首页 > 最新文献

Visceral Medicine最新文献

英文 中文
Hepatocellular Carcinoma: The Role of Surgery in Liver Cirrhosis. 肝细胞癌:手术在肝硬化中的作用。
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2024-02-01 Epub Date: 2024-01-03 DOI: 10.1159/000535782
Dominik T Koch, Fabian Horné, Matthias P Fabritius, Jens Werner, Matthias Ilmer

Background: Liver surgery is an essential component of hepatocellular carcinoma (HCC) treatment. Advances in surgical techniques and perioperative care have improved outcomes and have helped to expand surgical indications. However, liver fibrosis and cirrhosis still remain major problems for liver surgery due to the relevant impact on liver regeneration of the future liver remnant (FLR) after surgery. Especially in patients with clinically significant portal hypertension due to liver cirrhosis, surgery is limited. Despite recent efforts in developing predictive models, estimating the postoperative hepatic function remains difficult.

Summary: In this review, we focus on the role of surgery in the treatment of HCC in structurally altered livers. The importance of assessing FLR with techniques such as contrast-enhanced CT, e.g., with the help of artificial intelligence is highlighted. Moreover, strategies for increasing the FLR with approaches like portal vein embolization and liver vein deprivation prior to surgery are discussed. Patient selection, minimally invasive liver surgery including robotic techniques, and perioperative concepts like the Enhanced Recovery After Surgery (ERAS) guidelines are identified as crucial parts of avoiding posthepatectomy liver failure.

Key message: The need for ongoing research to optimize patient selection criteria and perioperative care and to develop innovative biomarkers for outcome prediction is emphasized.

