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Non-anatomical liver resection for hepatocellular carcinoma:the SegSubTe classification to overcome the problem of heterogeneity

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Hepatobiliary & Pancreatic Diseases International 2024年第3期23卷 265-271页

作者： Mattia Garancini alessandro Fogliati Mauro alessandro Scotti Cristina Ciulli Francesca Carissimi Antonio Rovere Luca Gianotti Fabrizio romano Unit of Hepatobiliopancreatic Surgery Department of SurgeryASST-MonzaSan Gerardo HospitalUniversity of Milano-Bicoccavia Pergolesi 33MonzaMB 20052Italy Interventional Radiology Department of RadiologyASST-MonzaSan Gerardo HospitalMilano-Bicocca Universityvia Pergolesi 33MonzaMB 20052Italy

Background:The superiority of anatomical resection(AR)vs.non-anatomical resection(NAR)in the surgical management of hepatocellular carcinoma(HCC)is debated.ARs are well-defined procedures,whereas the lack of NAR standardization results in heterogeneous outcomes.This study aimed to introduce the SegSubTe classification for NAR detailing the appropriateness of the level of surgical section of the Glissonean pedicles feeding the tumor.Methods:A single-center retrospective analysis of pre-and postoperative imaging of consecutive patients treated with NAR for single HCC between 2012 and 2020 was conducted.The quality of surgery was assessed classifying the type of vascular supply and the level of surgical section(segmental,subsegmental or terminal next to the tumor)of vascular pedicles feeding the HCCs;then,the population was divided in“SegSubTe-IN”or“SegSubTe-OUT”groups,and the tumor recurrence and survival were analyzed.Results:Ninety-seven patients who underwent NAR were included;76%were SegSubTe-IN and 24%were SegSubTe-OUT.Total disease recurrence,local recurrence and cut-edge recurrence in the SegSubTe-IN vs.SegSubTe-OUT groups were 50%vs.83%(P=0.006),20%vs.52%(P=0.003)and 16%vs.39%(P=0.020),respectively.SegSubTe-OUT odds ratio for local recurrence was 4.1 at univariate regression analysis.One-,three-,and five-year disease-free survival rates in the SegSubTe-IN vs.SegSubTe-OUT groups were 81%,58%and 35%vs.46%,21%and 11%,respectively(P<0.001).Conclusions:The SegSubTe classification is a useful tool to stratify and standardize NAR for HCC,aiming at improving long-term oncological outcomes and reducing the heterogeneity of quality of NAR for HCC.

关键词： Hepatocellular carcinoma Intraoperative ultrasound Liver surgery Computed tomography Surgical procedure

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Human bocavirus: Current knowledge and future challenges

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World Journal of Gastroenterology 2016年第39期22卷 8684-8697页

作者： Marcello Guido Maria Rosaria Tumolo Tiziano Verri alessandro romano Francesca Serio Mattia De Giorgi Antonella De Donno Francesco Bagordo Antonella Zizza Laboratory of Hygiene Department of Biological and Environmental Sciences and Technologies Faculty of Sciences University of Salento Institute of Clinical Physiology National Research Council Laboratory of Physiology Department of Biological and Environmental Sciences and Technologies University of Salento Neuropathology Unit Institute of Experimental Neurology and Division of Neuroscience IRCCS San Raffaele Scientific Institute

Human bocavirus(HBoV) is a parvovirus isolated about a decade ago and found worldwide in both respiratory samples, mainly from early life and children of 6-24 mo of age with acute respiratory infection, and in stool samples, from patients with gastroenteritis. Since then, other viruses related to the first HBoV isolate(HBoV 1), namely HBoV 2, HBoV 3 and HBoV 4, have been detected principally in human faeces. HBo Vs are small nonenveloped single-stranded DNA viruses of about 5300 nucleotides, consisting of three open reading frames encoding the first two the non-structural protein 1(NS1) and nuclear phosphoprotein(NP1) and the third the viral capsid proteins 1 and 2(VP1 and VP2). HBoV pathogenicity remains to be fully clarified mainly due to the lack of animal models for the difficulties in replicating the virus in in vitro cell cultures, and the fact that HBo V infection is frequently accompanied by at least another viral and/or bacterial respiratory and/or gastroenteric pathogen infection. Current diagnostic methods to support HBoV detection include polymerase chain reaction, real-time PCR, enzymelinked immunosorbent assay and enzyme immunoassay using recombinant VP2 or virus-like particle capsid proteins, although sequence-independent amplification techniques combined with next-generation sequencing platforms promise rapid and simultaneous detection of the pathogens in the future. This review presents the current knowledge on HBoV genotypes with emphasis on taxonomy, phylogenetic relationship and genomic analysis, biology, epidemiology, pathogenesis and diagnostic methods. The emerging discussion on HBoV s as true pathogen or innocent bystander is also emphasized.

