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Pancreatic ductal adenocarcinoma screening:New perspectives

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World Journal of Gastroenterology 2012年第36期18卷 4973-4977页

作者： Raffaele Pezzilli Dario fabbri andrea Imbrogno Department of Digestive Diseases and Internal Medicine Sant'OrsolaMalpighi Hospital40138 BolognaItaly

Pancreatic ductal adenocarcinoma accounts for more than 90% of all pancreatic cancers and its incidence has increased significantly *** with pancreatic ductal adenocarcinoma have a poor outcome and more than 95% of the people affected die from the disease within 12 mo after *** is the first-line treatment in the case of resectable neoplasm,but only 20% of patients are candidates for this *** of the reasons there are few candidates for surgery is that,during the early phases of the disease,the symptoms are poor or *** diagnosis is of crucial importance to improve patient outcome;therefore,we are looking for a good screening *** screening test must identify the disease in an early stage in order to be effective;having said this,a need exists to introduce the concept of "early" ductal *** has been reported that at least five additional years after the occurrence of the initiating mutation are required for the acquisition of metastatic ability of pancreatic adenocarcinoma and patients die an average of two years *** have reviewed the most recent literature in order to evaluate the present and future perspectives of screening programs of this deadly disease.

关键词： Pancreatic neoplasms Study population Prevention Therapeutics

Long-term metformin therapy and vitamin B12 deficiency: An association to bear in mind

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World Journal of Diabetes 2021年第7期12卷 916-931页

作者： Marco Infante Martina Leoni Massimiliano Caprio andrea fabbri UniCamillus Saint Camillus International University of Health SciencesRome 00131Italy Diabetes Research Institute Federation(DRIF) Division of Endocrinology and DiabetesCTO Alesini HospitalDepartment of Systems MedicineUniversity of Rome Tor VergataRome 00145Italy Network of Immunity in Infection Malignancy and Autoimmunity(NIIMA)Universal Scientific Education and Research Network(USERN)Rome 00145Italy Department of Human Sciences and Promotion of the Quality of Life San Raffaele Roma Open UniversityRome 00166Italy Laboratory of Cardiovascular endocrinology IRCCS San Raffaele PisanaRome 00166Italy

To date,metformin remains the first-line oral glucose-lowering drug used for the treatment of type 2 diabetes thanks to its well-established long-term safety and efficacy ***,metformin is the most widely used oral insulinsensitizing agent,being prescribed to more than 100 million people worldwide,including patients with prediabetes,insulin resistance,and polycystic ovary ***,over the last decades several observational studies and meta-analyses have reported a significant association between long-term metformin therapy and an increased prevalence of vitamin B12 *** note,evidence suggests that long-term and high-dose metformin therapy impairs vitamin B12 *** B12(also referred to as cobalamin)is a water-soluble vitamin that is mainly obtained from animal-sourced *** the cellular level,vitamin B12 acts as a cofactor for enzymes that play a critical role in DNA synthesis and ***,vitamin B12 deficiency can lead to a number of clinical consequences that include hematologic abnormalities(e.g.,megaloblastic anemia and formation of hypersegmented neutrophils),progressive axonal demyelination and peripheral ***,no definite guidelines are currently available for vitamin B12 deficiency screening in patients on metformin therapy,and vitamin B12 deficiency remains frequently unrecognized in such ***,in this“field of vision”article we propose a list of criteria for a cost-effective vitamin B12 deficiency screening in metformin-treated patients,which could serve as a practical guide for identifying individuals at high risk for this ***,we discuss additional relevant topics related to this field,including:(1)The lack of consensus about the exact definition of vitamin B12 deficiency;(2)The definition of reliable biomarkers of vitamin B12 status;(3)Causes of vitamin B12 deficiency other than metformin therapy that should be identified promptly in metformin-treated pat

关键词： Metformin Vitamin B12 deficiency Metformin-induced cobalamin deficiency Diabetes Type 2 diabetes Prediabetes Screening criteria Neuropathy Anemia

Microbiota-gut-brain axis and its affect inflammatory bowel disease:Pathophysiological concepts and insights for clinicians

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World Journal of Clinical Cases 2020年第6期8卷 1013-1025页

