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Reverse time-dependent effect of alphafetoprotein and disease control on survival of patients with Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma

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World Journal of Hepatology 2017年第36期9卷 1322-1331页

作者： Francesca Romana Ponziani Irene Spinelli Emanuele Rinninella Lucia Cerrito Antonio Saviano Alfonso Wolfango Avolio Michele Basso Luca Miele Laura Riccardi maria Assunta Zocco Brigida Eleonora Annicchiarico Matteo Garcovich Marco Biolato Giuseppe Marrone anna maria de gaetano Roberto Iezzi Felice Giuliante Fabio maria Vecchio Salvatore Agnes Giovanni Addolorato Massimo Siciliano Gian Lodovico Rapaccini Antonio Grieco Antonio Gasbarrini Maurizio Pompili department of Internal Medicine Gastroenterology and Hepatology Agostino Gemelli Hospital department of Liver Transplant Surgery Agostino Gemelli Hospital department of Oncology Gastroenterology and Hepatology Agostino Gemelli Hospital department of Bioimaging and Radiological Sciences Agostino Gemelli Hospital department of Hepatobiliary Surgery Agostino Gemelli Hospital department of Pathology Agostino Gemelli Hospital

AIM To characterize the survival of cirrhotic patients with Barcelona Clinic Liver Cancer(BCLC) stage C hepatocellular carcinoma(HCC) and to ascertain the factors predicting the achievement of disease control(DC).METHODS The cirrhotic patients with BCLC stage C HCC evaluated by the Hepatocatt multidisciplinary group were subjected to the investigation. demographic, clinical and tumor features, along with the best tumor response and overall survival were recorded. RESULTS One hundred and ten BCLC stage C patients were included in the analysis; the median overall survival was 13.4 mo(95%CI: 10.6-17.0). Only alphafetoprotein(AFP) serum level > 200 ng/m L and DC could independently predict survival but in a time dependent manner, the former was significantly associated with increased risk of mortality within the first 6 mo of follow-up(HR = 5.073, 95%CI: 2.159-11.916, P = 0.0002), whereas the latter showed a protective effect against death after one year(HR = 0.110, 95%CI: 0.038-0.314, P ded lower chances of achieving DC(OR = 0.263, 95%CI: 0.111-0.622, P = 0.002).CONCLUSION The BCLC stage C HCC includes a wide heterogeneous group of cirrhotic patients suitable for potentially curative treatments. The reverse and time dependent effect of AFP serum level and DC on patients' survival confers them as useful predictive tools for treatment management and clinical decisions.

关键词： Hepatocellular carcinoma Cirrhosis Barcelona Clinic Liver Cancer stage C Alphafetoprotein Disease control Performance status Survival

Radical cholecystectomy without liver resection for peritoneal side early incidental gallbladder cancer

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World Journal of Gastroenterology 2024年第32期30卷 3739-3742页

作者： gaetano Piccolo Matteo Barabino Guglielmo NiccolòPiozzi Paolo Pietro Bianchi department of Health Sciences(DISS) University of MilanSan Paolo HospitalMilan 20142LombardyItaly department of Colorectal Surgery Portsmouth Hospitals University NHS TrustPortsmouthUnited Kingdom

Gallbladder cancer(GBC)is a rare disease with a poor *** cholecystectomy may be an adequate treatment only for very early disease(Tis,T1a),whereas reoperation is recommended for more advanced disease(T1b and T2).Radical cholecystectomy should have two fundamental objectives:To radically resect the liver parenchyma and to achieve adequate clearance of the lymph ***,recent studies have shown that compared with lymph node dissection alone,liver resection does not improve survival *** oncological roles of lymphadenectomy and liver resection is ***,for patients with incidental GBC without liver invasion,hepatic resection is not always mandatory.

关键词： Incidental gallbladder cancer Reoperation Radical cholecystectomy Early stage Liver resection

Protocol of Investigation on Sudden death at Autopsy, Including Molecular, Genetic and Toxicology Testing

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World Journal of Cardiovascular Surgery 2024年第6期14卷 78-86页

作者： gaetano Thiene Donata Favretto department of Cardiac Thoracic Vascular Sciences and Public Health University of Padua Padova Italy

The role of the autopsy: 1) Whether the death is ascribable to a natural or unnatural cause and when natural, if cardiac or extra-cardiac;2) The nosology of the cardiac diseases and the mechanism of cardiac death, whether arrhythmic or mechanical;3) If the cardiac disease is inherited, screening and counselling of the next of kin is required. About 30% of sudden deaths is ascribable to genetically determined morbid entities, mostly transmissible with the autosomal dominant pattern of inheritance, so that 50% of the first degree relatives are genetically affected (“carriers”) and exposed at risk;4) If toxic or illicit drug abuse was involved.