关键词：人的 bocavirus 呼吸病毒分子的测试胃肠的病毒致病传染病学免疫分析方法

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Branching patterns of the left portal vein and consequent implications in liver surgery:The left anterior sector

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Hepatobiliary & Pancreatic Diseases International 2022年第4期21卷 399-402页

作者： Mattia Garancini Mauro alessandro Scotti Luca Gianotti Antonio Rovere Fabio Uggeri Marco Braga Fabrizio romano Unit of Hepatobiliary Pancreatic Surgery Department of General Surgery 1ASST-MonzaSan Gerardo HospitalMilano-Bicocca Universityvia Pergolesi 3320900 MonzaMBItaly Unit of Interventional Radiology Department of RadiologyASST-MonzaSan Gerardo HospitalMilano-Bicocca Universityvia Pergolesi 3320900 MonzaMBItaly

To the Editor: There are still some open issues about the systematization of the knowledge of the branching of the left portal vein(LPV) and the division in anatomo-functional units within the left liver. The first controversial topic concerns the division of S4 in subsegments. The Brisbane 20 0 0 system of Nomenclature of Hepatic Anatomy and Resections(B20 0 0) [1] does not mention such subdivision, but in literature this is still a matter of discussion.

关键词： branching portal discussion

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Massive bleeding from gastric submucosal arterial collaterals secondary to splenic artery thrombosis: A case report

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World Journal of Gastroenterology 2022年第37期28卷 5506-5514页

作者： Alberto Martino Marco Di Serafino Francesco Paolo Zito Franco Maglione Raffaele Bennato Luigi Orsini alessandro Iacobelli Raffaella Niola Luigia romano Giovanni Lombardi Department of Gastroenterology and Digestive Endoscopy AORN“Antonio Cardarelli”Napoli 80131Italy Department of General and Emergency Radiology AORN“Antonio Cardarelli”Napoli 80131Italy Department of Radiology Sanatrix ClinicNapoli 80127Italy Department of Pathology AORN“Antonio Cardarelli”Napoli 80131Italy Department of Interventional Radiology AORN“Antonio Cardarelli”Napoli 80131Italy

BACKGROUND Gastric submucosal arterial collaterals(GSAC)secondary to splenic artery occlusion is an extraordinary rare and potentially life-threatening cause of acute upper gastrointestinal bleeding.Here,we report a case of massive bleeding from GSAC successfully treated by means of a multidisciplinary minimally invasive approach.CASE SUMMARY A 60-year-old non-cirrhotic gentleman with a history of arterial hypertension was admitted due to hematemesis.Emergent esophagogastroduodenoscopy revealed pulsating and tortuous varicose shaped submucosal vessels in the gastric fundus along with a small erosion overlying one of the vessels.In order to characterize the fundic lesion,pre-operative emergent computed tomography-angiography was performed showing splenic artery thrombosis(SAT)and tortuous arterial structures arising from the left gastric artery and the left gastroepiploic artery in the gastric fundus.GSAC was successfully treated by means of a minimally invasive step-up approach consisting in endoscopic clipping followed by transcatheter arterial embolization(TAE).CONCLUSION This was a previously unreported case of bleeding GSAC secondary to SAT successfully managed by means of a multidisciplinary minimally invasive approach consisting in endoscopic clipping for the luminal bleeding control followed by elective TAE for the definitive treatment.

关键词： Upper gastrointestinal bleeding Non variceal upper gastrointestinal bleeding Acute upper gastrointestinal bleeding Gastric submucosal arterial collaterals Splenic artery thrombosis Case report

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Hericium erinaceus,a medicinal fungus with a centuries-old history:Evidence in gastrointestinal diseases

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World Journal of Gastroenterology 2023年第20期29卷 3048-3065页

作者： Antonietta Gerarda Gravina Raffaele Pellegrino Salvatore Auletta Giovanna Palladino Giovanni Brandimarte Rossella D'Onofrio Giusi Arboretto Giuseppe Imperio Andrea Ventura Marina Cipullo Marco romano alessandro Federico Department of Precision Medicine University of Campania“Luigi Vanvitelli”Naples 80138Italy Division of Internal Medicine and Gastroenterology Cristo Re HospitalRome 00167Italy

Hericium erinaceus is an edible and medicinal mushroom commonly used in traditional Chinese medicine for centuries.Several studies have highlighted its therapeutic potential for gastrointestinal disorders such as gastritis and inflammatory bowel diseases.In addition,some components of this mushroom appear to possess strong antineoplastic capabilities against gastric and colorectal cancer.This review aims to analyse all available evidence on the digestive therapeutic potential of this fungus as well as the possible underlying molecular mechanisms.

