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Scoring criteria for determining the safety of liver resection for malignant liver tumors 预览
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作者 Kohei Harada Minoru Nagayama +9 位作者 Yoshiya Ohashi Ayaka Chiba Kanako Numasawa Makoto Meguro Yasutoshi Kimura Hiroshi Yamaguchi Masahiro Kobayashi Koji Miyanishi Junji Kato Toru Mizuguchi 《世界荟萃分析杂志》 2019年第5期234-248,共15页
BACKGROUND Liver resection has become safer as it has become less invasive.However,the minimum residual liver volume(RLV)required to maintain homeostasis is unclear.Furthermore,the formulae used to calculate standard ... BACKGROUND Liver resection has become safer as it has become less invasive.However,the minimum residual liver volume(RLV)required to maintain homeostasis is unclear.Furthermore,the formulae used to calculate standard liver volume(SLV)are complex.AIM To review previously reported SLV formulae and the methods used to evaluate the minimum RLV,and explore the association between liver volume and mortality.METHODS A systematic review of Medline,PubMed,and grey literature was performed.References in the retrieved articles were cross-checked manually to obtain further studies.The last search was conducted on January 20,2019.We developed an SLV formula using data for 86 consecutive patients who underwent hepatectomy at our institution between July 2009 and August 2011.RESULTS Linear regression analysis revealed the following formula:SLV(mL)=822.7×body surface area(BSA)?183.2(R2=0.419 and R=0.644,P<0.001).We retrieved 25 studies relating to SLV formulae and 12 studies about the RLV required for safe liver resection.Although the previously reported formulae included various coefficient and constant values,a simplified version of the SLV,the common SLV(cSLV),can be calculated as follows:cSLV(mL)=710 or 770×BSA.The minimum RLV for normal and damaged livers ranged from 20%-40%and 30%-50%,respectively.The Sapporo score indicated that the minimum RLV ranges from 35%-95%depending on liver function.CONCLUSION We reviewed SLV formulae and the minimum RLV required for safe liver resection.The Sapporo score is the only liver function-based method for determining the minimum RLV. 展开更多
关键词 Standard LIVER VOLUME RESIDUAL LIVER VOLUME HEPATECTOMY MORTALITY LIVER FAILURE LIVER function
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Organoids of liver diseases: From bench to bedside 预览
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作者 Li-Jun Wu Zi-Yan Chen +3 位作者 Yi Wang Jun-Gang Zhao Xiao-Zai Xie Gang Chen 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第16期1913-1927,共15页
Understanding the occurrence, development, and treatment of liver diseases is the main goal of hepatopathology research. Liver diseases are not only diverse but also highly heterogeneous among individuals. At present,... Understanding the occurrence, development, and treatment of liver diseases is the main goal of hepatopathology research. Liver diseases are not only diverse but also highly heterogeneous among individuals. At present, research on liver diseases is conducted mainly through cell culture, animal models, pathological specimens, etc. However, these methods cannot fully reveal the pathogenic mechanism and therapeutic characteristics of individualized liver diseases. Recent advances in three-dimensional cell culture technology (organoid culture techniques) include pluripotent stem cells and adult stem cells that are cultured in vitro to form self-organizing properties, making it possible to achieve individualized liver disease research. This review provides a comprehensive overview of the development of liver organoids, the existing and potential applications of liver regenerative medicine, the pathogenesis of liver disease heterogeneity, and drug screening. 展开更多
关键词 ORGANOIDS LIVER DISEASES Individualized research LIVER cancer Threedimensional cell CULTURE LIVER ORGANOIDS
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Endoscopic ultrasound guided liver biopsy for parenchymal liver disease 预览
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作者 Aun Raza Shah Muhannad Al-Hanayneh +2 位作者 Monica Chowdhry Mohammad Bilal Shailendra Singh 《世界肝病学杂志:英文版(电子版)》 2019年第4期335-343,共9页