背景:肝脏手术是肝细胞癌(HCC)治疗的重要组成部分。手术技术和围手术期护理的进步改善了治疗效果,并有助于扩大手术适应症。然而,肝纤维化和肝硬化仍然是肝脏手术的主要问题,因为这对术后未来残余肝脏(FLR)的肝脏再生有相关影响。特别是对于因肝硬化导致门静脉高压的患者,手术治疗更是受到限制。摘要:在这篇综述中,我们重点讨论了手术在治疗肝脏结构改变的 HCC 中的作用。我们强调了利用对比增强 CT 等技术(如人工智能)评估 FLR 的重要性。此外,还讨论了通过门静脉栓塞和手术前剥夺肝静脉等方法提高FLR的策略。患者选择、微创肝脏手术(包括机器人技术)以及围手术期概念(如术后增强恢复(ERAS)指南)被认为是避免肝切除术后肝功能衰竭的关键部分:强调有必要持续开展研究,以优化患者选择标准和围手术期护理,并开发创新的生物标志物来预测结果。
{"title":"Hepatocellular Carcinoma: The Role of Surgery in Liver Cirrhosis.","authors":"Dominik T Koch, Fabian Horné, Matthias P Fabritius, Jens Werner, Matthias Ilmer","doi":"10.1159/000535782","DOIUrl":"10.1159/000535782","url":null,"abstract":"<p><strong>Background: </strong>Liver surgery is an essential component of hepatocellular carcinoma (HCC) treatment. Advances in surgical techniques and perioperative care have improved outcomes and have helped to expand surgical indications. However, liver fibrosis and cirrhosis still remain major problems for liver surgery due to the relevant impact on liver regeneration of the future liver remnant (FLR) after surgery. Especially in patients with clinically significant portal hypertension due to liver cirrhosis, surgery is limited. Despite recent efforts in developing predictive models, estimating the postoperative hepatic function remains difficult.</p><p><strong>Summary: </strong>In this review, we focus on the role of surgery in the treatment of HCC in structurally altered livers. The importance of assessing FLR with techniques such as contrast-enhanced CT, e.g., with the help of artificial intelligence is highlighted. Moreover, strategies for increasing the FLR with approaches like portal vein embolization and liver vein deprivation prior to surgery are discussed. Patient selection, minimally invasive liver surgery including robotic techniques, and perioperative concepts like the Enhanced Recovery After Surgery (ERAS) guidelines are identified as crucial parts of avoiding posthepatectomy liver failure.</p><p><strong>Key message: </strong>The need for ongoing research to optimize patient selection criteria and perioperative care and to develop innovative biomarkers for outcome prediction is emphasized.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10836947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139682002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Microbiota Therapy in Inflammatory Bowel Disease 炎症性肠病的微生物群疗法
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2024-01-29 DOI: 10.1159/000536254
Luc Biedermann, A. Kreienbühl, Gerhard Rogler
Background: In both Crohn’s disease (CD) and ulcerative colitis (UC), the two major forms of inflammatory bowel disease (IBD) the immune reaction is – at least partially – directed against components of the luminal microbiota of the gut. These immune responses as well as other factors contribute to a phenomenon frequently described as “dysbiosis” meaning an alteration of the composition of the colonic microbiota. To improve the dysbiosis and to restore the normal composition of the colonic microbiota, fecal microbiota transplantation (FMT) has been tested as a therapeutic option to induce and maintain remission in IBD patients. Summary: This review will first discuss changes in the composition of the intestinal microbiota found in IBD patients and second the therapeutic potential of microbiological interventions for the treatment of these patients. FMT has been studied in several clinical trials in both, CD and UC. Reported results and subsequent meta-analyses indicate that FMT may be effective to induce remission in UC. However, the optimal route of FMT, the necessary number of administrations and the question whether life bacteria of freshly prepared stool is more effective than frozen are still unclear. Concepts associated with an optimization of FMT such as the “super donor concept” or the “consortia-approach” will be discussed to illustrate open questions and difficulties associated with microbiota therapy in IBD. Key Messages: The microbiota composition in IBD patients shows significant alterations compared to healthy individuals termed as “dysbiosis”. FMT and other therapeutic approaches to modify the microbiota composition have been studied in clinical trials in recent years. Efficacy has been shown in UC; however, many questions with respect to the optimization of microbiota therapy remain to be answered.
背景:克罗恩病(CD)和溃疡性结肠炎(UC)是炎症性肠病(IBD)的两种主要形式,在这两种疾病中,免疫反应至少部分是针对肠腔微生物群的成分。这些免疫反应以及其他因素导致了一种经常被描述为 "菌群失调 "的现象,即结肠微生物群组成的改变。为了改善菌群失调并恢复结肠微生物群的正常组成,粪便微生物群移植(FMT)已被测试为一种治疗方法,可诱导并维持 IBD 患者的病情缓解。摘要:本综述将首先讨论 IBD 患者肠道微生物群组成的变化,其次讨论微生物干预治疗这些患者的潜力。FMT 已在 CD 和 UC 的多项临床试验中进行了研究。报告结果和随后的荟萃分析表明,FMT 可有效诱导 UC 患者病情缓解。然而,FMT 的最佳途径、必要的给药次数以及新鲜粪便中的生命细菌是否比冷冻粪便更有效等问题仍不清楚。我们将讨论与 FMT 优化相关的概念,如 "超级供体概念 "或 "联合方法",以说明与 IBD 微生物群疗法相关的未决问题和困难。关键信息:与健康人相比,IBD 患者的微生物群组成发生了显著变化,被称为 "菌群失调"。近年来,临床试验对 FMT 和其他改变微生物群组成的治疗方法进行了研究。在 UC 中已显示出疗效;然而,在优化微生物群疗法方面仍有许多问题有待解答。
