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Single-incision laparoscopic colorectal surgery for cancer: State of art

World Journal of Gastroenterology 2014年第20期20卷 6073-6080页

作者： Fabio Cianchi Fabio Staderini benedetta badii Department of Surgery and Translational Medicine Center of Oncological Minimally Invasive Surgery University of Florence 50134 Florence Italy

A number of clinical trials have demonstrated that the laparoscopic approach for colorectal cancer resection provides the same oncologic results as open surgery along with all clinical benefits of minimally invasive surgery.During the last years,a great effort has been made to research for minimizing parietal trauma,yet for cosmetic reasons and in order to further reduce surgery-related pain and morbidity.New techniques,such as natural orifice transluminal endoscopic surgery(NOTES)and single-incision laparoscopy(SIL)have been developed in order to reach the goal of"scarless"surgery.Although NOTES may seem not fully suitable or safe for advanced procedures,such as colectomies,SIL is currently regarded as the next major advance in the progress of minimally invasive surgical approaches to colorectal disease that is more feasible in generalized use.The small incision through the umbilicus allows surgeons to use familiar standard laparoscopic instruments and thus,perform even complex procedures which require extraction of large surgical specimens orintestinal anastomosis.The cosmetic result from SIL is also better because the only incision is made through the umbilicus which can hide the wound effectively after operation.However,SIL raises a number of specific new challenges compared with the laparoscopic conventional approach.A reduced capacity for triangulation,the repeated conflicts between the shafts of the instruments and the difficulties to achieve a correct exposure of the operative field are the most claimed issues.The use therefore of this new approach for complex colorectal procedures might understandingly be viewed as difficult to implement,especially for oncologic cases.

关键词： Colorectal cancer Laparoscopic surgery Single-inci

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Robotic rectal surgery: State of the art

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World Journal of Gastrointestinal Oncology 2016年第11期8卷 757-771页

作者： Fabio Staderini Caterina Foppa Alessio Minuzzo benedetta badii Etleva Qirici Giacomo Trallori Beatrice Mallardi Gabriele Lami Giuseppe Macrì Andrea Bonanomi Siro Bagnoli Giuliano Perigli Fabio Cianchi Center of Oncological Minimally Invasive Surgery Department of Surgery and Translational Medicine University of Florence Department of Experimental and Clinical Biomedical Sciences University of Florence Istituto per lo Studio e Prevenzione Onco-logica Unit of Gastroenterology

Laparoscopic rectal surgery has demonstrated its superiority over the open approach, however it still has some technical limitations that lead to the development of robotic platforms. Nevertheless the literature on this topic is rapidly expanding there is still no consensus about benefits of robotic rectal cancer surgery over the laparoscopic one. For this reason a review of all the literature examining robotic surgery for rectal cancer was performed. Two reviewers independently conducted a search of electronic databases(Pub Med and EMBASE) using the key words "rectum", "rectal", "cancer", "laparoscopy", "robot". After the initial screen of 266 articles, 43 papers were selected for review. A total of 3013 patients were included in the review. The most commonly performed intervention was low anterior resection(1450 patients, 48.1%), followed by anterior resections(997 patients, 33%), ultra-low anterior resections(393 patients, 13%) and abdominoperineal resections(173 patients, 5.7%). Robotic rectal surgery seems to offer potential advantages especially in low anterior resections with lower conversions rates and better preservation of the autonomic function. Quality of mesorectum and status of and circumferential resection margins are similar to those obtained with conventional laparoscopy even if robotic rectal surgery is undoubtedly associated with longer operative times. This review demonstrated that robotic rectal surgery is both safe and feasible but there is no evidence of its superiority over laparoscopy in terms of postoperative, clinical outcomes and incidence of complications. In conclusion robotic rectal surgery seems to overcome some of technical limitations of conventional laparoscopic surgery especially for tumors requiring low and ultralow anterior resections but this technical improvement seems not to provide, until now, any significant clinical advantages to the patients.

