Hepatobiliary Pancreat Dis Int

	2021 Vol. 20 No. 6
	Published: 2021-12-15


	Pages 511-610
	REVIEW ARTICLES ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas CLINICAL IMAGE LETTERS TO THE EDITOR THANKS

REVIEW ARTICLES

	511	Khan AA, Liu ZK, Xu X
		Recent advances in immunotherapy for hepatocellular carcinoma ^Hot!
		Background: Treatment of hepatocellular carcinoma (HCC) is challenging as most patients are diagnosed at advanced stage with underlying chronic liver conditions. Conventional systemic chemotherapy has failed in HCC, and the clinical efficacy of FDA-approved molecular targeted agents such as sorafenib and lenvatinib remains unsatisfactory. Data sources: Literature search was conducted in PubMed for relevant articles published before January 2021. The search aimed to identify recent developments in immune-based treatment approaches for HCC. Information of clinical trials was obtained from https://clinicaltrials.gov/ . Results: Two immune checkpoint inhibitors (ICIs), nivolumab and pembrolizumab were approved as monotherapies, which has revolutionized HCC treatment. Besides, combination ICIs have also got accelerated FDA approval recently. Immune-based therapies have challenged targeted drugs owing to their safety, tolerability, and survival benefits. In addition to the significant success in ICIs, other immunother- apeutic strategies such as cancer vaccine, chimeric antigen receptor T-cells, natural killer cells, cytokines, and combination therapy, have also shown promising outcomes in clinical trials. Various diagnostic and prognostic biomarkers have been identified which can help in clinical decision making when starting treatment with ICIs. Conclusions: Immunotherapy has emerged as one of the mainstream treatment modalities for advanced HCC in recent years. However, challenges such as low response rate and acquired resistance in previously respondent patients still exist. Further research is needed to understand the unique resistance mechanism to immunotherapy and to discover more predictive biomarkers to guide clinical decision making.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 511-520 . [Abstract] ( 109 ) [HTML 1KB] [PDF 0KB] ( 83 )

	521	Gao Y, Nepal N, Jin SZ
		Toll-like receptors and hepatitis C virus infection ^Hot!
		Background: Hepatitis C virus (HCV) infection is a worldwide issue. However, the current treatment for hepatitis C has many shortcomings. Toll-like receptors (TLRs) are pattern recognition receptors involved in HCV infection, and an increasing number of studies are focusing on the role of TLRs in the progression of hepatitis C. Data sources: We performed a PubMed search up to January 2021 with the following keywords: hepatitis C, toll-like receptors, interferons, inflammation, and immune evasion. We also used terms such as single-nucleotide polymorphisms (SNPs), susceptibility, fibrosis, cirrhosis, direct-acting antiviral agents, agonists, and antagonists to supplement the query results. We reviewed relevant publications analyzing the correlation between hepatitis C and TLRs and the role of TLRs in HCV infection. Results: TLRs 1–4 and 6–9 are involved in the process of HCV infection. When the host is exposed to the HCV, TLRs, as important participants in HCV immune evasion, trigger innate immunity to remove the virus and also promote inflammation and liver fibrosis. TLR gene SNPs affect hepatitis C susceptibility, treatment, and prognosis. The contribution of each TLR to HCV is different. Drugs targeting various TLRs are developed and validated, and TLRs can synergize with classic hepatitis C drugs, including interferon and direct-acting antiviral agents, constituting a new direction for the treatment of hepatitis C. Conclusions: TLRs are important receptors in HCV infection. Different TLRs induce different mechanisms of virus clearance and inflammatory response. Although TLR-related antiviral therapy strategies exist, more studies are needed to explore the clinical application of TLR-related drugs.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 521-529 . [Abstract] ( 124 ) [HTML 1KB] [PDF 0KB] ( 83 )

	530	Wang Y, Zhou XY, Lu XY, Chen KD, Yao HP
		Involvement of the circular RNA/microRNA/glucose-6-phosphate dehydrogenase axis in the pathological mechanism of hepatocellular carcinoma
		Hepatocellular carcinoma (HCC) is the third most common cause of cancer-related death worldwide with high mortality. The incidence of HCC is increasing in China. Abnormal activation of glucose-6-phosphate dehydrogenase (G6PD) exists in all malignant tumors, including HCC, and is closely related to the de- velopment of HCC. In addition, the differential expression of non-coding RNAs is closely related to the development of HCC. This systematic review focuses on the relationship between G6PD, HCC, and non- coding RNA, which form the basis for the circRNA/miRNA/G6PD axis in HCC. The circular RNA (cir- cRNA)/microRNA (miRNA)/G6PD axis is involved in development of HCC. We proposed that non-coding RNA molecules of the circRNA/miRNA/G6PD axis may be novel biomarkers for the pathological diagnosis, prognosis, and targeted therapy of HCC.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 530-534 . [Abstract] ( 94 ) [HTML 1KB] [PDF 0KB] ( 104 )

