21 results on '"Chen XP"'
Search Results
2. Interaction of age and CYP2C19 genotypes on voriconazole steady-state trough concentration in Chinese patients.
- Author
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Du YX, Zhu YX, Li L, Yang J, and Chen XP
- Subjects
- Adult, Aged, Aged, 80 and over, Female, Humans, Male, Middle Aged, Young Adult, China, East Asian People genetics, Genotype, Polymorphism, Single Nucleotide genetics, Age Factors, Antifungal Agents administration & dosage, Antifungal Agents blood, Antifungal Agents pharmacokinetics, Cytochrome P-450 CYP2C19 genetics, Voriconazole pharmacokinetics, Voriconazole blood, Voriconazole administration & dosage
- Abstract
Objectives: Both age and CYP2C19 genotypes affect voriconazole plasma concentration; the interaction of age and CYP2C19 genotypes on voriconazole plasma concentration remains unknown. This study aims to investigate the combined effects of age and CYP2C19 genotypes on voriconazole plasma concentration in Chinese patients., Methods: A total of 480 patients who received voriconazole treatment were recruited. CYP2C19*2 (rs4244285) and CYP2C19*3 (rs4986893) polymorphisms were genotyped. Patients were divided into the young and the elderly groups by age of 60 years old. Influence of CYP2C19 genotype on steady-state trough concentration (C ss-min ) in overall patients and in age subgroups was analyzed., Results: Voriconazole C ss-min correlated positively with age, and mean voriconazole C ss-min was significantly higher in the elderly group ( P < 0.001). CYP2C19 poor metabolizers showed significantly increased mean voriconazole C ss-min in the young but not the elderly group. The percentage of patients with subtherapeutic voriconazole C ss-min (<1.0 mg/l) was higher in the young group and that of supratherapeutic voriconazole C ss-min (>5.5 mg/l) was higher in the elderly patients. When the average C ss-min in the CYP2C19 normal metabolizer genotype was regarded as a reference, CYP2C19 genotypes showed greater impact on voriconazole C ss-min in the young group, while the influence of age on voriconazole C ss-min exceeded CYP2C19 genotypes in the elderly., Conclusion: CYP2C19 genotypes affects voriconazole exposure is age dependent. Influence of CYP2C19 poor metabolizer genotype on increased voriconazoleexposure is prominent in the young, while age is a more important determinant factor for increased voriconazole exposure in the elderly patients., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2024
- Full Text
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3. A Prospective Study Using Propensity Score Matching to Compare Long-term Survival Outcomes After Robotic-assisted, Laparoscopic, or Open Liver Resection for Patients With BCLC Stage 0-A Hepatocellular Carcinoma.
- Author
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Zhu P, Liao W, Zhang WG, Chen L, Shu C, Zhang ZW, Huang ZY, Chen YF, Lau WY, Zhang BX, and Chen XP
- Subjects
- Humans, Hepatectomy methods, Length of Stay, Postoperative Complications epidemiology, Propensity Score, Prospective Studies, Retrospective Studies, Carcinoma, Hepatocellular surgery, Hypertension, Portal etiology, Laparoscopy methods, Liver Neoplasms surgery, Robotic Surgical Procedures
- Abstract
Objective: To compare the short- and long-term outcomes of robot-assisted (RALR), laparoscopic (LLR), or open liver resection (OLR) in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage 0-A hepatocellular carcinoma (HCC)., Summary Background Data: Following the Balliol IDEAL classification, long-term oncological outcomes can be used to evaluate the value of minimally invasive techniques in the treatment of HCC, and to assess whether they should become a standard practice., Methods: Data from prospective cohorts of patients with BCLC stage 0-A HCC who underwent curative liver resection using OLR, LLR, or RALR at Tongji Hospital were reviewed. The short-term and long-term oncological outcomes of these 3 different surgical approaches after adequate follow-up were compared using propensity score matching to reduce selection bias., Results: Of 369 patients included in this study (71, RALR; 141, LLR; and 157, OLR), 56 patients in each of the 3 groups were chosen for further comparison, after propensity score matching. In the minimally invasive group (RALR+LLR), both the operative time and duration of Pringle's maneuver were significantly longer than those in the OLR group; however, the length of hospital stay was significantly shorter. There were no significant differences in the other intraoperative parameters and the incidence of postoperative complications among the 3 groups. HCC recurrence in the minimally invasive group when compared with the OLR group was characterized by a significantly higher proportion of single lesion or early-stage HCC. However, there were no significant differences in the 5-year disease-free survival (63.8%, 54.4%, and 50.6%) or overall survival rates (80.8%, 78.6%, and 75.7%, respectively) among the 3 groups. Clinically significant portal hypertension was the only risk factor that negatively affected the 5-year disease-free survival rate. Multivariate Cox regression analysis showed that clinically significant portal hypertension, serum alpha-fetoprotein level (≥400 ng/mL), and Edmondson-Steiner grading (III+IV) were independent risk factors for poor long-term survival., Conclusion: Both robotic and laparoscopic hepatectomies were safe and effective for patients with BCLC stage 0-A HCC when compared with open hepatectomy., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)
- Published
- 2023
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4. Clinical Risk Factors for Treatment Failure-A Retrospective Single Centre Analysis of Patients With Unresponsive Class IV Lupus Nephritis.
