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Gastrointestinal stromal tumors:a multidisciplinary challenge

World Journal of Gastroenterology 2018年第18期24卷 1925-1941页

作者： Juan Manuel Sanchez-Hidalgo Manuel Duran-Martinez Rafael Molero-Payan Sebastian Rufian-Pena Alvaro Arjona-Sanchez angela casado-adam Antonio Cosano-Alvarez Javier Briceno-Delgado Department of General and Digestive Surgery Reina Sofia University HospitalAvda.Menéndez Pidal s/nCordoba 14004Spain Department of Intern Medicine Reina Sofia University HospitalAvda.Menéndez Pidal s/nCordoba 14004Spain Lipids and Atherosclerosis Research Unit IMIBIC/Hospital Universitario Reina Sofía/Universidad de CórdobaCordoba 14004Spain

Gastrointestinal stromal tumors(GISTs) are the most common mesenchymal tumors located in the alimentary tract. Its usual manifestation is gastrointestinal bleeding. However, small asymptomatic lesions are frequently detected as incidental finding. Characteristically, most GISTs(> 95%) are positive for the KIT protein(CD117) by IHC staining and approximately 80%-90% of GISTs carry a mutation in the c-KIT or PDGFRA genes. Mutational analysis should be performed when planning adjuvant and neoadjuvant therapy, due to its possible resistance to conventional treatment. The arise of tyrosine kinase inhibitor has supposed a revolution in GISTs treatment being useful as adjuvant, neoadjuvant or recurrence disease treatment. That is why a multidisciplinary approach to this disease is required. The correct characterization of the tumor at diagnosis(the diagnosis of recurrences and the evaluation of the response to treatment with tyrosine kinase inhibitors) is fundamental for facing these tumors and requires specialized Endoscopist, Radiologists and Nuclear Medicine Physician. Surgery is the only potentially curative treatment for suspected resectable GIST. In the case of high risk GISTs, surgery plus adjuvantImatinib-Mesylate for 3 years is the standard treatment. Neoadjuvant imatinib-mesylate should be considered to shrink the tumor in case of locally advanced primary or recurrence disease, unresectable or potentially resectable metastasic tumors, and potentially resectable disease in complex anatomic locations to decrease the related morbidity. In the case of Metastatic GIST under Neoadjuvant treatment, when there are complete response, stable disease or limited disease progression, complete cytoreductive surgery could be a therapeutic option if feasible.

关键词： Gastrointestinal stromal tumors Surgery Oncology Radiology Endoscopy Nuclear medicine Pathology Disease management Tyrosine kinase inhibitors Gastroenterology

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Colorectal peritoneal metastases:Optimal management review

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World Journal of Gastroenterology 2019年第27期25卷 3484-3502页

作者： Juan Manuel Sánchez-Hidalgo Lidia Rodríguez-Ortiz Alvaro Arjona-Sánchez Sebastián Rufián-Pena angela casado-adam Antonio Cosano-Alvarez Javier Briceno-Delgado Department of General and Digestive Surgery Reina Sofia University HospitalCordoba 14004Spain

The peritoneum is a common site of dissemination for colorrectal cancer, with a poorer prognosis than other sites of metastases. In the last two decades, it has been considered as a locoregional disease progression and treated as such with curative intention treatments. Cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC) is the actual reference treatment for these patients as better survival results have been reached as compared to systemic chemotherapy alone, but its therapeutic efficacy is still under debate. Actual guidelines recommend that the management of colorectal cancer with peritoneal metastases should be led by a multidisciplinary team carried out in experienced centers and consider CRS + HIPEC for selected patients. Accumulative evidence in the last three years suggests that this is a curative treatment that may improve patients disease-free survival, decrease the risk of recurrence, and does not increase the risk of treatment-related mortality. In this review we aim to gather the latest results from referral centers and opinions from experts about the effectiveness and feasibility of CRS + HIPEC for treating peritoneal disease from colorectal malignancies.