关键词： Hericium erinaceus Fungus Gastritis Inflammatory bowel diseases Gastric cancer Colorectal cancer

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Fat:A matter of disturbance for the immune system

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World Journal of Gastroenterology 2010年第38期16卷 476-4772页

作者： alessandro Federico Elena D’Aiuto Francesco Borriello Giusi Barra Antonietta Gerarda Gravina Marco romano Raffaele De Palma Section of Gastroenterology Department of Clinical and Experimental MedicineSecond University of Naples Section of Clinical Immunology Department of Clinical and Experimental Medicine Second University of Naples

Obesity is increasingly being recognized as a risk factor for a number of benign and malignant gastrointestinal conditions. However, literature on the underlying pathophysiological mechanisms is sparse and ambiguous. There is compelling evidence that both overnutrition and undernutrition negatively interfere with the immune system. Overnutrition has been found to increase susceptibility to the development of inflammatory diseases, autoimmune diseases and cancer. In the regulation of immune and in? ammatory processes, white adipose tissue plays a critical role, not only as an energy store but also as an important endocrine organ. The obese state is characterised by a low-grade systemic in? ammation, mainly as a result of increased adipocytes as well as fat resident-and recruited-macrophage activity. In the past few years, various products of adipose tissue including adipokines and cytokines have been characterised and a number of pathways linking adipose tissue metabolism with the immune system have been identified. Activation of the innate immune system plays a major role in hepatic steatosis. Non-alcoholic fatty liver disease includes a wide spectrum of diseases, from pure steatosis to non-alcoholic steato-hepatitis in the absence of signif icant alcohol consumption. Although steatosis is considered a non-progressive disease, non-alcoholic steatohepatitis may deteriorate in advanced chronic liver diseases, cirrhosis, and hepatocellular carcinoma. An important parallel between obesityrelated pathology of adipose tissue and liver pertains to the emerging role of macrophages, and growing evidence suggests that Kupffer cells critically contribute to progression of non-alcoholic fatty liver disease. Moreover, a close link between specif ic immune activation and atherosclerosis has been well established, suggesting that fat can directly trigger immune responses. This review discusses the role of fat as "a matter of disturbance for the immune system" with a focus on hepatic steatosis.

关键词： Adipocytokine Adipose tissue Fat Immune system Kupffer cell Natural killer Steatosis

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Atypical antipsychotics and oxidative cardiotoxicity:review of literature and future perspectives to prevent sudden cardiac death

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Journal of Geriatric Cardiology 2021年第8期18卷 663-685页

作者： Stefano D’Errico Raffaele La Russa Aniello Maiese alessandro Santurro Matteo Scopetti Silvia romano Martina Zanon Paola Frati Vittorio Fineschi Department of Medical Surgical and Health SciencesUniversity of TriesteTriesteItaly Department of Clinical and Experimental Medicine University of FoggiaFoggiaItaly IRCSS Neuromed Mediterranean Neurological Institute PozzilliItaly Department of Surgical Pathology MedicalMolecular and Critical AreaUniversity of PisaPisaItaly Department of Anatomical HistologicalForensic and Orthopaedic SciencesSapienza University of RomeRomeItaly

Oxidative stress is considered the principal mediator of myocardial injury under pathological conditions.It is well known that reactive oxygen(ROS)or nitrogen species(RNS)are involved in myocardial injury and repair at the same time and that cellular damage is generally due to an unbalance between generation and elimination of the free radicals due to an inad-equate mechanism of antioxidant defense or to an increase in ROS and RNS.Major adverse cardiovascular events are often asso-ciated with drugs with associated findings such as fibrosis or inflammation of the myocardium.Despite efforts in the preclinical phase of the development of drugs,cardiotoxicity still remains a great concern.Cardiac toxicity due to second-generation anti-psychotics(clozapine,olanzapine,quetiapine)has been observed in preclinical studies and described in patients affected with mental disorders.A role of oxidative stress has been hypothesized but more evidence is needed to confirm a causal relationship.A better knowledge of cardiotoxicity mechanisms should address in the future to establish the right dose and length of treatment without impacting the physical health of the patients.