- Author
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Wang M, Zhang YR, Qi YY, Ma X, Meng RX, Yang Y, Ma L, Chen XP, Zhang LL, Ning YX, Wang JL, and Wang J
- Subjects
- Humans, Retrospective Studies, Kidney, Treatment Failure, Risk Factors, Lupus Nephritis drug therapy
- Abstract
Competing Interests: The authors have no conflicts of interest to declare.
- Published
- 2022
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5. Comment on "Sub-classification of Microscopic Vascular Invasion in Hepatocellular Carcinoma".
- Author
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Zhang EL, Chen XP, and Huang ZY
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- Humans, Neoplasm Invasiveness, Neoplasm Recurrence, Local, Carcinoma, Hepatocellular, Liver Neoplasms
- Abstract
Competing Interests: The authors declare no conflicts of interest.
- Published
- 2021
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6. Resection might be a meaningful choice for hepatocellular carcinoma with portal vein thrombosis: A systematic review and meta-analysis.
- Author
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Zhang ZY, Dong KS, Zhang EL, Zhang LW, Chen XP, and Dong HH
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- Conservative Treatment mortality, Female, Humans, Male, Survival Rate, Treatment Outcome, Venous Thrombosis, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular therapy, Chemoembolization, Therapeutic mortality, Hepatectomy mortality, Liver Neoplasms mortality, Liver Neoplasms therapy, Portal Vein surgery, Sorafenib therapeutic use
- Abstract
Background: According to the Barcelona Clinic Liver Cancer (BCLC) staging system, the presence of portal vein tumor thrombosis (PVTT) is considered to indicate an advanced stage of hepatocellular carcinoma (HCC) with nearly no cure. Hepatic resection and transarterial chemoembolization (TACE) have recently been recommended for treatment of HCC with PVTT., Methods: We conducted a systematic review to compare the overall survival between patients with HCC and PVTT undergoing hepatectomy, TACE or conservative treatment including sorafenib chemotherapy. The PubMed, Web of Science, and Cochrane Library databases were searched. All relevant studies were considered. Hazard ratios with 95% confidence intervals were calculated for comparison of the cumulative overall survival. Ten retrospective studies met the inclusion criteria and were included in the review., Results: Overall survival was not higher in the hepatectomy group than TACE group. But survival rate was higher in hepatectomy group than conservative group. The subgroup analysis demonstrated that hepatectomy was superior in patients without PVTT in the main trunk than in patients with main portal vein invasion. In patients without main PVTT, hepatectomy has showed more benefit than TACE. However, there has been no significant difference between the hepatectomy and TACE groups among patients with main PVTT., Conclusion: For patients with resectable HCC and PVTT, hepatectomy might be more effective in patients without PVTT in the main trunk than TACE or conservative treatment.
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- 2019
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7. Resident Autonomy in the Operating Room: How Faculty Assess Real-time Entrustability.
- Author
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Chen XP, Sullivan AM, Smink DS, Alseidi A, Bengtson JM, Kwakye G, and Dalrymple JL
- Subjects
- Attitude of Health Personnel, Decision Making, Female, Humans, Male, United States, Clinical Competence, Faculty, Medical psychology, Internship and Residency, Professional Autonomy, Specialties, Surgical education, Trust
- Abstract
Objective: This study aimed to identify the empirical processes and evidence that expert surgical teachers use to determine whether to take over certain steps or entrust the resident with autonomy to proceed during an operation., Background: Assessing real-time entrustability is inherent in attending surgeons' determinations of residents' intraoperative autonomy in the operating room. To promote residents' autonomy, it is necessary to understand how attending surgeons evaluate residents' performance and support opportunities for independent practice based on the assessment of their entrustability., Methods: We conducted qualitative semi-structured interviews with 43 expert surgical teachers from 21 institutions across 4 regions of the United States, using purposeful and snowball sampling. Participants represented a range of program types, program size, and clinical expertise. We applied the Framework Method of content analysis to iteratively analyze interview transcripts and identify emergent themes., Results: We identified a 3-phase process used by most expert surgical teachers in determining whether to take over intraoperatively or entrust the resident to proceed, including 1) monitoring performance and "red flags," 2) assessing entrustability, and 3) granting autonomy. Factors associated with individual surgeons (eg, level of comfort, experience, leadership role) and the context (eg, patient safety, case, and time) influenced expert surgical teachers' determinations of entrustability and residents' final autonomy., Conclusion: Expert surgical teachers' 3-phase process of decisions on take-over provides a potential framework that may help surgeons identify appropriate opportunities to develop residents' progressive autonomy by engaging the resident in the determination of entrustability before deciding to take over.