Liver biopsy plays an essential role in the diagnosis, evaluation and management of a vast proportion of liver diseases. Conventionally, percutaneous and transjugular approaches have been used to obtain liver biopsies... Liver biopsy plays an essential role in the diagnosis, evaluation and management of a vast proportion of liver diseases. Conventionally, percutaneous and transjugular approaches have been used to obtain liver biopsies. Endoscopic ultrasound guided liver biopsy(EUS-LB) has emerged as a safe and effective alternate in the past two decades. EUS-LB carries a role in evaluation of both benign and malignant diseases of the liver. It can offer higher resolution imaging of the liver and can detect smaller lesions than computed tomography scan of the abdomen or ultrasound scans with the option for doppler assistance to reduce complications. Current evidence demonstrates the superiority of EUS-LB for a targeted approach of focal lesion and there is also evidence of less sampling variability in heterogeneous parenchymal pathologies. These advantages combined with an improved safety profile had led to the rapid progress in the development of new techniques, equipment and procedures for EUS-LB. We provide a comprehensive review of EUS-LB for parenchymal liver disease. 展开更多
关键词 LIVER BIOPSY ENDOSCOPIC ULTRASOUND ENDOSCOPIC ULTRASOUND GUIDED LIVER BIOPSY LIVER DISEASE
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Nonalcoholic fatty liver disease prevalence in an Italian cohort of patients with hidradenitis suppurativa: A multi-center retrospective analysis 预览
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作者 Giovanni Damiani Sebastiano Leone +11 位作者 Kristen Fajgenbaum Nicola L Bragazzi Alessia Pacifico Rosalynn RZ Conic Paolo DM Pigatto Carlo Maiorana Pierpaolo Poli Emilio Berti Maria C Pace Piergiorgio Malagoli Vincenzo Bettoli Marco Fiore 《世界肝病学杂志:英文版(电子版)》 2019年第4期391-401,共11页
BACKGROUND Nonalcoholic fatty liver disease (NAFLD) includes two distinct conditions, with different histologic features and prognosis: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). Furthe... BACKGROUND Nonalcoholic fatty liver disease (NAFLD) includes two distinct conditions, with different histologic features and prognosis: non-alcoholic fatty liver (NAFL) and non-alcoholic steatohepatitis (NASH). Furthermore, NASH is the more aggressive necro-inflammatory form, which may accumulate fibrosis and result in End stage liver disease (ESLD). NAFLD is also linked to systemic inflammatory conditions such as psoriasis. NAFLD is currently the most common cause of ESLD in Western countries, becoming a serious public health concern. Hidradenitis suppurativa (HS) is a systemic inflammatory/autoinflammatory disease of the terminal follicular epithelium of the apocrine gland with a prevalence of 0.05% to 4.10%. Due to its systemic inflammatory behavior several comorbidities were recently associated, however liver ones were scarcely assessed. AIM To evaluate the prevalence and characteristics of NASH/NAFL in HS patients. METHODS This retrospective study is a sub-analysis of a larger study carried out in 4 Italian dermatological centers. In this cohort, there were 83 patients: 51 patients with HS only, 20 patients with HS/NAFL and 12 with HS/NASH. RESULTS Inflammatory comorbidities were present in 3.9% of HS only patients, 25% of HS/NAFL patients and 58.3% of HS/NASH patients (P < 0.001). Similarly, mean Autoinflammatory Disease Damage Index (ADDI) was significantly higher among patients with HS/NASH (5.3 ± 2.2, P < 0.001) compared to patients with HS/NAFL or HS only (2.8 ± 1.6 and 2.6 ± 1.4 respectively). Furthermore, ADDI correlates with IHS4 in HS, HS/NAFL and HS/NASH. Diabetic patients have higher Hurley score than not diabetic ones. Ultrasound examination was significantly different in the three groups. CONCLUSION HS patients displayed a high prevalence of NASH/NAFLD and ultrasound examination should be particularly addressed to patients that display high ADDI scores. 展开更多
关键词 Non-alcoholic steatohepatitis Non-alcoholic FATTY LIVER Nonalcoholic FATTY LIVER DISEASE End stage LIVER DISEASE Hidradenitis suppurativa
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Outcomes of staged hepatectomies for liver malignancy 预览
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作者 Naif A Albati Ali A Korairi +2 位作者 Ibrahim Al Hasan Helayel K Almodhaiberi Abdullah A Algarni 《世界肝病学杂志:英文版(电子版)》 2019年第6期513-521,共9页