关键词： drugs inflammation oxidative

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Quality of bowel preparation in patients with inflammatory bowel disease undergoing colonoscopy:What factors to consider?

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World Journal of Gastrointestinal Endoscopy 2023年第3期15卷 133-145页

作者： Antonietta Gerarda Gravina Raffaele Pellegrino Mario Romeo Giovanna Palladino Marina Cipullo Giorgia Iadanza Simone Olivieri Giuseppe Zagaria Nicola De Gennaro Antonio Santonastaso Marco romano alessandro Federico Department of Precision Medicine University of Campania"Luigi Vanvitelli"Naples 80138Italy

An adequate bowel preparation in patients with inflammatory bowel disease(IBD)is a prerequisite for successful colonoscopy for screening,diagnosis,and surveillance.Several bowel preparation formulations are available,both high-and low-volume based on polyethylene glycol.Generally,low-volume formulations are also based on several compounds such as magnesium citrate preparations with sodium picosulphate,oral sulphate solution,and oral sodium phosphatebased solutions.Targeted studies on the quality of bowel preparation prior to colonoscopy in the IBD population are still required,with current evidence from existing studies being inconclusive.New frontiers are also moving towards the use of alternatives to anterograde ones,using preparations based on retrograde colonic lavage.

关键词： Bowel preparation Colonoscopy Inflammatory bowel disease Crohn’s disease Ulcerative colitis Artificial intelligence

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Duodenal duplication cyst causing severe pancreatitis:Imaging findings and pathological correlation

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World Journal of Gastroenterology 2006年第10期12卷 1630-1633页

作者： alessandro Guarise Niccolo' Faccioli Mauro Ferrari Luigi romano Alice Parisi Massimo Falconi Department of Radiology Negrar VeronaItaly Department of Surgery University of Verona VeronaItaly Department of Pathology University of Verona VeronaItaly Department of Radiology University of Verona VeronaItaly

We here report a case of a 18-year-old man with a history of recurrent abdominal pain and a previous episode of severe acute pancreatitis. Abdominal ultrasonography, contrast enhanced multislice computer tomography, endoscopic retrograde cholangiopancreatography, endoscopic ultrasonography and magnetic resonance imaging demonstrated a cystic mass lesion. Only on delayed phase magnetic resonance images after GadoliniumBOPTA injection, it was possible to demonstrate the lesion's relationship with the biliary tree, differentiating the lesion from intraluminal duodenal diverticulum, and to achieve the diagnosis of duodenal duplication cyst, a recognized rare cause of acute pancreatitis. The diagnosis was confirmed by histology.

关键词：十二直肠炎症胰腺炎病理学超声检查

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Eradication of Helicobacter pylori infection:Which regimen first?

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World Journal of Gastroenterology 2014年第3期20卷 665-672页

作者： alessandro Federico Antonietta Gerarda Gravina Agnese Miranda Carmela Loguercio Marco romano Department of Clinical and Experimental Medicine Gastroenterology UnitSecond University of Naples

Helicobacter pylori(H.pylori)is a well-known human pathogen that plays an essential role in the pathogenesis of chronic gastritis,peptic ulcer disease,and gastric malignancies.Although H.pylori is susceptible to several antimicrobials,this infection has proven challenging to cure because of the increasing prevalence of bacterial strains that are resistant to the most commonly used antimicrobials,particularly clarithromycin.An effective(i.e.,>90%)first-line therapy is mandatory for avoiding supplementary treatments and testing,and more importantly for preventing the development of secondary resistance.This study reviews the recent literature on first-line therapies forH.pylori.The eradication rates following standard triple therapy(a proton pump inhibitor plus amoxicillin and clarithromycin)for H.pylori infection are declining worldwide.Several first-line strategies have been proposed to increase the eradication rate,including extending the treatment duration to 14 d,the use of a four-drug regimen(bismuth-containing quadruple,sequential,and concomitant treatments),and the use of novel antibiotics,such as fluoroquinolones.However,the ef5ficacy of these regimens is controversial.A first-line eradication regimen should be based on what works best in a defined geographical area and must take into account the prevalence of antimicrobial resistance in that region.

关键词： Helicobacter pylori Sequential therapy Hybrid ther

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