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- 2019
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8. Letter by Li et al Regarding Article, "Erectile Dysfunction as an Independent Predictor of Future Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis".
- Author
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Li DJ, Chen XP, and Zhang XB
- Subjects
- Ethnicity, Humans, Male, Atherosclerosis, Erectile Dysfunction
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- 2019
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9. Acute portal vein thrombosis after hepatectomy in a patient with hepatolithiasis: A case report and review of the literature.
- Author
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Zhang ZY, Dong KS, Zhang EL, Huang ZY, Chen XP, and Dong HH
- Subjects
- Acute Disease, Administration, Intravenous, Adult, Anticoagulants therapeutic use, Biliary Tract Surgical Procedures adverse effects, Fatal Outcome, Heparin administration & dosage, Heparin therapeutic use, Humans, Liver Diseases surgery, Male, Portal Vein diagnostic imaging, Portal Vein surgery, Postoperative Complications surgery, Thrombectomy methods, Ultrasonography, Venous Thrombosis drug therapy, Venous Thrombosis surgery, Biliary Tract pathology, Hepatectomy adverse effects, Portal Vein pathology, Venous Thrombosis complications
- Abstract
Rationale: Portal vein thrombosis is defined as any thrombosis that develops in the portal vein system. It is considered a very rare and extremely lethal complication of hepatopancreatobiliary surgery., Patient Concerns: Acute portal vein thrombosis after hepatectomy in patients with hepatolithiasisis very rare. Acute portal vein thrombosis is considered as a dangerous complication after hepatectomy. It is easy to ignore the symptom of acute portal vein thrombosis. Once the appropriate time of treatment is past, it would lead to patients' death., Diagnose: Acute portal vein thrombosis after hepatectomy in a patient with hepatolithiasis INTERVENTIONS:: We consider anticoagulation therapy and percutaneous transhepatic portal vein puncture and thrombectomy once the diagnosis of acute portal vein thrombosis is confirmed., Outcomes: The patient's liver function continued to deteriorate, eventually resulting in death., Lessons: Acute portal vein thrombosis after hepatectomy is difficult to diagnose. The management of acute portal vein thrombosis remains controversial according to its severity, location or time of discovering.
- Published
- 2018
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10. Primary functioning hepatic paraganglioma mimicking hepatocellular carcinoma: A case report and literature review.
- Author
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Liao W, Ding ZY, Zhang B, Chen L, Li GX, Wu JJ, Zhang B, Chen XP, and Zhu P
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- Diagnosis, Differential, Female, Hepatectomy, Humans, Liver Neoplasms diagnosis, Liver Neoplasms surgery, Middle Aged, Paraganglioma diagnosis, Paraganglioma surgery, Liver Neoplasms pathology, Paraganglioma pathology
- Abstract
Introduction: Hepatic paraganglioma (HPGL) originates from the sympathetic nervous tissue in the liver, and is an extremely rare type of the sympathetic paragangliomas. Till now, only 11 HPGL cases have been reported., Case Presentation: A 49-year-old woman presented to our hospital with a lesion in the right lobe of the liver, which grew from 2 to 6 cm in 2 years. In addition, she had a 6-year history of diabetes. The patient was initially diagnosed as hepatocellular carcinoma and hepatectomy was performed. Surgical resection of the liver lesion was successful, but the blood pressure rose and fell sharply when the lesion was being removed. The pathological examination of the liver lesion showed that it was HPGL. After the operation, the patient recovered uneventfully. Follow-up examination showed the blood glucose level went back to the normal range in 20 days after the operation, and MRI and I-MIBG scan showed that there was no evidence of recurrence and metastasis in >2 years., Conclusion: By means of reporting this case and reviewing 11 reported cases, we conclude that the incidence of HPGLs is extremely low and the clinical and radiological characteristics of HPGLs are nonspecific; thus, it is hard to diagnose HPGLs correctly. Surgical resection is curative therapy for HPGLs, whereas the removing of HPGLs may cause the releasing of catecholamine, and then lead to hypertension crisis and arrhythmia. Thus, antihypertensive therapy is necessary during the operation. Follow-ups after the operation are important for HPGL patients, for pathological examinations are not sufficient to differ malignant HPGLs from benign ones, and follow-ups are helpful for HPGL patients to find the recurrent foci or metastases timely.
- Published
- 2018
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11. Entrustment Evidence Used by Expert Gynecologic Surgical Teachers to Determine Residents' Autonomy.
