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Management of liver transplantation biliary stricture: Results from a tertiary hospital

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World Journal of Gastrointestinal Endoscopy 2015年第7期7卷 747-757页

作者： Fernanda Prata Martins Michel Kahaleh angelo P ferrari Endoscopy Unit Hospital Israelita Albert Einstein Division of Gastroenterology and Hepatology Department of Medicine Weill Cornell Medical College Division of Gastroenterology Universidade Federal de Sao Paulo

AIM: To review results of endoscopic treatment for anastomotic biliary strictures after orthotopic liver transplantation(OLT) during an 8-year period. METHODS: This is a retrospective review of all endoscopic retrograde cholangiopancreatographys(ERCPs) performed between May 2006 and June 2014 in deceased OLT recipients with anastomotic stricture at a tertiary care hospital. Patients were divided into 2 groups, according to the type of stent used(multiple plastic or covered self-expandable metal stents), which was chose on a case-by-case basis and their characteristics. The primary outcome was anastomotic stricture resolution rate determined if there was no more than a minimum waist at cholangiography and a 10 mm balloon could easily pass through the anastomosis with no need for further intervention after final stent removal. Secondary outcomes were technical successrate, number or ERCPs required per patient, number of stents placed, stent indwelling, stricture recurrence rate and therapy for recurrent anastomotic biliary stricture(AS). Stricture recurrence was defined as clinical laboratorial and/or imaging evidence of obstruction at the anastomosis level, after it was considered completely treated, requiring subsequent interventional ***: A total of 195 post-OLT patients were assessed for eligibility. One hundred and sixty-four(164) patients were diagnosed with anastomotic biliary stricture. ERCP was successfully performed in 157/164(95.7%) patients with AS, that were treated with either multiple plastic(n = 109) or metallic billiary stents(n = 48). Mean treatment duration, number of procedures and stents required were lower in the metal stent group. Acute pancreatitis was the most common procedure related complication, occurring in 17.1% in the covered self-expandable metal stents(c SEMS) and 4.1% in the multiple plastic stent(MPS) group. Migration was the most frequent stent related complication, observed in 4.3% and 5.5%(c SEMS and MPS respectively

关键词： Biliary stricture Benign Liver transplant Endoscopic retrograde cholangiopancreatographys Endoscopic treatment Plastic stent Self-expandablemetal stent

Chronic radiation proctopathy: A practical review of endoscopic treatment

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World Journal of Gastrointestinal Surgery 2016年第2期8卷 151-160页

作者： Luciano Lenz Rachel Rohr Frank Nakao Ermelindo Libera angelo ferrari Fleury Medicina e Saue Centro de Medicina Diagnatica SaPaulo 04513-100 Brazil Endoscopy Unity Universidade Federal de SaPaulo SaPaulo 04513-100 Brazil Endoscopy Unit Hospital Israelita Albert EinsteinSao Paulo 04513-100 Brazil

Chronic radiation proctopathy(CRP) is a troublesome complication of pelvic radiotherapy. The most common presentation is rectal bleeding. CRP symptoms interfere with daily activities and decrease quality of life. Rectal bleeding management in patients with CRP represents a conundrum for practitioners. Medical therapy is ineffective in general and surgical approach has a high morbidmortality. Endoscopy has a role in the diagnosis,staging and treatment of this disease. Currently available endoscopic modalities are formalin,potassium titanyl phosphate laser,neodymium:yttrium-aluminum-garnet laser,argon laser,bipolar electrocoagulation(BiCAP),heater probe,band ligation,cryotherapy,radiofrequency ablation and argon plasma coagulation(APC). Among these options,APC is the most promising.