{"title":"Microbiota Therapy in Inflammatory Bowel Disease","authors":"Luc Biedermann, A. Kreienbühl, Gerhard Rogler","doi":"10.1159/000536254","DOIUrl":"https://doi.org/10.1159/000536254","url":null,"abstract":"Background: In both Crohn’s disease (CD) and ulcerative colitis (UC), the two major forms of inflammatory bowel disease (IBD) the immune reaction is – at least partially – directed against components of the luminal microbiota of the gut. These immune responses as well as other factors contribute to a phenomenon frequently described as “dysbiosis” meaning an alteration of the composition of the colonic microbiota. To improve the dysbiosis and to restore the normal composition of the colonic microbiota, fecal microbiota transplantation (FMT) has been tested as a therapeutic option to induce and maintain remission in IBD patients. Summary: This review will first discuss changes in the composition of the intestinal microbiota found in IBD patients and second the therapeutic potential of microbiological interventions for the treatment of these patients. FMT has been studied in several clinical trials in both, CD and UC. Reported results and subsequent meta-analyses indicate that FMT may be effective to induce remission in UC. However, the optimal route of FMT, the necessary number of administrations and the question whether life bacteria of freshly prepared stool is more effective than frozen are still unclear. Concepts associated with an optimization of FMT such as the “super donor concept” or the “consortia-approach” will be discussed to illustrate open questions and difficulties associated with microbiota therapy in IBD. Key Messages: The microbiota composition in IBD patients shows significant alterations compared to healthy individuals termed as “dysbiosis”. FMT and other therapeutic approaches to modify the microbiota composition have been studied in clinical trials in recent years. Efficacy has been shown in UC; however, many questions with respect to the optimization of microbiota therapy remain to be answered.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140488459","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Exploring the Relationship between Liver Disease, Bacterial Translocation, and Dysbiosis: Unveiling the Gut-Liver Axis 探索肝病、细菌转运和菌群失调之间的关系:揭开肠道-肝脏轴的面纱
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2024-01-23 DOI: 10.1159/000535962
O. Juanola, Rubén Francés, E. Caparrós
Background: The global burden of liver disease and cirrhosis has been progressively increasing in the last decade. The interplay between gut microbiota and immune system and the bidirectional relationship with the liver, known as the gut-liver axis, has arisen as a fundamental aspect of liver disease. Summary: Alterations of the gut microbiome have been described and include both dysbiotic microbial signatures and intestinal bacterial overgrowth. The integrity of the intestinal epithelial barrier is essential for preventing the access of harmful substances and bacterial products into the host. Bacterial translocation due to altered host-microbiota interactions triggers local immune cell activation and facilitates a chronic inflammatory state that can ultimately lead to immune exhaustion, characteristic of cirrhosis. In cirrhosis, breakdown of the gut vascular barrier allows access of bacterial products to portal blood circulation and facilitates their influx into the liver, further contributing to disease progression. Key Messages: A better understanding of the contributing factors to pathological bacterial translocation and the impact of dysbiosis in liver disease will lead to achieve innovative therapeutic strategies in cirrhosis.
背景:近十年来,全球肝病和肝硬化的负担逐渐加重。肠道微生物群与免疫系统之间的相互作用以及与肝脏之间的双向关系(称为肠肝轴)已成为肝病的一个基本方面。摘要:肠道微生物组的改变已被描述,包括微生物特征失调和肠道细菌过度生长。肠道上皮屏障的完整性对于防止有害物质和细菌产物进入宿主体内至关重要。宿主-微生物群相互作用改变导致的细菌转运会引发局部免疫细胞活化,促进慢性炎症状态,最终导致免疫衰竭,这是肝硬化的特征。在肝硬化患者中,肠道血管屏障的破坏会使细菌产物进入门静脉血液循环,并促进其流入肝脏,从而进一步导致病情恶化。关键信息:更好地了解病理细菌转运的诱因以及肝病中菌群失调的影响,将有助于实现肝硬化的创新治疗策略。
{"title":"Exploring the Relationship between Liver Disease, Bacterial Translocation, and Dysbiosis: Unveiling the Gut-Liver Axis","authors":"O. Juanola, Rubén Francés, E. Caparrós","doi":"10.1159/000535962","DOIUrl":"https://doi.org/10.1159/000535962","url":null,"abstract":"Background: The global burden of liver disease and cirrhosis has been progressively increasing in the last decade. The interplay between gut microbiota and immune system and the bidirectional relationship with the liver, known as the gut-liver axis, has arisen as a fundamental aspect of liver disease. Summary: Alterations of the gut microbiome have been described and include both dysbiotic microbial signatures and intestinal bacterial overgrowth. The integrity of the intestinal epithelial barrier is essential for preventing the access of harmful substances and bacterial products into the host. Bacterial translocation due to altered host-microbiota interactions triggers local immune cell activation and facilitates a chronic inflammatory state that can ultimately lead to immune exhaustion, characteristic of cirrhosis. In cirrhosis, breakdown of the gut vascular barrier allows access of bacterial products to portal blood circulation and facilitates their influx into the liver, further contributing to disease progression. Key Messages: A better understanding of the contributing factors to pathological bacterial translocation and the impact of dysbiosis in liver disease will lead to achieve innovative therapeutic strategies in cirrhosis.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139603700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Challenge of Anticoagulation in Liver Cirrhosis. 肝硬化患者抗凝治疗的挑战。
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-12-21 DOI: 10.1159/000535438
Julia Carolin Eichholz, Heiner Wedemeyer, Benjamin Maasoumy

