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| 1 | Transfusion and coagulation management in liver transplantation显示文摘There is wide variation in the management of coagulation and blood transfusion practice in liver transplantation.The use of blood products intraoperatively is declining and transfusion free transplantations take place ever more frequently.Allogenic blood products have been shown to increase morbidity and mortality.Primary haemostasis,coagulation and fibrinolysis are altered by liver disease.This,combined with intraoperative disturbances of coagulation,increases the risk of bleeding.Meanwhile,the rebalancing of coagulation homeostasis can put patients at risk of hypercoagulability and thrombosis.The application of the principles of patient blood management to transplantation can reduce the risk of transfusion.This includes:preoperative recognition and treatment of anaemia,reduction of perioperative blood loss and the use of restrictive haemoglobin based transfusion triggers.The use of point of care coagulation monitoring using whole blood viscoelastic testing provides a picture of the complete coagulation process by which to guide and direct coagulation management.Pharmacological methods to reduce blood loss include the use of anti-fibrinolytic drugs to reduce fibrinolysis,and rarely,the use of recombinant factorⅦa.Factor concentrates are increasingly used;fibrinogen concentrates to improve clot strength and stability,and prothrombin complex con-centrates to improve thrombin generation.Non-pharmacological methods to reduce blood loss include surgical utilisation of the piggyback technique and maintenance of a low central venous pressure.The use of intraoperative cell salvage and normovolaemic haemodilution reduces allogenic blood transfusion.Further research into methods of decreasing blood loss and alternatives to blood transfusion remains necessary to continue to improve outcomes after transplantation. | Ben Clevenger Susan V Mallett | 2014 | World Journal of Gastroenterology2014，20，20： | 25 |
| 2 | Cirrhotic cardiomyopathy: Implications for the perioperative management of liver transplant patients显示文摘Cirrhotic cardiomyopathy is a disease that has only recently been recognised as a definitive clinical entity. In the setting of liver cirrhosis, it is characterized by a blunted inotropic and chronotropic response t o s t r e s s, i m p a i r e d d i a s t o l i c r e l a x a t i o n o f t h e myocardium and prolongation of the QT interval in the absence of other known cardiac disease. A key pathological feature is the persistent over-activation of the sympathetic nervous system in cirrhosis, which leads to down-regulation and dysfunction of theβ-adrenergic receptor. Diagnosis can be made using a combination of echocardiography(resting and stress), tissue Doppler imaging, cardiac magnetic resonance imaging, 12-lead electrocardiogram and measurement of biomarkers. There are significant implications of cirrhotic cardiomyopathy in a number of clinical situations in which there is an increased physiological demand, which can lead to acute cardiac decompensation and heart failure. Prior to transplantation there is an increased risk of hepatorenal syndrome, cardiac failure following transjugular intrahepatic portosystemic shunt insertion and increased risk of arrhythmias during acute gastrointestinal bleeding. Liver transplantation presents the greatest physiological challenge with a further risk of acute cardiac decompensation. Peri-operative management should involve appropriate choice of graft and minimization of large fluctuations in preload and afterload. The avoidance of cardiac failure during this period has important prognostic implications, as there is evidence to suggest a long-term resolution of the abnormalities in cirrhotic cardiomyopathy. | Suehana Rahman Susan V Mallett | 2015 | World Journal of Hepatology2015，7，3： | 8 |
| 3 | K48-1inked ubiquitination and protein degradation regulate 53BP1 recruitment at DNA damage sites显示文摘 | Frederick A Mallette | 2012 | Cell Research2012，22，8： | 7 |
| 4 | Early acute kidney injury after liver transplantation: Predisposing factors and clinical implications显示文摘AIM To investigate the additional clinical impact of hepatic ischaemia reperfusion injury(HIRI) on patients sustaining acute kidney injury(AKI) following liver transplantation.METHODS This was a single-centre retrospective study of consecutive adult patients undergoing orthotopic liver transplantation(OLT) between January 2013 and June 2014. Early AKI was identified by measuring serum creatinine at 24 h post OLT(> 1.5 × baseline) or by the use of continuous veno-venous haemofiltration(CVVHF) during the early post-operative period. Patients with and without AKI were compared to identify risk factors associated with this complication. Peak serum aspartate aminotransferase(AST) within 24 h post-OLT was used as a surrogate marker for HIRI and severity was classified as minor(< 1000 IU/L), moderate(1000-5000 IU/L) or severe(> 5000 IU/L). The impact on time to extubation, intensive care length of stay, incidence of chronic renal failure and 90-d mortality