关键词： Peritoneal metastases Colorectal cancer Cytoreductive surgery Hyperthermic intraperitoneal chemotherapy Peritoneal carcinomatosis

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Peritoneal metastases of colorectal origin treated by cytoreduction and HIPEC: An overview

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World Journal of Gastrointestinal Oncology 2014年第10期6卷 407-412页

作者： Alvaro Arjona-Sánchez Francisco Javier Medina-Fernández Francisco Cristobal Mu?oz-Casares angela casado-adam Juan Manuel Sánchez-Hidalgo Sebastián Rufián-Pe?a Unit of Oncological and Pancreatic Surgery Department of General and Digestive Surgery University Hospital Reina Sofia 14004 Cordoba Spain

Colorectal peritoneal carcinomatosis was considered a terminal condition with a merely palliative treatment that included only supportive care, palliative surgery and the best systemic chemotherapy. Since the birth of a new approach, cytoreductive surgery with peritonectomy procedures together with hyperthermic intraperitoneal chemotherapy and/or early postoperative intraperitoneal chemotherapy to treat peritoneal carcinomatosis, many research groups contributed with promising results using this procedure being up to date this strategy the only one that has shown curative benefits on colorectal peritoneal carcinomatosis achieving reported overall survival rates up to 64 mo and fiveyear survival rates up to 51%. The aim of this paper is to expose an updated overview of the therapeutic possibilities of these procedures in colorectal peritoneal metastases in the same way that our Unit of Oncologic Surgery has performed since 1997 with more than four hundred procedures.

关键词： Carcinomatosis peritoneal Colon cancer Intraperitoneal chemotherapy Cytoreduction Perito-nectomy

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Multiparametric ultrasound as a new concept of assessment of liver tissue damage

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World Journal of Gastroenterology 2024年第12期30卷 1663-1669页

作者： angela Peltec Ioan Sporea Department of Internal Medicine Discipline of GastroenterologyState University of Medicine and Pharmacy"Nicolae Testemitanu"Chishinev 2019Moldova Department of Gastroenterology and Hepatology "Victor Babes"University of Medicine and PharmacyTimisoara 300736Romania

Liver disease accounts for approximately 2 million deaths per year worldwide.All chronic liver diseases(CLDs),whether of toxic,genetic,autoimmune,or infectious origin,undergo typical histological changes in the structure of the tissue.These changes may include the accumulation of extracellular matrix material,fats,triglycerides,or tissue scarring.Noninvasive methods for diagnosing CLD,such as conventional B-mode ultrasound(US),play a significant role in diagnosis.Doppler US,when coupled with B-mode US,can be helpful in evaluating the hemodynamics of hepatic vessels and detecting US findings associated with hepatic decompensation.US elastography can assess liver stiffness,serving as a surrogate marker for liver fibrosis.It is important to note that interpreting these values should not rely solely on a histological classification.Contrast-enhanced US(CEUS)provides valuable information on tissue perfusion and enables excellent differentiation between benign and malignant focal liver lesions.Clinical evaluation,the etiology of liver disease,and the patient current comorbidities all influence the interpretation of liver stiffness measurements.These measurements are most clinically relevant when interpreted as a probability of compensated advanced CLD.B-mode US offers a subjective estimation of fatty infiltration and has limited sensitivity for mild steatosis.The controlled attenuation parameter requires a dedicated device,and cutoff values are not clearly defined.Quan-titative US parameters for liver fat estimation include the attenuation coefficient,backscatter coefficient,and speed of sound.These parameters offer the advantage of providing fat quantification alongside B-mode evaluation and other US parameters.Multiparametric US(MPUS)of the liver introduces a new concept for complete noninvasive diagnosis.It encourages examiners to utilize the latest features of an US machine,including conventional B-mode,liver stiffness evaluation,fat quantification,dispersion imaging,Doppler US,and CEUS for focal liver lesion chara

关键词： Multiparametric ultrasound Ultrasound-based elastography Liver stiffness Noninvasive diagnostic test for chronic liver disease Liver steatosis assessment Portal hypertension evaluation

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Is it possible to anchor a tooth with photobiomodulation?