- Author
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Chen XP, Sullivan AM, Bengtson JM, and Dalrymple JL
- Subjects
- Female, Humans, Male, Clinical Competence standards, Gynecologic Surgical Procedures education, Internship and Residency
- Abstract
Objective: To identify entrustment evidence used by expert gynecologic surgical teachers to determine obstetrics and gynecology residents' level of autonomy in the operating room., Methods: A qualitative interview study was undertaken from March to November 2016. Four selection criteria were used to define and purposefully sample expert gynecologic surgical teachers across the United States to represent all four geographic regions. All interviews were audio-recorded and transcribed. We applied the Framework Method of content analysis. Transcripts were iteratively analyzed and emergent themes identified., Results: Twenty-seven expert gynecologic surgical teachers from 15 institutions across the United States participated in 30-minute interviews. We identified four domains of entrustment evidence (resident characteristics, medical knowledge, technical performance, and "beyond current surgical case") commonly reported by expert gynecologic surgical teachers to determine residents' autonomy as well as the particular evidence associated with expert gynecologic surgical teachers' determination of resident autonomy at two decision-making points (surgical time-out and taking over certain intraoperative steps) in the operating room. Onsite direct observation and conversation were two common methods used by expert gynecologic surgical teachers to obtain this evidence., Conclusion: Entrustment evidence from resident characteristics, medical knowledge, and technical performance domains and from "beyond current surgical case" was commonly used by expert gynecologic surgical teachers to determine residents' autonomy. Our findings provide a potential framework for designing educational interventions that aim to increase residents' readiness for autonomy and entrustment in the operating room.
- Published
- 2017
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12. DNMT3A R882 Mutations Predict a Poor Prognosis in AML: A Meta-Analysis From 4474 Patients.
- Author
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Yuan XQ, Peng L, Zeng WJ, Jiang BY, Li GC, and Chen XP
- Subjects
- DNA Methyltransferase 3A, Humans, Prognosis, Survival Analysis, DNA (Cytosine-5-)-Methyltransferases genetics, Leukemia, Myeloid, Acute diagnosis, Leukemia, Myeloid, Acute genetics
- Abstract
DNA (cytosine-5)-methyltransferase 3 alpha (DNMT3A) mutations were widely believed to be independently associated with inferior prognosis in acute myeloid leukemia (AML) patients. As dominant missense alterations in DNMT3A mutations, R882 mutations cause the focal hypomethylation phenotype. However, there remains debate on the influence of R882 mutations on AML prognosis. Thus, this meta-analysis aimed at further illustrating the prognostic power of DNMT3A R882 mutations in AML patients.Eligible studies were identified from 5 databases containing PubMed, Embase, Web of Science, Clinical Trials, and the Cochrane Library (up to October 25, 2015). Effects (hazard ratios [HRs] with 95% confidence interval [CI]) of relapse-free survival (RFS) and overall survival (OS) were pooled to estimate the prognostic power of mutant DNMT3A R882 in overall patients and subgroups of AML patients.Eight competent studies with 4474 AML patients including 694 with DNMT3A R882 mutations were included. AML patients with DNMT3A R882 mutations showed significant shorter RFS (HR = 1.40, 95% CI = 1.24-1.59, P < 0.001) and OS (HR = 1.47, 95% CI = 1.17-1.86, P = 0.001) in the overall population. DNMT3A R882 mutations predicted worse RFS and OS among the subgroups of patients under age 60 (RFS: HR = 1.44, 95% CI = 1.25-1.66, P < 0.001; OS: HR = 1.48, 95% CI = 1.15-1.90, P = 0.002), over age 60 (RFS: HR = 2.03, 95% CI = 1.40-2.93, P < 0.001; OS: HR = 1.85, 95% CI = 1.36-2.53, P < 0.001), cytogenetically normal (CN)-AML (RFS: HR = 1.52, 95% CI = 1.26-1.83, P < 0.001; OS: HR = 1.67, 95% CI = 1.16-2.41, P = 0.006), and non-CN-AML (RFS: HR = 1.96, 95% CI = 1.20-3.21, P = 0.006; OS: HR = 2.51, 95% CI = 1.52-4.15, P = 0.0038).DNMT3A R882 mutations possessed significant unfavorable prognostic influence on RFS and OS in AML patients.
- Published
- 2016
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13. Selective Inflow Occlusion Technique Versus Intermittent Pringle Maneuver in Hepatectomy for Large Hepatocellular Carcinoma: A Retrospective Study.
