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Endoscopic management of difficult common bile duct stones:Where are we now?A comprehensive review

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World Journal of Gastroenterology 2021年第44期27卷 7597-7611页

作者： alberto tringali Deborah Costa Alessandro Fugazza Matteo Colombo Kareem Khalaf Alessandro Repici Andrea Anderloni Gastroenterology and Endoscopy Unit Department of MedicineConegliano HospitalULSS 2 Marca TrevigianaConegliano 31015Italy Digestive Endoscopy Unit Department of GastroenterologyHumanitas Research Hospital IRCCSRozzano 20089MilanItaly Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20072MilanItaly

Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone *** recent years,variable methods have emerged that have attributed to higher stone removal success rates,reduced cost and lower adverse *** this review,we outline a stepwise approach in CBD stone *** first line therapy,endoscopic sphincterotomy and large balloon dilation are recommended,due to a 30%-50%reduction of the use of mechanical *** the other hand,cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale *** discussed,findings suggest that management needs to be tailored to the patient’s characteristics and anatomical ***,we evaluate the management of CBD stones in various surgical altered anatomy(Billroth II,Roux-en-Y and Roux-en-Y gastric bypass).Moreover,we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use,rather than following a failed management *** addition,we discuss the importance of dissecting other techniques,such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have *** conclusion,we recognize that endoscopic sphincterotomy and large balloon dilation,mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones,but emerging techniques are in rapid evolution with encouraging results.

关键词： Common bile duct stones Balloon dilation Endoscopic retrograde cholangiopancreatography Endoscopic ultrasonography Anastomoses,Roux en y Double balloon enteroscopy Mechanical lithotripsy Cholangioscopy

Endoscopic multiple metal stenting for the treatment of enteral leaks near the biliary orifice: A novel effective rescue procedure

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World Journal of Gastrointestinal Endoscopy 2016年第15期8卷 533-540页

作者： Massimiliano Mutignani Lorenzo Dioscoridi Stefanos Dokas Paolo Aseni Pietro Carnevali Edoardo Forti Raffaele Manta Mariano Sica alberto tringali Francesco Pugliese Digestive and Interventional Endoscopy Unit Ospedale Ca’Granda Niguarda Endoscopy Department St Lukes Hospital Emergency Department Ospedale Ca’Granda Niguarda General Oncology and Mini-Invasive Surgical Unit Ospedale Ca’ Granda Niguarda

Between April 2013 and October 2015, 6 patients developed periampul ary duodenal or jejunal/biliary leaks after major abdominal surgery. In all patients, percutaneous drainage of the collection or re-operation with primary surgical repair was attempted at first but failed. A fully covered enteral metal stent was placed in all patients to seal the leak. Subsequently, we cannulated the common bile duct and, in some cases, and the main pancreatic duct inserting hydrophilic guidewires through the stent after dilating the stent mesh with a dilatation balloon or breaking the meshes with Argon Plasma Beam. Finally, we inserted a fully covered biliary metal stent to drain the bile into the lumen of the enteral stent. In cases of normal proximal upper gastrointestinal anatomy, a pancreatic plastic stent was also inserted. Oral food intake was initiated when the abdominal drain outflow stopped completely. Stent removal was scheduled four to eight weeks later after a CT scan to confirm the complete healing of the fistula and the absence of any perilesional residual fluid collection. The leak resolved in five patients. One patient died two days after the procedure due to severe, pre-existing, sepsis. The stents were removed endoscopically in four weeks in four patients. In one patient we experiencedstent migration causing small bowel obstruction. In this case, the stents were removed surgically. Four patients are still alive today. They are still under follow-up and doing well. Bilio-enteral fully covered metal stenting with or without pancreatic stenting was feasible, safe and effective in treating postoperative enteral leaks near the biliopancreatic orifice in our small series. This minimally invasive procedure can be implemented in selected patients as a rescue procedure to repair these challenging leaks.

