP and are particularly useful to study rare diseases such as inflammatory bowel disease in transgender and gender non-conforming *** are also vital in generating and disseminating early signals and encouraging further *** these methodologies have weaknesses,particularly with regards to bias and loss of patient confidentiality for rare pathologies,they have an important part to play in EBP and when appropriately utilised can significantly impact upon clinical practice.

关键词： Evidence based medicine Hierarchy of evidence Case reports Case series

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Hepatolithiasis:Epidemiology,presentation,classification and management of a complex disease

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World Journal of Gastroenterology 2024年第13期30卷 1836-1850页

作者： Rodrigo V.Motta Francesca Saffioti Vasileios K Mavroeidis Translational Gastroenterology and Liver Unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit Royal Free Hospital and University College LondonLondon NW32QGUnited Kingdom Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Transplant Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom Department of Gastrointestinal Surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic *** disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary *** the last century,owing to migration,its global incidence has *** main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic *** classifications have aimed at providing useful insight of clinically relevant aspects and guidance for *** management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious *** comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.

关键词： Cholelithiasis Intrahepatic stones Cholangiocarcinoma Biliary parasites Recurrent pyogenic cholangitis Oriental cholangiohepatitis Hepatectomy Cholangioscopy Liver transplant Paediatric

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Transurethral resection of bladder tumor: A systematic review of simulator-based training courses and curricula

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Asian Journal of Urology 2024年第1期11卷 1-9页

作者： Panagiotis Kallidonis Angelis Peteinaris Gernot Ortner Kostantinos Pagonis Costantinos Adamou Athanasios Vagionis Evangelos Liatsikos Bhaskar Somani Theodoros Tokas Department of Urology University Hospital of RionPatrasGreece Department of Urology and Andrology General Hospital Hall I.T.Hall in TirolAustria Medical University of Vienna ViennaAustria Department of Urology University Hospital Southampton NHS Foundation TrustSouthamptonUK

Objective:Transurethral resection of bladder tumor is one of the most common everyday urological *** kind of surgery demands a set of skills that need training and *** this review,we aimed to investigate the current literature to find out if simulators,phantoms,and other training models could be used as a tool for teaching ***:A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic *** out of 932 studies met our inclusion criteria and are presented in the current ***:The UroTrainer(Karl Storz GmbH,Tuttlingen,Germany),a virtual reality training simulator,achieved positive feedback and an excellent face and construct validity by the *** inspection of bladder mucosa,blood loss,tumor resection,and procedural time was improved after the training,especially for inexperienced urologists and medical *** construct validity of UroSim®(VirtaMed,Zurich,Switzerland)was *** simulator(Samed GmbH,Dresden,Germany)was found to be a realistic and useful tool by experts and urologists with intermediate *** test objective competency model based on SIMBLA simulator could be used for evaluating *** porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried *** Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity,and 60%of participants would like to use the simulators in the *** 5-day multimodal training curriculum“Boot Camp”in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the ***:Simulators and courses or curricula based on a simulator training could be a valuable learning tool fo

关键词： Simulator Train Curriculum Transurethral resection Vaporesection Laser Bladder

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Radical cholecystectomy without liver resection for peritoneal side early incidental gallbladder cancer

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World Journal of Gastroenterology 2024年第32期30卷 3739-3742页

作者： Gaetano Piccolo Matteo Barabino Guglielmo NiccolòPiozzi Paolo Pietro Bianchi Department of Health Sciences(DISS) University of MilanSan Paolo HospitalMilan 20142LombardyItaly Department of Colorectal Surgery Portsmouth Hospitals University NHS TrustPortsmouthUnited Kingdom

Gallbladder cancer(GBC)is a rare disease with a poor *** cholecystectomy may be an adequate treatment only for very early disease(Tis,T1a),whereas reoperation is recommended for more advanced disease(T1b and T2).Radical cholecystectomy should have two fundamental objectives:To radically resect the liver parenchyma and to achieve adequate clearance of the lymph ***,recent studies have shown that compared with lymph node dissection alone,liver resection does not improve survival *** oncological roles of lymphadenectomy and liver resection is ***,for patients with incidental GBC without liver invasion,hepatic resection is not always mandatory.

