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Endoluminal vacuum-assisted therapy to treat rectal anastomotic leakage:A critical analysis

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World Journal of Gastroenterology 2022年第14期28卷 1394-1404页

作者： andrea Vignali paola De Nardi Department of Gastrointestinal Surgery IRCCS San Raffaele Scientific InstituteMilano 20132Italy Department of Surgery Vita-Salute UniversityMilano 20132Italy

Endoluminal vacuum-assisted therapy(EVT)has been introduced recently to treat colorectal anastomotic leaks in clinically stable non-peritonitic *** application has been mainly reserved to low colorectal and colo-anal *** main advantage of this new procedure is to ensure continuous drainage of the abscess cavity,to promote and to accelerate the formation of granulation tissue resulting in a reduction of the abscess *** reported results are promising allowing a higher preservation of the anastomosis when compared to conventional treatments that include trans-anastomotic tube placement,percutaneous drainage,endoscopic clipping of the anastomotic defect or stent ***,despite this procedure is gaining acceptance among the surgical community,indications,inclusion criteria and definitions of success are not yet standardized and extremely heterogeneous,making it difficult to reach definitive conclusions and to ascertain which are the real benefits of this new ***,long-term and functional results are poorly *** present review is focused on critically analyzing the theoretical benefits and risks of the procedure,short-and long-term functional results and future direction in the application of EVT.

关键词： Anastomotic leakage Rectal surgery Endoluminal vacuum therapy Endosponge Complications

Multidisciplinary treatment of rectal cancer in 2014: Where are we going?

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World Journal of Gastroenterology 2014年第32期20卷 11249-11261页

作者： andrea Vignali paola De Nardi Department of Surgery San Raffaele Scientific Institute Vita Salute University

In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not *** preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer.

关键词： Rectal cancer Cancer staging Cancer restaging Neoadjuvant chemoradiation Response Treatment Local control Local excision Complete pathologic response Rectal cancer surgery

Effect of grassland mosaic structure and dynamism on the reproductive habitat suitability for Alectoris graeca in central Apennines

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Journal of Mountain Science 2019年第12期16卷 2783-2792页

作者： andrea BRUSAFERRO Valentina IESARI Federico Maria TARDELLA paola SCOCCO andrea CATORCI School of Biosciences and Veterinary Medicine University of Camerino

Over the last several decades,the Mediterranean region has been subjected to mountain abandonment and farming cessation,leading to changes in vegetation and coenological features of grasslands,contextually to the strong decline of the rock partridge(Alectoris graeca).Our hypothesis was that the ongoing dynamic processes leading to the compositional changes of grasslands in central Apennines affect the habitat suitability for the singing male(territorial male defending its reproductive site).In 2015,we defined the presence/absence of spring territorial singing males in seven sites(1,250-2,400 m a.s.l.),by the census in 74 playback stations,distributed along 15 *** characterized the topography and the vegetation mosaic of such sites according to the collected topographic and vegetation cover data in 59 randomly selected plots(100 m×100 m)along the *** understand the relations among the environmental variables and the effect of the composition and dynamism of the vegetation mosaics on the presence/absence of the singing male,we used principal components analysis and generalized linear mixed-effect *** results emphasized the marked overlap between the general environmental conditions,which proved to define the habitat suitability for ***,and the characteristics of the site chosen by the singing male for starting the reproductive ***,we found that the site suitability for the singing male decreases when the vegetation recovery processes are ongoing,because of the spread of coarse tall grassesdominated communities and/or grassland types with dense *** grass-dominated communities and thick-turf grasslands exert their negative effect decreasing the habitat suitability for the singing male starting from low cover ***,it is conceivable that singing male’s suitable habitat will be dramatically restricted to the steepest south-facing slopes,where topographic and soil conditions do not allow the spread of grassl

关键词： Brachypodium genuense Grazing cessation Reproductive habitat suitability Rock partridge Singing male Vegetation recovery processes

A multi-agent system for itinerary suggestion in smart environments

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CAAI Transactions on Intelligence Technology 2021年第4期6卷 377-393页

作者： Alessandra De paola Salvatore Gaglio andrea Giammanco Giuseppe Lo Re Marco Morana Universita degzi studi di Palermo PalermoItaly Srart Cities and Comtnunitics Natioral Jab CINI-Consorzio Interuniversitario Nazionale per l'Infortnatica PalerinoItaly

Modem smart environments pose several challenges,among which the design of intelligent algorithms aimed to assist the *** a variety of points of interest are available,for instance,trajectory recommendations are needed to suggest users the most suitable itineraries based on their interests and contextual *** in many cases,these interests must be explicitly requested and their lack causes the so-called cold-start ***,lengthy travelling distances and excessive crowdedness of specific points of interest make itinerary planning more *** address these aspects,a multi-agent itinerary suggestion system that aims at assisting the users in an online and collaborative way is proposed.A profiling agent is responsible for the detection of groups of users whose movements are characterised by similar semantic,spatial and temporal features;then,a recommendation agent leverages contextual information and dynamically associates the current user with the trajectory clusters according to a Multi-Armed Bandit policy;Framing the trajectory recommendation as a reinforcement learning problem permits to provide high-quality suggestions while avoiding both cold-start and preference elicitation *** effectiveness of the approach is demonstrated by some deployments in real-life scenarios,such as smart campuses and theme parks.