关键词： Endoscopic retrograde pancreatic duct Fully covered metal stent Duodenal leak Postoperative complications Enteral leak Enteral stent Biliary stent Pancreatic stent

ERPETOFAUNA E TERIOFAUNA DELL'AREA SABINA MERIDIONALE E DEL TERRITORIO CICOLANO(Lazio,Italia Centrale)

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Natural Disaster Reduction in China 1988年第1期 231-254页

作者： PIERANGELO CRUCITTI MARCELLO MALORI GIOVANNI ROTELLA LUCA tringali e alberto VIRDIA Società Romana di Scienze Naturali S.R.S.N.

*** and Mammals of Sabini Mts. and Cicolano districts, Latium. Central *** a brief introduction to the main geological, climatological and botanical features of the area-a territoryof Latium region, Central Italy-the work synthetized data about its vertebrate fauna with exclusive regard toAmphibians, Reptiles and Mammals. In this list 46 species and subspecies are considered of which 8 are Amp-hibians,11 Reptiles and 27 Mammals. Ecological analysis has focused the attenction on the absence or scarcityof many thermophilous species, a fact which finds explanation, according to the Authors, in the"continental"position of the district. Among the species, many are rare or localized and some considerations are carried outin order to their management and protection.

关键词： Pi IV Lazio,Italia Centrale ERPETOFAUNA E TERIOFAUNA DELL’AREA SABINA MERIDIONALE E DEL TERRITORIO CICOLANO OC

Achieving control of resistant hypertension:Not just the number of blood pressure medications

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World Journal of Hypertension 2019年第1期9卷 1-16页

作者： Kara Schmidt William Kelley Steven tringali Jian Huang Department of Internal Medicine University of California San Francisco-Fresno Medical Education Program Medicine Service VA Central California Health Care System

Resistant hypertension(RH) has a prevalence of around 12% and is associated with an increased risk of cardiovascular disease, progression to end-stage renal disease, and even mortality. In 2017, the American College of Cardiology and American Heart Association released updated guidelines that detail steps to ensure proper diagnosis of RH, including the exclusion of *** modifications, such as low salt diet and physical exercise, remain at the forefront of optimizing blood pressure control. Secondary causes of RH also need to be investigated, including screening for obstructive sleep apnea. Notably, the guidelines demonstrate a major change in medication management recommendations to include mineralocorticoid receptor antagonists. In addition to advances in medication optimization, there are several device-based therapies that have been showing efficacy in the treatment of RH. Renal denervation therapy has struggled to show efficacy for blood pressure control, but with a redesigned catheter device, it is once again being tested in clinical trials. Carotid baroreceptor activation therapy(BAT) via an implantable pulse generator has been shown to be effective in lowering blood pressure both acutely and in longterm follow up data, but there is some concern about the safety profile. Both a second-generation pulse generator and an endovascular implant are being tested in new clinical trials with hopes for improved safety profiles while maintaining therapeutic efficacy. Both renal denervation and carotid BAT need continued study before widespread clinical implementation. Central arteriovenous anastomosis has emerged as another possible therapy and is being actively explored. The ongoing pursuit of blood pressure control is a vital part of minimizing adverse patient outcomes. The future landscape appears hopeful for helping patients achieve blood pressure goals not only through the optimization of antihypertensive medications but also through device-bas

关键词： Resistant hypertension Pseudoresistance Mineralocorticoid receptor antagonists Device-based hypertension treatment Renal denervation Carotid baroreceptor activation therapy Central arteriovenous anastomosis

Pediatric T-tube in adult liver transplantation:Technical refinements of insertion and removal

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1628-1637页

作者： Gabriele Spoletini Giuseppe Bianco Antonio Franco Francesco Frongillo Erida Nure Francesco Giovinazzo Federica Galiandro Andrea tringali Vincenzo Perri Guido Costamagna Alfonso Wolfango Avolio Salvatore Agnes General Surgery and Liver Transplantation Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy

BACKGROUND With the increasing use of extended-criteria donor organs,the interest around Ttubes in liver transplantation(LT)was restored whilst concerns regarding T-tuberelated complications *** To describe insertion and removal protocols implemented at our institution to safely use pediatric rubber 5-French T-tubes and subsequent outcomes in a consecutive series of adult *** Data of consecutive adult LT patients from brain-dead donors,treated from March 2017 to December 2019,were collected(i.e.,biliary complications,adverse events,treatment after T-Tube removal).Patients with upfront hepaticojejunostomy,endoscopically removed T-tubes,those who died or received retransplantation before T-tube removal were *** Seventy-two patients were included in this study;T-tubes were removed 158 d(median;IQR 128-206 d)after *** four(5.6%)patients accidental T-tube removal occurred requiring monitoring only;in 68(94.4%)patients Nelaton drain insertion was performed according to our protocol,resulting in 18(25%)patients with a biliary output,subsequently removed after 2 d(median;IQR 1-4 d).Three(4%)patients required endoscopic retrograde cholangiopancreatography(ERCP)due to persistent Nelaton drain ***(4%)patients developed suspected biliary peritonitis,requiring ERCP with sphincterotomy and nasobiliary drain insertion(only one revealing contrast extravasation);no patient required percutaneous drainage or emergency *** The use of pediatric rubber 5-French T-tubes in LT proved safe in our series after insertion and removal procedure refinements.

关键词： Liver transplantation T-tube Kehr Biliary fistula Endoscopic retrograde cholangio-pancreatography Biliary drainage

5-HTr Expression in Primary Trigeminal Neuron Following Injury

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Journal of Behavioral and Brain Science 2012年第4期2卷 427-435页

作者： Ombretta Mameli Antonella Russo Stefania Stanzani Giovanni tringali Elio Insirello Marcello Alessandro Caria Pier Luigi De Riu Department of Clinical and Experimental Medicine Human Physiology Division University of Sassari Sassari Italy Department of Physiological Sciences University of Catania Catania Italy Istituto di Ricerca Medica e Ambientale Catania Italy

Trigeminal ganglia neurons significantly affect the amplitude and type of 5-HT receptor gene expression following activation of their axon terminals and sensitisation by painful stimuli. Moreover, these neurons significantly alter gene expression in cytoskeletal proteins following injury. The aim of the present study was to determine whether peripheral and/or central deafferenting lesions affect gene expression in serotonergic receptors that are involved in pain transmission. Adult rats were subjected to unilateral ablation of the facial sensory and motor cortices. Fifteen days after the surgery, degeneration of the cortico-trigeminal pathway was observed. Presynaptic deafferentation of the primary trigeminal neurons and central afferents of the contralateral ganglia was conducted. As a consequence of the excision of the meninges covering the ablated cortices, the peripheral axotomy of the trigeminal-vascular primary neurons of the ipsi-lateral side was induced. Serotonergic receptor (5-HT5A/5B/1B/1D/1F) gene expression was analysed in both sides of the trigeminal ganglia neurons. The results of the present study showed a significant increase in 5-HT5A/5B/1B/1D receptor gene expression in the primary sensory neurons of both ganglia, with the highest levels of expression noted in the ganglia contralateral to the lesion. 5-HT1F receptor expression, however, was more strongly expressed in the ganglia ipsilateral to the lesion. Our results also confirm that the adaptive response of primary trigeminal neurons to injury involves anatomical remodelling, as well as changes in receptor gene expression involved in sensory transmission. This may explain the distortion of sensory signals observed in trigeminal neuropathic states, and may lead to the development of novel pharmacological interventions.