were examined firstly for each of the two complications(AKI and HIRI) alone and then as a combined outcome. RESULTS Out of the 116 patients included in the study, 50% developed AKI, 24% required CVVHF and 70% sustainedmoderate or severe HIRI. Median peak AST levels were 1248 IU/L and 2059 IU/L in the No AKI and AKI groups respectively(P = 0.0003). Furthermore, peak serum AST was the only consistent predictor of AKI on multivariate analysis P = 0.02. AKI and HIRI were individually associated with a longer time to extubation, increased length of intensive care unit stay and reduced survival. However, the patients who sustained both AKI and moderate or severe HIRI had a longer median time to extubation(P < 0.001) and intensive care length of stay(P = 0.001) than those with either complication alone. Ninety-day survival in the group sustaining both AKI and moderate or severe HIRI was 89%, compared to 100% in the groups with either or neither complication(P = 0.049). CONCLUSION HIRI has an important role in the development of AKI post-OLT and has a negative impact on patient outcomes, especially when occurring alongside AKI. | Suehana Rahman Susan V Mallett Brian R Davidson | 2017 | World Journal of Hepatology2017，9，18： | 6 |
| 5 | Reducing transfusion requirements in liver transplantation显示文摘Liver transplantation(LT) was historically associated with massive blood loss and transfusion. Over the past two decades transfusion requirements have reduced dramatically and increasingly transfusionfree transplantation is a reality. Both bleeding and transfusion are associated with adverse outcomes in LT. Minimising bleeding and reducing unnecessary transfusions are therefore key goals in the perioperative period. As the understanding of the causes of bleeding has evolved so too have techniques to minimize or reduce the impact of blood loss. Surgical 'piggyback' techniques, anaesthetic low central venous pressure and haemodilution strategies and the use of autologous cell salvage, point of care monitoring and targeted correction of coagulopathy, particularly through use of factor concentrates, have all contributed to declining reliance on allogenic blood products. Pre-emptive management of preoperative anaemia and adoption of more restrictive transfusion thresholds is increasingly common as patient blood management(PBM) gains momentum. Despite progress, increasing use of marginal grafts and transplantation of sicker recipients will continue to present new challenges in bleeding and transfusion management. Variation in practice across different centres and within the literature demonstrates the current lack of clear transfusion guidance. In this article we summarise the causes and predictors of bleeding and present the evidence for a variety of PBM strategies in LT. | Ciara I Donohue Susan V Mallett | 2015 | World Journal of Transplantation2015，5，4： | 4 |
| 6 | Thrombocytopenia in cirrhosis:Impact of fibrinogen on bleeding risk显示文摘AIM To investigate the relationship between baseline platelet count,clauss fibrinogen,maximum amplitude(MA) on thromboelastography,and blood loss in orthotopic liver transplantation(OLT).METHODS A retrospective analysis of our OLT Database(2006-2015) was performed.Baseline haematological indices and intraoperative blood transfusion requirements,as a combination of cell salvage return and estimation of 300 mls/unit of allogenic blood,was noted as a surrogate for intraoperative bleeding.Two groups:Excessive transfusion(>1200 mL returned) and No excessive transfusion(<1200 m L returned) were analysed.All data analyses were conducted using IBM SPSS Statistics version 23.RESULTS Of 322 OLT patients,77 were excluded due to fulminant disease;redo transplant or baseline haemoglobin(Hb) of<80 g/L.One hundred and fourteen(46.3%) were classified into the excessive transfusion group,132(53.7%) in the no excessive transfusion group.Mean age and gender distribution were similar in both groups.Baseline Hb(P≤0.001),platelet count(P=0.005),clauss fibrinogen(P=0.004) and heparinase MA(P=0.001) were all statistically significantly different.Univariate logistic regression with a cut-off of platelets<50×10~9/L as the predictor and Haemorrhage as the outcome showed an odds ratio of 1.393(95%CI:0.758-2.563;P=0.286).Review of receiver operating characteristic curves showed an area under the curve(AUC) for platelet count of 0.604(95%CI:0.534-0.675;P=0.005) as compared with AUC for fibrinogen level,0.678(95%CI:0.612-0.744;P≤0.001).A multivariate logistic regression shows United Kingdom model for End Stage Liver Disease(P=0.006),Hb(P=0.022) and Fibrinogen(P=0.026) to be statistically significant,whereas Platelet count was not statistically significant.CONCLUSION Platelet count alone does not predict excessive transfusion.Additional investigations,e.g.,clauss fibrinogen and viscoelastic tests,provide more robust assessment of bleeding-risk in thrombocytopenia and cirrhosis. | Sonali V Thakrar Susan V Mallett | 2017 | World Journal of Hepatology2017，9，6： | 4 |