Background: Advanced liver diseases are characterized by a number of changes in the hemostatic system. Due to the occurrence of bleeding events in patients with liver cirrhosis, there seems to be a hesitance to the administration of anticoagulant medications. This review summarizes challenges, recommendations, and current developments of anticoagulation in the cirrhotic patient.

Summary: The risk of thrombotic events in patients with liver cirrhosis is at least as high as in patients with healthy liver function if not even higher. Standard laboratory markers do not truly reflect the complexity of changes that take place in the coagulative system and therefore cannot be used as a reference for risk of thrombosis or hemorrhage. Potential options for anticoagulant therapy are heparins, vitamin K antagonists, and direct-acting oral anticoagulants which come with differences in safety, application, possible side effects, and data availability for the patient cohort.

Key message: The administration of anticoagulation can be beneficial in patients with liver disease if the indication is present and bleeding prophylaxis has been established. Direct-acting oral anticoagulants appear to be a promising new approach with many improvements compared to conventional substances. Nevertheless, there is a need for further data and prospective trials on the use in patients with liver cirrhosis.

背景:晚期肝病的特点是止血系统发生一系列变化。由于肝硬化患者会发生出血事件,因此在使用抗凝药物时似乎有些犹豫不决。摘要:肝硬化患者发生血栓事件的风险至少与肝功能健康的患者一样高,甚至更高。标准实验室指标不能真实反映凝血系统发生的复杂变化,因此不能作为血栓形成或出血风险的参考。抗凝疗法的潜在选择包括肝素、维生素 K 拮抗剂和直接作用口服抗凝剂,这些药物在安全性、应用、可能的副作用以及患者群体的数据可用性方面存在差异:关键信息:如果肝病患者有适应症并已确立出血预防措施,服用抗凝药对患者有益。直接作用口服抗凝剂似乎是一种很有前景的新方法,与传统药物相比有很多改进。然而,在肝硬化患者中使用这种药物还需要更多的数据和前瞻性试验。
{"title":"The Challenge of Anticoagulation in Liver Cirrhosis.","authors":"Julia Carolin Eichholz, Heiner Wedemeyer, Benjamin Maasoumy","doi":"10.1159/000535438","DOIUrl":"10.1159/000535438","url":null,"abstract":"<p><strong>Background: </strong>Advanced liver diseases are characterized by a number of changes in the hemostatic system. Due to the occurrence of bleeding events in patients with liver cirrhosis, there seems to be a hesitance to the administration of anticoagulant medications. This review summarizes challenges, recommendations, and current developments of anticoagulation in the cirrhotic patient.</p><p><strong>Summary: </strong>The risk of thrombotic events in patients with liver cirrhosis is at least as high as in patients with healthy liver function if not even higher. Standard laboratory markers do not truly reflect the complexity of changes that take place in the coagulative system and therefore cannot be used as a reference for risk of thrombosis or hemorrhage. Potential options for anticoagulant therapy are heparins, vitamin K antagonists, and direct-acting oral anticoagulants which come with differences in safety, application, possible side effects, and data availability for the patient cohort.</p><p><strong>Key message: </strong>The administration of anticoagulation can be beneficial in patients with liver disease if the indication is present and bleeding prophylaxis has been established. Direct-acting oral anticoagulants appear to be a promising new approach with many improvements compared to conventional substances. Nevertheless, there is a need for further data and prospective trials on the use in patients with liver cirrhosis.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Baseline Interleukin-6 as a Preoperative Biomarker for Liver Fibrosis. 作为肝纤维化术前生物标志物的基线白细胞介素-6
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2024-01-01 Epub Date: 2023-12-27 DOI: 10.1159/000535627
Dominik Thomas Koch, Dionysios Koliogiannis, Moritz Drefs, Malte Schirren, Viktor von Ehrlich-Treuenstätt, Hanno Nieß, Bernhard Renz, Matthias Ilmer, Joachim Andrassy, Markus O Guba, Jens Werner, Florian Kühn

Introduction: Liver (hepatic) fibrosis (LF) is characterized by impaired function and regenerative capacity of the liver and can lead to significantly increased morbidity and mortality in the context of surgical liver resection (LR). For this reason, it is crucial to identify the extent of LF preoperatively. Interleukin-6 (IL-6) is known to play a key role in the pathogenesis of LF, but its exact value as a preoperative marker is unknown. This study aimed to investigate the correlation between preoperatively determined IL-6 and the presence of LF.

Methods: In this prospective study, IL-6 was determined in 134 consecutive patients undergoing LR. Patients with liver cirrhosis (LC) and patients with clinical or laboratory signs of inflammation were excluded. LF was graded by a blinded pathologist with regard to the degree of LF according to the Desmet classification (0-4). Baseline IL-6 and degree of LF were correlated.

Results: A total of 134 patients were prospectively included prior to LR. For 104 patients, LF was graded and inflammatory parameters were available. Thirty-five of these patients showed LC (Desmet 4), and another 33 patients showed preoperatively elevated inflammatory markers. Two of the remaining patients were liver transplant patients. These patients were excluded from the final analysis. According to Desmet, the remaining 34 patients had LF grade 0 or 1 (none or minimal LF) in 26 cases and LF grade 2 or 3 (moderate-to-severe LF) in 8 cases. Correlation of LF with preoperatively determined IL-6 yielded significantly higher IL-6 levels in the group of patients with moderate-to-severe LF (Desmet 2 or 3) compared to the group with none or minimal LF (Desmet 0 or 1; p = 0.0495).