关键词： artificial intelligence pattern recognition

Conduction disorder and primary cardiac tumor: a fatal case of multiple lipomas of the right atrium

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Journal of Geriatric Cardiology 2019年第5期16卷 431-433页

作者： Stefano D’Errico andrea Mazzanti paola Frati Vittorio Fineschi Department of Legal Medicine Azienda Ospedaliera Universitaria Sant’Andreavia di GrottarossaRomaItaly Molecular Cardiology Istituti Clinici Scientifici MaugeriIstituto di Ricovero e Cura a Carattere ScientificoPaviaItalyDepartment of Molecular MedicineUniversity of PaviaPaviaItaly Department SAIMLAL Sapienza University of RomaViale Regina ElenaRomaItaly

Cardiac primary tumors are uncommon with an estimated prevalence between 0.17%and 0.19%.[1,2]Cardiac lipoma are extremely rare representing only 10%?19%of primary cardiac tumors and only few are symptomatic,depending on their location within the heart.[3,4]They originate from the subendocardium(50%),subepicardium(25%)or myocardium(25%)and with different sizes and locations.[5]Few cases of sudden death due to primary cardiac tumors are reported in literature(0.0025%);in these cases,conductive and haemodinamic abnormalities have been indicated as the cause of death.

关键词： Autopsy Lipoma Primary cardiac tumor Sudden cardiac death

Mycobacterium avium subspecies paratuberculosis in the etiology of Crohn's disease, cause or epiphenomenon?

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World Journal of Gastroenterology 2014年第36期20卷 13060-13070页

作者： Elisa Liverani Eleonora Scaioli Carla Cardamone paola Dal Monte andrea Belluzzi Gastroenterology Division Department of Medical and Surgical Sciences Sant’Orsola-Malpighi University Hospital 40138 Bologna Italy Diagnostic and Speciality Medicine Department of Experimental Microbiology Unit Sant’Orsola-Malpighi University Hospital 40138 Bologna Italy

The origin of inflammatory bowel disease is unknown. Attempts have been made to isolate a microorganism that could explain the onset of inflammation, but no pathological agent has ever been identified. Johne’s disease is a granulomatous chronic enteritis of cattle and sheep caused by Mycobacterium avium subspecies paratuberculosis (MAP) and shows some analogies with Crohn’s disease (CD). Several studies have tried to clarify if MAP has a role in the etiology of CD. The present article provides an overview of the evidence in favor and against the “MAP-hypothesis”, analyzing the methods commonly adopted to detect MAP and the role of antimycobacterial therapy in patients with inflammatory bowel disease. Studies were identified through the electronic database, MEDLINE, and were selected based on their relevance to the objective of the review. The presence of MAP was investigated using multiple diagnostic methods for MAP detection and in different tissue samples from patients affected by CD or ulcerative colitis and in healthy controls. On the basis of their studies, several authors support a close relationship between MAP and CD. Although increasing evidence of MAP detection in CD patients is unquestionable, a clear etiological link still needs to be proven.

关键词： Mycobacterium avium paratuberculosis Crohn’ s disease Inflammatory bowel disease Johne’ s disease Mycobacterial protein tyrosine phosphatase

Short and long-term outcomes of laparoscopic colectomy in obese patients

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World Journal of Gastroenterology 2013年第42期19卷 7405-7411页

作者： andrea Vignali paola De Nardi Luca Ghirardelli Saverio Di Palo Carlo Staudacher Department of Surgery San Raffaele Scientific InstituteUniversity Vita Salute20132 MilanItaly

AIM:To investigate the impact of laparoscopic colectomy on short and long-term outcomes in obese patients with colorectal ***:A total of 98 obese(body mass index>30kg/m2)patients who underwent laparoscopic(LPS)right or left colectomy over a 10 year period were identified from a prospective institutionally approved database and manually matched to obese patients who underwent open *** were selected to match for body mass index,site of primary disease,American Society of Anesthesiologists score,and year of surgery(±3 year).The parameters analyzed included age,gender,comorbid conditions,American Society of Anaesthesiologists class,diagnosis,procedure,and duration of operation,operative blood loss,and amount of homologous blood *** rate,intra and postoperative complications as were as reoperation rate,30 d and long-term morbidity rate were also *** continuous variables,the Student’s t test was used for normally distributed data the Mann-Whitney U test for nonnormally distributed *** Pearson’sχ2tests,or the Fisher exact test as appropriate,were used for ***:Conversion to open surgery was necessary in 13 of 98 patients(13.3%).In the LPS group,operative time was 29 min longer and blood loss was 78 mL lower when compared to open colectomy(P=0.03,P=0.0001,respectively).Overall morbidity,anastomotic leak and readmission rate did not significantly differ between the two groups.A trend toward a reduction of wound complications was observed in the LPS when compared to open group(P=0.09).In the LPS group,an earlier recovery of bowel function(P=0.001)and a shorter length of stay(P=0.03)were *** a median follow-up of 62(range 12-132)mo 23patients in the LPS group and 38 in the open group experienced long-term complications(LPS vs open,P=0.03).Incisional hernia resulted to be the most frequent long-term complication with a significantly higher occurrence in the open group when compared to the lapa

