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国际肝胆胰疾病杂志（英文版）
浙江省医学学术交流管理中心、浙江大学医学院附属第一医院、浙江大学出版社有限责任公司
国际肝胆胰疾病杂志（英文版）

浙江省医学学术交流管理中心、浙江大学医学院附属第一医院、浙江大学出版社有限责任公司

双月

1499-3872

hbpdint@126.com

0571-87236559

310003

杭州市上城区庆春路79号

国际肝胆胰疾病杂志（英文版）/Journal Hepatobiliary & Pancreatic Diseases InternationalCSCD北大核心SCI
查看更多>>《国际肝胆胰疾病杂志（英文版）》（双月刊），创刊于2002年，由浙江省卫生厅主管，浙江大学医学院附属第一医院主办。杂志涵盖主题领域包括医学、外科、放射学、病理学、生化、生理学和组织学等方面的内容。
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    Advancing immunosuppression in liver transplantation:A narrative review

    Samuele IesariFrancesca Laura NavaIlaria Elena ZaisLaurent Coubeau...
    441-448页
    查看更多>>摘要：Immunosuppression is essential to ensure recipient and graft survivals after liver transplantation(LT).However,our understanding and management of the immune system remain suboptimal.Current im-munosuppressive therapy cannot selectively inhibit the graft-specific immune response and entails a sig-nificant risk of serious side effects,i.e.,among others,de novo cancers,infections,cardiovascular events,renal failure,metabolic syndrome,and late graft fibrosis,with progressive loss of graft function.Pharma-cological research,aimed to develop alternative immunosuppressive agents in LT,is behind other solid-organ transplantation subspecialties,and,therefore,the development of new compounds and strategies should get priority in LT.The research trajectories cover mechanisms to induce T-cell exhaustion,to in-hibit co-stimulation,to mitigate non-antigen-specific inflammatory response,and,lastly,to minimize the development and action of donor-specific antibodies.Moreover,while cellular modulation techniques are complex,active research is underway to foster the action of T-regulatory cells,to induce tolerogenic den-dritic cells,and to promote the function of B-regulatory cells.We herein discuss current lines of research in clinical immunosuppression,particularly focusing on possible applications in the LT setting.
      原文链接:
    • 国家科技期刊平台
    • NETL
    • NSTL
    • 万方数据

    Surgical techniques to prevent delayed gastric emptying after pancreaticoduodenectomy

    Peng DuanLu SunKai KouXin-Rui Li...
    449-457页
    查看更多>>摘要：Background:Delayed gastric emptying(DGE)is one of the most common complications after pancreatico-duodenectomy(PD).DGE represents impaired gastric motility without significant mechanical obstruction and is associated with an increased length of hospital stay,increased healthcare costs,and a high read-mission rate.We reviewed published studies on various technical modifications to reduce the incidence of DGE.Data sources:Studies were identified by searching PubMed for relevant articles published up to De-cember 2022.The following search terms were used:"pancreaticoduodenectomy","pancreaticojejunos-tomy","pancreaticogastrostomy","gastric emptying","gastroparesis"and"postoperative complications".The search was limited to English publications.Additional articles were identified by a manual search of references from key articles.Results:In recent years,various surgical procedures and techniques have been explored to reduce the incidence of DGE.Pyloric resection,Billroth Ⅱ reconstruction,Braun's enteroenterostomy,and antecolic reconstruction may be associated with a decreased incidence of DGE,but more high-powered studies are needed in the future.Neither laparoscopic nor robotic surgery has demonstrated superiority in preventing DGE,and the use of staplers is controversial regarding whether they can reduce the incidence of DGE.Conclusions:Despite many innovations in surgical techniques,there is no surgical procedure that is su-perior to others to reduce DGE.Further larger prospective randomized studies are needed.
      原文链接:
    • 国家科技期刊平台
    • NETL
    • NSTL
    • 万方数据

    Visceral adipose tissue predicts severity and prognosis of acute pancreatitis in obese patients

    Yuan TianQing HuangYu-Tang RenXuan Jiang...
    458-462页
    查看更多>>摘要：Acute pancreatitis is a common systemic inflammatory disease,manifested by a spectrum of severity,ranging from mild in the majority of patients to severe acute pancreatitis.Patients with severe acute pancreatitis suffer from severe local and systemic complications and organ failure,leading to a poor prog-nosis.The early recognition of the severe condition is important to improve prognosis.Obesity has risen in tandem with an increase in the severity of acute pancreatitis in recent years.Studies have revealed that adipose tissue,particularly visceral adipose tissue is associated with the prognosis of acute pancre-atitis.This review discussed the role of visceral adipose tissue in obese patients with acute pancreatitis and explored the possible mechanism involved.
      原文链接:
    • 国家科技期刊平台
    • NETL
    • NSTL
    • 万方数据

