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| 1 | Viscoelastic tests in liver disease: where do we stand now?显示文摘Hemostasis is a complex physiological process based on the balance between procoagulant and anticoagulant systems to avoid pathological bleeding or thrombosis.The changes in standard coagulation tests in liver disease were assumed to reflect an acquired bleeding disorder,and cirrhotic patients were considered naturally anticoagulated.In the light of the new evidence,the theory of rebalanced hemostasis replaced the old concept.According to this model,the hemostatic alteration leads to a unique balance between pro-coagulant,anticoagulant,and fibrinolytic systems.But the balance is fragile and may prone to bleeding or thrombosis depending on various risk factors.The standard coagulation tests[INR(international normalized ratio),platelet count and fibrinogen]only explore parts of the hemostasis,not offering an entire image of the process.Rotational thromboelastometry(ROTEM)and thromboelastography(TEG)are both point of care viscoelastic tests(VET)that provide real-time and dynamic information about the entire hemostasis process,including clot initiation(thrombin generation),clot kinetics,clot strength,and clot stability(lysis).Despite prolonged PT/INR(international normalized ratio of prothrombin time)and low platelet counts,VET is within the normal range in many patients with both acute and chronic liver disease.However,bleeding remains the dominant clinical issue in patients with liver diseases,especially when invasive interventions are required.VET has been shown to asses more appropriately the risk of bleeding than conventional laboratory tests,leading to decrial use of blood products transfusion.Inappropriate clotting is common but often subtle and may be challenging to predict even with the help of VET.Although VET has shown its benefit,more studies are needed to establish cut-off values for TEG and ROTEM in these populations and standardization of transfusion guidelines before invasive interventions in cirrhotic patients/orthotopic liver transplantation. | Alina Buliarca Adelina Horhat Tudor Mocan Rares Craciun Bogdan Procopet Zeno Sparchez | 2021 | World Journal of Gastroenterology2021，27，23： | 3 |
| 2 | Endoscopic or percutaneous biliary drainage in hilar cholangiocarcinoma:When and how?显示文摘Hilar cholangiocarcinoma (hCCA) is a primary liver tumor associated with a dimprognosis. The role of preoperative and palliative biliary drainage has long beendebated. The most common techniques are endoscopic retrograde cholangiopancreatography(ERCP) and percutaneous transhepatic biliary drainage (PTBD);however, recently developed endoscopic ultrasound-assisted methods are gainingmore atention. Selecting the best available method in any specific scenario iscrucial, yet sometimes challenging. Thus, this review aimed to discuss theavailable techniques, indications, perks, pitfalls, and timing-related issues in themanagement of hCCA. In a preoperative setting, PTBD appears to have someadvantages: low risk of postprocedural complications (namely cholangitis) andbetter priming for surgery. For palliative purposes, we propose ERCP/PTBDdepending on the experience of the operators, but also on other factors: the levelof bilirubin (if very high, rather PTBD), length of the stenosis and the presence ofcholangitis (PTBD), ERCP failure, or altered biliary anatomy. | Tudor Mocan Adelina Horhat Emil Mois Florin Graur Cristian Tefas Rares Craciun Iuliana Nenu Mihaela Spârchez Zeno Sparchez | 2021 | World Journal of Gastrointestinal Oncology2021，13，12： | 3 |
| 3 | Novel approaches in search for biomarkers of cholangiocarcinoma显示文摘Cholangiocarcinoma(CCA)arises from the ductular epithelium of the biliary tree,either within the liver(intrahepatic CCA)or more commonly from the extrahepatic bile ducts(extrahepatic CCA).This disease has a poor prognosis and a growing worldwide prevalence.The poor outcomes of CCA are partially explained by the fact that a final diagnosis is challenging,especially the differential diagnosis between hepatocellular carcinoma and intrahepatic CCA,or distal CCA and pancreatic head adenocarcinoma.Most patients present with an advanced disease,unresectable disease,and there is a lack in non-surgical therapeutic modalities.Not least,there is an acute lack of prognostic biomarkers which further complicates disease management.Therefore,there is a dire need to find alternative diagnostic and follow-up pathways that can lead to an accurate result,either singlehandedly or combined with other methods.In the'-omics'era,this goal can be attained by various means,as it has been successfully demonstrated in other primary tumors.Numerous variants can reach a biomarker status ranging from circulating nucleic acids to proteins,metabolites,extracellular vesicles,and ultimately circulating tumor cells.However,given the relatively heterogeneous data,extracting clinical meaning from the inconsequential noise might become a tall task.The current review aims to navigate the nascent waters of the non-invasive approach to CCA and provide an evidence-based input to aid clinical decisions and provide grounds for future research. | Lavinia-Patricia Mocan Maria Ilieș Carmen Stanca Melincovici Mihaela Spârchez RareșCrăciun Iuliana Nenu Adelina Horhat Cristian Tefas Zeno Spârchez Cristina Adela Iuga Tudor Mocan Carmen Mihaela Mihu | 2022 | World Journal of Gastroenterology2022，28，15： | 1 |