Conclusion: In the context of LR, our results showed a correlation of preoperatively determined IL-6 with the extent of LF present. Higher serum baseline IL-6 concentrations were associated with a higher degree of LF, whereas no other blood parameter or score was that predictive for LF. Our results suggest that baseline IL-6 might serve as a valuable parameter to assess LF prior to LR. More patients need to be analyzed to further evaluate and confirm the predictive accuracy of IL-6 for LF.

导言:肝(肝)纤维化(LF)的特点是肝脏功能和再生能力受损,可导致手术肝切除(LR)的发病率和死亡率显著增加。因此,术前确定肝纤维化的程度至关重要。众所周知,白细胞介素-6(IL-6)在肝纤维化的发病机制中起着关键作用,但其作为术前标志物的确切价值尚不清楚。本研究旨在探讨术前测定的 IL-6 与 LF 存在之间的相关性:在这项前瞻性研究中,对 134 名连续接受 LR 的患者进行了 IL-6 测定。排除了肝硬化(LC)患者和有临床或实验室炎症迹象的患者。LF由盲法病理学家根据Desmet分类法(0-4)对LF程度进行分级。基线IL-6与LF程度相关:结果:共有 134 名患者在 LR 前接受了前瞻性研究。其中 104 例患者的 LF 已分级,炎症参数也已获得。其中 35 例患者出现低密度脂蛋白血症(Desmet 4),另有 33 例患者术前炎症指标升高。其余两名患者为肝移植患者。这些患者被排除在最终分析之外。根据 Desmet 的数据,其余 34 例患者中,26 例患者的 LF 等级为 0 或 1(无或轻度 LF),8 例患者的 LF 等级为 2 或 3(中度至重度 LF)。LF 与术前测定的 IL-6 的相关性显示,中重度 LF 患者组(Desmet 2 或 3)的 IL-6 水平明显高于无 LF 或轻度 LF 患者组(Desmet 0 或 1;P = 0.0495):我们的研究结果表明,在 LR 的情况下,术前测定的 IL-6 与 LF 的存在程度相关。较高的血清基线 IL-6 浓度与较高的 LF 程度相关,而其他血液参数或评分均不能预测 LF。我们的研究结果表明,基线 IL-6 可能是在 LR 之前评估 LF 的一个有价值的参数。需要对更多患者进行分析,以进一步评估和确认 IL-6 对 LF 的预测准确性。
{"title":"Baseline Interleukin-6 as a Preoperative Biomarker for Liver Fibrosis.","authors":"Dominik Thomas Koch, Dionysios Koliogiannis, Moritz Drefs, Malte Schirren, Viktor von Ehrlich-Treuenstätt, Hanno Nieß, Bernhard Renz, Matthias Ilmer, Joachim Andrassy, Markus O Guba, Jens Werner, Florian Kühn","doi":"10.1159/000535627","DOIUrl":"10.1159/000535627","url":null,"abstract":"<p><strong>Introduction: </strong>Liver (hepatic) fibrosis (LF) is characterized by impaired function and regenerative capacity of the liver and can lead to significantly increased morbidity and mortality in the context of surgical liver resection (LR). For this reason, it is crucial to identify the extent of LF preoperatively. Interleukin-6 (IL-6) is known to play a key role in the pathogenesis of LF, but its exact value as a preoperative marker is unknown. This study aimed to investigate the correlation between preoperatively determined IL-6 and the presence of LF.</p><p><strong>Methods: </strong>In this prospective study, IL-6 was determined in 134 consecutive patients undergoing LR. Patients with liver cirrhosis (LC) and patients with clinical or laboratory signs of inflammation were excluded. LF was graded by a blinded pathologist with regard to the degree of LF according to the Desmet classification (0-4). Baseline IL-6 and degree of LF were correlated.</p><p><strong>Results: </strong>A total of 134 patients were prospectively included prior to LR. For 104 patients, LF was graded and inflammatory parameters were available. Thirty-five of these patients showed LC (Desmet 4), and another 33 patients showed preoperatively elevated inflammatory markers. Two of the remaining patients were liver transplant patients. These patients were excluded from the final analysis. According to Desmet, the remaining 34 patients had LF grade 0 or 1 (none or minimal LF) in 26 cases and LF grade 2 or 3 (moderate-to-severe LF) in 8 cases. Correlation of LF with preoperatively determined IL-6 yielded significantly higher IL-6 levels in the group of patients with moderate-to-severe LF (Desmet 2 or 3) compared to the group with none or minimal LF (Desmet 0 or 1; <i>p</i> = 0.0495).</p><p><strong>Conclusion: </strong>In the context of LR, our results showed a correlation of preoperatively determined IL-6 with the extent of LF present. Higher serum baseline IL-6 concentrations were associated with a higher degree of LF, whereas no other blood parameter or score was that predictive for LF. Our results suggest that baseline IL-6 might serve as a valuable parameter to assess LF prior to LR. More patients need to be analyzed to further evaluate and confirm the predictive accuracy of IL-6 for LF.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10775852/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139418699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Microbiota Manipulation as an Emerging Concept in Cancer Therapy 操纵微生物群是癌症治疗的新概念
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2023-12-12 DOI: 10.1159/000534810
M. Spalinger, Michael Scharl