    Validation and performance of three scoring systems for predicting primary non-function and early allograft failure after liver transplantation

    Yu NieJin-Bo HuangShu-Jiao HeHua-Di Chen...
    463-471页
    查看更多>>摘要：Background:Primary non-function(PNF)and early allograft failure(EAF)after liver transplantation(LT)seriously affect patient outcomes.In clinical practice,effective prognostic tools for early identifying recip-ients at high risk of PNF and EAF were urgently needed.Recently,the Model for Early Allograft Function(MEAF),PNF score by King's College(King-PNF)and Balance-and-Risk-Lactate(BAR-Lac)score were de-veloped to assess the risks of PNF and EAF.This study aimed to externally validate and compare the prognostic performance of these three scores for predicting PNF and EAF.Methods:A retrospective study included 720 patients with primary LT between January 2015 and De-cember 2020.MEAF,King-PNF and BAR-Lac scores were compared using receiver operating characteristic(ROC)and the net reclassification improvement(NRI)and integrated discrimination improvement(IDI)analyses.Results:Of all 720 patients,28(3.9％)developed PNF and 67(9.3％)developed EAF in 3 months.The overall early allograft dysfunction(EAD)rate was 39.0％.The 3-month patient mortality was 8.6％while 1-year graft-failure-free survival was 89.2％.The median MEAF,King-PNF and BAR-Lac scores were 5.0(3.5-6.3),-2.1(-2.6 to-1.2),and 5.0(2.0-11.0),respectively.For predicting PNF,MEAF and King-PNF scores had excellent area under curves(AUCs)of 0.872 and 0.891,superior to BAR-Lac(AUC=0.830).The NRI and IDI analyses confirmed that King-PNF score had the best performance in predicting PNF while MEAF served as a better predictor of EAD.The EAF risk curve and 1-year graft-failure-free survival curve showed that King-PNF was superior to MEAF and BAR-Lac scores for stratifying the risk of EAF.Conclusions:MEAF,King-PNF and BAR-Lac were validated as practical and effective risk assessment tools of PNF.King-PNF score outperformed MEAF and BAR-Lac in predicting PNF and EAF within 6 months.BAR-Lac score had a huge advantage in the prediction for PNF without post-transplant variables.Proper use of these scores will help early identify PNF,standardize grading of EAF and reasonably select clinical endpoints in relative studies.
      原文链接:
    • 国家科技期刊平台
    • NETL
    • NSTL
    • 万方数据

    Differentiation and immunosuppressive function of CD19+CD24hiCD27+regulatory B cells are regulated through the miR-29a-3p/NFAT5 pathway

    Jin-Yang LiTian-Shuo FengJi GaoXin-Xiang Yang...
    472-480页
    查看更多>>摘要：Background:Regulatory B cells(Bregs)is an indispensable element in inducing immune tolerance after liver transplantation.As one of the microRNAs(miRNAs),miR-29a-3p also inhibits translation by degrad-ing the target mRNA,and yet the relationship between Bregs and miR-29a-3p has not yet been fully explored.This study aimed to investigate the impact of miR-29a-3p on the regulation of differentiation and immunosuppressive functions of memory Bregs(mBregs)and ultimately provide potentially effective therapies in inducing immune tolerance after liver transplantation.Methods:Flow cytometry was employed to determine the levels of Bregs in peripheral blood mononu-clear cells.TaqMan low-density array miRNA assays were used to identify the expression of different miRNAs,electroporation transfection was used to induce miR-29a-3p overexpression and knockdown,and dual luciferase reporter assay was used to verify the target gene of miR-29a-3p.Results:In patients experiencing acute rejection after liver transplantation,the proportions and im-munosuppressive function of mBregs in the circulating blood were significantly impaired.miR-29a-3p was found to be a regulator of mBregs differentiation.Inhibition of miR-29a-3p,which targeted nuclear factor of activated T cells 5(NFAT5),resulted in a conspicuous boost in the differentiation and immuno-suppressive function of mBregs.The inhibition of miR-29a-3p in CD19+B cells was capable of raising the expression levels of NFAT5,thereby promoting B cells to differentiate into mBregs.In addition,the observed enhancement of differentiation and immunosuppressive function of mBregs upon miR-29a-3p inhibition was abolished by the knockdown of NFAT5 in B cells.Conclusions:miR-29a-3p was found to be a crucial regulator for mBregs differentiation and immunosup-pressive function.Silencing miR-29a-3p could be a potentially effective therapeutic strategy for inducing immune tolerance after liver transplantation.
      原文链接:
    • 国家科技期刊平台
    • NETL
    • NSTL
    • 万方数据

    Intrahepatic portal venous systems in adult patients with cavernous transformation of portal vein:Imaging features and a new classification