ORIGINAL ARTICLES/Liver

	535	Xiao LL, Wu XX, Chen JJ, Yan D, Shi DY, Huang JR, Xu XW, Li LJ
		Progress in hepatitis B virus-related acute-on-chronic liver failure treatment in China: A large, multicenter, retrospective cohort study using a propensity score matching analysis ? ^Hot!
		Background: Hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) has a high short-term mortality. However, the treatment progression for HBV-ACLF in China in the past decade has not been well characterized. The present study aimed to determine whether the HBV-ACLF treatment has significantly improved during the past decade. Methods: This study retrospectively compared short-term (28/56 days) survival rates of two different nationwide cohorts (cohort I: 2008-2011 and cohort II: 2012-2015). Eligible HBV-ACLF patients were en- rolled retrospectively. Patients in the cohorts I and II were assigned either to the standard medical ther- apy (SMT) group (cohort I-SMT, cohort II-SMT) or artificial liver support system (ALSS) group (cohort I-ALSS, cohort II-ALSS). Propensity score matching analysis was conducted to eliminate baseline differences, and multivariate logistic regression analysis was used to explore the independent factors for 28-day survival. Results: Short-term (28/56 days) survival rates were significantly higher in the ALSS group than those in the SMT group ( P < 0.05) and were higher in the cohort II than those in the cohort I ( P < 0.001). After propensity score matching, short-term (28/56 days) survival rates were higher in the cohort II than those in the cohort I for both SMT (60.7% vs. 53.0%, 50.0% vs. 39.8%, P < 0.05) and ALSS (66.1% vs. 56.5%, 53.0% vs. 44.4%, P < 0.05) treatments. The 28-day survival rate was higher in patients treated with nucleos(t)ide analogs than in patients without such treatments ( P = 0.046). Multivariate logistic regression analysis revealed that ALSS (OR = 0.962, 95% CI: 0.951-0.973, P = 0.038), nucleos(t)ide analogs (OR = 0.927, 95% CI: 0.871-0.983, P = 0.046), old age (OR = 1.028, 95% CI: 1.015-1.041, P < 0.001), total bilirubin (OR = 1.002, 95% CI: 1.001-1.003, P = 0.004), INR (OR = 1.569, 95% CI: 1.044-2.358, P < 0.001), COSSH-ACLF grade (OR = 2.683, 95% CI: 1.792-4.017, P < 0.001), and albumin (OR = 0.952, 95% CI: 0.924-0.982, P = 0.002) were independent factors for 28-day mortality. Conclusions: The treatment for patients with HBV-ACLF has improved in the past decade.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 535-541 . [Abstract] ( 122 ) [HTML 1KB] [PDF 0KB] ( 116 )

	542	Maupoey Ibanez J, Montalva Oron EM, Bosca Robledo A, Camacho-Ramirez A, Hernando Sanz A, Granero Castro P, Alegre Delgado A, Lopez-Andujar R
		From conventional two-stage hepatectomy to ALPPS: Fifteen years of experience in a hepatobiliary surgery unit
		Background: Hepatectomy in patients with large tumor load may result in postoperative liver failure and associated complications due to excessive liver parenchyma removal. Conventional two-stage hep- atectomy (TSH) and associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) technique are possible solutions to this problem. Colorectal liver metastases (CRLM) is the most frequent indication, and there is a need to assess outcomes for both techniques to improve surgical and long-term oncological outcomes in these patients. Methods: A single-center retrospective study was designed to compare TSH with ALPPS in patients with initially unresectable bilateral liver tumors between January 2005 and January 2020. ALPPS was performed from January 2012 onwards as the technique of choice. Long-term overall survival (OS) and disease-free survival (DFS) were evaluated as primary outcome in CRLM patients. Postoperative morbidity, mortality and liver growth in all patients were also evaluated. Results: A total of 38 staged hepatectomies were performed: 17 TSH and 21 ALPPS. Complete resection rate was 76.5% ( n = 13) in the TSH group and 85.7% ( n = 18) in the ALPPS group ( P = 0.426). Overall major morbidity (Clavien-Dindo ≥3a) (stage 1 + stage 2) was 41.2% ( n = 7) in TSH and 33.3% ( n = 7) in ALPPS patients ( P = 0.389), and perioperative 90-day mortalities were 11.8% ( n = 2) vs. 19.0% ( n = 4) in each group, respectively ( P = 0.654). Intention-to-treat OS rates at 1 and 5 years in CRLM patients for TSH ( n = 15) were 80% and 33%, and for ALPPS ( n = 17) 76% and 35%, respectively. DFS rates at 1 and 5 years were 36% and 27% in the TSH group vs. 33% and 27% in the ALPPS group, respectively. Conclusions: ALPPS is an effective alternative to TSH in bilateral affecting liver tumors, allowing higher resection rate, but patients must be carefully selected. In CRLM patients similar long-term OS and DFS can be achieved with both techniques.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 542-550 . [Abstract] ( 80 ) [HTML 1KB] [PDF 0KB] ( 85 )