关键词： Sensory Neurons Plasticity Trigeminal Ganglia Neurons Axotomy Pre-Synaptic Deafferentation 5-HT Receptors

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5TH CELL的《描绘生命》

程序员（游戏创造） 2008年第5期 44-49页

作者： Joseph M. tringali 韦欢不详北方工业大学

我们在2003年成立了5TH Cell公司，目标是开发优质的原创游戏。开始时一帆风顺，尽管公司当时没有办公室也没有正式的员工，但是有3个手机游戏概念（当时手机游戏市场正在蓬勃兴起）：只要能够创作出手机游戏就不愁发行方面的问题，因... 详细信息

我们在2003年成立了5TH Cell公司，目标是开发优质的原创游戏。开始时一帆风顺，尽管公司当时没有办公室也没有正式的员工，但是有3个手机游戏概念（当时手机游戏市场正在蓬勃兴起）：只要能够创作出手机游戏就不愁发行方面的问题，因此公司很容易就得到了开发第一款授权游戏的机会。这在当时是进入游戏圈的必经之路，但这一步也使我们偏离了最初的理想轨道。我们租了一间办公室并雇佣了几名员工，

关键词： CELL 手机游戏生命描绘 Cell 一帆风顺游戏市场办公室

Effects of cigarette smoking on the evolution of hearing loss caused by industrial noise

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Health 2010年第10期2卷 1163-1169页

作者： Abbate Carmelo Giorgianni Concetto Zirilli Agata tringali Maria Antonietta D’Arrigo Graziella Brecciaroli Renato Abbate Adriana Salmaso Luigi 不详

The few studies evaluating the changes caused by cigarette smoking on hearing loss induced by occupational exposure to noise have reached discordant conclusions. The aim of this study is to investigate the interactions between cigarette smoking and occupational exposure to noise as risk factors in the onset and development of hearing loss. The study was performed on a sample of 557 shipyard workers exposed to noise at an Equivalent Level (Leq) of 93 dBA. On the basis of their smoking habits, they were divided into three groups: group (A), non-smokers;group (B), smokers (15-30 cigarettes per day);and group (C), heavy smokers (over 30 cigarettes per day). The study focussed on the audiometric responses of the subjects at the frequencies of 500, 1000, 2000, 3000 and 4000 Hz. The results were then compared using statistical techniquees (Internal correlation coefficient, exponential model, ANCOVA, NPC test). Comparison of the audiometric responses showed statistically significant differences between the three groups. Non-parametric analysis, performed using the NPC test, highlighted that the interaction between smoking and exposure to noise has an influence on hearing loss at all frequencies, and particularly at high frequencies (3000-4000 Hz). The data obtained from the examined sample show that smoking and exposure to noise cause an increase in occupational hearing loss and that this is directly related to the number of cigarettes smoked.

关键词： Smoking Hearing Loss Noise Audiometric Test Non Parametric Test

Safety and feasibility of thullium laser transurethral resection of prostate for the treatment of benign prostatic enlargement in overweight patients

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Asian Journal of Urology 2019年第3期6卷 270-274页

作者： Luca Carmignani Maria Chiara Clementi Claudia Signorini Gloria Motta Sebastiano Nazzani Franco Palmisano Elisa De Lorenzis Michele Catellani Alessandro Francesco Mistretta Andrea Conti Valeria tringali Maria Beatrice Costa Damiano Vizziello Policlinico San Donato UrologySan DonatoMilaneseItaly Ospedale Maggiore Policlinico UrologyMilanItaly Istituto Europeo di Oncologia UrologyMilanItaly Ospedale San Giuseppe UrologyMilanItaly

Objective:We aimed to determine safety and feasibility of thulium laser transurethral vapoenucleation of prostate(ThuVEP)for treatment of obese patients affected by benign prostatic hyperplasia(BPH).Methods:We retrospectively analysed data of 452 patients with BPH who underwent ThuVEP from February 2012 to March 2016 in a single *** were divided into three groups according to body mass index(BMI,kg/m^2):Normal weight(18.5≤BMI0.05).There was no statistically significant difference among three groups as for hospital stay and days of catheterization(p>0.05).Conclusion:Our results showed that ThuVEP was safe and feasible even in overweight patients with substantially enlarged prostate.

关键词： Laser Thulium Prostate Overweight