- Author
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Zhu P, Zhang B, Wang R, Mei B, Cheng Q, Chen L, Wei G, Xu DF, Yu J, Xiao H, Zhang BX, and Chen XP
- Subjects
- Adult, Blood Transfusion, Carcinoma, Hepatocellular pathology, Female, Hepatectomy adverse effects, Humans, Liver Neoplasms pathology, Male, Middle Aged, Retrospective Studies, Blood Loss, Surgical prevention & control, Carcinoma, Hepatocellular surgery, Hemostasis, Surgical methods, Hepatectomy methods, Liver Neoplasms surgery
- Abstract
Selective inflow occlusion (SIO) maneuver preserved inflow of nontumorous liver and was supposed to protect liver function. This study aims to evaluate whether SIO maneuver is superior to Pringle maneuver in patients undergoing partial hepatectomy with large hepatocellular carcinomas (HCCs). Between January 2008 and May 2012, 656 patients underwent large HCC resections and were divided into 2 groups: intermittent Pringle maneuver (IP) group (n = 336) and SIO group (n = 320). Operative parameters, postoperative laboratory tests, and morbidity and mortality were analyzed. In comparison to the IP maneuver, the SIO maneuver significantly decreased intraoperative blood loss (473 vs 691 mL, P = 0.001) and transfusion rates (11.3% vs 28.6%, P = 0.006). The rate of major complication between the 2 groups was comparable (22.6% vs 18.8%, P = 0.541). Patients with moderate/severe cirrhosis, total bilirubin > 17 μmol/L, or HBV DNA> = 104 copy/mL in SIO group resulted in lower major complication rates. The SIO maneuver is a safe and effective technique for large HCC resections. In patients with moderate/severe cirrhosis, total bilirubin > 17 μmol/L, or HBV DNA> = 104 copy/mL, the SIO technique is preferentially recommended., Competing Interests: The authors have no conflicts of interest to disclose.
- Published
- 2015
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14. Early Application of Auxiliary Partial Orthotopic Liver Transplantation in Murine Model of Wilson Disease.
- Author
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Cheng Q, He SQ, Gao D, Lei B, Long X, Liang HF, Zhu P, Jin JF, Tang B, Tomlinson S, Wu ZY, and Chen XP
- Subjects
- Adenosine Triphosphatases deficiency, Adenosine Triphosphatases genetics, Animals, Biomarkers blood, Cation Transport Proteins deficiency, Cation Transport Proteins genetics, Ceruloplasmin metabolism, Copper blood, Copper-Transporting ATPases, Disease Models, Animal, Disease Progression, Feasibility Studies, Hepatolenticular Degeneration blood, Hepatolenticular Degeneration genetics, Hepatolenticular Degeneration pathology, Liver metabolism, Liver pathology, Male, Mice, Inbred C57BL, Mice, Knockout, Time Factors, Hepatolenticular Degeneration surgery, Liver surgery, Liver Transplantation methods
- Abstract
Background: Liver transplantation (LT) is the only option of treatment for Wilson disease (WD) when chelation therapy fails, but it is limited due to the shortage of donor. Auxiliary partial orthotopic LT (APOLT) has been performed successfully in end-stage WD patients, which expands the donor pool., Methods: Atp7bmice were used as experimental model of WD. Eight- and 20-week-old mice were used as different timepoints to perform APOLT. Serum copper, tissue copper, serum ceruloplasmin (CP), and liver histological examination were observed after operation., Results: Hepatic and serum copper levels in Atp7b mice decreased after APOLT, and copper metabolism disorder of WD mice was relieved at both early and late stages. The progression of pathology in the native liver was delayed only when transplantation was performed at an early stage., Conclusions: Auxiliary partial orthotopic LT can significantly improve copper metabolism disorder in the Atp7b mice, and early transplantation may prevent the disease progression.
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- 2015
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15. Surgical Treatment of Giant Liver Hemangioma Larger Than 10 cm: A Single Center's Experience With 86 Patients.
- Author
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Zhang W, Huang ZY, Ke CS, Wu C, Zhang ZW, Zhang BX, Chen YF, Zhang WG, Zhu P, and Chen XP
- Subjects
- Adult, Aged, Blood Loss, Surgical, Female, Humans, Male, Middle Aged, Prognosis, Retrospective Studies, Tumor Burden, Hemangioma pathology, Hemangioma surgery, Hepatectomy methods, Liver Neoplasms pathology, Liver Neoplasms surgery
- Abstract
The ideal surgical treatment of giant liver hemangioma is still controversial. This study aims to compare the outcomes of enucleation with those of resection for liver hemangioma larger than 10 cm in different locations of the liver and establish the preoperative predictors of increased intraoperative blood loss.Eighty-six patients underwent enucleation or liver resection for liver hemangioma larger than 10 cm was retrospectively reviewed. Patient demographic, tumor characteristics, surgical indications, the outcomes of both surgical treatment, and the clinicopathological parameters influencing intraoperative blood loss were analyzed.Forty-six patients received enucleation and 40 patients received liver resection. Mean tumor size was 14.1 cm with a range of 10-35 cm. Blood loss, blood product usage, operative time, hepatic vascular occlusion time and frequency, complications and postsurgical hospital stay were similar between liver resections and enucleation for right-liver and left-liver hemangiomas. There was no surgery-related mortality in either group. Bleeding was more related to adjacency of major vascular structures than the size of hemangioma. Adjacency to major vascular structures and right or bilateral liver hemangiomas were independently associated with blood loss >550 mL (P = 0.000 and 0.042, respectively).Both enucleation and liver resection are safe and effective surgical treatments for liver hemangiomas larger than 10 cm. The risk of intraoperative blood loss is related to adjacency to major vascular structures and the location of hemangioma.