	551	Gao Y, Li ZT, Jin L, Lin J, Fan ZL, Zeng Z, Huang HF
		Melatonin attenuates hepatic ischemia-reperfusion injury in rats by inhibiting NF-κB signaling pathway
		Background: The sterile inflammatory response is one of the key mechanisms leading to hepatic ischemia-reperfusion injury. Melatonin has been shown to prevent organ injuries, but its roles in the inflammatory response after hepatic ischemia-reperfusion injury have not been fully explored, especially in late ischemia-reperfusion injury. The present study aimed to investigate the roles and possible mechanisms of melatonin in the inflammatory response after hepatic ischemia-reperfusion injury. Methods: Sixty Sprague-Dawley rats were randomly divided into a sham group, ischemia-reperfusion injury group (I/R group), and melatonin-treated group (M + I/R group). The rats in the I/R group were subjected to 70% hepatic ischemia for 45 min, followed by 5 or 24 h of reperfusion. The rats in the M + I/R group were injected with melatonin (10 mg/kg, intravenous injection) 15 min prior to ischemia and immediately before reperfusion. Serum and samples of ischemic liver lobes were harvested for future analysis, and the 7-day survival rate was assessed after hepatic ischemia-reperfusion surgery. Results: In comparison with the I/R group, the M + I/R group showed markedly decreased expression levels of inflammatory cytokines (IL-6 and TNF- α) and numbers of apoptotic hepatocytes ( P < 0.05). Immunoblotting showed that the expression levels of IL-6, p-NF-κBp65/t-NF-κBp65 and p-I κB- α/t-I κB- αin the M + I/R group were significantly lower than those in the I/R group, and immunofluorescence staining showed that the expression level of p-NF- κBp65 in the M + I/R group was lower than that in the I/R group ( P < 0.05). The 7-day survival rates were 20% in the I/R group and 50% in the M + I/R group ( P < 0.05). Conclusions: Melatonin downregulated the activity of the NF- κB signaling pathway in the early and late stages of hepatic ischemia-reperfusion injury, alleviated the inflammatory response, protected the liver from ischemia-reperfusion injury, and increased the survival rate.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 551-560 . [Abstract] ( 83 ) [HTML 1KB] [PDF 0KB] ( 84 )

ORIGINAL ARTICLES/Biliary

	561	Jo IH, Paik CN, Kim DB, Lee JS, Lee JY, Chang JH, Paik KH, Park WS
		Unilateral versus bilateral Y-type stent-in-stent metal stent insertions in inoperable malignant hilar biliary strictures: A multicenter retrospective study ^Hot!
		Background: To date, there is controversy regarding unilateral versus bilateral stent placement in patients with malignant hilar biliary strictures (MHBSs). The aim of this study was to compare the clinical outcomes and complications of unilateral and bilateral (stent-in-stent method) stent placements for these patients. Methods: We conducted a multicenter retrospective analysis of patients with inoperable MHBS who underwent endoscopic self-expandable metal stent (SEMS) placement from January 2009 to December 2019. Two groups classified according to the stent procedure method were compared for demographic, proce- dural, and postprocedure factors. Survival analysis for patency loss and overall survival was also conducted. Results: A total of 236 subjects were included. A superior technical success rate was found in the unilat- eral stent group (98.8% vs. 82.5%, P < 0.001), whereas the clinical success rate was higher in the bilateral group (85.7% vs. 70.5%, P = 0.028). There was no significant difference with respect to complications or patency loss, and the bilateral group had better overall survival ( P < 0.01). In the Cox proportional hazard model, MHBSs from lymph node compression were associated with a higher risk of death (HR = 9.803, P = 0.003). In contrast, bilateral SEMS insertion showed reduced postprocedural mortality (HR = 0.316, P = 0.001). Conclusions: Y-type stent-in-stent bilateral SEMSs are technically difficult but demonstrated more fa- vorable overall survival for palliative bile drainage of inoperable MHBS patients compared to unilateral insertions.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 561-567 . [Abstract] ( 129 ) [HTML 1KB] [PDF 0KB] ( 96 )