    Xin HuangQian LuYue-Wei ZhangLin Zhang...
    481-486页
    查看更多>>摘要：Background:Cavernous transformation of the portal vein(CTPV)due to portal vein obstruction is a rare vascular anomaly defined as the formation of multiple collateral vessels in the hepatic hilum.This study aimed to investigate the imaging features of intrahepatic portal vein in adult patients with CTPV and establish the relationship between the manifestations of intrahepatic portal vein and the progression of CTPV.Methods:We retrospectively analyzed 14 CTPV patients in Beijing Tsinghua Changgung Hospital.All pa-tients underwent both direct portal venography(DPV)and computed tomography angiography(CTA)to reveal the manifestations of the portal venous system.The vessels measured included the left portal vein(LPV),right portal vein(RPV),main portal vein(MPV)and the portal vein bifurcation(PVB).Results:Nine males and 5 females,with a median age of 40.5 years,were included in the study.No significant difference was found in the diameters of the LPV or RPV measured by DPV and CTA.The visualization in terms of LPV,RPV and PVB measured by DPV was higher than that by CTA.There was a significant association between LPV/RPV and PVB/MPV in term of visibility revealed with DPV(P=0.01),while this association was not observed with CTA.According to the imaging features of the portal vein measured by DPV,CTPV was classified into three categories to facilitate the diagnosis and treatment.Conclusions:DPV was more accurate than CTA for revealing the course of the intrahepatic portal vein in patients with CTPV.The classification of CTPV,that originated from the imaging features of the portal vein revealed by DPV,may provide a new perspective for the diagnosis and treatment of CTPV.
      原文链接:
    • 国家科技期刊平台
    • NETL
    • NSTL
    • 万方数据

    Red cell distribution width-to-albumin ratio is a simple promising prognostic marker in acute cholangitis requiring biliary drainage

    Fatih AcehanHüseyin CamliCagdas KalkanMesut Tez...
    487-494页
    查看更多>>摘要：Background:It is crucial to assess the severity of acute cholangitis(AC).There are currently several prog-nostic markers.However,the accuracies of these markers are not satisfied.The present study aimed to investigate the predictive value of the red cell distribution width(RDW)-to-albumin ratio(RAR)for the prognosis of AC.Methods:We retrospectively evaluated consecutive patients diagnosed with AC between May 2019 and March 2022.RAR was calculated,and its predictive ability for in-hospital mortality,intensive care unit(ICU)admission,bacteremia,and the length of hospitalization were analyzed.Results:Out of 438 patients,34(7.8％)died.Multivariate analysis showed that malignant etiology[odds ratio(OR)=4.816,95％confidence interval(CI):1.936-11.980],creatinine(OR=1.649,95％CI:1.095-2.484),and RAR(OR=2.064,95％CI:1.494-2.851)were independent risk factors for mortality.When ad-justed for relevant covariates,including age,sex,malignant etiology,Tokyo severity grading(TSG),Charl-son comorbidity index,and creatinine,RAR significantly predicted mortality(adjusted OR=1.833,95％CI:1.280-2.624).When the cut-off of RAR was set to 3.8,its sensitivity and specificity for mortality were 94.1％and 56.7％,respectively.Patients with an RAR of＞3.8 had a 20.9-fold(OR=20.9,95％CI:4.9-88.6)greater risk of mortality than the remaining patients.The area under the curve value of RAR for mortality was 0.835(95％CI:0.770-0.901),which was significantly higher than that of TSG and the other prognostic markers,such as C-reactive protein-to-albumin ratio,and procalcitonin-to-albumin ratio.Lastly,RAR was not inferior to TSG in predicting ICU admission,bacteremia,and the length of hospitalization.Conclusions:RAR successfully predicted the in-hospital mortality,ICU admission,bacteremia,and the length of hospitalization of patients with AC,especially in-hospital mortality.RAR is a promising marker that is more convenient than TSG and other prognostic markers for predicting the prognosis of patients with AC.
      原文链接:
    • 国家科技期刊平台
    • NETL
    • NSTL
    • 万方数据

    Diagnosis and treatment of biliary mucinous cystic neoplasms:A single-center experience

