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Protective effect of ischemic preconditioning against hepatic ischemia-reperfusion injury and associated remote organ damage 认领 引用 被引量：1
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作者 Christina Mouratidou Efstathios T Pavlidis +7 位作者 Georgios Katsanos Serafeim-Chrysovalantis Kotoulas Athanasios Kofinas Alexandra G Marneri Eleni Massa Georgios Tsoulfas Ioannis N Galanis Theodoros E Pavlidis 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第2期36-55,共20页
Hepatic ischemia-reperfusion injury is a significant complication of liver surgery,including major hepatectomy,trauma surgery and liver transplantation.It is a key factor in postoperative organ failure,which negativel... Hepatic ischemia-reperfusion injury is a significant complication of liver surgery,including major hepatectomy,trauma surgery and liver transplantation.It is a key factor in postoperative organ failure,which negatively affects prognosis and overall patient survival.Beyond its localized hepatic effects,ischemia-reperfusion injury is increasingly recognized as a potent trigger of the systemic inflammatory response and remote organ damage.The cellular and molecular mechanisms involved are highly complicated and have yet to be entirely elucidated.The core pathophysiological mechanisms of hepatic ischemia-reperfusion injury include a transition to anaerobic metabolism and adenosine triphosphate depletion;the development of intracellular acidosis and calcium overload;the impairment of mitochondrial function;oxidative stress;the activation and accumulation of distinct cell populations,notably Kupffer cells,neutrophils and platelets;the upregulation and downregulation of microRNAs;increased nitric oxide production;and the triggering of an immune system response with the activation of the complement system and excessive cytokine release.Ischemic preconditioning(IP)is a surgical technique in which brief cycles of controlled ischemia followed by reperfusion are applied directly to an organ,aiming to enhance its tolerance to subsequent prolonged ischemia.Hepatic IP has been demonstrated to reduce ischemia-reperfusion injury by decreasing the release of proinflammatory cytokines and damage-associated molecular patterns;suppressing reactive oxygen species production;activating the antioxidant enzyme heme-oxygenase 1,caspase,heat shock proteins and protein kinase cascades;modulating energy supplies and electrolyte homeostasis;and intervening in cell death pathways.In addition to its local effects on the liver,growing evidence indicates that IP also provides systemic advantages by reducing the inflammatory response and limiting injury to distant organs following major hepatic injury.This review integrates current data on IP,highlighting its role in hepatic protection and prevention of remote organ damage,while exploring the underlying mechanisms and translational potential of this approach in hepatic surgery and transplantation. 展开更多
关键词 Hepatic ischemia-reperfusion injury Remote organ damage Systemic inflammatory response Ischemic preconditioning Liver transplantation Protective method Pathophysiological mechanisms
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Essential strategies for the management of challenging laparoscopic cholecystectomy procedures 认领 引用
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作者 Efstathios T Pavlidis Theodoros E Pavlidis +3 位作者 Christina Mouratidou Alexandra G Marneri Athanasios Kofinas Kalliopi E Stavrati 《World Journal of Gastrointestinal Surgery》 SCIE 2026年第6期36-49,共14页
Laparoscopic cholecystectomy(LC)represents the most frequently conducted surgical intervention for managing symptomatic cholelithiasis.However,in the contemporary context of laparoscopic and robotic cholecystectomy pr... Laparoscopic cholecystectomy(LC)represents the most frequently conducted surgical intervention for managing symptomatic cholelithiasis.However,in the contemporary context of laparoscopic and robotic cholecystectomy procedures,open cholecystectomy remains a relevant surgical approach that minimizes the risk of severe complications.LC is considered to be a straightforward procedure in approximately 60%of cases and presents no significant challenges for most surgeons.However,in 20%-30%of cases,the procedure involves a moderate level of difficulty,and in 10%-15%of cases,the complexity is substantial,thus potentially requiring conversion to an open cholecystectomy approach and the involvement of a highly experienced surgeon who is proficient in both laparoscopic and open techniques.Existing scoring systems have the potential to predict procedural difficulty.Obesity,cirrhosis,elevated American Society of Anesthesiologists scores,prior abdominal surgeries,and the presence of acute cholecystitis or common bile duct stones have been identified as factors contributing to the complexity of cholecystectomy procedures.Radiological findings such as gallbladder wall thickening,pericholecystic fluid accumulation,and impacted gallstones are also