ORIGINAL ARTICLES/Pancreas

	568	Wang SJ, Li YF, Liao S, Wei YZ, Zhou YM
		Proposal of a new T-stage classification system for ampullary carcinoma based on Surveillance, Epidemiology and End Result (SEER) database
		Background: Tumor size is still considered a useful prognostic factor in currently available tumor-node-metastasis (TNM) classification staging systems for most solid tumors, but the significance of tumor size on the prognosis of ampullary carcinoma remains controversial. The aim of the current study was to propose a new T-stage classification system for ampullary carcinoma to address the impact of tumor size on the prognostic outcome. Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database, we identified 1080 patients with ampullary carcinoma who underwent radical surgical resection between 2004 and 2015. Based on the results obtained from analysis of various clinicopathologic factors, a new T-stage classifica- tion system was proposed. Results: Among the 1080 patients, 618 were men and 462 were women, with a median tumor size of 2.3 (range 0.1–12) cm. Using the 7th edition of the American Joint Committee on Cancer (AJCC) staging manual, we noticed significant differences in overall survival (OS) between T2 vs. T3 tumors ( P < 0.001) and T3 vs. T4 tumors ( P = 0.002), but failed to observe significant differences between T1 vs. T2 tumors ( P = 0.498) in our pair-wise comparison. Using the newly developed T-stage classification system, we were able to differentiate significant differences in OS between T1 vs. T2 tumors ( P = 0.032), T2 vs. T3 tumors ( P < 0.001) and T3 vs. T4 tumor ( P = 0.003) in all pair-wise comparisons. The c-index of the new staging system was 0.653 (95% CI: 0.629–0.677), showing a better discriminatory power than the 0.636 of the 7th AJCC staging system (95% CI: 0.612–0.660). Conclusions: The new T-stage classification system described herein can better differentiate prognostic outcomes after radical resection in patients with ampullary carcinoma by incorporating tumor size and depth of tumor infiltration.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 568-573 . [Abstract] ( 70 ) [HTML 1KB] [PDF 0KB] ( 97 )

CLINICAL IMAGE

	574	Qian YR, Jiang N, Liu P, Zhang XF, Liu XM, Lv Y, Xiang JX
		Hepatocellular-cholangiocarcinoma with sarcomatous change: Clinicopathological features and outcomes
		Combined hepatocellular-cholangiocarcinoma (cHCC-CCA) is a rare type of cancer, accounting for 0.4%-14.2% of hepato-carcinoma. Hepatic sarcoma is only less than 2% of primary malignant liver tumors. Thus, sarcomatoid cHCC-CCA is extremely rare. To the best of our knowledge, only twenty-six cases had been reported in the literature [1-19]. Consensus cannot be reached due to the difficulty of preoperative pathological diagnosis and disagreement for the selection of the treatment. Therefore, clinicopathological features and outcome data about sarcomatoid cHCC-CCA are essential for diagnosis and treatment. We reported in this article three cases with clinical data and prognostic analysis, and summarized 26 cases of sarcomatoid cHCC-CCA from published literatures.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 574-578 . [Abstract] ( 69 ) [HTML 1KB] [PDF 0KB] ( 94 )

	579	Louro JM, Alves AM, Brandao JR, Franca M
		Hepatic adenomatosis in glycogen storage disease: Radio-pathological correlation
		Glycogen storage disease type I (GSD type I), also known as von Gierke disease, is an autosomal recessive disorder of the glycogen metabolism pathway, caused by a deficiency of glucose-6-phosphatase (GSD type Ia) or glucose-6-phosphate translocase (GSD type Ib) [1]. These enzymes are crucial in the last step of both glycogenolysis and gluconeogenesis, and their deficiency results in excessive glycogen and fat accumulation in the liver, kidney and intestinal mucosa [1]. GSD type I has an overall incidence of 1/10 0,0 0 0 live births [1], and 80% of patients are type Ia [2]. Patients commonly present between 3 and 6 months of age with severe hypoglycemia, hepatomegaly, hypertriglyceridemia and growth retardation. They often develop renal disease, hyperuricemia and, in those with GSD type Ib, recurrent infections due to neutropenia. Diagnosis is usually straightforward; nevertheless, genetic testing is necessary for confirmation [1,2].
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 579-581 . [Abstract] ( 73 ) [HTML 1KB] [PDF 0KB] ( 84 )