Liver malignancies are the fifth most common cause of death worldwide.Surgical intervention with curative intent is the treatment of choice for liver tumors as it provides long-term survival.However,only 20%of patient... Liver malignancies are the fifth most common cause of death worldwide.Surgical intervention with curative intent is the treatment of choice for liver tumors as it provides long-term survival.However,only 20%of patients with metastatic liver lesions can be managed by curative liver resection.In most of the cases,hepatectomy is not feasible because of insufficient future liver remnant(FLR).Two-stage hepatectomy is advocated to achieve liver resection in a patient who is considered to not be a candidate for resection.Procedures of staged hepatectomy include conventional two-stage hepatectomy,portal vein embolization,and associating liver partition and portal vein ligation for a staged hepatectomy.Technical success is high for each of these procedures but variable between them.All the procedures have been reported as being effective in achieving a satisfactory FLR and completing the second-stage resection.Moreover,the overall survival and disease-free survival rates have improved significantly for patients who were otherwise considered nonresectable;yet,an increase in the morbidity and mortality rates has been observed.We suggest that this type of procedure should be carried out in high-flow centers and through a multidisciplinary approach.An experienced surgeon is key to the success of those interventions. 展开更多
关键词 Staged HEPATECTOMY PORTAL VEIN EMBOLIZATION PORTAL VEIN LIGATION Colorectal LIVER metastasis Hepatocellular carcinoma Associated LIVER partition and PORTAL VEIN LIGATION for staged HEPATECTOMY
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Liver failure associated with benzbromarone: A case report and review of the literature 预览
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作者 Ming-Yuan Zhang Jun-Qi Niu +1 位作者 Xiao-Yu Wen Qing-Long Jin 《世界临床病例杂志》 2019年第13期1717-1725,共9页
BACKGROUND Benzbromarone is a uricosuric agent that reduces proximal tubular reabsorption of uric acid.Because of hepatotoxicity,it has been withdrawn from the market in Europe.Recently,some benefit-risk assessments o... BACKGROUND Benzbromarone is a uricosuric agent that reduces proximal tubular reabsorption of uric acid.Because of hepatotoxicity,it has been withdrawn from the market in Europe.Recently,some benefit-risk assessments of benzbromarone suggest that benzbromarone has greater benefits than risks,and the application of benzbromarone in the treatment of gout and hyperuricemia is still under debate.CASE S UMMARY A 39-year-old man was admitted to the hospital for icterus and nausea,and he was treated with benzbromarone(100 mg/d)for 4 mo because of hyperuricemia He had a 10-year history of beer drinking(alcohol:about 28 g/d).Laboratory data showed severe liver injury and serious coagulation dysfunction;tests for autoimmune antibodies,viral hepatitis,and human immunodeficiency virus were negative.Despite administration of liver function-protecting drugs and efficient supportive treatment,the patient deteriorated quickly after hospitalization and developed grade Ⅱ encephalopathy within a few days.The patient accepted continuous plasma exchange six times;however,his condition did not improve.Based on suggestions from multidisciplinary consultation,the patient underwent liver transplantation 26 d after admission.Liver specimen pathology results showed massive necrosis consistent with drug-induced liver injury,supporting the diagnosis of acute liver failure associated with benzbromarone.The patient recovered quickly thereafter.CONCL USION This case highlights that clinicians should be on the alert for the severe hepatotoxicity of benzbromarone.Before prescribing benzbromarone,physicians should evaluate the high-risk factors that may lead to liver injury and provide suggestions for monitoring benzbromarone’s hepatotoxicity during treatment. 展开更多
关键词 BENZBROMARONE HEPATOTOXICITY LIVER FAILURE LIVER TRANSPLANTATION Case report
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Hepatocellular carcinoma recurrence in living and deceased donor liver transplantation:a systematic review and meta-analysis
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作者 Hai-Ming Zhang Yue-Xian Shi +1 位作者 Li-Ying Sun Zhi-Jun Zhu 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第13期1599-1609,共11页