关键词： Obesity Colon cancer Laparoscopy Right colectomy Left colectomy Colorectal disease

The breast cancer tumor microenvironment and precision medicine:immunogenicity and conditions favoring response to immunotherapy

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Journal of the National Cancer Center 2024年第1期4卷 14-24页

作者： andrea Nicolini paola Ferrari Roberto Silvestri Federica Gemignani Department of Oncology Transplantations and New Technologies in MedicineUniversity of PisaPisaItaly Department of Biology Genetic UnitUniversity of PisaPisaItaly

Some main recent researches that have dissected tumor microenvironment(TME)by imaging mass cytometry(IMC)in different subtypes of primary breast cancer samples were *** many phenotypic variants,clusters of epithelial tumor and immune cells,their structural features as well as the main genetic aberrations,sub-clonal heterogeneity and their systematic classification also have been *** evolution has been assessed in primary and metastatic breast cancer ***,based on these findings the current concept of precision medicine is questioned and challenged by alternative therapeutic *** the last two decades,immunotherapy as a powerful and harmless tool to fight cancer has received huge ***,the tumor immune microenvironment(TIME)composition,its prognostic role for clinical course as well as a novel definition of immunogenicity in breast cancer are *** clinical trials carried out by us and other findings suggest that G0-G1 state induced in endocrine-dependent metastatic breast cancer is more suitable for successful immune *** micro-metastatic disease seems to be another specific condition that can significantly favor the immune response in breast and other solid tumors.

关键词： Breast cancer Tumor microenvironment Immunotherapy

Final results of a 2:1 control-case observational study using interferon beta and interleukin-2,in addition to first-line hormone therapy,in estrogen receptor-positive,endocrine-responsive metastatic breast cancer patients

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Journal of Cancer Metastasis and Treatment 2022年第1期8卷 54-66页

作者： andrea Nicolini Giuseppe Rossi paola Ferrari Riccardo Morganti Angelo Carpi Department of Oncology Transplantations and New Technologies in MedicineUniversity of PisaPisa 56100Italy National Research Council(CNR) Epidemiology and Biostatistics UnitInstitute of Clinical Physiology and G.Monasterio FoundationPisa 56100Italy Statistics Section University Hospital of PisaPisa 56100Italy Department of Clinical and Experimental Medicine University of PisaPisa 56100Italy

Aim:We conducted a pilot study that combines immunotherapy(cyclic interleukin-2 interferon-beta sequence)and hormone therapy(HT)to overcome endocrine resistance in metastatic breast ***:The final results of a 2:1 control-case retrospective observational study are here shown following 22 additional months of postoperative follow-up and 6 further *** were 95 controls and 42 cases in *** 95 controls were ER+/HER2-metastatic breast cancer patients who underwent first-line HT with aromatase inhibitors(AIs)or ***-eight of them(28.9%)also received biological drugs including cyclin kinase inhibitors(CKIs).The 42 cases were ER+metastatic breast cancer patients who received interferon beta-interleukin-2 immunotherapy in addition to first-line *** estrogen receptor modulators/down-regulators(SERMs/SERDs)were used for HT in 39(92.9%)of them and AIs in the remaining ***:Median progression-free survival(PFS)and overall survival(OS)were significantly longer in the 42 studied patients who received hormone immunotherapy(HIT)than in the 95 controls(median time 33 vs.18 months,P=0.002,and 81 vs.62 months,P=0.019).In the analysis adjusted for disease-free interval(DFI),hormone receptor,HER2 status,visceral involvement,AIs,and biological therapy,the PFS and OS hazard ratio(HR)further increased in favor of the 42 cases(P=0.004 and P=0.044 respectively).In the same ER+/HER2-metastatic breast cancer patients treated with both AIs and CKIs,a median PFS ranging from 25.3 to 28.18 months and a median OS of 37.5 months were ***:This study strongly suggests multi-center randomized clinical trials should be performed to enter our proposed immunotherapy into clinical practice.

关键词： Breast cancer metastasis hormone-dependent hormone resistance immunotherapy