Background: The human body is colonized by billions of bacteria that provide nutrients to the host, train our immune system, and importantly affect our heath. It has long been suggested that microbes might play a role in tumor pathogenesis; however, compelling evidence was only provided in the past decades when novel detection methods that do not depend on culturing techniques had been developed. Summary: The microbiome impacts tumor development and anti-tumor therapies on various levels. Bacteria can promote or suppress tumor growth via direct interactions with cancer cells, production of metabolites that promote or inhibit tumor growth, and via stimulation or suppression of the local and systemic immune response. Cancer patients harbor a distinct microbiome when compared to healthy controls, which could potentially be employed to detect, identify, and treat cancer. Manipulation of the microbiome either via supplementation of single strains, bacterial consortia, fecal microbiota transfer or the use of pre- and probiotics has been suggested as therapeutic approach to directly target tumor growth or to enhance the efficacy of current state-of-the-art treatment options. Key Messages: (1) Bacteria have a tremendous impact on anti-cancer immune responses. (2) Cancer patients harbor a distinct microbiome when compared to healthy controls. (3) The microbiome seems to be cancer-type specific. (4) Exploitation of bacteria to promote anti-tumor therapy is a novel, very promising venue in cancer treatment.
背景:人体内有数十亿个细菌,它们为宿主提供营养,训练我们的免疫系统,并对我们的健康产生重要影响。长期以来,人们一直认为微生物可能在肿瘤发病机制中发挥作用;然而,直到过去几十年中,不依赖培养技术的新型检测方法被开发出来,才提供了令人信服的证据。摘要:微生物组在不同层面上影响着肿瘤的发展和抗肿瘤疗法。细菌可通过与癌细胞的直接相互作用、产生促进或抑制肿瘤生长的代谢物以及刺激或抑制局部和全身免疫反应来促进或抑制肿瘤生长。与健康对照组相比,癌症患者体内的微生物组截然不同,这有可能被用来检测、识别和治疗癌症。有人建议通过补充单一菌株、细菌联合体、粪便微生物群转移或使用预益生菌和益生菌来操纵微生物群,作为直接针对肿瘤生长或提高当前最先进治疗方案疗效的治疗方法。关键信息:(1)细菌对抗癌免疫反应有巨大影响。(2)与健康对照组相比,癌症患者体内的微生物组截然不同。(3)微生物组似乎具有癌症类型特异性。(4)利用细菌促进抗肿瘤治疗是癌症治疗中一个非常有前景的新领域。
{"title":"Microbiota Manipulation as an Emerging Concept in Cancer Therapy","authors":"M. Spalinger, Michael Scharl","doi":"10.1159/000534810","DOIUrl":"https://doi.org/10.1159/000534810","url":null,"abstract":"Background: The human body is colonized by billions of bacteria that provide nutrients to the host, train our immune system, and importantly affect our heath. It has long been suggested that microbes might play a role in tumor pathogenesis; however, compelling evidence was only provided in the past decades when novel detection methods that do not depend on culturing techniques had been developed. Summary: The microbiome impacts tumor development and anti-tumor therapies on various levels. Bacteria can promote or suppress tumor growth via direct interactions with cancer cells, production of metabolites that promote or inhibit tumor growth, and via stimulation or suppression of the local and systemic immune response. Cancer patients harbor a distinct microbiome when compared to healthy controls, which could potentially be employed to detect, identify, and treat cancer. Manipulation of the microbiome either via supplementation of single strains, bacterial consortia, fecal microbiota transfer or the use of pre- and probiotics has been suggested as therapeutic approach to directly target tumor growth or to enhance the efficacy of current state-of-the-art treatment options. Key Messages: (1) Bacteria have a tremendous impact on anti-cancer immune responses. (2) Cancer patients harbor a distinct microbiome when compared to healthy controls. (3) The microbiome seems to be cancer-type specific. (4) Exploitation of bacteria to promote anti-tumor therapy is a novel, very promising venue in cancer treatment.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139008976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Role of Open-Pore Film Drainage Systems in Endoscopic Vacuum Therapy: Current Status and Review of the Literature 开孔膜引流系统在内窥镜真空治疗中的作用:现状与文献综述
IF 1.9 4区 医学 Q2 Medicine Pub Date : 2023-12-11 DOI: 10.1159/000535029
Konstantinos Kouladouros, Dörte Wichmann, Gunnar Loske