    Jun-Jun JiaYa-Fen ChengMei-Bao FengLi Liu...
    495-501页
    查看更多>>摘要：Background:Biliary mucinous cystic neoplasms(BMCNs)are rare hepatobiliary cystic tumors,which can be divided into noninvasive and invasive types.This study aimed to investigate the diagnosis,treatment,and prognosis of BMCNs in a large single center.Methods:We analyzed 49 patients with BMCNs confirmed by postoperative pathology at the First Affili-ated Hospital,Zhejiang University School of Medicine between January 2007 and December 2021.Results:Among the 49 patients,37 were female(75.5％),and the average age was 57.04 years.Common symptoms included abdominal discomfort,jaundice and fever,while 22 patients(44.9％)had no symp-toms.Serum carbohydrate antigen(CA)19-9 and CA125 concentrations were elevated in 34.8％and 19.6％of patients,respectively.Forty-eight patients had tumors in the intrahepatic bile ducts and only one had a tumor in the extrahepatic bile duct.Forty-eight patients with noninvasive intrahepatic BMCNs were further analyzed in terms of pathological features:34(70.8％)had low-grade intraepithelial neoplasms(LGINs),and 14(29.2％)had high-grade intraepithelial neoplasms(HGINs).The potential immunohisto-chemical markers of BMCNs were cytokeratin(CK)19,CK7,estrogen receptor and progesterone receptor.Follow-up data for 37 patients with intrahepatic BMCNs were obtained.The median overall survival(OS)of BMCNs was not reached.The longest survival time was 137 months.The 5-and 10-year OS rates were 100％and 85.4％,respectively.The 5-and 10-year recurrence-free survival(RFS)rates were 93.9％and 80.2％,respectively.Conclusions:BMCNs are rare cystic neoplasms that commonly occur in middle-aged females.BMCNs can only be diagnosed and classified by postoperative pathology,as there are no specific clinical presenta-tions,serological indicators or imaging modalities for preoperative diagnosis.Complete surgical resection is necessary for BMCNs,and the postoperative prognosis is favorable.
      原文链接:
    • 国家科技期刊平台
    • NETL
    • NSTL
    • 万方数据

    Surgical site infection following pancreaticoduodenectomy in a referral cancer center in Mexico

    Rodrigo Villase?or-EchavarriJavier Melchor-RuanMercedes Aranda-AudeloGabriela Arredondo-Salda?a...
    502-508页
    查看更多>>摘要：Background:Pancreaticoduodenectomy is the standard treatment for resectable periampullary cancer.Surgical site infections(SSI)are common complications with increased morbidity.The study aimed to describe the prevalence,risk factors,microbiology,and outcomes of SSI among patients undergoing pan-creaticoduodenectomy.Methods:We conducted a retrospective study in a referral cancer center between January 2015 and June 2021.We analyzed baseline patient characteristics and SSI occurrence.Culture results and susceptibility patterns were described.Multivariate logistic regression was used to determine risk factors,proportional hazards model to evaluate mortality,and Kaplan-Meier analysis to assess long-term survival.Results:A total of 219 patients were enrolled in the study;101(46％)developed SSI.Independent factors for SSI were diabetes mellitus,preoperative albumin level,biliary drainage,biliary prostheses,and clini-cally relevant postoperative pancreatic fistula.The main pathogens were Enterobacteria and Enterococci.Multidrug-resistance rate in SSI was high but not associated with increased mortality.Infected patients had higher odds of sepsis,longer hospital stay and intensive care unit stay,and readmission rate.Neither 30-day mortality nor long-term survival was significantly different between infected and non-infected patients.Conclusions:SSI prevalence among patients undergoing pancreaticoduodenectomy was high and largely caused by resistant microorganisms.Most risk factors were related to preoperative instrumentation of the biliary tree.SSI was associated with greater risk of unfavorable outcomes;however,survival was unaffected.
      原文链接:
    • 国家科技期刊平台
    • NETL
    • NSTL
    • 万方数据

    Endoscopic treatment of biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants:Lessons learned from single-balloon enteroscopy-assisted ERCP

    Rodrigo Garcés-DuránLaurent MoninoPierre H DeprezHubert Piessevaux...
    509-514页
    查看更多>>摘要：Background:Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple's pancreaticoduodenectomy.This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography(SBE-ERCP)to treat biliopancreatic pathology in patients with Whipple's pancreaticoduodenectomy surgical variants.Methods:We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple's variants.Technical and clinical success rates and adverse events were evaluated.Results:Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17,including 5 with both indications.From a total of 106 SBE-ERCP procedures,76 were biliary indication with technical suc-cess rate of 68/76(90％)procedures and clinical success rate of 30/34(88％)patients.Mild adverse event rate was 8/76(11％),without serious adverse events.From a total of 106 SBE-ERCP procedures,30 were pancreatic indication with technical success rate of 24/30(80％)procedures(P=0.194 vs.biliary SBE-ERCP)and clinical success rate of 11/17(65％)patients(P=0.016 vs.biliary SBE-ERCP).Mild adverse event rate was 6/30(20％)(P=0.194 vs.biliary SBE-ERCP),without serious adverse events.After SBE-ERCP fail-ure,endoscopic ultrasound-guided drainage,percutaneous drainage and redo surgery were alternative therapeutic options.Conclusions:Biliopancreatic pathology after Whipple's pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events.Technical and clinical success rates are high for biliary indications,whereas clinical success rate of pancreatic indications is significantly lower.SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.
      原文链接:
    • 国家科技期刊平台
    • NETL
    • NSTL
    • 万方数据