关键词： Endoscopic treatment Radiation proctopathy Proctitis Argon plasma coagulation Cryotherapy Radiofrequency ablation Formalin Laser Bipolar probe Pelvic radiotherapy

Efficacy and safety of endoscopic prophylactic treatment with undiluted cyanoacrylate for gastric varices

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World Journal of Gastrointestinal Endoscopy 2014年第6期6卷 254-259页

作者： Matheus Cavalcante Franco Gustavo Flores Gomes Frank Shigeo Nakao Gustavo Andrade de Paulo angelo Paulo ferrari Jr Ermelindo Della Libera Jr Digestive Endoscopy Unit Division of GastroenterologyFederal University of Sao Paulo Endoscopy Division Fleury Medicina e Saúde Endoscopy Division Hospital Israelita Albert Einstein

AIM:To evaluate the efficacy and safety of undiluted N-butyl-2 cyanoacrylate plus methacryloxysulfolane(NBCM)as a prophylactic treatment for gastric varices(GV)***:This prospective study was conducted at a single tertiary-care teaching hospital between October 2009 and March *** with portal hypertension(PH)and GV,with no active gastrointestinal bleeding,were enrolled in primary prophylactic treatment with NBCM injection without lipiodol *** diagnosis of GV was based on endoscopy and confirmed with endosonography(EUS); the same procedure was used after treatment to confirm eradication of *** puncturing the GV with a regular injection needle,1 mL of undiluted NBCM was injected intranasally into *** injection was repeated as necessary to achieve eradication or until a maximum total volume of 3 mL of NBCM had been *** were followed clinically and evaluated with endoscopy at 3,6 and 12 *** follow-ups were performed *** main outcome measures were efficacy(GV eradication),safety(adverse events related to cyanoacrylate injection),recurrence,bleeding from GV and mortality related to GV ***:A total of 20 patients(15 male)with PH and GV were enrolled in the study and treated with undiluted NBCM *** 2(10%)patients had no esophageal varices(EV); 18(90%)patients were treated with endoscopic band ligation to eradicate EV before inclusion in the *** patients were followed clinically and endoscopically for a median of 31 mo(range:6-40 mo).Eradication of GV was observed in all patients(13 patients were treated with 1 session and 7 patients with 2 sessions),with a maximum injected volume of 2 mL *** patient had GV recurrence,confirmed by EUS,at 6-mo follow-up,and another had late recurrence with GV bleeding after 35 mo of follow-up; overall,GV recurrence was observed in 2 patients(10%),after 6 and 35 mo of follow-up,and GV bleeding rate was 5%(1 patient).Mild epigastric pain was r

关键词： Gastric varices Primary prevention Endoscopy Gastrointestinal Cyanoacrylates Gastrointestinal hemorrhage

Endoscopic therapy using a self-expandable metallic stent with an anti-migration system for postorthotopic liver transplantation anastomotic biliary stricture

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World Journal of Gastrointestinal Endoscopy 2022年第9期14卷 547-554页

作者： Larissa Wermelinger Pinheiro Fernanda Prata Martins Gustavo Andrade De Paulo Mðnica Lúcia Campos Contini angelo Paulo ferrari Ermelindo Della Libera Department of Gastroenterology Federal University of São Paulo/Escola Paulista de MedicinaSão Paulo 04023-900Brazil Department of Endoscopy Unit Hosp Israelita Albert EinsteinSão Paulo 04042033Brazil

BACKGROUND Endoscopic therapy using multiple plastic stents(MPSs)is the standard therapy for postorthotopic liver transplantation(p-OLT)anastomotic biliary stricture(ABS).However,this approach demands repeated *** studies us-ing fully covered self-expandable metallic stents(FCSEMS)have shown en-couraging results,but migration occurs in 10%to 40%of *** objective of this retrospective study was to evaluate the efficacy of endoscopic treatment using FCSEMS with an anti-migration system(Am-FCSEMS)in patients with p-OLT *** To evaluate the efficacy of endoscopic treatment using an Am-FCSEMS in patients with p-OLT *** This study was conducted in a private tertiary care centre in S?o Paulo,Brazil and was approved by our institution's Human Research *** April 2018 to October 2020,regardless of previous endoscopic treatment(MPS or FCSEMS),17 patients with p-OLT ABS and indications for endoscopic therapy were included in this *** exclusion criteria were pregnancy,nonanastomotic biliary or hilar stricture,hepatic artery stenosis/thrombosis,isolated biliary fistulae,a distance shorter than 2 cm from the stricture to the hepatic hilum,and patient *** primary endpoint was the efficacy of p-OLT ABS endoscopic treatment using an Am-FCSEMS that re-mained in place for a 12-mo *** sphincterotomy was performed in patients with native papilla,and an Am-FCSEMS(10 mm in final diameter and 60 or 80 mm in length)was placed(Hanarostent TM MI Tech,Co).Balloon stricture dilation was performed only if necessary to introduce the *** Three patients were excluded due to loss to follow-up before stent *** the 14 patients included and followed,7 were women,and the average age was 56 years(range:28-76).The average period of Am-FCSEMS placement was 362±109 *** success occurred in all 14 patients(100%).There were no cases of distal stent *** resolution of the stricture occurred in 13/14 patien