Background: Endoscopic vacuum therapy (EVT) is an increasingly popular endoscopic technique used for the treatment of wall defects in the gastrointestinal tract. Open-pore film drainage (OFD) systems are a new addition to the armamentarium of EVT and have shown encouraging results in a wide spectrum of applications. The aim of this review is to summarize the current literature on the applications of OFD systems in the gastrointestinal tract. Summary: Open-pore film drainage (OFD) systems have been used for the treatment of several defects of the gastrointestinal tract. The small size and easy placement of these devices make them very useful, particularly for the treatment of defects that are small in size or difficult to reach. OFDs have been successfully used for both perforations and anastomotic leaks in various locations, with most reports focusing on the treatment of duodenal defects, although successful applications in the esophagus, stomach, and colon have also been reported. Lately, the role of OFDs in preemptive EVT has also been explored. Key Messages: OFD systems are easy to use, particularly for small defects and challenging localizations. The current literature, consisting mainly of small case series and case reports, shows encouraging results, but further prospective studies are needed to explore and verify the indications and technical aspects of this innovative method.
背景:内窥镜真空治疗(EVT)是一种日益流行的内窥镜技术,用于治疗胃肠道壁缺损。开孔膜引流(OFD)系统是 EVT 的新成员,在广泛的应用中取得了令人鼓舞的效果。本综述旨在总结目前有关胃肠道开孔膜引流系统应用的文献。摘要:开孔薄膜引流系统(OFD)已被用于治疗多种胃肠道缺损。这些设备体积小、易于放置,因此非常有用,尤其是在治疗体积小或难以触及的缺损时。OFD 已成功用于治疗不同部位的穿孔和吻合口漏,大多数报道都集中在十二指肠缺损的治疗上,但也有成功应用于食道、胃和结肠的报道。最近,人们还探索了 OFD 在先期 EVT 中的作用。关键信息:OFD 系统易于使用,尤其适用于小缺损和具有挑战性的定位。目前的文献主要由小型病例系列和病例报告组成,显示了令人鼓舞的结果,但还需要进一步的前瞻性研究来探索和验证这种创新方法的适应症和技术方面。
{"title":"The Role of Open-Pore Film Drainage Systems in Endoscopic Vacuum Therapy: Current Status and Review of the Literature","authors":"Konstantinos Kouladouros, Dörte Wichmann, Gunnar Loske","doi":"10.1159/000535029","DOIUrl":"https://doi.org/10.1159/000535029","url":null,"abstract":"Background: Endoscopic vacuum therapy (EVT) is an increasingly popular endoscopic technique used for the treatment of wall defects in the gastrointestinal tract. Open-pore film drainage (OFD) systems are a new addition to the armamentarium of EVT and have shown encouraging results in a wide spectrum of applications. The aim of this review is to summarize the current literature on the applications of OFD systems in the gastrointestinal tract. Summary: Open-pore film drainage (OFD) systems have been used for the treatment of several defects of the gastrointestinal tract. The small size and easy placement of these devices make them very useful, particularly for the treatment of defects that are small in size or difficult to reach. OFDs have been successfully used for both perforations and anastomotic leaks in various locations, with most reports focusing on the treatment of duodenal defects, although successful applications in the esophagus, stomach, and colon have also been reported. Lately, the role of OFDs in preemptive EVT has also been explored. Key Messages: OFD systems are easy to use, particularly for small defects and challenging localizations. The current literature, consisting mainly of small case series and case reports, shows encouraging results, but further prospective studies are needed to explore and verify the indications and technical aspects of this innovative method.","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.9,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138979299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Microbiota Therapy: Ready for Clinical Practice? 微生物群疗法:准备好临床实践了吗?
4区 医学 Q2 Medicine Pub Date : 2023-11-14 DOI: 10.1159/000534778
Michael Scharl, Gerhard Rogler
{"title":"Microbiota Therapy: Ready for Clinical Practice?","authors":"Michael Scharl, Gerhard Rogler","doi":"10.1159/000534778","DOIUrl":"https://doi.org/10.1159/000534778","url":null,"abstract":"","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134955340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Interdisciplinary Frontiers – The View of Surgery 跨学科的前沿-外科的观点
4区 医学 Q2 Medicine Pub Date : 2023-10-27 DOI: 10.1159/000533743
Pompiliu Piso, Maximilian Babucke, Vanessa Schmitt, Sebastian Blaj
{"title":"Interdisciplinary Frontiers – The View of Surgery","authors":"Pompiliu Piso, Maximilian Babucke, Vanessa Schmitt, Sebastian Blaj","doi":"10.1159/000533743","DOIUrl":"https://doi.org/10.1159/000533743","url":null,"abstract":"","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136233982","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Hydatid Disease of the Liver. 肝棘球蚴病。
IF 1.8 4区 医学 Q3 GASTROENTEROLOGY & HEPATOLOGY Pub Date : 2023-10-01 Epub Date: 2023-09-25 DOI: 10.1159/000533807
Virandera Pal Bhalla, Souvik Paul, Ernst Klar