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- 2015
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16. Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka.
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Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, OʼRourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, and Strasberg SM
- Subjects
- Hepatectomy adverse effects, Hepatectomy standards, Humans, Laparoscopy adverse effects, Laparoscopy standards, Liver blood supply, Liver pathology, Liver Neoplasms surgery, Middle Aged, Necrosis etiology, Patient Selection, Hepatectomy methods, Laparoscopy methods
- Abstract
The use of laparoscopy for liver surgery is increasing rapidly. The Second International Consensus Conference on Laparoscopic Liver Resections (LLR) was held in Morioka, Japan, from October 4 to 6, 2014 to evaluate the current status of laparoscopic liver surgery and to provide recommendations to aid its future development. Seventeen questions were addressed. The first 7 questions focused on outcomes that reflect the benefits and risks of LLR. These questions were addressed using the Zurich-Danish consensus conference model in which the literature and expert opinion were weighed by a 9-member jury, who evaluated LLR outcomes using GRADE and a list of comparators. The jury also graded LLRs by the Balliol Classification of IDEAL. The jury concluded that MINOR LLRs had become standard practice (IDEAL 3) and that MAJOR liver resections were still innovative procedures in the exploration phase (IDEAL 2b). Continued cautious introduction of MAJOR LLRs was recommended. All of the evidence available for scrutiny was of LOW quality by GRADE, which prompted the recommendation for higher quality evaluative studies. The last 10 questions focused on technical questions and the recommendations were based on literature review and expert panel opinion. Recommendations were made regarding preoperative evaluation, bleeding controls, transection methods, anatomic approaches, and equipment. Both experts and jury recognized the need for a formal structure of education for those interested in performing major laparoscopic LLR because of the steep learning curve.
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- 2015
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17. Involvement of anandamide transporter in calcitonin gene-related peptide expression stimulated by nitroglycerin and influence of ALDH2 Glu504Lys polymorphism.
- Author
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Peng LM, Chen XP, Shi RZ, Chen L, Li YJ, and Yang TL
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- Adult, Aldehyde Dehydrogenase, Mitochondrial, Arachidonic Acids pharmacology, Asian People genetics, Gene Expression Regulation drug effects, Genotype, Humans, Leukocytes, Mononuclear metabolism, Male, Nitroglycerin pharmacology, Polymorphism, Genetic, RNA, Messenger metabolism, Aldehyde Dehydrogenase genetics, Arachidonic Acids metabolism, Calcitonin Gene-Related Peptide genetics, Endocannabinoids metabolism, Membrane Transport Proteins metabolism, Polyunsaturated Alkamides metabolism
- Abstract
The aim of this study was to investigate whether N-arachidonic acid ethanolamine (anandamide, AEA) transporter contributed to calcitonin gene-related peptide (CGRP) expression mediated by nitroglycerin (GTN) in peripheral blood mononuclear cells (PBMCs) of healthy volunteers and its association with the mitochondrial aldehyde dehydrogenase-2 (ALDH2) Glu504Lys (ALDH2*2) polymorphism. In 10 ALDH2*2-genotyped Chinese volunteers, we assessed the activity of AEA transporter and expression of CGRP messenger ribonucleic acid (mRNA) in cultured PBMCs treated with different concentration of GTN with or without pretreatment with AM404 (the AEA transporter blocker). In this study, the activity of AEA transporter and expression of CGRP mRNA elevated with the increase in the concentration of GTN. Pretreatment of the cells with AM404 (1 μM) 2 hours before GTN reduced the GTN-induced increase in both AEA transporter activity and CGRP mRNA expression significantly, and cells with the ALDH2*1/*1 homozygote genotype showed significantly higher activity of AEA transporter and CGRP mRNA expression than carriers of the ALDH2*2 allele. Therefore, we strongly suggested that GTN can stimulate CGRP expression by elevating the AEA transporter activity, which is affected by ALDH2 Glu504Lys polymorphism.
- Published
- 2014
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18. Rs495828 polymorphism of the ABO gene is a predictor of enalapril-induced cough in Chinese patients with essential hypertension.