关键词：机器的外科机器的直肠的外科 DaVinci 直肠的外科机器的直肠的癌症为直肠的癌症的机器人学机器的直肠的切除术

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Minimally invasive surgery for gastric cancer: A comparison between robotic, laparoscopic and open surgery

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World Journal of Gastroenterology 2017年第13期23卷 2376-2384页

作者： Amilcare Parisi Daniel Reim Felice Borghi Ninh T Nguyen Feng Qi Andrea Coratti Fabio Cianchi Maurizio Cesari Francesca Bazzocchi Orhan Alimoglu Johan Gagnière Graziano Pernazza Simone D'Imporzano Yan-Bing Zhou Juan-Santiago Azagra Olivier Facy Steven T Brower Zhi-Wei Jiang Lu Zang Arda Isik Alessandro Gemini Stefano Trastulli Alexander Novotny Alessandra Marano Tong Liu Mario Annecchiarico benedetta badii Giacomo Arcuri Andrea Avanzolini Metin Leblebici Denis Pezet Shou-Gen Cao Martine Goergen Shu Zhang Giorgio Palazzini Vito D'Andrea Jacopo Desiderio Department of Digestive Surgery St.Mary's HospitalUniversity of Perugia Klinik und Poliklinik fuer Chirurgie Klinikum Rechts der IsarTechnical University Munich Department of Surgery General and Oncologic Surgery UnitSanta Croce e Carle Hospital Department of Surgery Division of Gastrointestinal SurgeryUniversity of CaliforniaIrvine Medical Center Gastrointestinal Surgery Tianjin Medical University General Hospital Division of Oncological and Robotic Surgery Department of OncologyCareggi University Hospital Unit of general and endocrine surgery Center of oncologic minimally invasive surgery(COMIS)Careggi University Hospital Department of General Surgery Hospital of Cittàdi CastelloUSL1 Umbria Department of General Surgery Division of GeneralGastroenterologic and Minimally Invasive SurgeryG.B.Morgagni Hospital Department of General Surgery School of MedicineIstanbul Medeniyet University Department of Digestive and Hepatobiliary Surgery Estaing University Hospital Department of Surgery Robotic General Surgery UnitSan Giovanni Addolorata Hospital Esophageal Surgery Unit Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal DiseaseMedical University of Pisa Department of General Surgery The Affiliated Hospital of Qingdao University Unitédes Maladies de l'Appareil Digestif et Endocrine Centre Hospitalier de Luxembourg Service de Chirurgie Digestive et Cancérologique CHU Bocage Department of Surgical Oncology and HPB Surgery Englewood Hospital and Medical Center Department of General Surgery Jinling HospitalMedical SchoolNanjing University Department of Surgery Ruijin HospitalShanghai Jiaotong UniversitySchool of Medicine Department of General Surgery Erzincan UniversitySchool of Medicine Department of Surgical Science “La Sapienza”University Department of Digestive Surgery St.Mary's Hospital of Terni-University of Perugia

AIM To investigate the role of minimally invasive surgery for gastric cancer and determine surgical, clinical, and oncological outcomes.METHODS This is a propensity score-matched case-control study, comparing three treatment arms: robotic gastrectomy(RG), laparoscopic gastrectomy(LG), open gastrectomy(OG). Data collection started after sharing a specific study protocol. Data were recorded through a tailored and protected web-based system. Primary outcomes: harvested lymph nodes, estimated blood loss, hospital stay, complications rate. Among the secondary outcomes, there are: operative time, R0 resections, POD of mobilization, POD of starting liquid diet and soft solid diet. The analysis includes the evaluation of type and grade of postoperative complications. Detailed information of anastomotic leakages is also provided.RESULTS The present analysis was carried out of 1026 gastrectomies. To guarantee homogenous distribution of cases, patients in the RG, LG and OG groups were 1:1:2 matched using a propensity score analysis with a caliper = 0.2. The successful matching resulted in a total sample of 604 patients(RG = 151; LG = 151; OG = 302). The three groups showed no differences in all baseline patients characteristics, type of surgery(P = 0.42) and stage of the disease(P = 0.16). Intraoperative blood loss was significantly lower in the LG(95.93 ± 119.22) and RG(117.91 ± 68.11) groups compared to the OG(127.26 ± 79.50, P = 0.002). The mean number of retrieved lymph nodes was similar between the RG(27.78 ± 11.45), LG(24.58 ± 13.56) and OG(25.82 ± 12.07) approach. A benefit in favor of the minimally invasive approaches was found in the length of hospital stay(P < 0.0001). A similar complications rate was found(P = 0.13). The leakage rate was not different(P = 0.78) between groups.CONCLUSION Laparoscopic and robotic surgery can be safely performed and proposed as possible alternative to open surgery. The main highlighted benefit is a faster postoperative functional recovery.