关键词： Incidental gallbladder cancer Reoperation Radical cholecystectomy Early stage Liver resection

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Endoscopic treatment of scarred polyps with a non-thermal device(Endorotor):A review of the literature

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World Journal of Gastroenterology 2024年第12期30卷 1706-1713页

作者： Mariam Zaghloul Hameed Rehman Stefano Sansone Konstantinos Argyriou Adolfo Parra-Blanco Department of Hepatology Gastroenterology and Infectious DiseasesKafrelsheikh UniversitKafr-Elshikh 33516Egypt Department of Gastroenterology Service Nottingham City Hospital CampusNottingham University Hospitals NHS TrustNottingham NG51PBUnited Kingdom Department of Gastroenterology University Hospital of LarissaLarissa 41334Greece NIHR Nottingham Biomedical Research Centre Nottingham University Hospitals NHS Trust and University of NottinghamNottingham NG72UHUnited Kingdom

Endoscopic resection(ER)of colorectal polyps has become a daily practice in most endoscopic units providing a colorectal cancer screening program and requires the availability of local experts and high-end endoscopic *** procedures have evolved over the past few years from endoscopic mucosal resection(EMR)to more advanced techniques,such as endoscopic submucosal dissection and endo-scopic full-thickness *** resection and disease eradication are the ultimate goals of ER-based techniques,and novel devices have been developed to achieve these *** EndoRotor®Endoscopic Powered Resection System(Interscope Medical,Inc.,Northbridge,Massachusetts,United States)is one such *** EndoRotor is a powered resection tool for the removal of alimentary tract mucosa,including post-EMR persistent lesions with scarring,and has both CE Mark and FDA *** review covers available published evidence documenting the usefulness of EndoRotor for the management of recurrent colorectal polyps.

关键词： EndoRotor Scarred polyps Recurrent polyps Colorectal cancer Colorectal polyps

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Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

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World Journal of Diabetes 2024年第4期15卷 598-605页

作者： Vasileios K Mavroeidis Jennifer Knapton Francesca Saffioti Daniel L Morganstein Department of HPB Surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Gastrointestinal Surgery Southmead HospitalNorth Bristol NHS TrustBristol BS105NBUnited Kingdom Department of Academic Surgery Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health University College LondonLondon NW32PFUnited Kingdom Department of Endocrinology Chelsea and Westminster Hospital NHS Foundation TrustLondon SW109NHUnited Kingdom Department of Gastrointestinal Unit Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic *** centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved *** this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic *** 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and *** preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative *** incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe *** involvement of a specialist diabetes team is essential to ensure a holistic *** the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve *** various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required *** need for perioperative support of diabetic

关键词： Pancreatectomy Pancreatoduodenectomy Whipple’s Pancreatitis Diabetes specialist Type 3c pancreatogenic diabetes mellitus

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Optimal transcorneal electrical stimulation parameters for preserving photoreceptors in a mouse model of retinitis pigmentosa

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Neural Regeneration Research 2024年第11期19卷 2543-2552页

作者： Sam Enayati Karen Chang Anton Lennikov Menglu Yang Cherin Lee Ajay Ashok Farris Elzaridi Christina Yen Kasim Gunes Jia Xie Kin-Sang Cho Tor Paaske Utheim Dong Feng Chen Schepens Eye Research Institute of Massachusetts Eye and Ear Department of OphthalmologyHarvard Medical SchoolBostonMAUSA Institute of clinical medicine Faculty of MedicineUniversity of OsloOsloNorway Department of Medical Biochemistry Oslo University HospitalUniversity of OsloOsloNorway Department of Ophthalmology Drammen HospitalVestre Viken Hospital TrustDrammenNorway Department of Histology and Embryology School of MedicineMarmara UniversityIstanbulTurkiye

Retinitis pigmentosa is a hereditary retinal disease that affects rod and cone photoreceptors,leading to progressive photoreceptor *** research supports the beneficial effect of electrical stimulation on photoreceptor *** study aims to identify the most effective electrical stimulation parameters and functional advantages of transcorneal electrical stimulation(tcES)in mice affected by inherited retinal ***,the study seeked to analyze the electric field that reaches the retina in both eyes in mice and post-mortem *** this study,we recorded waveforms and voltages directed to the retina during transcorneal electrical stimulation in C57BL/6J mice using an intraocular needle probe with rectangular,sine,and ramp *** investigate the functional effects of electrical stimulation on photoreceptors,we used human retinal explant cultures and rhodopsin knockout(Rho^(-/-))mice,demonstrating progressive photoreceptor degeneration with *** retinal explants isolated from the donors’eyes were then subjected to electrical stimulation and cultured for 48 hours to simulate the neurodegenerative environment in *** density was evaluated by rhodopsin *** vivo Rho^(-/-)mice were subjected to two 5-day series of daily transcorneal electrical stimulation using rectangular and ramp *** function and visual perception of mice were evaluated by electroretinography and optomotor response(OMR),*** was used to assess the morphological and biochemical changes of the photoreceptor and bipolar cells in mouse *** recordings indicated effective delivery of rectangular,sine,and ramp waveforms to the retina by transcorneal electrical stimulation,of which the ramp waveform required the lowest *** of the total conductive resistance of the post-mortem human compared to the mouse eyes indicated higher cornea-to-retina resistance in human *** tem