correlated with increased surgical difficulty.Elevated body mass index and increased C-reactive protein levels were identified as significant independent predictors of surgical difficulty during LC in patients with acute cholecystitis.For cases in which the operation is anticipated to be challenging,the utilization of intraoperative imaging techniques(including intraoperative cholangiography,intraoperative ultrasound,and near-infrared cholangiography)is advised.When the safe attainment of the critical view of the hepatocystic triangle is not feasible,alternative surgical strategies[such as subtotal cholecystectomy(STC)or an anterograde approach]should be considered.Conversion to open surgery is recommended in instances of significant hemorrhage,cholecystoenteric fistula,Mirizzi syndrome,or suspected malignancy.Furthermore,consultation with or assistance from an additional surgeon is advised under complex operative conditions.The body-first approach and STC represent significant surgical approaches in cases of severe inflammation and fibrosis(including cholecystitis,choledocholithiasis,and biliary pancreatitis)and anatomical variations.Laparoscopic STC encompasses both fenestrating and reconstituting techniques.Moreover,robotic subtotal fenestrating cholecystectomy is the prevailing technique due to the three-dimensional view.Thus,failure to appropriately manage challenging cases may result in severe complications,given the demanding nature of biliary surgery. 展开更多
关键词 Gallbladder diseases Cholelithiasis Laparoscopic cholecystectomy Biliary surgery Complications Common bile duct injury Difficult cholecystectomy Bailout techniques
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Preconditioning with sufentanil confers protective effects in transplantation by attenuating hepatic ischemia-reperfusion injury 认领 引用
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作者 Christina Mouratidou Efstathios T Pavlidis +5 位作者 Georgios Katsanos Athanasios Kofinas Alexandra G Marneri Kalliopi E Stavrati Georgios Tsoulfas Theodoros E Pavlidis 《World Journal of Transplantation》 2026年第2期81-95,共15页
Hepatic ischemia-reperfusion injury(HIRI)is a significant contributor to liver dysfunction and failure following liver transplantation and hepatic surgical procedures.With the increasing global incidence of end-stage ... Hepatic ischemia-reperfusion injury(HIRI)is a significant contributor to liver dysfunction and failure following liver transplantation and hepatic surgical procedures.With the increasing global incidence of end-stage liver disease necessitating transplantation,strategies to mitigate HIRI have become important.Ferroptosis,a regulated form of cell death characterized by iron dependency and lipid peroxidation,has recently been recognized as a pivotal mechanism underlying hepatocellular injury during ischemia-reperfusion events.Emerging evidence suggests that in the context of HIRI,ferroptosis is facilitated by the convergence of iron overload,compromised antioxidant defenses,and excessive generation of lipid reactive oxygen species.Notably,EMP1/p38-mediated ferroptosis in liver sinusoidal endothelial cells directly contributes to hepatocyte damage via activation of the p38 mitogen-activated protein kinase pathway.Consequently,ferroptosis represents a promising therapeutic target for HIRI.Pharmacological inhibition of ferroptosis through modulation of the glutathione peroxidase 4 and cyclic guanosine monophosphate-adenosine monophosphate synthase pathways has been shown to ameliorate liver function.The organ-protective effects of sufentanil,a potentμ-opioid receptor agonist commonly employed for perioperative analgesia,extend beyond its anesthetic properties.Preconditioning with sufentanil appears to regulate ferroptosis by targeting activating transcription factor 3.Additionally,sufentanil downregulates the expression of hypoxia-inducible factor 1-alpha and the long noncoding RNA KCNQ1OT1 in HIRI,counteracting their pathological upregulation.These protective effects are closely associated with the attenuation of oxidative stress through the activation of nuclear factor erythroid 2-related factor 2,modulation of inflammatory responses,and preservation of mitochondrial integrity,all of which are mechanistically linked to the regulation of ferroptosis.This review synthesizes current insights into the role of ferroptosis in HIRI and explores the potential of sufentanil preconditioning in mitigating hepatic injury via ferroptosis-related pathways.The evidence to date suggests that sufentanil may attenuate ferroptosis and improve clinical outcomes in HIRI by modulating oxidative stress and associated signaling pathways.Further research on ferroptosis-targeted therapies,including pharmacological modulation of opioid receptor pathways,shows promise for developing novel interventions that protect the liver from ischemia-reperfusion injury. 展开更多
关键词 Hepatic ischemia-reperfusion injury Liver transplantation Ferroptosis Iron metabolism Lipid peroxidation Oxidative stress Hepatocellular injury Sufentanil