Background:Although a number of technical problems and donor safety issues associated with living donor liver transplantation(LDLT)have been resolved,some initial clinical studies showed an increased risk of hepatocel... Background:Although a number of technical problems and donor safety issues associated with living donor liver transplantation(LDLT)have been resolved,some initial clinical studies showed an increased risk of hepatocellular car cinoma(HCC)recurrence in LDLT.This meta-analysis was conducted to assess differences in tumor recurrence between LDLT and deceased donor liver transplantation(DDLT).Methods:After systematic retrievals of studies about LDLT and DDLT for HCC,articles were selected with a rationale of emphasizing inter-group comparability.Results from multivariate analyses were combined and discussed together with univariate analyses.In subgroup analysis,the impact of organ allocation policy was taken into consideration.Results:Seven articles were included in the meta-analysis.Overall,a salient result that emerged from the seven studies was a significant increased risk of HCC recurrence in the LDLT group than in the DDLT group(P=0.01).The most significant increase in hazard ratio was found in studies where organs tended to be allocated to non-tumor patients.Conclusions:An increased risk for HCC recurrence in LDLT as compared with DDLT patients was found.The relatively shorter preoperative observation windows in LDLT may lead to fewer cases of HCC with invasive features being screened out,which may provide a possible explanation for the high rates of HCC recurrence. 展开更多
关键词 LIVING DONOR LIVER TRANSPLANTATION Deceased DONOR LIVER TRANSPLANTATION Hepatocellular car cinoma META-ANALYSIS
肝脏T1rho MRI扫描优化及对肝纤维化的诊断价值初探 预览
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作者 谢双双 李清 +3 位作者 程悦 陈丽华 张莉 沈文 《放射学实践》 北大核心 2019年第1期35-40,共6页
目的:探讨3.0T肝脏T1rho MRI最简自旋锁定时间(SLT)扫描方案及用于诊断肝纤维化的可行性。方法:前瞻性搜集20例正常志愿者(正常组)和20例慢性肝病且临床疑诊为肝纤维化者(肝纤维化组),均行肝脏T1rho MRI扫描。自旋锁定脉冲设定为500 Hz,... 目的:探讨3.0T肝脏T1rho MRI最简自旋锁定时间(SLT)扫描方案及用于诊断肝纤维化的可行性。方法:前瞻性搜集20例正常志愿者(正常组)和20例慢性肝病且临床疑诊为肝纤维化者(肝纤维化组),均行肝脏T1rho MRI扫描。自旋锁定脉冲设定为500 Hz,SLT为1、10、20、30、40和50 ms。扫描结束后分别采用所有6-SLT(1、10、20、30、40和50 ms)和5种简化SLT组合,即最大SLT为40 ms的5-SLT(1、10、20、30、和40 ms)、最大SLT为50 ms的3-SLT(1、10、50 ms;1、20、50 ms;1、30、50 ms;1、40、50 ms),生成T1rho mapping。通过兴趣区(ROI)放置法测量各组合肝脏的T1rho值。采用配对样本t检验比较各简化SLT组合与6-SLT所测肝脏T1rho值的差异;采用Bland-Altman法分析各简化SLT组合与6-SLT所测肝脏T1rho值的一致性。采用ROC曲线分析6-SLT与简化SLT组合对肝纤维化诊断效能的差异。结果:正常组、肝纤维化组6-SLT和5种简化SLT组合所测肝脏T1rho值分别为(44.86±2.65)ms vs(53.01±5.79)ms、(43.07±3.15)ms vs(50.90±5.62)ms、(45.24±2.62)ms vs(53.22±5.25)ms、(45.11±2.53)ms vs(53.85±5.13)ms、(45.11±2.60)ms vs(52.80±5.53)ms和(45.22±2.64)ms vs(53.68±5.78)ms,两组间的差异均有统计学意义(P值均<0.001),用于诊断肝纤维化的曲线下面积(AUC)分别为0.910、0.895、0.910、0.933、0.917和0.923;5种简化SLT组合与6-SLT相比,诊断效能差异均无统计学意义(P值均>0.05)。其中正常组和肝纤维化组最大SLT为50 ms的3-SLT所测肝脏T1rho值与6-SLT差异均无统计学意义(P>0.05),最大SLT为40 ms的5-SLT所测肝脏T1rho值与6-SLT差异有统计学意义(P<0.01)。Bland-Altman分析结果显示所有3-SLT组合与6-SLT差值的散点分布在正常组和肝纤维化组中均较集中,且3-SLT(1、10、50 ms)组合的差值和95%一致性区间最小,分别为-0.37(-2.12~1.37)、-0.2(-3.7-3.3)。结论:3-SLT和5-SLT均能简化6-SLT(1~50 ms)以测量肝脏T1rho值,可用于诊断肝纤维化,且最大SLT为50 ms的3-SLT� 展开更多
关键词 肝脏 肝纤维化 磁共振成像 磁共振T1rho成像 自旋锁定时间
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基于肝表面智能自动对位法的超声-CT/MR融合成像的可行性研究 预览
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作者 曾庆劲 颜荣华 +5 位作者 吴宇轩 龙颖琳 罗丽萍 李凯 许尔蛟 郑荣琴 《中山大学学报(医学版)》 CAS CSCD 北大核心 2019年第1期117-123,共7页
【目的】探讨基于肝表面智能自动对位法的超声-CT/MR融合成像在肝脏局灶性病变定位的可行性及简便性。【方法】采用飞利浦EPIQ7的PercuNav融合成像系统对30例增强CT或MR发现肝内局灶性病变的患者进行超声-CT/MR融合成像检查。同时采用... 【目的】探讨基于肝表面智能自动对位法的超声-CT/MR融合成像在肝脏局灶性病变定位的可行性及简便性。【方法】采用飞利浦EPIQ7的PercuNav融合成像系统对30例增强CT或MR发现肝内局灶性病变的患者进行超声-CT/MR融合成像检查。同时采用系统配置的基于肝表面智能自动对位法(智能法)和常规内定标人工对位法(人工法)进行融合成像配准,比较两种方法的配准成功率、初步配准误差、微调配准次数。【结果】所有30例患者中,智能法和人工法的配准成功率均为96.67%(29/30),且初步配准误差和微调配准次数两种方法之间比较无统计学差异(P >0.05)。进一步分层分析,左肝病例中,人工法的初步配准误差优于智能法,差异有统计学意义(P=0.00),而微调配准次数虽然人工法少于智能法,但两者比较差异无统计学意义(P=0.09);而在右肝病例中,智能法的初步配准误差和微调配准次数均优于人工法,差异有统计学意义(P<0.05)。【结论】基于肝表面智能自动对位法的超声-CT/MR融合成像技术具有较高的配准成功率,可行性较好;相对于常规的内定标人工对位法,对于右肝病灶其融合成像操作过程更为简便高效,有助于降低对操作者融合成像技术经验的依赖性。 展开更多
关键词 肝脏 融合成像 智能对位 超声 肝表面
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Donor ductal anomaly is not a contraindication to right liver lobe donation 预览
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作者 Kenneth SH Chok James YY Fung +5 位作者 Wing Chiu Dai Sui Ling Sin Ka Wing Ma Albert CY Chan Tan To Cheung Chung Mau Lo 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第4期343-347,共5页