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World Journal of Clinical Cases 2024年第5期12卷 872-874页

作者： angela Dominguez Department of Orthodontics Faculty of DentistryBenemerita Universidad Autónoma de PueblaZaragoza de Puebla Calle 4 Sur 104PueblaMexico

During orthodontic treatment,we can achieve differential movements by using photobiomodulation(PBM)as an adjuvant before applying force.We can expect a greater bone density that initially resists movement while applying PBM to the other teeth to achieve an accelerating effect.The proposed protocol is to use an 810 nm laser at 0.1W power,applying between 4 and 6J per tooth for 22 s on the vestibular and lingual root surfaces,following the axial axis of the tooth.The energy density depends on the tip selected in the instrument.Normal bone remodeling cannot be avoided by applying high doses of PBM.PBM should be applied before orthodontic force to reduce tooth movement.In addition,PBM can be used during force application to teeth that require acceleration to achieve differential movement in orthodontic treatments.The protocol is the same in both scenarios.

关键词： Photobiomodulation Orthodontic movement Diode laser PBM Anchorage in orthodontics

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The Wave Front Set Correspondence for Dual Pairs with One Member Compact

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Acta Mathematica Sinica,English Series 2024年第3期40卷 823-869页

作者： Mark MCKEE angela PASQUALE Tomasz PRZEBINDA Hammond Lane ProvidenceUT 84332USA Universite de Lorraine CNRSIECLF-57000 MetzFrance Department of Mathematics University of OklahomaNormanOK 73019USA

Let W be a real symplectic space and(G,G')an irreducible dual pair in Sp(W),in the sense of Howe,with G compact.Let G be the preimage of G in the metaplectic group Sp(W).Given an irreducible unitary representation II of G that occurs in the restriction of the Weil representation to G,let On denote its character.We prove that,for a suitable embedding T of Sp(W)in the space of tempered distributions on W,the distribution T(On)admits an asymptotic limit,and the limit is a nilpotent orbital integral.As an application,we compute the wave front set of II',the representation of G dual to II,by elementary means.

关键词： Reductive dual pairs Howe duality Weil representation wave front set orbital integrals

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Deep learning automation of radiographic patterns for hallux valgus diagnosis

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World Journal of Orthopedics 2024年第2期15卷 105-109页

作者： angela Hussain Cadence Lee Eric Hu Farid Amirouche Department of Orthopaedic Surgery University of Illinois College of MedicineChicagoIL 60612United States Department of Orthopaedics Surgery University of Illinois at ChicagoChicagoIL 60612United States Department of Orthopaedic Surgery Northshore University Health SystemSkokieIL 6007United States

Artificial intelligence(AI)and deep learning are becoming increasingly powerful tools in diagnostic and radiographic medicine.Deep learning has already been utilized for automated detection of pneumonia from chest radiographs,diabetic retinopathy,breast cancer,skin carcinoma classification,and metastatic lymphadenopathy detection,with diagnostic reliability akin to medical experts.In the World Journal of Orthopedics article,the authors apply an automated and AIassisted technique to determine the hallux valgus angle(HVA)for assessing HV foot deformity.With the U-net neural network,the authors constructed an algorithm for pattern recognition of HV foot deformity from anteroposterior highresolution radiographs.The performance of the deep learning algorithm was compared to expert clinician manual performance and assessed alongside clinician-clinician variability.The authors found that the AI tool was sufficient in assessing HVA and proposed the system as an instrument to augment clinical efficiency.Though further sophistication is needed to establish automated algorithms for more complicated foot pathologies,this work adds to the growing evidence supporting AI as a powerful diagnostic tool.