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Harnessing artificial intelligence in gastroenterology and hepatology:Current applications and future perspectives 认领 引用
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作者 Panagiotis Boutos Konstantina-Eleni Karakasi +3 位作者 Georgios Katsanos Nikolaos Antoniadis Athanasios Kofinas Georgios Tsoulfas 《World Journal of Hepatology》 2026年第1期72-83,共12页
Artificial intelligence(AI)has made remarkable strides,becoming an essential tool in modern medicine.As AI continues to evolve,it is crucial to redefine its scope,classifications,and subtypes to better align with its ... Artificial intelligence(AI)has made remarkable strides,becoming an essential tool in modern medicine.As AI continues to evolve,it is crucial to redefine its scope,classifications,and subtypes to better align with its clinical applications and potential.With a growing number of sophisticated models,AI is now widely used in gastroenterology and hepatology,offering new ways to enhance patient care.In gastroenterology,AI helps doctors identify lesions during endoscopy,detect gastrointestinal bleeding,and support the diagnosis and treatment of conditions like inflammatory bowel disease and gastrointestinal cancers.In hepatology,it aids in staging liver fibrosis,tracking disease progression,and predicting hepatocellular carcinoma risks.Machine learning further personalizes treatment plans,helping physicians make more informed decisions.However,despite its promise,AI still faces hurdles,including biases in data,ethical considerations,regulatory challenges,and the need for better transparency.Moving forward,refining these models,conducting extensive validation studies,and integrating AI seamlessly into clinical practice will be crucial in fully realizing its benefits for gastroenterology and hepatology. 展开更多
关键词 Trustworthiness Interpretability Endoscopy Medical imaging Clinical decision support Hepatology Gastroenterology Deep learning Machine learning Artificial intelligence
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Current perspectives on diagnosis and management of primary and secondary breast endometriosis and potential risk of breast cancer 认领 引用
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作者 Alexandra G Marneri Efstathios T Pavlidis +4 位作者 Kalliopi E Stavrati Christina Mouratidou Athanasios Kofinas Irida Konstantopoulou Theodoros E Pavlidis 《World Journal of Clinical Oncology》 2026年第4期74-84,共11页
Breast endometriosis represents an exceptionally rare extragenital manifestation of ectopic endometrial tissue,with only a few histologically confirmed breast cases reported worldwide.There appears to be a potential r... Breast endometriosis represents an exceptionally rare extragenital manifestation of ectopic endometrial tissue,with only a few histologically confirmed breast cases reported worldwide.There appears to be a potential relationship between endometriosis and an increased risk of developing breast cancer.The proposed mechanisms include chronic inflammation,oxidative stress,hormonal dysregulation,and genetic factors such as mutations in the GATA binding protein 2,phosphatase and tensin homolog,Kirsten rat sarcoma viral oncogene homolog,and AT-rich interactive domaincontaining protein 1A genes,as well as alterations in circulating microRNAs,primarily miR-199a and the let-7 family of miRNAs.However,the molecular mechanisms underlying this association are not yet fully understood.A structured literature search revealed a small number of primary and secondary breast cases,all of which were confirmed by histopathology.Primary lesions occurred spontaneously,whereas secondary cases were associated with prior breast surgery,suggesting possible implantation of endometrial tissue during surgical manipulation.Morphologic diagnosis relies on identifying endometrial glands and stroma,supported by immunoreactivity for CD10 and paired box gene 8 and negativity for GATA binding protein 2.Clinically,lesions may present as palpable nodules or painful masses,often mimicking malignancy or fat necrosis,particularly in patients with a history of reconstructive or reduction surgery.Complete surgical excision was curative in all reported cases,with no recurrence or malignant transformation documented during follow-up.Although exceedingly rare,recognition of this entity is essential to avoid misdiagnosis and to enhance the understanding of the mechanisms underlying ectopic endometrial implantation in extrapelvic sites such as the breast. 展开更多
关键词 Endometriosis Mammary endometriosis Rare breast lesions Genomic profile of endometriosis Ectopic extrapelvic location Palpable nodules Painful masses Malignant transformation risk
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Experimental beneficial effect of rosuvastatin on burn wound healing in a rat model 认领 引用
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作者 Alexandra G Marneri Efstathios T Pavlidis +8 位作者 Kalliopi E Stavrati Athanasios Kofinas Christina Mouratidou Ioannis Gkoutziotis Serafeim-Chrysovalantis Kotoulas Christina Marouda Dimitra Psalla Konstantinos D Ballas Theodoros E Pavlidis 《World Journal of Experimental Medicine》 2026年第1期232-248,共17页