	582	Zhi XT, Yu BR, Chen ZQ
		A rare type of choledochal cysts of Todani type IV-B with typical pancreaticobiliary maljunction
		Choledochal cysts (CCs), first described by Vater and Ezler in 1723, are rare congenital cystic dilations of biliary tract [1]. The most widely adopted classification system from Todani et al. divides CCs into five major types and several subtypes [2]. Almost all of the CCs are type I and type IV-A, while type IV-B is extremely rare [3,4]. The accurate diagnosis and precise categorization of CCs are crucial for surgeons to perform proper operative strategy. Here, we report a typical CCs of Todani type IV-B with a typical scenario of pancreaticobiliary maljunction (PBM) in a 50-year-old male, and proper surgical treatment was conducted with uneventful recovery.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 582-584 . [Abstract] ( 84 ) [HTML 1KB] [PDF 0KB] ( 87 )

LETTERS TO THE EDITOR

	585	Brungardt JG, King CD, Schropp KP
		An NSQIP survey of outcomes after resection of choledochal cysts in adults
		Choledochal cysts, now generally termed biliary cysts to include intrahepatic cysts, are a rare lesion with unknown incidence [1]. These cysts more often affect females than males (4:1) [2]. Often associated with the pediatric population of congenital etiology, some series have found adults equally affected [3]. Classification of biliary cysts follows the Todani classification with six groups [4]. This has allowed physicians to consider treatment according to their type. While treatment typically consists of excision with Roux-en-Y reconstruction, data on the subject is limited to case series or single-institution cohorts. Other treatment modalities include sphincterotomy (endoscopic more commonly than open) in the case of type III cysts, and a liver transplant for patients with type V cysts, which were not captured in this study. Without treatment, patients risk poor biliary drainage, leading to hepatic fibrosis, or neoplastic transformation [5]. The low incidence of biliary cysts creates difficulty in their study. A recent multi-institutional study included 135 children and 259 adults, with adult rate of overall complication 35%, readmission rate of 1.4%, and 30-day mortality of 6.9%, which is representative of other studies [6] . Few studies have been done within larger databases to evaluate shortterm clinical outcomes after surgery for biliary cysts. We sought to determine morbidity and mortality in patients undergoing surgical treatment of biliary and choledochal cysts within a nationally recognized database.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 585-587 . [Abstract] ( 67 ) [HTML 1KB] [PDF 0KB] ( 96 )

	588	Kuan LL, Neal CP, Robertson V, Jones M, Dennison AR, Garcea G
		Outcomes of Pringle maneuver in patients undergoing hepatic resection for colorectal liver metastases
		The Pringle maneuver (PM) was initially described more than a century ago to control bleeding associated with hepatic trauma and it remains the most common method to block hepatic inflow and minimize blood loss during hepatic resections [1]. The potential effects of ischemia-reperfusion injury (IRI), a consequence of the PM, on the function of the liver remnant remain controversial [2]. Pre-clinical data have suggested that IRI may potentiate the growth of metastatic colorectal cells [3] , raising concerns regarding long-term oncological outcomes associated with use of the PM. Several large clinical studies involving patients undergoing resections for colorectal liver metastases (CRLM) have shown no significant differences in survival or hepatic recurrence regardless of whether the PM is used [4,5]. However, there remain concerns whether the PM may influence long-term oncological outcomes.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 588-591 . [Abstract] ( 73 ) [HTML 1KB] [PDF 0KB] ( 98 )