- Author
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Luo JQ, He FZ, Luo ZY, Wen JG, Wang LY, Sun NL, Tang GF, Li Q, Guo D, Liu ZQ, Zhou HH, Chen XP, and Zhang W
- Subjects
- Adult, Angiotensin-Converting Enzyme Inhibitors administration & dosage, Asian People genetics, Cough chemically induced, Cough genetics, Cough pathology, Enalapril administration & dosage, Essential Hypertension, Female, Genetic Association Studies, Haplotypes, Humans, Hypertension drug therapy, Male, Middle Aged, ABO Blood-Group System genetics, Angiotensin-Converting Enzyme Inhibitors adverse effects, Enalapril adverse effects, Hypertension genetics
- Abstract
Objective: ABO genetic polymorphisms have recently been associated with angiotensin-converting enzyme (ACE) activity and inflammation, which play a critical role in the pathogenic mechanism of ACE inhibitor-induced cough. Therefore, the current study determined the association of ABO genetic polymorphisms with enalapril-induced cough in Chinese patients with essential hypertension., Methods: A total of 450 essential hypertensive patients treated with 10 mg of enalapril maleate were genotyped for ABO genetic polymorphisms using the PCR-direct sequencing method. Cough was recorded when patients were bothered by cough and respiratory symptoms during enalapril treatment without an identifiable cause., Results: The distribution of rs8176740 and rs495828 was different between the coughers and the controls [P=0.039; odds ratio (OR)=0.70, P=0.018; OR=1.41]. The risk of enalapril-induced cough in the rs495828 TT carriers was increased (P=0.008; OR=2.69), which remained significant after false discovery rate correction. The results for the rs8176740 polymorphism were significant in the female subgroup (P=0.027; OR=0.22). Haplotype analysis of the four ABO polymorphisms (rs8176746/rs8176740/rs495828/rs12683493) showed that the frequency of the GATC haplotype was higher in the coughers than those in the controls (26.6 vs. 18.8%, P=0.033; OR=1.43)., Conclusion: The rs495828 polymorphism was associated with enalapril-induced cough and may serve as a useful pharmacogenomics marker of the safety of enalapril in Chinese patients with essential hypertension. The mechanism for the associations may involve the effects of the ABO gene or ABO blood type on ACE activity and inflammation.
- Published
- 2014
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19. A controlled study to determine measurement conditions necessary for a reliable and valid operative performance assessment: a controlled prospective observational study.
- Author
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Williams RG, Sanfey H, Chen XP, and Dunnington GL
- Subjects
- Cholecystectomy, Laparoscopic standards, Competency-Based Education standards, Educational Measurement methods, Humans, Internship and Residency, Prospective Studies, Psychometrics, Reproducibility of Results, Surgical Procedures, Operative standards, Task Performance and Analysis, Clinical Competence, General Surgery education
- Abstract
Objective: This study evaluated operative performance rating (OPR) characteristics and measurement conditions necessary for reliable and valid operative performance (OP) assessment., Background: Operative performance is a signature surgical-practice characteristic that is not measured systematically and specifically during residency training., Methods: Expert surgeon raters from multiple institutions, blinded to resident characteristics, independently evaluated 8 open and laparoscopic OP recordings immediately after observation., Results: A plurality of raters agreed on operative performance ratings (OPRs) for all performances. Using 10 judges adjusted for rater idiosyncrasies. Interrater agreement was similar for procedure-specific and general items. Higher post graduate year (PGY) residents received higher OPRs. Supervising-surgeon ratings averaged 0.51 points (1.2 standard deviations) above expert ratings for the same performances., Conclusions: OPRs have measurement properties (reliability, validity) similar to those of other well-developed performance assessments (Mini-CEX [clinical evaluation exercise], standardized patient examinations) when ratings occur immediately after observation. OPRs by blinded expert judges reflect the level of resident training and are practically significant differences as the average rating for PGY 4 residents corresponded to a "Good" performance whereas those for PGY 5 residents corresponded to a "Very Good" performance. Supervising surgeon ratings are higher than expert judge ratings reflecting the effect of interpersonal factors on supervising surgeon ratings. Use of local and national norms for interpretation of OPRs would adjust for these interpersonal factors. The OPR system provides a practical means for measuring operative performance, which is a signature characteristic of surgical practice.
- Published
- 2012
- Full Text
- View/download PDF
20. Association of GSTM1 null polymorphism with isosorbide-5-mononitrate cardiovascular response and involvement of CGRP in healthy Chinese male volunteers.