| 7 | Bacterial presence on flexible endoscopes vs time since disinfection显示文摘AIM To correlate the length of endoscope hang time and number of bacteria cultured prior to use.METHODS Prospectively, we cultured specimens from 19 gastroscopes, 24 colonoscopes and 5 side viewing duodenoscopes during the period of 2011 to 2015. A total of 164 results had complete data denoting date of cleansing, number of days stored and culture results. All scopes underwent initial cleaning in the endoscopy suite utilizing tap water, and then manually cleaned and flushed. High level disinfection was achieved with a Medivator~? DSD(Medivator Inc., United States) automated endoscope reprocessor following manufacturer instructions, with Glutacide~?(Pharmax Limited, Canada), a 2% glutaraldehyde solution. After disinfection, all scopes were stored in dust free, unfiltered commercial cabinets for up to 7 d. Prior to use, all scopes were sampled and plated on sheep blood agar for 48 h; the colony count was obtained from each plate. The length of endoscope hang time and bacterial load was analyzed utilizing unpaired t-tests. The overall percentage of positive and negative cultures for each type of endoscope was also calculated. RESULTS All culture results were within the acceptable range(less than 200 cfu/mL). One colonoscope cultured 80 cfu/mL after hanging for 1 d, which was the highest count. ERCP scopes cultured at most 10 cfu, this occurred after 2 and 7 d, and gastroscopes cultured 50 cfu/mL at most, at 1 d. Most cultures were negative for growth, irrespective of the length of hang time. Furthermore, all scopes, with the exception of one colonoscope which had two positive cultures(each of 10 cfu/mL), had at most one positive culture. There was no significant difference in the number of bacteria cultured after 1 d compared to 7 d when all scopes were combined(day 2: P = 0.515; day 3: P = identical; day 4: P = 0.071; day 5: P = 0.470; day 6: P = 0.584; day 7: P = 0.575). There was also no significant difference in the number of bacteria cultured after 1 day compared to 7 d for gastroscopes(day 2: P = 0.895; day 3: P = identical; day 4: P = identical; day 5: P = 0.893; day 6: P = identical; day 7: P = 0.756), colonoscopes(day 2: P = 0.489; day 4: P = 0.493; day 5: P = 0.324; day 6: P = 0.526; day 7: P = identical), or ERCP scopes(day 2: P = identical; day 7: P = 0.685). CONCLUSION There is no correlation between hang time and bacterial load. Endoscopes do not need to be reprocessed if reused within a period of 7 d. | Katlin I Mallette Peter Pieroni Sonny S Dhalla | 2018 | World Journal of Gastrointestinal Endoscopy2018，10，1： | 3 |
| 8 | Management of severe perioperative bleeding: Guidelines from the European Society of Anaesthesiology显示文摘 | Sibylle A. Kozek-Langenecker Arash Afshari Pierre Albaladejo Cesar Aldecoa Alvarez Santullano Edoardo De Robertis Daniela C. Filipescu Dietmar Fries Klaus G?rlinger Thorsten Haas Georgina Imberger Matthias Jacob Marcus Lancé Juan Llau Sue Mallett Jens Mei | 2013 | European Journal of Anaesthesiology2013，，6： | 3 |
| 9 | Clinical utility of viscoelastic tests of coagulation in patients with liver disease显示文摘 | Susan V. Mallett Pratima Chowdary Andrew K. Burroughs | 2013 | Liver Int2013，，7： | 3 |
| 10 | An assessment of mine methane mitigation and utilisation technologies显示文摘 | Shi Su Andrew Beath Hua Guo Cliff Mallett | 2005 | Progress in Energy and Combustion Science2005，，2： | 2 |
| 11 | Rapid convergence rate in adaptive arrays 显示文摘 | REED I S MALLETT J D BRENNAN L E | 1974 | IEEE Transactions on Aerospace and Electronic Systems1974，10，6： | 1 |
| 12 | Effects of T-2 mycotoxin on gastrointestinal tissues : a review of in vivo and in vitro models 显示文摘 | WORRELL N R MALLETT A K COOK W M | 1989 | Environ Toxicol1989，18，1： | 1 |
| 13 | patients' & healthcare profession- als' values regarding true- & false-positive diagnosis when colorec- tal cancer screening by CT colonogmphy: discrete choice experi- ment 显示文摘 | Boone D Mallett S Zhu S | 2013 | PLoS One2013，8，80： | 1 |
| 14 | Dietary Intervention to Reverse Carotid Atherosclerosis显示文摘 | Iris Shai J. David Spence Dan Schwarzfuchs Yaakov Henkin Grace Parraga Assaf Rudich Aaron Fenster Christiane Mallett Noah Liel-Cohen Amir Tirosh Arkady Bolotin Joachim Thiery Georg Martin Fiedler Matthias Blüher Michael Stumvoll Meir J. Stampfer | 2010 | Circulation2010，，10： | 1 |
| 15 | Size dependent dissociation pH of thioL-coated cadmium chalcogenides nanoerystals 显示文摘 | Aldana J Mallette N Peng X | 2005 | J Am Chem Soc2005，127，8： | 1 |
| 16 | The spectrum of metabolic bone disease in lymphoblastic leukemia 显示文摘 | Cohn SL Morgan ER Mallette LE | 1987 | Cancer1987，59，2： | 1 |
| 17 | Systematic reviews of diagnostic tests in cancer:review of methods and reporting显示文摘 | Mallett S Deeks JJ Halligan S | 2006 | BMJ2006，333，7565： | 1 |
| 18 | SOCSI Links Cytokine Signaling to p53 and Senescence 显示文摘 | Calabrese V Mallette FA Deschenes-Simard X | 2009 | Molecular Cell2009，36，5： | 1 |
| 19 | The hypercalcemias显示文摘 | Mallette LE | 1992 | Semin Nephrol1992，12，： | 1 |
| 20 | Rapid Convergence Rate in Adaptive Arrays 显示文摘 | REED I S MALLETT J D BRENNAN L E | 1974 | IEEE Trans on Aerosp Electron Syst1974，，10： | 1 |
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