Background:Data of living-donor liver transplantation(LDLT)suggested that donor ductal anomaly may contribute to postoperative biliary complications in recipients and in donors.This retrospective study aimed to determ... Background:Data of living-donor liver transplantation(LDLT)suggested that donor ductal anomaly may contribute to postoperative biliary complications in recipients and in donors.This retrospective study aimed to determine if the occurrence of postoperative biliary stricture in donors or recipients in rightlobe LDLT(RLDLT)is related to donor biliary anatomy type.Methods:We analyzed our RLDLT recipients’clinical data and those of their graft donors.The recipients were divided into 2 groups:with and without postoperative biliary stricture.The 2 groups were compared.The primary endpoints were donor biliary anatomy type and postoperative biliary complication incidence;the secondary endpoints were 1-,3-and 5-year graft and patient survival rates.Results:Totally 127 patients were included in the study;25(19.7%)of them developed biliary anastomotic stricture.In these 25 patients,16 had type A biliary anatomy,3 had type B,2 had type C,3 had type D,and 1 had type E.In the 127 donors,96(75.6%)had type A biliary anatomy,13(10.2%)had type B,6(4.7%)had type C,10(7.9%)had type D,and 2(1.6%)had type E.Biliary stricture was seen in 2 donors,who had type A biliary anatomy.None of the recipients or donors developed bile leakage.No association between the occurrence of postoperative biliary stricture and donor biliary anatomy type was found(P=0.527).Conclusions:The incidence of biliary stricture in donors or recipients after RLDLT was not related to donor biliary anatomy type.As postoperative complications were similar in whatever type of donor bile duct anatomy,donor ductal anomaly should not be considered a contraindication to donation of right liver lobe. 展开更多
关键词 Living donor liver transplantation Right liver donation Biliary complications Cholangiograms Ductal anomaly
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Crizotinib-induced acute fatal liver failure in an Asian ALK-positive lung adenocarcinoma patient with liver metastasis: A case report 预览
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作者 Ying Zhang Yan-Yan Xu +2 位作者 Yi Chen Jin-Na Li Ying Wang 《世界临床病例杂志》 2019年第9期1080-1086,共7页
BACKGROUND Crizotinib-induce hepatotoxicity is rare and non-specific, and severe hepatotoxicity can develop into fatal liver failure. Herein, we report a case of fatal crizotinib-induced liver failure in a 37-year-old... BACKGROUND Crizotinib-induce hepatotoxicity is rare and non-specific, and severe hepatotoxicity can develop into fatal liver failure. Herein, we report a case of fatal crizotinib-induced liver failure in a 37-year-old Asian patient. CASE SUMMARY The patient complained of dyspnea and upper abdominal pain for a week in August 2017. He was diagnosed with anaplastic lymphoma kinase- rearranged lung adenocarcinoma combined with multiple distant metastases. Crizotinib was initiated as a first-line treatment at a dosage of 250 mg twice daily. No adverse effects were seen until day 46. On day 55, he was admitted to the hospital with elevated liver enzymes aspartate aminotransferase (AST)(402 IU/L), alanine aminotransferase (ALT)(215 IU/L) and total bilirubin (145 μmol/L) and was diagnosed with crizotinib-induced fulminant liver failure. Despite crizotinib discontinuation and intensive supportive therapy, the level of AST (1075 IU/L), ALT (240 IU/L) and total bilirubin (233 μmol/L) continued to rapidly increase, and he died on day 60. CONCLUSION Physicians should be aware of the potential fatal adverse effects of crizotinib. 展开更多
关键词 FATAL LIVER failure CRIZOTINIB HEPATOTOXICITY LIVER metastases ALK REARRANGEMENT Lung adenocarcinoma Case report
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从“肝喜调达”浅析《内经》论肝的特点
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作者 方妍 张焱 《吉林中医药》 2019年第4期421-424,共4页
结合《内经》原文,对肝的一些生理特性和病理特征进行浅析。从3个方面进行论述,一是肝体阴而用阳;二是女子以肝为先天;三是肝经与生殖的关系。介入现代医学研究,进一步验证古代先贤的医学理论,从而更好的指导临床实践。本文旨在更深入... 结合《内经》原文,对肝的一些生理特性和病理特征进行浅析。从3个方面进行论述,一是肝体阴而用阳;二是女子以肝为先天;三是肝经与生殖的关系。介入现代医学研究,进一步验证古代先贤的医学理论,从而更好的指导临床实践。本文旨在更深入地理解、还原《内经》原貌,通过细致的分析,更好地解释原文,运用经典。 展开更多
关键词 内经 体阴用阳 肝经
Pure three-dimensional laparoscopic full left hepatectomy of a living donor for an adolescent in China
