Dose and Duration of Aspirin Use to Reduce Incident Hepatocellular Carcinoma.
Dose and Duration of Aspirin Use to Reduce Incident Hepatocellular Carcinoma.
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使用阿司匹林的剂量和持续时间可减少肝细胞癌的发生。
DOI：
10.1002/hep.30813
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Hoshida,Yujin
中科院分区：
文献类型：
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作者：
Fujiwara,Naoto;Singal,AmitG;Hoshida,Yujin
我们怀着极大的兴趣阅读了贾西姆等人的论文，(1)其提供了与常规冷藏相比，在常温机器灌注（NMP）期间人肝脏的详细基因表达谱。作者应该祝贺这一广泛的分析，这是第一次显示在任何形式的再灌注在常温条件下的转录变化。(1)然而，我们要补充几点批评意见。作者分析了冷藏或NMP结束时以及移植物植入后的肝脏样本。首先，尽管NMP过程中基因改变的变化肯定是相关的，但我们要提到的是，NMP组中的所有肝脏在第一次活检之前在装置上经历了长时间的常温再灌注，第一次活检是在肝细胞与完全含氧血液相当大的接触之后获得的。另一次活检，例如，在NMP开始后1小时，对于证实NMP实际上积极导致炎症途径下调的假设是重要的（图1）。重要的是，对于肾脏，肺，心脏和肝脏，目前的研究表明相反。（2，3）第二，NMP和冷藏的适当比较需要在相似的常温再灌注持续时间后，在NMP装置上或在原位冷藏肝脏再灌注后，评估再灌注损伤。（1）（图1）预期，NMP和冷藏之间的基因表达谱似乎非常不同，并且与移植后的亚常温灌注肝脏的先前评估平行。(4)第三，结果暗示冷缺血后NMP触发较差的结果。（1，3）Consideration，沃森等人已经证明，当在具有累积高风险的肝脏中显著冷藏后进行NMP时，存在明显的炎症反应。(5)它
We read with great interest the paper by Jassem et al.,(1) which provides detailed gene expression profiles of human livers during normothermic machine perfusion (NMP), compared with conventional cold storage. The authors should be congratulated on this extensive analysis, which shows for the first time transcriptional changes during any form of reperfusion under normothermic conditions.(1) However, we would like to add a few critical comments. The authors analyzed liver samples at the end of cold storage or NMP, and after graft implantation. First, although changes in gene alteration during NMP are certainly relevant, we would like to mention that all livers in the NMP group underwent prolonged normothermic reperfusion on the device before the first biopsy, obtained after a considerable contact of liver cells with fully oxygenated blood.Another biopsy, for example, 1 hour after the start of NMP, would be important to confirm the hypothesis that NMP is in fact actively leading to downregulation of inflammatory pathways (Fig. 1). Importantly, for kidneys, lungs, hearts, and livers, current research has shown the opposite.(2, 3) Second, proper comparisons of NMP and cold storage require assessment of reperfusion injury after a similar duration of normothermic reperfusion, either on the NMP device or after reperfusion of cold stored livers in situ.(1)(Fig. 1) Expectedly, gene expression profiles between NMP and cold storage appear very different, and parallel previous assessments after transplantation of subnormothermically perfused livers.(4) Third, the results imply that NMP after cold ischemia triggers inferior outcome.(1, 3) Consistently, Watson et al. have demonstrated a clear inflammatory response when NMP was performed after significant cold storage in livers with a cumulative high risk.(5) It