作者： emanuele Sinagra erika Utzeri Gaetano Cristian Morreale Carlo fabbri Fabio Pace andrea Anderloni Gastroenterology and endoscopy Unit Fondazione Istituto Giuseppe GiglioContrada Pietra Pollastra PisciottoCefalù90015Italy euro-Mediterranean Institute of Science and Technology Palermo 90100Italy Nuova Casa di Cura di Decimomannu Cagliari 09100Italy Section of Gastroenterology S.Elia-Raimondi HospitalCaltanissetta 93100Italy Gastroenterology and Digestive endoscopy Unit Forlì-CesenaAzienda USL RomagnaForlì47121Italy Unit of Gastroenterology Bolognini HospitalBergamo 24100Italy Digestive endoscopy Unit Division of GastroenterologyHumanitas Research HospitalRozzano 20089Italy

Despite the bi-directional interaction between gut microbiota and the brain not being fully understood,there is increasing evidence arising from animal and human studies that show how this intricate relationship may facilitate inflammatory bowel disease(IBD)pathogenesis,with consequent important implications on the possibility to improve the clinical outcomes of the diseases themselves,by acting on the different components of this system,mainly by modifying the *** the emergence of precision medicine,strategies in which patients with IBD might be categorized other than for standard gut symptom complexes could offer the opportunity to tailor therapies to individual *** aim of this narrative review is to elaborate on the concept of the gutbrain-microbiota axis and its clinical significance regarding IBD on the basis of recent scientific literature,and finally to focus on pharmacological therapies that could allow us to favorably modify the function of this complex system.

关键词： Irritable bowel syndrome Inflammatory bowel disease Gut-brain axis Therapy

endoscopic ultrasound-guided treatments: Are we getting evidence based- a systematic review

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World Journal of Gastroenterology 2014年第26期20卷 8424-8448页

作者： Carlo fabbri Carmelo Luigiano andrea Lisotti Vincenzo Cennamo Clara Virgilio Giancarlo Caletti Pietro Fusaroli Unit of Gastroenterology and Digestive endoscopy AUSL Bologna Bellaria-Maggiore Hospital Unit of Gastroenterology and Digestive endoscopy Department of Medical and Surgical Sciences - DIMeC University of BolognaHospital S Maria della Scaletta

The continued need to develop less invasive alternatives to surgical and radiologic interventions has driven the development of endoscopic ultrasound(eUS)-guided *** include eUS-guided drainage of pancreatic fluid collections,eUS-guided necrosectomy,eUS-guided cholangiography and biliary drainage,eUSguided pancreatography and pancreatic duct drainage,eUS-guided gallbladder drainage,eUS-guided drainage of abdominal and pelvic fluid collections,eUS-guided celiac plexus block and celiac plexus neurolysis,eUSguided pancreatic cyst ablation,eUS-guided vascular interventions,eUS-guided delivery of antitumoral agents and eUS-guided fiducial placement and *** these procedures are technically challenging and require expertise in both eUS and interventional endoscopy,such as endoscopic retrograde cholangiopancreatography and gastrointestinal *** undertook a systematic review to record the entire body of literature accumulated over the past 2decades on eUS-guided interventions with the objective of performing a critical appraisal of published articles,based on the classification of studies according to levels of evidence,in order to assess the scientific progress made in this field.

关键词： endoscopic ultrasound Pseudocyst drainage Necrosectomy Celiac plexus neurolysis Levels of evidence Fine needle injection

endoscopic ultrasound fine-needle biopsy vs fine-needle aspiration for lymph nodes tissue acquisition:a systematic review and meta-analysis

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Gastroenterology Report 2022年第1期10卷 544-551页

作者： Antonio Facciorusso Stefano Francesco Crino Paraskevas Gkolfakis Daryl Ramai andrea Lisotti Ioannis S Papanikolaou Benedetto Mangiavillano Ilaria Tarantino andrea Anderloni Carlo fabbri Konstantinos Triantafyllou Pietro Fusaroli Gastroenterology Unit Department of Surgical and Medical SciencesUniversity of FoggiaFoggiaItaly Department of Medicine Gastroenterology and Digestive Endoscopy UnitThe Pancreas InstituteUniversity Hospital of VeronaVeronaItaly Department of Gastroenterology Hepatopancreatologyand Digestive OncologyCUB Erasme HospitalUniversite Libre de Bruxelles(ULB)BrusselsBelgium Gastroenterology and Hepatology University of Utah HealthSalt Lake CityUTUSA Gastroenterology Unit Hospital of ImolaUniversity of BolognaImolaItaly Hepatogastroenterology Unit Second Department of Internal Medicine-PropaedeuticMedical SchoolNational and Kapodistrian University of Athens‘Attikon’University General HospitalAthensGreece Gastrointestinal endoscopy Unit Humanitas Mater DominiCastellanzaVareseItaly endoscopy Service Department of Diagnostic and Therapeutic ServicesIRCCS-ISMETTPalermoItaly Digestive endoscopy Unit Humanitas Clinical and Research Center—IRCCSRozzanoMilanoItaly Gastroenterology and Digestive endoscopy Unit Forlì-Cesena HospitalsAUSL RomagnaForlì-CesenaItaly