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作者 Jiu-Lin Song Hong Wu Jia-Yin Yang 《中华医学杂志:英文版》 SCIE CAS CSCD 2019年第2期242-244,共3页
To the Editor:Living donor liver transplantation (LDLT) has expanded the donor pool in countries with low cadaveric organ donation rates.Generally, a left-side liver allograft is sufficient and safe for child and adol... To the Editor:Living donor liver transplantation (LDLT) has expanded the donor pool in countries with low cadaveric organ donation rates.Generally, a left-side liver allograft is sufficient and safe for child and adolescent recipients.[1] For the sake of the donor's cosmetic demands and for early functional rehabilitation, laparoscopic technology has been used in live hepatectomy since 2002.[2] Three-dimensional visualization provides better depth perception and tactile feedback than does conventional two-dimensional laparoscopy.[3] In this report, we presented a case of pure three-dimensional laparoscopic full left live hepatectomy. 展开更多
关键词 LIVING DONOR LIVER transplantation expanded LIVER
Iron and liver fibrosis:Mechanistic and clinical aspects 预览
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作者 Kosha J Mehta Sebastien Je Farnaud Paul A Sharp 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第5期521-538,共18页
Liver fibrosis is characterised by excessive deposition of extracellular matrix that interrupts normal liver functionality.It is a pathological stage in several untreated chronic liver diseases such as the iron overlo... Liver fibrosis is characterised by excessive deposition of extracellular matrix that interrupts normal liver functionality.It is a pathological stage in several untreated chronic liver diseases such as the iron overload syndrome hereditary haemochromatosis,viral hepatitis,alcoholic liver disease,non-alcoholic fatty liver disease,non-alcoholic steatohepatitis and diabetes.Interestingly,regardless of the aetiology,iron-loading is frequently observed in chronic liver diseases.Excess iron can feed the Fenton reaction to generate unquenchable amounts of free radicals that cause grave cellular and tissue damage and thereby contribute to fibrosis.Moreover,excess iron can induce fibrosis-promoting signals in the parenchymal and non-parenchymal cells,which accelerate disease progression and exacerbate liver pathology.Fibrosis regression is achievable following treatment,but if untreated or unsuccessful,it can progress to the irreversible cirrhotic stage leading to organ failure and hepatocellular carcinoma,where resection or transplantation remain the only curative options.Therefore,understanding the role of iron in liver fibrosis is extremely essential as it can help in formulating iron-related diagnostic,prognostic and treatment strategies.These can be implemented in isolation or in combination with the current approaches to prepone detection,and halt or decelerate fibrosis progression before it reaches the irreparable stage.Thus,this review narrates the role of iron in liver fibrosis.It examines the underlying mechanisms by which excess iron can facilitate fibrotic responses.It describes the role of iron in various clinical pathologies and lastly,highlights the significance and potential of iron-related proteins in the diagnosis and therapeutics of liver fibrosis. 展开更多
关键词 IRON LIVER PATHOLOGIES LIVER FIBROSIS Hepatic stellate cells Cirrhosis
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Chance and challenge of associating liver partition and portal vein ligation for staged hepatectomy 预览
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作者 Fei Xiang Ze-Min Hu 《国际肝胆胰疾病杂志:英文版》 SCIE CAS CSCD 2019年第3期214-222,共9页
Background: The associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) was first performed in 2007. The critical patient selection, timing to perform the second stage operation, and minimal... Background: The associating liver partition and portal vein ligation for staged hepatectomy(ALPPS) was first performed in 2007. The critical patient selection, timing to perform the second stage operation, and minimally invasive technique are three key factors for patient outcomes. The aim of this review is to summarize published data on these three aspects. Data sources: Studies were identified by searching Pub Med for articles published from January 2007 to October 2018, using the keywords “associating liver partition and portal vein ligation for staged hepatectomy” or “ALPPS” or “in situ split”. Studies on colorectal