Articles: cations.
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Secondary sclerosing cholangitis in critically ill patients (SSC-CIP) is a destructive cholangiopathy with a poor prognosis. Liver transplantation (LT) is an established therapeutic option in end-stage liver disease but is insufficiently evaluated in patients with SSC-CIP. Our aim was the retrospective analysis of the outcome and complications of patients with SSC-CIP undergoing LT between 2002 and 2012. ⋯ The 1-, 3-, and 5-year survival rates of patients with SSC-CIP versus control patients were 100% versus 98%, 86% versus 92%, and 76% versus 87%, respectively (P > 0.05). The QoL improved significantly after LT in SSC-CIP. In conclusion, LT is a valid option for patients with SSC-CIP with excellent long-term outcome and improvement of QoL.
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Demographics and vascular anatomy may play an important role in predicting periprocedural complications in symptomatic patients undergoing carotid artery stenting (CAS). ⋯ Our results suggest that CAS should be avoided in patients with multiple anatomic risk factors. High presenting National Institutes of Health Stroke Scale score and renal disease also increase the complication risk. The CAS scoring system devised here is simple, reproducible, and clinically valuable in predicting complications risk in symptomatic patients undergoing CAS.
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Venous thromboembolic events (VTE) occur in up to 20% of trauma patients and of these, pulmonary embolus is fatal in up to 50%. It is unknown whether fibrinolytic activation and consumption of precursors may subsequently render patients hypercoagulable. We hypothesised that an early hyperfibrinolytic state would lead to a propensity for developing VTE. ⋯ Patients developing VTE demonstrate early hyperfibrinolysis following injury. Hyperfibrinolysis depletes plasminogen and may induce a procoagulant state increasing susceptibility to VTE. Fibrinolytic profiling may improve risk stratification and enable targeted prophylaxis.
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Bergamot Juice extract (BJe) has raised much interest in recent years; it exerts many properties such us anti-inflammatory activity through both anti-oxidant effects and modulation of pivotal pro-inflammatory genes. Certain flavonoids have been shown to possess antiulcer activity and were able to prevent gastric mucosal lesions produced by various ulcer-producing methods, therefore, the aim of this study was to investigate the effects of BJe in a murine model of Intestinal Ischemia/Reperfusion (I/R). ⋯ In brief, we can affirm that BJe is able to reduce inflammatory and oxidant consequence of intestinal I/R therefore, it could represent a possible treatment against secondary events of intestinal I/R.
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Surgical treatment for perihilar cholangiocarcinoma frequently involves hepatectomy and extrahepatic bile duct resection with a choledochojejunostomy (CJ). Cholangitis owing to bilioenteric anastomosis is a common complication. The impact of CJ or regurgitating cholangitis on the liver regeneration process after major hepatectomy is unknown. ⋯ CJ perturbs early liver regeneration after hepatectomy. An excessive inflammatory response in the liver and suppression of liver regeneration-associated factors may play a role. Surgical relevance Patients with perihilar cholangiocarcinoma may need major hepatectomy with extrahepatic bile duct resection and choledochojejunostomy. This carries a substantial risk of postoperative complications including liver failure. A rat model of partial hepatectomy with choledochojejunostomy was established. The molecular mechanisms underlying liver regeneration, and perturbation of this process by duodenobiliary reflux via the choledochojejunostomy, are described. The results give insight into the pathophysiological events following major hepatectomy with extrahepatic bile duct resection and choledochojejunostomy. This may help to develop a treatment strategy to reduce postoperative liver failure.