关键词： Gastric cancer Gastrectomy Minimally invasive surgery Robotic Robot-assisted Laparoscopy

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Multi-User Semantic Communications System with Spectrum Scarcity

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Journal of Communications and Information Networks 2022年第4期7卷 375-382页

作者： Romano Fantacci benedetta Picano Via di Santa Marta 3 Florence 50139Italy

Nowadays,the emerging paradigm of semantic communications seems to offer an attractive opportunity to improve the transmission reliability and efficiency in new generation communication systems.In particular,focusing on spectrum scarcity,expected to afflict the upcoming sixth generation(6G)networks,this paper analyses the semantic communications behavior in the context of a cell-dense scenario,in which users belonging to different small base station areas may be allocated on a same channel giving rise to a non-negligible interference that severely affects the communications reliability.In such a context,artificial intelligence methodologies are of paramount importance in order to speed up the switch from traditional communication to the novel semantic communication paradigm.As a consequence,a deep-convolution neural networks based encoder-decoder architecture has been exploited here in the definition of the proposed semantic communications framework.Finally,extensive numerical simulations have been performed to test the advantages of the proposed framework in different interfering scenarios and in comparison with different traditional or semantic alternatives.

关键词： semantic communication terahertz communications machine learning

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Enzymatic activity and physico-chemical changes of terminal bud in rain-fed fig(Ficus carica L. ‘Sabz’) during dormant season

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Horticultural Plant Journal 2022年第2期8卷 195-204页

作者： Sahar Sedaghat badii Gaaliche Majid Rahemi Hamid Zare Moslem Jafari Department of Horticultural Science Faculty of AgricultureShiraz UniversityShiraz***Iran Laboratory of Horticulture National Agricultural Research Institute of Tunisia(INRAT)IRESA-University of CarthageEl MenzahTunis 1004Tunisia Fig Research Station Fars Agricultural and Natural Resources Research and Education CenterAgricultural ResearchEducation and Extension Organization(AREEO)Estahban 74518778Iran

Rain-fed fig culture is known to provide a good quality of dried figs, while almost no research has been reported so far on the enzyme activity comparisons of seasonal variations among terminal buds in this plant. Toward this goal, we evaluated the physiochemical changes of terminal buds of fig 'Sabz' and their micromorphology during the dormant season(November to April) using Scanning Electron Microscope(SEM) analysis during two consecutive years(2016 and 2017). Results indicated that the highest contents of total sugars in terminal fig buds were registered in January and the lowest values were noticed in April. SEM analysis showed the presence of vegetative terminal fig buds during the dormant season and after bud-break in April. An increasing trend was observed for the protein content, length and diameter of terminal buds at the beginning of bud-break. In dormant buds, ascorbate peroxidase, peroxidase and catalase enzymes exhibited initially an ascending pattern,while it decreased from December. A second increase for these enzymes occurred during the dormant season until bud-break. Superoxide dismutase activity increased in buds during the dormancy season until bud-break. Proline content remained stable in buds from November to February, while it decreased rapidly until bud-break. Furthermore, a downward trend of the total phenol content in buds was observed between the onset and end of dormant period. In general, the dormant buds in 'Sabz' fig cultivar were metabolically active with a short dormant period under the rain-fed conditions.

关键词： Fig Dormancy Bud break Enzyme activity Micromorphology

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Autoimmmune hepatitis

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Cellular & Molecular Immunology 2022年第2期19卷 158-176页

作者： benedetta Terziroli Beretta-Piccoli Giorgina Mieli-Vergani Diego Vergani Epatocentro Ticino&Facoltàdi Scienze Biomediche Universitàdella Svizzera ItalianaLuganoSwitzerland Institute for Research in Biomedicine BellinzonaSwitzerland. King’s College London Faculty of Life Sciences&Medicine at King’s College Hospital LondonUK. Paediatric Liver GI and Nutrition CentreMowatLabsKing’s College HospitalLondonUK. Institute of Liver Studies MowatLabsKing’s College HospitalLondonUK.

Autoimmune hepatitis(AIH)is a T-cell mediated,inflammatory liver disease affecting all ages and characterized by female preponderance,elevated serum transaminase and immunoglobulin G levels,positive circulating autoantibodies,and presence of interface hepatitis at liver histology.AIH type 1,affecting both adults and children,is defined by positive anti-nuclear and/or antismooth muscle antibodies,while type 2 AIH,affecting mostly children,is defined by positive anti-liver-kidney microsomal type 1 and/or anti-liver cytosol type 1 antibody.While the autoantigens of type 2 AIH are well defined,being the cytochrome P4502D6(CYP2D6)and the formiminotransferase cyclodeaminase(FTCD),in type 1 AIH they remain to be identified.AIH-1 predisposition is conferred by possession of the MHC class II HLA DRB1*03 at all ages,while DRB1*04 predisposes to late onset disease;AIH-2 is associated with possession of DRB1*07 and DRB1*03.The majority of patients responds well to standard immunosuppressive treatment,based on steroid and azathioprine;second-and third-line drugs should be considered in case of intolerance or insufficient response.This review offers a comprehensive overview of pathophysiological and clinical aspects of AIH.