liver metastasis(CRLM), perihilar cholangiocarcinoma(PHC), and hepatocellular carcinoma(HCC) indicated for ALPPS, cutoff values to determine the timing of stage 2, as well as modifications of ALPPS were included. Results: The mortality of ALPPS for CRLM is declining, for PHC is high. In patients with HCC, essential hypertrophy makes the ALPPS safer. However, the degrees of fibrosis affect the hypertrophy. The future liver remnant volume is still the gold standard to start the second stage. Hepatobiliary scintigraphy plays an important role in quantitatively assessing liver function, whereas cutoff values need to be further calibrated. Less-invasive ALPPS modifications have increased and led to a decreased mortality. Conclusions: ALLPS improved the CRLM outcomes;ALPPS is feasible in patients with PHC after failure of portal vein embolization;ALPPS may be an option for HCC patients with major vascular invasion and thrombosis. The simplified and less-invasive ALPPS is the trend. 展开更多
关键词 HEPATECTOMY LIVER regeneration Portal VEIN Colorectal LIVER metastasis Hepatocellular carcinoma Perihilar CHOLANGIOCARCINOMA
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西咪替丁对低剂量率照射比格犬肝细胞凋亡的影响及其机制研究 预览
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作者 王庆蓉 何颖 +6 位作者 赵忆宁 沈先荣 刘玉明 李珂娴 罗群 陈伟 侯登勇 《中国药房》 CAS 北大核心 2019年第12期1623-1628,共6页
目的:研究西咪替丁对低剂量率照射比格犬肝细胞凋亡的影响及其机制。方法:将健康雄性比格犬随机分为正常对照组、模型对照组、阳性药物组(香菇多糖,21.33mg/kg)和西咪替丁低、中、高剂量组(5.33、10.67、21.33mg/kg),每组4只。除正常对... 目的:研究西咪替丁对低剂量率照射比格犬肝细胞凋亡的影响及其机制。方法:将健康雄性比格犬随机分为正常对照组、模型对照组、阳性药物组(香菇多糖,21.33mg/kg)和西咪替丁低、中、高剂量组(5.33、10.67、21.33mg/kg),每组4只。除正常对照组外,其余各组比格犬均予60Co-γ射线(剂量率:0.040 8mgy/min)累积照射23d,各给药组于每日照射前口服相应药物1次。停止照射24h后,采用TUNEL法检测各组比格犬肝细胞凋亡情况,并计算凋亡细胞百分比;采用免疫组化法检测其肝组织中凋亡相关蛋白[Bax、Bcl-2、胱天蛋白酶3(Caspase-3)、p53]的表达水平。结果:与正常对照组比较,模型对照组比格犬肝组织中凋亡细胞以及Bax、Caspase-3、p53阳性细胞均明显增加,凋亡细胞百分比以及Bax、Caspase-3、p53蛋白表达水平均显著升高;Bcl-2阳性细胞明显减少,其蛋白表达水平均显著降低(P<0.05或P<0.01)。与模型对照组比较,各给药组比格犬肝组织中上述阳性细胞均有不同程度的变化,其中各给药组凋亡细胞百分比和p53蛋白表达水平,阳性药物组和西咪替丁低、高剂量组Bax蛋白表达水平以及西咪替丁各剂量组Caspase-3蛋白表达水平均显著降低;西咪替丁各剂量组Bcl-2蛋白表达水平均显著升高;且西咪替丁中、高剂量组凋亡细胞百分比以及西咪替丁各剂量组Caspase-3蛋白表达水平均显著低于阳性对照组,西咪替丁低剂量组p53蛋白表达水平显著高于阳性药物组(P<0.05或P<0.01)。结论:西咪替丁可抑制低剂量率照射所致的比格犬肝细胞凋亡,对其具有一定的辐射保护作用。这种作用可能与上调Bcl-2蛋白的表达,下调Bax、Caspase-3、p53蛋白的表达有关。 展开更多
关键词 西咪替丁 低剂量率辐射 肝脏 肝细胞凋亡 凋亡相关蛋白 比格犬 防辐射 机制
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Fluoroquinolones for the treatment of latent Mycobacterium tuberculosis infection in liver transplantation 预览
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作者 Jose Tiago Silva Rafael San-Juan +1 位作者 Mario Fernandez-Ruiz Jose Maria Aguado 《世界胃肠病学杂志:英文版》 SCIE CAS 2019年第26期3291-3298,共8页
Solid organ transplantation(SOT)is the best treatment option for end-stage organ disease.Newer immunosuppressive agents have reduced the incidence of graft rejection but have increased the risk of infection,particular... Solid organ transplantation(SOT)is the best treatment option for end-stage organ disease.Newer immunosuppressive agents have reduced the incidence of graft rejection but have increased the risk of infection,particularly due to the reactivation of latent infections due to opportunistic agents such as Mycobacterium tuberculosis.Active tuberculosis(TB)after SOT is a significant cause of morbidity and mortality.Most cases of posttransplant TB are secondary to reactivation of latent tuberculosis infection(LTBI)due to the effects of long-term immunosuppressive therapy.Risk minimization strategies have been developed to diagnose LTBI and initiate treatment prior to transplantation.Isoniazid with vitamin B6 supplementation is the treatment of choice.However,liver transplantation(LT)candidates and recipients have an increased risk of isoniazid-induced liver toxicity,leading to lower treatment completion rates than in other SOT populations.Fluoroquinolones(FQs)exhibit good in vitro antimycobacterial activity and a lower risk of drug-induced liver injury than isoniazid.In the present review,we highlight the disease burden posed by posttransplant TB and summarize the emerging clinical evidence supporting the use of FQs for the treatment of LTBI in LT recipients and candidates. 展开更多
关键词 FLUOROQUINOLONES MYCOBACTERIUM TUBERCULOSIS LATENT TUBERCULOSIS infection LIVER transplantation DRUG-INDUCED LIVER graft injury
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肝脏手术缝合技术与缝合材料选择中国专家共识(2018版)
