For much of the twentieth century, surgery was frequently the solution for peptic ulcer disease. Our understanding of the pathophysiology of ulcers paralleled the development of potent pharmaceutical therapy. As the s...For much of the twentieth century, surgery was frequently the solution for peptic ulcer disease. Our understanding of the pathophysiology of ulcers paralleled the development of potent pharmaceutical therapy. As the surgical world developed parietal cell vagotomy which would minimize the complications of surgery, patients failing medical therapy became rare. Emergent surgery for complicated peptic ulcers has not declined however. The development of proton pump inhibitors and the full understanding of the impact of H pylori has led to a trend towards minimalism in surgical therapy for complicated peptic ulcer disease. In addition to the changes in patient care, these developments have had an impact on the training of surgeons. This article outlines these trends and developments.展开更多
Background and Aims:End-stage liver disease is associated with disruptions in gut microbiota composition and function,which may facilitate gut-to-liver bacterial translocation,impacting liver graft integrity and clini...Background and Aims:End-stage liver disease is associated with disruptions in gut microbiota composition and function,which may facilitate gut-to-liver bacterial translocation,impacting liver graft integrity and clinical outcomes following liver transplantation.This study aimed to assess the impact of two liver graft preservation methods on fecal microbiota and changes in fecal and breath organic acids following liver transplantation.Methods:This single-center,non-randomized prospective pilot study enrolled liver transplant patients whose grafts were preserved using either static cold storage or ex situ normothermic machine perfusion(NMP).Fresh stool and breath samples were collected immediately before surgery and at postoperative months 3,6,and 12.Stool microbiota was profiled via 16S rRNA gene sequencing,stool short-chain fatty acids were measured using gas chromatography/-mass spectrometry,and breath volatile organic compounds(VOCs)were analyzed with selected-ion flow-tube mass spectrometry.Results:Both cohorts experienced a loss of microbiota diversity and dominance by single taxa.The NMP cohort demonstrated enrichment of several beneficial gut taxa,while the static cold storage cohort showed depletion of such taxa.Various gut bacteria were found to correlate with stool short-chain fatty acids(e.g.,lactic acid,butyric acid)and several VOCs.Conclusions:Fecal microbiota alterations associated with end-stage liver disease do not fully normalize to a healthy control profile following liver transplantation.However,notable differences in microbiota composition and function were observed between liver graft preservation methods.Future research with larger randomized cohorts is needed to explore whether the NMP-associated shift in gut microbiota impacts clinical outcomes and if breath VOCs could serve as biomarkers of the clinical trajectory in liver transplant patients.展开更多
文摘For much of the twentieth century, surgery was frequently the solution for peptic ulcer disease. Our understanding of the pathophysiology of ulcers paralleled the development of potent pharmaceutical therapy. As the surgical world developed parietal cell vagotomy which would minimize the complications of surgery, patients failing medical therapy became rare. Emergent surgery for complicated peptic ulcers has not declined however. The development of proton pump inhibitors and the full understanding of the impact of H pylori has led to a trend towards minimalism in surgical therapy for complicated peptic ulcer disease. In addition to the changes in patient care, these developments have had an impact on the training of surgeons. This article outlines these trends and developments.
基金supported in part by a grant from the Lerner Research Institute,Cleveland Clinic to GAMC and CQ.
文摘Background and Aims:End-stage liver disease is associated with disruptions in gut microbiota composition and function,which may facilitate gut-to-liver bacterial translocation,impacting liver graft integrity and clinical outcomes following liver transplantation.This study aimed to assess the impact of two liver graft preservation methods on fecal microbiota and changes in fecal and breath organic acids following liver transplantation.Methods:This single-center,non-randomized prospective pilot study enrolled liver transplant patients whose grafts were preserved using either static cold storage or ex situ normothermic machine perfusion(NMP).Fresh stool and breath samples were collected immediately before surgery and at postoperative months 3,6,and 12.Stool microbiota was profiled via 16S rRNA gene sequencing,stool short-chain fatty acids were measured using gas chromatography/-mass spectrometry,and breath volatile organic compounds(VOCs)were analyzed with selected-ion flow-tube mass spectrometry.Results:Both cohorts experienced a loss of microbiota diversity and dominance by single taxa.The NMP cohort demonstrated enrichment of several beneficial gut taxa,while the static cold storage cohort showed depletion of such taxa.Various gut bacteria were found to correlate with stool short-chain fatty acids(e.g.,lactic acid,butyric acid)and several VOCs.Conclusions:Fecal microbiota alterations associated with end-stage liver disease do not fully normalize to a healthy control profile following liver transplantation.However,notable differences in microbiota composition and function were observed between liver graft preservation methods.Future research with larger randomized cohorts is needed to explore whether the NMP-associated shift in gut microbiota impacts clinical outcomes and if breath VOCs could serve as biomarkers of the clinical trajectory in liver transplant patients.