关键词： Liver transplantation Endoscopy Endoscopic retrograde cholangiopancreatography Biliary strictures Self-expandable metallic biliary stents

Small heat shock protein B8:from cell functions to its involvement in diseases and potential therapeutic applications

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Neural Regeneration Research 2025年第10期20卷 2872-2886页

作者： Marta Chierichetti Riccardo Cristofani Valeria Crippa Veronica ferrari Marta Cozzi Elena Casarotto Paola Pramaggiore Laura Cornaggia Guglielmo Patelli Ali Mohamed Margherita Piccolella Mariarita Galbiati Paola Rusmini Barbara Tedesco angelo Poletti Laboratory of Experimental Biology Dipartimento di Scienze Farmacologiche e Biomolecolari“Rodolfo Paoletti”(DiSFeB)Universitàdegli Studi di MilanoMilanItaly

Heat shock protein family B(small)member 8(HSPB8)is a 22 kDa ubiquitously expressed protein belonging to the family of small heat shock ***8 is involved in various cellular mechanisms mainly related to proteotoxic stress response and in other processes such as inflammation,cell division,and ***8 binds misfolded clients to prevent their aggregation by assisting protein refolding or degradation through chaperone-assisted selective *** line with this function,the pro-degradative activity of HSPB8 has been found protective in several neurodegenerative and neuromuscular diseases characterized by protein misfolding and *** cancer,HSPB8 has a dual role being capable of exerting either a pro-or an anti-tumoral activity depending on the pathways and factors expressed by the model of cancer under ***,HSPB8 exerts a protective function in different diseases by modulating the inflammatory response,which characterizes not only neurodegenerative diseases,but also other chronic or acute conditions affecting the nervous system,such as multiple sclerosis and intracerebellar *** note,HSPB8 modulation may represent a therapeutic approach in other neurological conditions that develop as a secondary consequence of other *** is the case of cognitive impairment related to diabetes mellitus,in which HSPB8 exerts a protective activity by assuring mitochondrial *** review aims to summarize the diverse and multiple functions of HSPB8 in different pathological conditions,focusing on the beneficial effects of its ***-based and alternative therapeutic approaches targeting HSPB8 and its regulated pathways will be discussed,emphasizing how new strategies for cell and tissue-specific delivery represent an avenue to advance in disease treatments.

关键词： aggregation autophagy cancer chaperone chaperone-assisted selective autophagy cognitive impairment HSPB8 neuroinflammation neuromuscular diseases therapy

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

Antiviral therapy in hepatitis C virus cirrhotic patients in compensated and decompensated condition

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World Journal of Gastroenterology 2008年第42期14卷 6467-6472页

作者： angelo Iacobellis Antonio Ippolito angelo Andriulli Division of Gastroenterology "Casa Sollievo della Sofferenza" Hospital IRCCS San Giovanni Rotondo 71013 Italy