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作者 中华医学会外科学分会 赵玉沛 +15 位作者 刘连新 蔡建强 曾勇 梁霄 窦科峰 蔡秀军 姜洪池 陈规划 梁力建 李强 梁延波 彭承宏 钦伦秀 张水军 张学文 许戈良 《中国实用外科杂志》 CSCD 北大核心 2019年第1期11-14,共4页
目前,肝脏外科的发展已经从开展和完成半肝切除、右三叶肝切除和尾状叶肝切除等传统观念下难度较大的手术,逐渐转变为如何在保留足够肝脏体积的条件下开展更符合元瘤原则的手术(如静脉入路的解剖性肝切除),以及完成以往无法完成的手术[... 目前,肝脏外科的发展已经从开展和完成半肝切除、右三叶肝切除和尾状叶肝切除等传统观念下难度较大的手术,逐渐转变为如何在保留足够肝脏体积的条件下开展更符合元瘤原则的手术(如静脉入路的解剖性肝切除),以及完成以往无法完成的手术[如联合肝脏分隔和门静脉结扎的二步肝切除术(ALPPS)]等。微创技术在肝切除术中的应用和普及对术中出血控制要求更加严格,创面止血、血管胆管缝合重建也变得更加困难,而规范、科学地完成肝脏血管和胆管的缝合是预防术后大出血和胆漏的重要环节。为指导临床相关工作,中华医学会外科学分会组织国内部分专家,经反复讨论,制定本专家共识。 展开更多
关键词 肝脏 腹腔镜 肝切除 缝合技术 缝合材料
Rise of sodium-glucose cotransporter 2 inhibitors in the management of nonalcoholic fatty liver disease 预览
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作者 Amr Dokmak Mohammad Almeqdadi +1 位作者 Hirsh Trivedi Sandeep Krishnan 《世界肝病学杂志:英文版(电子版)》 2019年第7期562-573,共12页
Non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in the Western world. It is more prevalent in male gender, and with increasing age, obesity, and insulin resistance. Besides w... Non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in the Western world. It is more prevalent in male gender, and with increasing age, obesity, and insulin resistance. Besides weight loss, there are limited treatment options. The use of anti-diabetic medications has been studied with mixed results. In this review, we discuss the use of anti-diabetic medications in the management of NAFLD with a specific focus on sodium-glucose cotransporter 2 inhibitors. We shed light on the evidence supporting their use in detail and discuss limitations and future directions. 展开更多
关键词 Non-alcoholic fatty LIVER disease Non-alcoholic steatohepatitis Sodiumglucose COTRANSPORTER 2 INHIBITORS LIVER cirrhosis Diabetes
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Epidemiology and outcomes of acute liver failure in Australia 预览
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作者 Penelope Hey Timothy P Hanrahan +11 位作者 Marie Sinclair Adam G Testro Peter W Angus Adam Peterson Stephen Warrillow Rinaldo Bellomo Marcos V Perini Graham Starkey Robert M Jones Michael Fink Tess McClure Paul Gow 《世界肝病学杂志:英文版(电子版)》 2019年第7期586-595,共10页
BACKGROUND Acute liver failure (ALF) is a life-threatening syndrome with varying aetiologies requiring complex care and multidisciplinary management. Its changing incidence, aetiology and outcomes over the last 16 yea... BACKGROUND Acute liver failure (ALF) is a life-threatening syndrome with varying aetiologies requiring complex care and multidisciplinary management. Its changing incidence, aetiology and outcomes over the last 16 years in the Australian context remain uncertain. AIM To describe the changing incidence, aetiology and outcomes of ALF in South Eastern Australia. METHODS The database of the Victorian Liver Transplant Unit was interrogated to identify all cases of ALF in adults (> 16 years) in adults hospitalised between January 2002 and December 2017. Overall, 169 patients meeting criteria for ALF were identified. Demographics, aetiology of ALF, rates of transplantation and outcomes were collected for all patients. Transplant free survival and overall survival (OS) were assessed based on survival to discharge from hospital. Results were compared to data from a historical cohort from the same unit from 1988- 2001. RESULTS Paracetamol was the most common aetiology of acute liver failure, accounting for 50% of cases, with an increased incidence compared with the historical cohort (P = 0.046). Viral hepatitis and non-paracetamol drug or toxin induced liver injury accounted for 15% and 10% of cases respectively. Transplant free survival (TFS) improved significantly compared to the historical cohort (52% vs 38%, P = 0.032). TFS was highest in paracetamol toxicity with spontaneous recovery in 72% of cases compared to 31% of non-paracetamol ALF (P < 0.001). Fifty-nine patients were waitlisted for emergency liver transplantation. Nine of these died while waiting for an organ to become available. Forty-two patients (25%) underwent emergency liver transplantation with a 1, 3 and 5 year survival of 81%, 78% and 72% respectively. CONCLUSION Paracetamol toxicity is the most common aetiology of ALF in South-Eastern Australia with a rising incidence over 30 years. TFS has improved, however it remains low in non-paracetamol ALF. 展开更多
关键词 LIVER FAILURE Acute PARACETAMOL AUSTRALIA VICTORIA LIVER TRANSPLANT
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