Springer Science and Business Media LLC

The exact sequence of events leading to ultimate hepatocellular damage following ischemia/reperfusion (I/R) is incompletely understood. In this article, we review a mechanism of organ dysfunction after hepatic I/R or immunosuppressive treatment, in addition to the potential of liver sinusoidal endothelial cell (LSEC) protection and antiplatelet treatment for the suppression of hepatocellular damage.

A review of the literature, utilizing PubMed-NCBI, was used to provide information on the components necessary for the development of hepatocellular damage following I/R.

It is well-established that LSECs damage following hepatic I/R or immunosuppressive treatment followed by extravasated platelet aggregation (EPA) is the root cause of organ dysfunction in liver transplantation. We have classified three phases, from LSECs damage to organ dysfunction, utilizing the predicted pathogenic mechanism of sinusoidal obstruction syndrome. The first phase is detachment of LSECs and sinusoidal wall destruction after LSECs injury by hepatic I/R or immunosuppressive treatment. The second phase is EPA, accomplished by sinusoidal wall destruction. The various growth factors, including thromboxane A2, serotonin, transforming growth factor-beta and plasminogen activator inhibitor-1, released by EPA in the Disse’s space of zone three, induce portal hypertension and the progression of hepatic fibrosis. The third phase is organ dysfunction following portal hypertension, hepatic fibrosis, and suppressed liver regeneration through various growth factors secreted by EPA.

We suggest that EPA in the space of Disse, initiated by LSECs damage due to hepatic I/R or immunosuppressive treatment, and activated platelets may primarily contribute to liver damage in liver transplantation. Endothelial protective therapy or antiplatelet treatment may be useful in the treatment of hepatic I/R following EPA.

The use of technology in surgical education has rapidly evolved. Blended learning refers to provision of online instruction platforms by international technology companies, prompting a combination of face-to-face teaching with computer-mediated tuition. This nonsystematic literature review focuses on online teaching platforms with applications for potential use in future surgical education. A literature search was performed using PubMed, Embase, OVID, and Google Scholar. To identify studies on online platforms in surgical education, the following search terms were used: “online platform,” “online learning,” “surgical education and online learning,” and “surgical education and blended learning.” The search was limited to citations in English from 1998 to 2018. The first author performed the detailed literature search. The final list of the articles was included by consensus between authors. Search items were studied from the nature of the articles, country of origin, date of publication, and aims and findings in relation to use of online platforms surgical education. Altogether 279 relevant citations were reviewed, of which 22 articles met the inclusion criteria: 19 papers (ten original research, two review items, seven Internet articles) and three books were found to be relevant for this study. Their analysis comprised models of platforms along with their applications in surgical education. Data on the advantages and disadvantages of online platforms as well as authors’ personal experience of this instruction manner in surgical education were extracted. Problems with determining, analyzing, and integrating reading matters in a nonsystematic literature review comprising different teaching methods combined with the use of online platforms in surgical education were discussed and resolved. Online platforms were introduced by international technology companies to encourage paperless blended learning in schools. We envisaged the use of online classrooms in surgical education because of its simple format, easy access, low costs, and interaction-inspiring nature between teachers and students in professional surgical education.