Background:endoscopic ultrasound(eUS)-guided tissue acquisition represents the choice of methods for suspected lymph nodes(LNs)located next to the gastrointestinal *** study aimed to compare the pooled diagnostic performance of eUS-guided fine-needle biopsy(eUS-FNB)and fine-needle aspiration(eUS-FNA)for LNs ***:We searched PubMed/MedLine and embase databases through August *** outcome was diagnostic accuracy;secondary outcomes were sensitivity,specificity,sample adequacy,optimal histological core procurement,number of passes,and adverse *** performed a pairwise meta-analysis using a random-effects *** results are presented as odds ratio(OR)or mean difference along with 95%confidence interval(CI).Results:We identified nine studies(1,276 patients)in this *** these patients,66.4%were male;the median age was 67 *** accuracy was not significantly different between the two approaches(OR,1.31;95%CI,0.81–2.10;P=0.270).The accuracy of eUS-FNB was significantly higher when being performed with newer end-cutting needles(OR,1.87;95%CI,1.17–3.00;P=0.009)and in abdominal LNs(OR,2.48;95%CI,1.52–4.05;Perence in terms of sample adequacy was observed between the two approaches(OR,1.40;95%CI,0.46–4.26;P=0.550);however,histological core procurement and diagnostic sensitivity with eUS-FNB were significantly higher than those with eUS-FNA(OR,6.15;95%CI,1.51–25.07;P=0.010 and OR,1.87;95%CI,1.27–2.74,P=0.001).The number of needle passes needed was significantly lower in the eUS-FNB group than in the eUS-FNA group(mean difference,-0.54;95%CI,-0.97 to -0.12;P=0.010).Conclusions eUS-FNA and eUS-FNB perform similarly in LN sampling;however,FNB performed with end-cutting needles outperformed FNA in terms of diagnostic accuracy.

关键词： eUS FNA FNB cancer metastases lymphoma

Cystic dystrophy of the duodenal wall is not always associated with chronic pancreatitis

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World Journal of Gastroenterology 2011年第39期17卷 4349-4364页

作者： Raffaele Pezzilli Donatella Santini Lucia Calculli Riccardo Casadei Antonio Maria Morselli-Labate andrea Imbrogno Dario fabbri Giovanni Taffurelli Claudio Ricci Roberto Corinaldesi Pancreas Unit Department of Digestive Diseases and Internal MedicineSant'Orsola-Malpighi Hospital Department of Pathology Sant'Orsola-Malpighi HospitalUniversity of Bologna Department of Radiology Sant'Orsola-Malpighi HospitalUniversity of Bologna Department of Surgery Sant'Orsola-Malpighi HospitalUniversity of Bologna

Cystic dystrophy of the duodenal wall is a rare form of the disease which was described in 1970 by French authors who reported the presence of focal pancreatic disease localized in an area comprising the C-loop of the duodenum and the head of the ***-man authors have defined this area as a"groove".We report our recent experience on cystic dystrophy of the paraduodenal space and systematically review the data in the literature regarding the alterations of this space.A MeDLINe search of papers published between 1966 and 2010 was carried out and 59 paperswere considered for the present study;there were 19 cohort studies and 40 case *** majority of patients having groove pancreatitis were middle *** age was significantly higher in patients having groove *** diagnosis of cystic dystrophy of the duodenal wall can now be assessed by multi-detector computer tomography,magnetic resonance imaging and endoscopic *** latter two techniques may also add more information on the involvement of the remaining pancreatic gland not involved by the duodenal malformation and they may help in differentiating"groove pancreatitis"from "groove adenocarcinoma".In conclusion,chronic pan-creatitis involving the entire pancreatic gland was present in half of the patients with cystic dystrophy of the duodenal wall and,in the majority of them,the pan-creatitis had calcifications.