| 4 | Combined treatments in hepatocellular carcinoma:Time to put them in the guidelines?显示文摘The time for battling cancer has never been more suitable than nowadays and fortunately against hepatocellular carcinoma(HCC)we do have a far-reaching arsenal.Moreover,because liver cancer comprises a plethora of stages-from very early to advanced disease and with many treatment options–from surgery to immunotherapy trials–it leaves the clinician a wide range of options.The scope of our review is to throw light on combination treatments that seem to be beyond guidelines and to highlight these using evidence-based analysis of the most frequently used combination therapies,discussing their advantages and flaws in comparison to the current standard of care.One particular combination therapy seems to be in the forefront:Transarterial chemoembolization plus ablation for medium-size non-resectable HCC(3-5 cm),which is currently at the frontier between Barcelona Clinic Liver Cancer classification A and B.Not only does it improve the outcome in contrast to each individual therapy,but it also seems to have similar results to surgery.Also,the abundance of immune checkpoint inhibitors that have appeared lately in clinical trials are bringing promising results against HCC.Although the path of combination therapies in HCC is still filled with uncertainty and caveats,in the following years the hepatology and oncology fields could witness an HCC guideline revolution. | Zeno Sparchez Pompilia Radu Adrian Bartos Iuliana Nenu Rares Craciun Tudor Mocan Adelina Horhat Mihaela Spârchez Jean-François Dufour | 2021 | World Journal of Gastrointestinal Oncology2021，13，12： | 1 |
| 5 | Pulmonary complications of portal hypertension:The overlooked decompensation显示文摘The systemic nature of cirrhosis and portal hypertension has long been recognized,and the amount of data characterizing the interplay between each system is becoming ever so complex.Lung involvement was among the first described associated entities in cirrhosis,with reports dating back to the late nineteenth century.However,it appears that throughout the years,interest in the pulmonary complications of portal hypertension has generally faded,especially in contrast to other decompensating events,as expertise in this field has primarily been concentrated in highly experienced tertiary care facilities and liver transplantation centers.Despite affecting up to 10%-15%of patients with advanced liver disease and having a proven prognostic impact,hepato-pulmonary syndrome,porto-pulmonary hypertension,and hepatic hydrothorax are frequently misdiagnosed,mistreated,or misinterpreted.This lack of precision might adversely impact patient care,referral to expert centers,and,ultimately,liver disease-related mortality and successful transplantation odds.The present minireview aims to increase awareness of the pulmonary complications of chronic liver disease by providing a brief overview of each of the three entities.The paper focuses on the essential theoretical aspects,addressing the most critical knowledge gaps on the one hand and,on the other hand,critically discussing one key issue for each complication. | Rares Craciun Tudor Mocan Bogdan Procopet Andrada Nemes Cristian Tefas Mihaela Sparchez Lavinia-Patricia Mocan Zeno Sparchez | 2022 | World Journal of Clinical Cases2022，10，17： | 0 |
| 6 | Hepatocellular carcinoma extracellular vesicle ECG score as a diagnostic tool close to the ideal显示文摘Introduction In recent decades,numerous indicators for early detection and monitoring of hepatocellular carcinoma(HCC)have been suggested and published in reputable journals.These markers have gained recognition and endorsement from prominent international associations such as the European Association for the Study of the Liver(EASL),the Asian Pacific Association for the Study of the Liver(APASL),as well as national professional organizations like the American Association for the Study of Liver Diseases(AASLD),among others. | Artur Słomka Tudor Mocan Arnulf G.Willms Veronika Lukacs-Kornek Miroslaw T.Kornek | 2023 | Hepatobiliary Surgery and Nutrition2023，12，6： | 0 |
| 7 | Contemporary role of liver biopsy in hepatocellular carcinoma显示文摘A correct diagnosis of hepatocellular carcinoma(HCC) in cirrhotic patients with focal liver lesions is one of the most important issues nowadays. Probably one of the oldest debates in the hepatology community is whether to perform liver biopsy(LB) in all cirrhotic patients with focal liver lesions. We now face a time when oncology is moving towards personalized medicine. According to the current European Association for the study of Liver diseases HCC guidelines, LB has only a minor role in the management of HCC. However, the current recommendations were made more than five years ago. As time has passed, the development of high-throughput molecular technologies has helped reveal the main molecular mechanism involved in HCC development and progression. Several subtypes of HCC, with both molecular and histological characterization, have been described. Importantly, some of these subtypes have prognostic impact. In the context of personalized treatment, the role of LB will be carefully reconsidered. Until then, it is mandatory to know the various techniques of LB, their performances, complications and limitations. The balance of risk and benefit defines many of the decisions that we make as providers of medical care. In this review, we discuss not only the risks associated with LB, but also the benefits of biopsy in various clinical scenarios. Not long from now, the role of LB will be reconsidered. It is possible that we will go back in time and once again use biopsy for HCC diagnosis. Then again, we may move back to the future to try to improve the use of liquid biopsy in the follow-up of HCC patients after various treatment modalities. | Zeno Sparchez Tudor Mocan | 2018 | World Journal of Hepatology2018，10，7： | 0 |
| 8 | Extracellular vesicles small RNA clusters:hit the nail on the head of liver cancer detection显示文摘There is a very urgent need and clinical demand of robust biomarkers in cancer screening,especially in early hepatocellular carcinoma(HCC)surveillance as outlined by various professional international associations as the European Association for the study of the Liver(EASL),or the Asian Pacific Association for the Study of the Liver(APASL)and national professional organisations as the American Association for the Study of Liver Diseases(AASLD),besides others.Newest data on primarily HCC is still depicting this cancer entity as the sixth most frequently diagnosed cancer,with over 900,000 new cases and over 830,000 deaths worldwide(1).This type of cancer,therefore,remains at the forefront of malignant diseases.Thus,every element of patient management,including early diagnosis and prognosis of treatment response and survival,is a challenge. | Artur Słomka Bingduo Wang Tudor Mocan Maria González-Carmona Christian P.Strassburg Veronika Lukacs-Kornek Miroslaw T.Kornek | 2022 | Hepatobiliary Surgery and Nutrition2022，11，1： | 0 |
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