关键词： Artificial intelligence Hallux valgus Deep learning Automated radiography

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World Journal of Clinical Cases 2024年第1期12卷 176-179页

作者： Hsin-Chia angela Lin Kam-Fai Lee Tzu Hao Huang Division of General Surgery Department of SurgeryChang Gung Memorial HospitalChiayi 613Taiwan Department of Anatomic Pathology Chang Gung Memorial HospitalChiayi 613Taiwan

BACKGROUND Gastric IgG4-related disease(IgG4-RD)is rarely encountered in clinical practice,and especially more so among pediatric patients.To our knowledge,this is the first report of IgG4-RD presenting as a calcifying gastric mass in a child.We describe how this entity was difficult to differentiate from a gastrointestinal stromal tumor(GIST)imaging-based approaches.Therefore,this case highlights the importance of considering IgG4-RD in the differential diagnosis of gastric tumor before performing surgical resection,especially to distinguish it from malignancy to avoid unnecessary surgery.CASE SUMMARY The patient suffered from epigastric pain for several days.Panendoscopy and computed tomography scan revealed a submucosal tumor.Differential diagnoses included GIST,leiomyoma,teratoma,and mucinous adenocarcinoma.However,laparoscopic proximal gastrectomy allowed for the definitive diagnosis of IgG4-related stomach disease.CONCLUSION We emphasize the importance of considering IgG4-RD in the differential diagnosis of gastric submucosal tumors before performing surgical resection.

关键词： IgG4-related disease Gastrointestinal stromal tumor Child Pediatric Case report

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Going deep:Roots,carbon,and analyzing subsoil carbon dynamics

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Molecular Plant 2024年第1期17卷 1-3页

作者： Ezhilmathi angela Joseph Fernando Michael Selvaraj Yusaku Uga Wolfgang Busch Hunt Bowers Joe Tohme Alliance of Bioversity International and CIAT Km 17 Recta Cali-PalmiraAprtado Aereo 6713Cali 763537Colombia National Institute of Agrobiological Sciences(NIAS) TsukubaIbaraki 305-0856Japan Salk Institute for Biological Studies 10010 N Torrey Pines RoadLa JollaCA 92037USA Earth Optics Suite 840ArlingtonVA 22202USA

Agricultural practices currently contribute to the emission of approximately 10%–12%atmospheric greenhouse gasses,with tillage agriculture accelerating soil disruption and carbon dioxide release.Nevertheless,various options exist,such as converting new lands for agriculture,promoting healthier plant-based diets,adopting advanced management technologies,and minimizing food loss.However,these measures alone are insufficient to ensure environmental sustainability within planetary boundaries.

关键词： soil measures carbon

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Intraoperative cholangio-ultrasonography(IOCUS)during hepatectomy with resection of the biliary confluence:An effective alternative to intraoperative cholangiography

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Hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 417-420页

作者： Daniele Del Fabbro Fabio Procopio Jacopo Galvanin Guido Costa Simone Famularo angela Palmisano Matteo Donadon Guido Torzilli Division of Hepatobiliary Surgery Department of SurgeryIRCCS Humanitas Research HospitalVia A.Manzoni 56Rozzano 20089MilanItaly Department of Biomedical Sciences Humanitas UniversityVia Rita Levi Montalcini 4Pieve Emanuele 20072MilanItaly

Intraoperative ultrasonography(IOUS)in hepatobiliary surgery is well known as an essential tool for radical and safe hepatectomies,allowing to perform parenchymal sparing surgery and,as consequence,to expand the surgical indications for patients otherwise considered unresectable.Nevertheless,since many years,despite its effectiveness in the study of vascular anatomy of the liver,the gold standard for the assessment of biliary anatomy during surgery is intraoperative cholangiography(IOC),which is used for the validation of preoperative imaging as well as for guiding reconstruction in case of bile duct injury or resection.

关键词： anatomy biliary ultrasonography

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