关键词： Family Screening Genetics Inheritance Molecular Autopsy Sudden death Toxicology

Effect of pediatric Tuina on children's recurrent acute respiratory tract infections: a retrospective cohort study in Southern China

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Journal of Traditional Chinese Medicine 2024年第3期44卷 586-594页

作者： YIN Lingjia STALSBY LUNDBORG Cecilia WU Darong YANG Jinghua ALVESSON Helle Molsted CAI Jianxiong LU Taoying XIE Qianwen MARRONE gaetano department of Global Public Health Karolinska InstitutetStockholm 17177Swede State Key Laboratory of Dampness Syndrome of Chinese Medicine the Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120China Outcome Assessment Research Team in Chinese Medicine the Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120China Health Construction Administration Centre Guangdong Provincial Hospital of Chinese MedicineGuangzhou 510120China Guangdong Provincial Key Laboratory of Clinical Research on Traditional Chinese Medicine Syndrome the Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou 510120China department of Pediatrics the Second Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou510120China

OBJECTIVE: To determine the effectiveness of pediatric Tuina(PT) in preventing recurrent acute respiratory tract infections(ARTIs) in children. METHODS: This is a retrospective cohort study based on the electronic medical records of children with recurrent ARTIs in 2016. Children were divided into a PT group or a non-PT group, according to whether they had received PT or not in 2016. The primary outcome was the number of ARTI episodes in 2017 and 2018. The secondary outcomes were the number of ARTIs leading to outpatient department visits and outpatient antibiotic prescriptions due to ARTIs in the same time period. Negative binomial regressions were used to detect the association between PT and the outcomes. RESULTS: A total of 2303 children were included in the analysis, including 94 in the PT group and 2209 in the non-PT group. Children who received PT six or more times in 2016 had fewer episodes of ARTIs in 2017 [incidence rate ratio(IRR): 0.59, 95% confidence interval(CI)(0.42-0.84)] and 2018 [IRR: 0.58, 95% CI(0.36-0.94)] and fewer outpatient department visits due to ARTIs in 2017 [IRR: 0.56, 95% CI(0.38-0.83)] than children who had not received PT in 2016. There was no significant difference in the number of outpatient antibiotic prescriptions between the two groups. CONCLUSIONS: Receiving PT six or more times within one year is associated with a decrease in recurrent ARTIs in children in the following two years. Randomized controlled trials are needed for effect evaluation prior to establishing PT as a method for preventing recurrent ARTIs among children.

关键词： child massage pediatric Tuina respiratory tract infections

A Structured Method of Teaching Epidural Block reduces the incidence of accidental dural puncture in inexperienced trainees.

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Open Journal of Anesthesiology 2024年第4期14卷 131-135页

作者： Marco Scorzoni Gianluigi Gonnella Emanuele Capogna Marina Campione gaetano Draisci Matteo Velardo Giorgio Capogna department of Anesthesiology Fondazione Policlinico Gemelli IRCCS Rome Italy department of Economics and Law Enna Kore University Enna Italy European School of Obstetric Anesthesia Rome Italy

Background: The rate of accidental dural puncture is particularly high during the period of training, especially in novices. The structured epidural teaching model (SETM) includes three standardized video lessons, the construction of a 3D epidural module by trainees and practical training by using an epidural simulator with and without the CompuFlo™ Epidural instrument. In this study we report the retrospective analysis of the accidental dural puncture rate of inexperienced trainees during their 6 months clinical practice rotation in obstetrics before and after the introduction of the SETM in our Institution. Method: We evaluated the incidence of accidental dural puncture before the introduction of the SETM methodology and afterwards by analyzing our departmental database from February 2019 to January 2023. All epidural blocks were executed by trainees who had never previously performed an epidural block and were about to begin their obstetrics rotation. Results: We analyzed 7415 epidurals: 3703 were performed before the introduction of the SETM methodology (control group) and 3712 afterwards (study group). The incidence of accidental dural puncture was 0.37% for the control group and 0.13% for the study group (pdental dural puncture was 64% (OR: 0.36) lower for trainees who had the training than for those who did not. Conclusions: After the introduction of the structured teaching method, we observed a significant reduction of accidental dural puncture during the training period. We hope that our observation will encourage a constructive discussion among experts about the need to use standardized and validated tools as a valuable aid in teaching epidural anesthesia.