BACKGROUND In addition to their primary lipid-lowering effects,statins also exhibit pleiotropic properties,including anti-inflammatory,immunomodulatory,antimicrobial,antioxidative,and angiogenic effects,all of which p... BACKGROUND In addition to their primary lipid-lowering effects,statins also exhibit pleiotropic properties,including anti-inflammatory,immunomodulatory,antimicrobial,antioxidative,and angiogenic effects,all of which promote wound healing.Rosuvastatin,a synthetic hydrophilic statin,has recently been proposed to enhance wound healing by stimulating angiogenesis and accelerating tissue regeneration.Its hydrophilic nature,longer half-life,greater hepatoselectivity,and better efficacy/safety than other statins are believed to contribute to its superior efficacy in wound repair,as suggested by promising preliminary results.However,current data on its use remain limited,necessitating further preclinical and clinical studies to thoroughly investigate this novel treatment option for burns.AIM To investigate the effects of rosuvastatin and its mechanism of action on burn wound healing process in an experimental study.METHODS Ninety male Wistar albino rats aged 12-16 weeks were randomly assigned to three groups of 30,subjected to burn using specific stainless steel sealer.Burn eschar was removed the following day applying topical rosuvastatin cream(study),Eucerin cream(placebo),normal saline(control),and sterile wound dressing.Each group was divided into three subgroups of ten according to sacrifice day(3rd,6th,9th).C-reactive protein(CRP),tumor necrosis factor-alpha(TNF-α),interleukin(IL)-1β,IL-6,digital assessment of burn healing,and histopathology were performed.RESULTS Using the value on the third day in the control group as the baseline,reductions were measured on the sixth and ninth days.Similarly,reduction values were recorded on the third,sixth,and ninth days in the study group.A statistically significant reduction was observed in the study group compared to the control group,with greater reductions corresponding to later sacrifice days(3rd,6th,and 9th)in CRP(P<0.01),TNF-α(P<0.01),IL-1β(P<0.01),and IL-6(P<0.01)levels and burn size(P<0.01).Histopathology revealed a statistically significant reduction in inflammatory infiltration,coagulative necrosis,and microhemorrhage(P<0.01).Conversely,statistically significant increases in neovascularization(P=0.012)and fibroblastic reactions(P=0.023)were noted.No adverse effects or deaths were observed.CONCLUSION Rosuvastatin reduces inflammation by lowering TNF-α,IL-1β,IL-6,CRP while increasing neo-angiogenesis,fibroblast reactions and microenvironmental protection in burn wounds.These effects promote repair and positively impact burn wound healing. 展开更多
关键词 Experimental skin burns Statins Rosuvastatin Burn wound healing Skin burn treatment Inflammation Antiinflammatory rosuvastatin action
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Enhanced recovery after surgery in liver transplantation:Challenges and feasibility 认领 引用 被引量：5
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作者 Georgios Katsanos Konstantina-Eleni Karakasi +13 位作者 Nikolaos Antoniadis Stella Vasileiadou Athanasios Kofinas Antonios Morsi-Yeroyannis Evangelia Michailidou Ioannis Goulis Emmanouil Sinakos Olga Giouleme Ilias Marios Oikonomou George Evlavis Georgios Tsakiris Eleni Massa Eleni Mouloudi Georgios Tsoulfas 《World Journal of Transplantation》 2022年第7期195-203,共9页
BACKGROUND Enhanced recovery after surgery(ERAS)started a revolution that changed age-old surgical stereotypical practices regarding the overall management of the surgical patient.In the last decade,ERAS has gained si... BACKGROUND Enhanced recovery after surgery(ERAS)started a revolution that changed age-old surgical stereotypical practices regarding the overall management of the surgical patient.In the last decade,ERAS has gained significant acceptance in the community of general surgery,in addition to several other surgical specialties,as the evidence of its advantages continues to grow.One of the last remaining fields,given its significant complexity and intricate nature,is liver transplantation(LT).AIM To investigate the existing efforts at implementing ERAS in LT.METHODS We conducted a systematic review of the existing studies that evaluate ERAS in orthotopic LT,with a multimodal approach and focusing on measurable clinical primary endpoints,namely length of hospital stay.RESULTS All studies demonstrated a considerable decrease in length of hospital stay,with no readmission or negative impact of the ERAS protocol applied to the postoperative course.CONCLUSIONS ERAS is a well-validated multimodal approach for almost all types of surgical procedures,and its future in selected LT patients seems promising,as the preliminary results advocate for the safety and efficacy of ERAS in the field of LT. 展开更多