- Author
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Guo R, Chen L, Li L, Guo X, Sun J, Xiong XM, Cheng ZN, Li YJ, and Chen XP
- Subjects
- Adult, Aldehyde Dehydrogenase metabolism, Aldehyde Dehydrogenase, Mitochondrial, Blood Pressure drug effects, Calcitonin Gene-Related Peptide blood, China, Glutathione Transferase metabolism, Heart Rate drug effects, Humans, Isosorbide Dinitrate administration & dosage, Isosorbide Dinitrate blood, Isosorbide Dinitrate pharmacology, Male, Nitric Oxide Donors blood, Nitric Oxide Donors pharmacokinetics, Vasodilator Agents blood, Vasodilator Agents pharmacokinetics, Aldehyde Dehydrogenase genetics, Calcitonin Gene-Related Peptide physiology, Cardiovascular System drug effects, Glutathione Transferase genetics, Isosorbide Dinitrate analogs & derivatives, Nitric Oxide Donors administration & dosage, Vasodilator Agents administration & dosage
- Abstract
Objectives: To determine whether functional polymorphisms of glutathione S-transferase μ type 1 (GSTM1) and aldehyde dehydrogenase-2 (ALDH2) affect the isosorbide 5-mononitrate (IS-5-MN) response, and the role of the calcitonin gene-related peptide (CGRP) in IS-5-MN response in healthy volunteers., Methods: A two-phase, placebo-controlled study was carried out in 24 healthy Chinese volunteers with their ALDH2 and GSTM1 genotypes known. During each phase, either 20-mg IS-5-MN tablet or placebo was orally administered; blood pressure (BP), heart rate, and plasma concentration of CGRP was determined before and at several time points after drug administration. Pharmacokinetic parameters of IS-5-MN were determined., Results: GSTM1 null individuals showed significantly lower systolic BP (SBP) and diastolic BP (DBP), and higher degree of decreases in SBP (ΔSBP) and DBP (ΔDBP) after IS-5-MN administration. GSTM1 null individuals showed significantly decreased IS-5-MN area under the plasma concentration-time curve than GSTM1 wild-type individuals (P<0.05). Plasma concentration of CGRP was increased significantly at 0.5 (P<0.01), 1 (P<0.05), and 2 h (P<0.05) after IS-5-MN administration in GSTM1 null individuals but not wild-type individuals. GSTM1 null individuals also showed significantly higher degree of percentage increase in the plasma concentration of CGRP than GSTM1 wild-type individuals at 1 h after IS-5-MN administration (P<0.05). IS-5-MN upregulated CGRP I and CGRP II mRNA expressions in cultured peripheral blood mononuclear cells, and the IS-5-MN-induced CGRP II mRNA expression was inhibited by GSTs inhibitor, ethacrynic acid. No difference in the IS-5-MN response was observed between ALDH2 genotypes., Conclusion: We suggest that GSTM1, but not ALDH2, may interfere with the bioactivation of IS-5-MN, and CGRP contributes to the IS-5-MN response in a GSTM1 genotype-dependent manner.
- Published
- 2011
- Full Text
- View/download PDF
21. The effects of warm-water footbath on relieving fatigue and insomnia of the gynecologic cancer patients on chemotherapy.
- Author
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Yang HL, Chen XP, Lee KC, Fang FF, and Chao YF
- Subjects
- Adult, Aged, Analysis of Variance, Baths methods, Fatigue chemically induced, Female, Foot, Genital Neoplasms, Female drug therapy, Health Status Indicators, Humans, Middle Aged, Platinum Compounds adverse effects, Prospective Studies, Sleep Initiation and Maintenance Disorders chemically induced, Water, Young Adult, Antineoplastic Agents adverse effects, Fatigue therapy, Genital Neoplasms, Female complications, Hot Temperature therapeutic use, Hydrotherapy methods, Sleep Initiation and Maintenance Disorders therapy
- Abstract
Background: Most patients experience fatigue during chemotherapy. Ignoring this fatigue can contribute to worsening overall health of patients and a slowed recovery process., Objective: We investigated the effectiveness of a warm-water footbath on relieving fatigue and insomnia problems in patients undergoing chemotherapy., Methods: This was a 2-group, longitudinal study design. Adults diagnosed with gynecologic cancer and receiving a 4-series platinum chemotherapy regimen were recruited and then followed up for 6 months. They completed fatigue and insomnia items on the 1st, 2nd, 4th, 7th, and 14th days after each scheduled chemotherapy. Participants in the experimental group soaked their feet in 41°C to 42°C warm water for 20 minutes every evening, starting from the eve of receiving the first chemotherapy, whereas participants in the comparison group did not do so., Results: : There were 25 and 18 participants in the comparison and experimental groups, respectively, who completed the study. Participants in the experimental group reported a significant reduction in fatigue and improvement in sleep quality from the second session of chemotherapy and continued to improve during the study period., Conclusions: A warm-water footbath intervention resulted in reduced fatigue and insomnia symptoms for gynecologic cancer patients during chemotherapy., Implications for Practice: A warm-water footbath is local moist heat application. It is noninvasive and easy to apply at home. The findings provide empirical support that a warm-water footbath relieves fatigue and insomnia problems of patients undergoing chemotherapy. It can be a nonpharmaceutical method to help patients overcome fatigue and sleep problems during chemotherapy.
- Published
- 2010
- Full Text
- View/download PDF
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