关键词： teaching epidural Anesthesia obstetrical Anesthesia Anesthesia

Portal vein thrombosis:Insight into physiopathology,diagnosis,and treatment

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World Journal of Gastroenterology 2010年第2期16卷 143-155页

作者： Francesca R Ponziani maria A Zocco Chiara Campanale Emanuele Rinninella annalisa Tortora Luca Di Maurizio Giuseppe Bombardieri Raimondo de Cristofaro anna M de gaetano Raffaele Landolfi Antonio Gasbarrini department of Internal Medicine Catholic University of Rome department of Bioimaging and Radio-logical Sciences Catholic University of Rome

Portal vein thrombosis (PVT) is a relatively common complication in patients with liver cirrhosis, but might also occur in absence of an overt liver disease. Several causes, either local or systemic, might play an important role in PVT pathogenesis. Frequently, more than one risk factor could be identified; however, occasionally no single factor is discernable. Clinical examination, laboratory investigations, and imaging are helpful to provide a quick diagnosis, as prompt treatment might greatly affect a patient's outcome. In this review, we analyze the physiopathological mechanisms of PVT development, together with the hemodynamic and functional alterations related to this condition. Moreover, we describe the principal factors most frequently involved in PVT development and the recent knowledge concerning diagnostic and therapeutic procedures. Finally, we analyze the implications of PVT in the setting of liver transplantation and its possible influence on patients' future prognoses.

关键词： Portal vein thrombosis Portal hypertension Thrombophilic factors Liver cirrhosis Liver transplantation Anticoagulants

Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a delphi consensus project

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Asian Journal of Urology 2024年第2期11卷 271-279页

作者： Andrea Cocci Marta Pezzoli Fernando Bianco Franco Blefari Pierluigi Bove Francois Cornud gaetano de Rienzo Paolo destefanis Danilo Di Trapani Alessandro Giacobbe Luca Giovanessi Antonino Laganà Giovanni Lughezzani Guglielmo Manenti Gianluca Muto Gianluigi Patelli Novello Pinzi Stefano Regusci Giorgio I.Russo Juan I.M.Salamanca Matteo Salvi Luigi Silvestri Fabrizio Verweij Eric Walser Riccardo GBertolo Valerio Iacovelli Alessandro Bertaccini debora Marchiori Hugo Davila Pasquale Ditonno Paolo Gontero Gennaro Iapicca Theo M de Reijke Vito Ricapito Pierluca Pellegrini Andrea Minervini Sergio Serni Francesco Sessa department of Urology Careggi HospitalUniversity of FlorenceFlorenceItaly Urology Section University of FlorenceFlorenceItaly Urological Research Network MiamiFLUSA Urology Section Prato HospitalPratoItaly Torvergata Oncoscience Research Centre of Excellence TORDepartment of Experimental MedicineUniversity of Rome Tor VergataRomeItaly department of Urology San Carlo di Nancy HospitalRomeItaly department of Radiology Hôpital CochinParis Descartes UniversityParisFrance Urology and Andrology Unit II Department of Emergency and Organ TransplantationUniversity of BariBariItaly Unit of Urology Cittàdella Salute e della Scienza HospitalUniversity of TurinTurinItaly Urology Unit Buccheri La Ferla Fatebenefratelli HospitalPalermoItaly department of Urology Humanitas Gradenigo HospitalTurinItaly Urology Unit Surgical DepartmentFondazione Poliambulanza Istituto OspedalieroBresciaItaly departement of Urology “S.Giovanni Evangelista”HospitalTivoliItaly Humanitas Clinical and Research CentereIRCCS Department of UrologyRozzanoItaly department of Biomedical Sciences Humanitas UniversityPieve EmanueleItaly department of Biomedicine and Prevention University of Rome“Tor Vergata”RomeItaly department of Diagnostic Imaging and Interventional Radiology University of Rome“Tor Vergata”RomeItaly department of Interventional Radiology Pesenti-Fenaroli Hospital-ASST Bergamo EstAlzano LombardoItaly department of Urology University of SienaSienaItaly Swiss International Prostate Center GenevaSwitzerland Clinique Générale Beaulieu GenevaSwitzerland department of Urology University of CataniaItaly department of Urology Puerta de Hierro-Majadahonda University HospitalMadridSpain Lyx Institute of Urology Universidad Francisco de VitoriaMadridSpain department of Medico-Surgical Sciences and Biotechnologies Sapienza University of RomeFaculty of Pharmacy and MedicineUrology Unit ICOTLatinaItaly department of Urology European Institute of Oncology(IEO)IRCCSMilanItaly department of Radiology D

Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the delphi consensus ***: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and ***: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from 80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading t

关键词： Transperineal laser ablation Prostatecancer Benignprostatic hyperplasia delphi consensus

Gut microbiota in alcoholic liver disease: Pathogenetic role and therapeutic perspectives

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World Journal of Gastroenterology 2014年第44期20卷 16639-16648页

作者： Giulia Malaguarnera maria Giordano Giuseppe Nunnari gaetano Bertino Michele Malaguarnera department of Clinical and Molecular Biomedicine Section of Pharmacology and Biochemistry Research Centre "The Great Senescence" University of Catania Cannizzaro Hospital Infective Diseases Department of Clinical and Molecular Biomedicine Garibaldi Hospital of Nesima Hepatology Unit Department of Medical and Pediatric Science University of Catania

Alcoholic liver disease(ALD) is the commonest cause of cirrhosis in many Western countries and it has a high rate of morbidity and mortality. The pathogenesis is characterized by complex interactions between metabolic intermediates of alcohol. Bacterial intestinal flora is itself responsible for production of endogenous ethanol through the fermentation of carbohydrates. The intestinal metabolism of alcohol produces a high concentration of toxic acetaldehyde that modifies gut permeability and microbiota equilibrium. Furthermore it causes direct hepatocyte damage. In patients who consume alcohol over a long period, there is a modification of gut microbiota and, in particular, an increment of Gram negative bacteria. This causes endotoxemia and hyperactivation of the immune system. Endotoxin is a constituent of Gram negative bacteria cell walls. Two types of receptors, cluster of differentiation 14 and Toll-like receptors-4, present on Kupffer cells, recognize endotoxins. Several studies have demonstrated the importance of gut-liver axis and new treatments have been studied in recent years to reduce progression of ALD modifying gut microbiota. It has focused attention on antibiotics, prebiotics, probiotics and synbiotics.

关键词： Alcoholic liver disease Bacterial translocation Dysbiosis Prebiotics Probiotics Synbiotic Gut microbiota Endotoxin

Optimization of wavelength range and data interval in chemometric analysis of complex pharmaceutical mixtures

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Journal of Pharmaceutical Analysis 2016年第1期6卷 64-69页

作者： Michele de Luca Giuseppina Ioele Claudia Spatari gaetano Ragno department of Pharmacy Health and Nutritional Sciences University of Calabria

The performance of different chemometric approaches was evaluated in the spectrophotometric determination of pharmaceutical mixtures characterized by having the amount of components with a very high ratio. Principal component regression （PCR）, partial least squares with one dependent variable （PLS1） or multi-dependent variables （PLS2）, and multivariate curve resolution （MCR） were applied to the spectral data of a ternary mixture containing paracetamol, sodium ascorbate and chlorpheniramine （150：140：1, m/m/m）, and a quaternary mixture containing paracetamol, caffeine, phenylephrine and chlorpheniramine （125：6. 25：1.25：1, m/m/m/m）. The UV spectra of the calibration samples in the range of 200-320 nm were pre-treated by removing noise and useless data, and the wavelength regions having the most useful analytical information were selected using the regression coefficients calculated in the multivariate modeling. All the defined chemometric models were validated on external sample sets and then applied to commercial pharmaceutical formulations. Different data intervals, fixed at 0.5, 1.0, and 2.0 point/nm, were tested to optimize the prediction ability of the models. The best results were obtained using the PLSlcalibration models and the quantification of the species of a lower amount was sig- nificantly improved by adopting 0.5 data interval, which showed accuracy between 94.24% and 107.76%.

关键词： Chemometrics'Spectrophotometry'Principal component analysis'Partial least squares'Multivariate curve resolution