关键词： Pancreatitis Cystic dystrophy of duodenal wall Therapy Outcome

Molecular phylogenetic analysis of Leibnitzia Cass.(Asteraceae:Mutisieae:Gerbera-complex),an Asian-North American disjunct genus

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Journal of Systematics and evolution 2010年第3期48卷 161-174页

作者： Kristen e.BAIRD Vicki A.FUNK andrea WeeKS Department of environmental Science and Policy George Mason University US National Herbarium Smithsonian InstitutionMRC 166P.O.Box 371012WashingtonDC 20013-7012USA

Leibnitzia comprises six species of perennial herbs that are adapted to high elevation conditions and is one of only two Asteraceae genera known to have an exclusively disjunct distribution spanning central to eastern Asia and North *** phylogenetic analysis of Leibnitzia and other Gerbera-complex members indicates that Leibnitzia is monophyletic,which is in contrast with our expectation that the American Leibnitzia species L. lyrata and *** would be more closely related to another American member of the Gerbera-complex,namely *** area reconstructions show that the historical biogeography of the Gerbera-complex mirrors that of the entire Asteraceae,with early diverging lineages located in South America that were followed by transfers to Africa and eurasia and,most recently,to North *** transfer of Leibnitzia appears to have been directed from Asia to North *** calibrations of nuclear(ribosomal DNA internal transcribed spacer region)and chloroplast(trnL-rpl32 intron)DNA sequence data using relaxed clock methods and either mean rate or fossil-based priors unanimously support Miocene and younger divergence times for Gerbera-complex *** ages are not consistent with most Gondwanan vicariance episodes and,thus,the global distribution of Gerbera-complex members must be explained in large part by long-distance *** species of Leibnitzia are estimated to have diverged from their Asian ancestor during the Quaternary(ca.2 mya)and either migrated overland to North America via Beringia and retreated southwards along high elevation corridors to their present location in southwestern North America or were dispersed long distance.

关键词： Beringia biogeography Gerbera-complex Mutisieae.

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Asian Journal of Andrology 2012年第1期14卷 136-137页

作者： andrea A Chan Steven e Canfield Run Wang Division of Urology University of Texas Medical School at Houston Houston TX 77030 USA Department of Urology University of Texas MD Anderson Cancer Center Houston TX 77030 USA

The Scandinavian Prostate Cancer Group- 4 recently reported the long-term survival benefit in men who were randomized to radical prostatectomy versus men watchful waiting for localized prostate cancer.1 The authors have now presented the companion article that updates the long-term quality of life evaluation in these men.2 Given the excellent prognosis of patients with early stage prostate cancer, the impact of therapy on patient＇s quality of life is a significant factor in the optimal management of this disease.

关键词： Health-related quality of life Scandinavian patients radical prostatectomy watchful waiting

Immunological roulette: Luck or something more? Considering the connections between host and environment in TB

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Cellular & Molecular Immunology 2018年第3期15卷 226-232页

作者： John e Pearl Mrinal Das andrea M Cooper Department of Infection Immunity and Inflammation Leicester Tuberculosis Research Group(LTBRG)University of LeicesterUniversity RoadLeicesterLE17RHUK

Accurate prediction of which patient will progress from a sub-clinical Mycobacterium tuberculosis infection to active tuberculosis represents an elusive,yet critical,clinical research *** the individual perspective,progression can be considered to be the product of a series of unfortunate events or even a run of bad ***,we identify the subtle physiological relationships that can influence the odds of progression to active TB and how this progression may reflect directed dysbiosis in a number of interrelated *** infected individuals who progress to disease have apparently good immune responses,but these responses are,at times,compromised by either local or systemic environmental *** disease promoting processes,such as tissue-damaging granulomata,usually manifest in the lung,but illness is *** apparent dichotomy between local and systemic reflects a clear need to define the factors that promote progression to active disease within the context of the body as a physiological *** discuss aspects of the host environment that can impact expression of immunity,including the microbiome,glucocorticoid-mediated regulation,catecholamines and interaction between the gut,liver and *** suggest the importance of integrating precision medicine into our analyses of experimental outcomes such that apparently conflicting results are not contentious,but rather reflect the impact of these subtle relationships with our environment and microbiota.

关键词： gut-liver-lung axis microbiome tuberculosis