关键词 Enhanced recovery Enhanced recovery after surgery Recovery Liver transplantation Liver
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Critical considerations for the management of acute abdomen in transplant patients 认领 引用 被引量：1
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作者 Efstathios T Pavlidis Georgios Katsanos +3 位作者 Athanasios Kofinas Georgios Tsoulfas Ioannis N Galanis Theodoros E Pavlidis 《World Journal of Transplantation》 2024年第2期8-12,共5页
The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transp... The number of solid organ transplantations performed annually is increasing and are increasing in the following order:Kidney,liver,heart,lung,pancreas,small bowel,and uterine transplants.However,the outcomes of transplants are impro-ving(organ survival>90%after the 1st year).Therefore,there is a high probability that a general surgeon will be faced with the management of a transplant patient with acute abdomen.Surgical problems in immunocompromised patients may not only include graft-related problems but also nongraft-related problems.The perioperative regulation of immunosuppression,the treatment of accompanying problems of immunosuppression,the administration of cortisol and,above all,the realization of a rapidly deteriorating situation and the accurate evaluation and interpretation of clinical manifestations are particularly important in these patients.The perioperative assessment and preparation includes evaluation of the patient’s cardiovascular system and determining if the patient has hypertension or suppression of the hypothalamic-pituitary-adrenal axis,or if the patient has had any coagulation mechanism abnormalities or thromboembolic episodes.Immunosuppression in transplant patients is associated with the use of calci-neurin inhibitors,corticosteroids,and antiproliferation agents.Many times,the clinical picture is atypical,resulting in delays in diagnosis and treatment and leading to increased morbidity and mortality.Multidetector computed tomo-graphy is of utmost importance for early diagnosis and management.Transplant recipients are prone to infections,especially specific infections caused by cytomegalovirus and Clostridium difficile,and they are predisposed to intraop-erative or postoperative complications that require great care and vigilance.It is necessary to follow evidence-based therapeutic protocols.Thus,it is required that the clinician choose the correct therapeutic plan for the patient(conservative,emergency open surgery or minimally invasive surgery,including laparoscopic or even robotic surgery). 展开更多
关键词 Acute abdomen Abdominal emergency surgery Transplantation Immunocompromised patients Immuno-suppression Posttransplantation surgery
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Volumetric assessment of hepatic grafts using a light detection and ranging system for 3D scanning:Preliminary data 认领 引用
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作者 Georgios Katsanos Konstantina-Eleni Karakasi +4 位作者 Ion-Anastasios Karolos Athanasios Kofinas Nikolaos Antoniadis Vassilios Tsioukas Georgios Tsoulfas 《World Journal of Hepatology》 2022年第7期1504-1511,共8页
BACKGROUND Liver transplantation has evolved into a safe life-saving operation and remains the golden standard in the treatment of end stage liver disease.The main limiting factor in the application of liver transplan... BACKGROUND Liver transplantation has evolved into a safe life-saving operation and remains the golden standard in the treatment of end stage liver disease.The main limiting factor in the application of liver transplantation is graft shortage.Many strategies have been developed in order to alleviate graft shortage,such as living donor partial liver transplantation and split liver transplantation for adult and pediatric patients.In these strategies,liver volume assessment is of paramount importance,as size mismatch can have severe consequences in the success of liver transplantation.AIM To evaluate the safety,feasibility,and accuracy of light detection and ranging(LIDAR)3D photography in the prediction of whole liver graft volume and mass.METHODS Seven liver grafts procured for orthotopic liver transplantation from brain deceased donors were prospectively measured with an LIDAR handheld camera and their mass was calculated and compared to their actual weight.RESULTS The mean error of all measurements was 17.03 g(range 3.56-59.33 g).Statistical analysis of the data yielded a Pearson correlation coefficient index of 0.9968,indicating a strong correlation between the values and a Student’s t-test P value of 0.26.Mean accuracy of the measurements was calculated at 97.88%.CONCLUSION Our preliminary data indicate that LIDAR scanning of liver grafts is a safe,cost-effective,and feasible method of ex vivo determination of whole liver volume and mass.More data are needed to determine the precision and accuracy of this method. 展开更多
关键词 Light detection and ranging Graft volume 3dscan Ex vivo volumetry Liver grafts
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