The main goals of treating cirrhotic patients with antiviral therapy are to attain sustained viral clearance(SVR),halt disease progression,and prevent re-infection of the liver ***,while the medical need is great,the use of interferon and ribavirin might expose these patients to severe treated-related side effects as a large proportion of them have pre-existing hematological *** have reviewed potential benefits and risks associated with antiviral drugs in patients with liver cirrhosis,due to hepatitis C virus(HCV) *** cases presenting with bridging fibrosis or cirrhosis,current regimens of antiviral therapy have attained a 44%-48% rate of *** cirrhotic patients with portal hypertension,the SVR rate was 22% overall,12.5% in patients with genotype 1,and 66.7% in those with genotypes 2 and 3 following therapy with low doses of either Peg-IFN alpha-2b and of *** patients with decompensated cirrhosis,full dosages of Peg-IFN alpha-2b and of ribavirin produced a SVR rate of 35% overall,16% in patients with genotype 1 and 4,and 59% in those with genotype 2 and *** of hematological cytokines will either ensure full course of treatment to be accomplished with and prevent development of treatment-associated side *** benefits after HCV eradication were partial recovery of liver metabolic activity,prevention of hepatitis C recurrence after transplantation,and removal of some patients from the waiting list for liver *** observations highlighted that therapy is inadvisable for individuals with poor hepatic reserve(Child-Pugh-Turcotte score ≥ 10).Although SVR rates are low indecompensated cirrhotics due to hepatitis C,these patients have the most to gain as successful antiviral therapy is potentially lifesaving.

关键词： Hepatitis C virus Cirrhosis Peg-interferon Ribavirin Therapy

Correlation between expectations of recovery and injury severity perception in whiplash-associated disorders

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2011年第8期12卷 683-686页

作者： Robert ferrari Deon LOUW Department of Medicine University of AlbertaEdmonton

Objective:To assess the correlation between expectations of recovery and whiplash patients' perceptions of injury severity using a simplified *** of recovery have been shown to predict rate of recovery from whiplash injury in population-based *** perception of having more severe pathology or more ominous diagnostic labels has also been associated with a worse ***:Consecutive patients with whiplash-associated disorder grade 1 or 2,presenting in the acute stage to a primary care centre,were asked "do you think that your injury will…" with response options "get better soon;get better slowly;never get better;don't know." Injury severity perception (ISP) was measured with a numerical rating scale which ranged from 0-10,on which subjects were asked to rate how severe (in terms of damage) they thought their injury *** anchors were labeled "no damage" (0) and "severe,and maybe permanent damage" (10).The primary outcome measure was the correlation between the subject's ISP score and expectation of ***:A total of 94 subjects (34 males,60 females,and mean age (40.6±10.0) years,range 19-60 years) were *** initial responses to expectation of recovery were:get better soon (29/94);get better slowly (22/94);never get better (11/94);don't know (32/94).The mean ISP score was 4.9±1.7 (range 2-9 out of 10).There was a high correlation between expectations and ISP scores (Spearman's rank correlation coefficient 0.68).Those who expected to recover soon and those who expected to get better slowly had the lowest ISP ***:The more slowly whiplash patients expect to recover,or the less sure they are of recovery,the more severe their initial perceptions of injury.

关键词： Whiplash-associated disorders (WAD) Expectations of recovery Injury severity perception (ISP)

Development of a symptom expectation questionnaire for minor head injury

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Journal of Zhejiang University-Science B(Biomedicine & Biotechnology) 2011年第6期12卷 499-502页

作者： Robert ferrari Deon LOUW Department of Medicine University of AlbertaEdmonton

Background and objective:Expectations and beliefs are important predictors of outcome following minor head *** this paper,the primary purpose is to develop a simple symptom expectation questionnaire for minor head injury for use in future research ***:An existing database of 179 injury-naive subjects who completed a 56-item checklist of expected symptoms for minor head injury was analyzed to determine which items could correctly identify an a priori case definition of an expecter (a subject who expected at least one of these symptoms would remain chronic following minor head injury).A total of six of the 56 items were found to be discriminatory,and these were tested in additional subject groups against the original ***:From the original database of 179 subjects completing a 56-item symptom expectation checklist,135 expected that at least one of the 56 symptoms would be chronic following minor head *** 135 expecters,however,all chose at least one of six items:headache,anxious or worried,depressed,difficulty concentrating,dizziness,and neck *** these six items,in two new groups of subjects,all those who endorsed one of the 56 symptoms as likely to be chronic following minor head injury (expecters) could also be identified on the 6-item ***:A shortened (6-item) symptom expectation checklist of commonly reported symptoms following minor head injury (headache,anxious or worried,depressed,difficulty concentrating,dizziness,and neck pain) correctly identifies subjects who expect that at least one symptom will be chronic following minor head injury (i.e.,an expecter).

关键词： Minor head iniurv Expectation Outcomes