	592	Popescu M, Dima S, Brasoveanu V, Tudor A, Simionescu M, Tomescu D
		High perioperative lactate levels and decreased lactate clearance are associated with increased incidence of posthepatectomy liver failure
		Extensive liver resection represents a life-saving intervention in patients with primary or secondary liver tumors. Recent advances made in the field of chemotherapy and surgical techniques have translated into a greater number of patients who are older and with more complex comorbidities presenting for major liver surgery [1] and thus having an increased risk of perioperative mortality. Of those, posthepatectomy liver failure (PHLF) represents a life-threatening complication of liver surgery and one of the most important causes of perioperative mortality. The incidence reported in current literature varies between 4.9% and 32% [2,3]. Such patients need to be managed by a multidisciplinary team in a dedicated intensive care unit to minimize multi-organ dysfunction associated with PHLF [4] . We hypothesized that lactate dynamics in the setting of liver surgery can be used as a marker of poor liver function. This study aimed to assess the correlation between lactate levels, lactate kinetics and postoperative PHLF in the perioperative period of major hepatic surgery.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 592-594 . [Abstract] ( 82 ) [HTML 1KB] [PDF 0KB] ( 99 )

	595	Xie M, Zang YJ, Zhang B, Rao W
		Successful withdrawal of antiviral treatment in two HBV-related liver transplant recipients after hepatitis B vaccination with long-term follow-up
		Hepatitis B immunoglobulin (HBIG) combined with nucleos( t)ide analogues (NAs) has become the standard regimen for preventing recurrence of hepatitis B virus (HBV) infection in HBV-related liver transplant (LT) recipients. HBsAg seropositivity was detected in only 7.2%–8.6% of LT recipients who received monotherapy with high-genetic-barrier NAs after a short period of combined therapy [1,2]. Despite progress in the application of newer NAs in HBV-related LT recipients, complete withdrawal of HBV prophylaxis after LT was controversial and considered risky by some centers [3]. We here present two cases of complete and sustained HBV cccDNA-negative status after withdrawal of prophylaxis when intrahepatic and active immune response was achieved with hepatitis B vaccination. Our experience provides a strategy for reliable and safe withdrawal of anti-HBV prophylaxis in HBV-related LT recipients.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 595-597 . [Abstract] ( 75 ) [HTML 1KB] [PDF 0KB] ( 108 )

	598	Zhu WF, Zheng SS
		Glucagonoma syndrome with necrolytic migratory erythema as initial manifestation
		Necrolytic migratory erythema (NME) is a group of cutaneous lesions characterized by periodic episodes of annular or figurative dark red plaques, which are typically accompanied by blisters, erosions, and crusting. It is often associated with glucagonoma. Glucagonoma is an extremely rare neuroendocrine tumor that arises from pancreatic islet α cells and manifests as elevated glucagon, with an incidence of about 1 in 20 million per year [1,2]. Glucagonoma with NME is defined as glucagonoma syndrome (GS), and the presence of skin lesions helps in the timely diagnosis and treatment of pancreatic tumors [3,4]. Here we reported a case of GS with NME as initial manifestation aiming to improve our understanding of GS and achieve an early diagnosis.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 598-600 . [Abstract] ( 72 ) [HTML 1KB] [PDF 0KB] ( 101 )

	601	Martins PN, Buchwald JE, Movahedi B, Torres U, Emhoff T,Walker J, DeBusk MG, Bozorgzadeh A
		Successful treatment of complete traumatic transection of the suprahepatic inferior vena cava with veno-venous and cardiopulmonary bypass with hypothermic circulatory arrest ?
		Complete traumatic transection of the suprahepatic inferior vena cava (IVC) has almost invariably a fatal outcome. There are very few cases in the literature of patients that survived this type of injury. Here we presented a case that was approached multidisciplinary (trauma surgeon, liver transplant surgeon, perfusionist, anesthesiologist, and cardiac surgeon) with a successful outcome including early recovery of all body functions and quality of life. We also reviewed the literature of cases of survival following blunt incomplete and complete IVC transection including those treated with cardiopulmonary bypass.
		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 601-610 . [Abstract] ( 86 ) [HTML 1KB] [PDF 0KB] ( 80 )

THANKS

	611
		Thanks

		Hepatobiliary Pancreat Dis Int. 2021; 20(6): 611-A9-10 . [Abstract] ( 65 ) [HTML 1KB] [PDF 34KB] ( 153 )

Forgot your password?

Enter your e-mail address to receive an e-mail with your account information.

Submission Guidance

Top cited articles

- Most Cited Hepatobiliary & Pancreatic Diseases International Articles

- Most Downloaded Hepatobiliary & Pancreatic Diseases International Articles

more>>

Top downloaded articles

more>>

Services

Web feed

hbpdint@126.com

hbpdje@zju.edu.cn

Copyright © Official Publication of First Affiliated Hospital
Official Publication of First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
浙ICP备05050873号-1