关键词： bipolar cells electrical stimulation neuroprotection photoreceptor degeneration retina retinal explants retinitis pigmentosa transcorneal electrical stimulation waveform

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Safety of tranexamic acid in surgically treated isolated spine trauma

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World Journal of Orthopedics 2024年第4期15卷 346-354页

作者： Wajiha Zahra Sandeep Krishan Nayar Ashwin Bhadresha Vinay Jasani Syed Aftab Trauma and Orthopedics Department University Hospital of North Midlands NHS TrustStoke-on-Trent ST46QGUnited Kingdom Trauma and Orthopedics Department Royal London HospitalBarts Health InstituteLondon E11BBUnited Kingdom Craniospinal Services University Hospital of North Midlands NHS TrustStokeon-Trent ST46QGUnited Kingdom Spine Department Royal London HospitalBarts Health InstituteLondon E11BBUnited Kingdom

BACKGROUND Tranexamic acid(TXA),a synthetic antifibrinolytic drug,effectively reduces blood loss by inhibiting plasmin-induced fibrin *** is the first study in the United Kingdom to investigate the effectiveness of TXA in the surgical management of isolated spine *** To assess the safety of TXA in isolated spine *** primary and secondary outcomes are to assess the rate of thromboembolic events and to evaluate blood loss and the incidence of blood transfusion,*** This prospective observational study included patients aged≥17 years with isolated spine trauma requiring surgical intervention over a 6-month period at two major trauma centers in the United *** We identified 67 patients:26(39%)and 41(61%)received and did not receive TXA,*** groups were matched in terms of age,gender,American Society of Anesthesiologists grade,and mechanism of injury.A higher proportion of patients who received TXA had a subaxial cervical spine injury classification or thoracolumbar injury classification score>4(74%vs 56%).All patients in the TXA group underwent an open approach with a mean of 5 spinal levels involved and an average operative time of 203 min,compared with 24 patients(58%)in the non TXA group who underwent an open approach with an average of 3 spinal levels involved and a mean operative time of 159 *** patients who received TXA,blood loss was<150 and 150–300 mL in 8(31%)and 15(58%)patients,*** were no cases of thromboembolic events in any patient who received *** Our study demonstrated that TXA is safe for isolated spine *** is challenging to determine whether TXA effectively reduces blood loss because most surgeons prefer TXA for open or multilevel ***,larger studies are necessary to explore the rate,dosage,and mode of administration of TXA.

关键词： Tranexamic acid Infection Trauma Thromboembolic disease Minimally invasive Percutaneous

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Adipose-derived regenerative therapies for the treatment of knee osteoarthritis

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World Journal of Stem Cells 2024年第4期16卷 324-333页

作者： Ilias E Epanomeritakis Wasim S Khan Division of Trauma and Orthopaedic Surgery Addenbrooke’s HospitalCambridge University Hospitals NHS Foundation TrustCambridge CB20QQUnited Kingdom Division of Trauma and Orthopaedic Surgery Department of SurgeryUniversity of CambridgeCambridge CB20QQUnited Kingdom

Knee osteoarthritis is a degenerative condition with a significant disease burden and no disease-modifying *** treatment ultimately requires joint *** capable of regenerating cartilage could significantly reduce financial and clinical *** regenerative potential of mesenchymal stromal cells(MSCs)has been extensively studied in the context of knee *** has yielded promising results in human studies,and is likely a product of immunomodulatory and chondroprotective biomolecules produced by MSCs in response to ***-derived MSCs(ASCs)are becoming increasingly popular owing to their relative ease of isolation and high proliferative *** vascular fraction(SVF)and micro-fragmented adipose tissue(MFAT)are produced by the enzymatic and mechanical disruption of adipose tissue,*** avoids expansion of isolated ASCs ex vivo and their composition of heterogeneous cell populations,including immune cells,may potentiate the reparative function of *** this editorial,we comment on a multicenter randomized trial regarding the efficacy of MFAT in treating knee *** discuss the study’s findings in the context of emerging evidence regarding adipose-derived regenerative *** underlying mechanism of action of ASCs is proposed while drawing important distinctions between the properties of isolated ASCs,SVF,and MFAT.

关键词： Knee osteoarthritis Mesenchymal stromal cells Adipose tissue Stromal vascular fraction Micro-fragmented adipose tissue Regeneration

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