Background: Echinococcosis also known as hydatid disease is a zoonotic parasitic disease caused by a tapeworm. It has a worldwide distribution. For long, it was thought to be a problem of the poorly sanitized "third world" and not given the importance it deserved. However, its occurrence in countries like Australia and New Zealand and recently in countries in Central Europe has meant that it is included in a WHO list of neglected diseases, has recently been the subject of extensive epidemiological studies, and has been the recipient of increased research funding.

Summary: The diagnosis is still based on clinical presentation in an endemic area corroborated with typical findings on imaging which routinely include ultrasound and CT scan. Serological tests have been used in some centers to support the diagnosis. Treatment depends on the site of involvement and can vary from wait and watch to extensive radical surgical procedures. The common element of all treatments is the addition of albendazole which forms an essential cornerstone of all treatment protocols. Inspite having been used for a fairly long time, there is still no consensus on the dose, duration, and timing of therapy with albendazole.

Key message: Hydatid disease continues to be a significant global health problem inspite of a good understanding of its life cycle and rising standards of public sanitation. Though diagnosis is straightforward and not expensive, treatment can sometimes be complicated. The addition of albendazole to all treatment protocols is an important advance, but firm guidelines on duration of its use are still awaited.

背景:棘球蚴病又称棘球蚴症,是一种由绦虫引起的人畜共患寄生虫病。它在全球范围内发行。长期以来,这被认为是“第三世界”消毒不力的问题,没有得到应有的重视。然而,它在澳大利亚和新西兰等国以及最近在中欧国家的出现意味着它被列入世界卫生组织被忽视疾病名单,最近成为广泛流行病学研究的主题,并获得了更多的研究资金。总结:诊断仍然基于流行地区的临床表现,并与常规包括超声和CT扫描在内的典型成像结果相证实。一些中心已经使用血清学测试来支持诊断。治疗取决于涉及的部位,从等待和观察到广泛的根治性手术都有可能。所有治疗的共同因素是添加阿苯达唑,这是所有治疗方案的重要基石。尽管阿苯达唑已经使用了相当长的时间,但在剂量、持续时间和治疗时间方面仍然没有达成共识。关键信息:尽管人们对棘球蚴病的生命周期有很好的了解,而且公共卫生标准不断提高,但它仍然是一个重大的全球健康问题。尽管诊断简单且不昂贵,但治疗有时可能很复杂。在所有治疗方案中加入阿苯达唑是一个重要的进展,但关于其使用期限的确切指导方针仍在等待中。
{"title":"Hydatid Disease of the Liver.","authors":"Virandera Pal Bhalla, Souvik Paul, Ernst Klar","doi":"10.1159/000533807","DOIUrl":"10.1159/000533807","url":null,"abstract":"<p><strong>Background: </strong>Echinococcosis also known as hydatid disease is a zoonotic parasitic disease caused by a tapeworm. It has a worldwide distribution. For long, it was thought to be a problem of the poorly sanitized \"third world\" and not given the importance it deserved. However, its occurrence in countries like Australia and New Zealand and recently in countries in Central Europe has meant that it is included in a WHO list of neglected diseases, has recently been the subject of extensive epidemiological studies, and has been the recipient of increased research funding.</p><p><strong>Summary: </strong>The diagnosis is still based on clinical presentation in an endemic area corroborated with typical findings on imaging which routinely include ultrasound and CT scan. Serological tests have been used in some centers to support the diagnosis. Treatment depends on the site of involvement and can vary from wait and watch to extensive radical surgical procedures. The common element of all treatments is the addition of albendazole which forms an essential cornerstone of all treatment protocols. Inspite having been used for a fairly long time, there is still no consensus on the dose, duration, and timing of therapy with albendazole.</p><p><strong>Key message: </strong>Hydatid disease continues to be a significant global health problem inspite of a good understanding of its life cycle and rising standards of public sanitation. Though diagnosis is straightforward and not expensive, treatment can sometimes be complicated. The addition of albendazole to all treatment protocols is an important advance, but firm guidelines on duration of its use are still awaited.</p>","PeriodicalId":56003,"journal":{"name":"Visceral Medicine","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2023-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10601525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71415381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Visceral Medicine
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1