关键词： Autoimmune Hepatitis Immunopathophysiology Treatment Genetic Predisposition

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Viral hepatitis:Innovations and expectations

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World Journal of Gastroenterology 2022年第5期28卷 517-531页

作者： Simona Leoni Alberto Casabianca benedetta Biagioni Ilaria Serio Division of Internal Medicine Hepatobiliary and Immunoallergic DiseasesIRCCS Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy

Viral hepatitis is a significant health problem worldwide,associated with morbidity and mortality.Hepatitis B,C,D,and occasionally E viruses(HBV,HCV,HDV,and HEV)can evolve in chronic infections,whereas hepatitis A virus(HAV)frequently produces acute self-limiting hepatitis.In the last years,different studies have been performed to introduce new antiviral therapies.The most important goal in the treatment of viral hepatitis is to avoid chronic liver disease and complications.This review analyzes currently available therapies,in particular for viruses associated with chronic liver disease.The focus is especially on HBV and HCV therapies,investigating new drugs already introduced in clinical practice and clinical trials.We also describe new entry inhibitors,developed for the treatment of chronic HDV and HBV and currently available treatments for HEV.The last drugs introduced have shown important efficacy in HCV,with achievable target HCV elimination by 2030.Concurrently,renewed interest in curative HBV therapies has been registered;current nucleotide/nucleoside analogs positively impact liver-related complications,ensuring high safety and tolerability.Novel approaches to HBV cure are based on new antivirals,targeting different steps of the HBV life cycle and immune modulators.The improved knowledge of the HDV life cycle has facilitated the development of some direct-acting agents,as bulevirtide,the first drug conditionally approved in Europe for HDV associated compensated liver disease.Further studies are required to identify a new therapeutic approach in hepatitis E,especially in immunosuppressed patients.

关键词： Viral hepatitis Chronic liver disease Treatments Antiviral Immunotherapy Vaccination

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Applications of endoscopic ultrasound elastography in pancreatic diseases: From literature to real life

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World Journal of Gastroenterology 2022年第9期28卷 909-917页

作者： Clara benedetta Conti Giacomo Mulinacci Raffaele Salerno Marco Emilio Dinelli Roberto Grassia Interventional Endoscopy Unit ASST MonzaOspedale San GerardoMonza 20900Italy Gastroenterology and Endoscopy Unit ASST Fatebenefratelli-SaccoMilan 20121Italy Gastroenterology and Endoscopy Unit ASST CremonaCremona 26100Italy

Elastography is a non-invasive method widely used to measure the stiffness of the tissues,and it is available in most endoscopic ultrasound machines,using either qualitative or quantitative techniques.Endoscopic ultrasound elastography is a tool that should be applied to obtain a complementary evaluation of pancreatic diseases,together with other imaging tests and clinical data.Elastography can be informative,especially when studying pancreatic masses and help the clinician in the differential diagnosis between benign or malignant lesions.However,further studies are necessary to standardize the method,increase the reproducibility and establish definitive cut-offs to distinguish between benign and malignant pancreatic masses.Moreover,even if promising,elastography still provides little information in the evaluation of benign conditions.

关键词： Elastography Pancreas Pancreatic stiffness Pancreatitis Pancreatic cancer Endosonography Endoscopic ultrasound Quantitative elastography Strain elastography Pancreatic diseases

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Restaging rectal cancer following neoadjuvant chemoradiotherapy

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World Journal of Gastrointestinal Oncology 2023年第5期15卷 700-712页

作者： Dajana Cuicchi Giovanni Castagna Stefano Cardelli Cristina Larotonda benedetta Petrello Gilberto Poggioli Department of Medical and Surgical Sciences Surgery of the Alimentary TractIRCCS Azienda Ospedaliero-Universitaria di BolognaBologna 40138Italy

Correct tumour restaging is pivotal for identifying the most personalised surgical treatment for patients with locally advanced rectal cancer undergoing neoadjuvant therapy,and works to avoid both poor oncological outcome and overtreatment.Digital rectal examination,endoscopy,and pelvic magnetic resonance imaging are the recommended modalities for local tumour restaging,while chest and abdominal computed tomography are utilised for the assessment of distant disease.The optimal length of time between neoadjuvant treatment and restaging,in terms of both oncological safety and clinical effectiveness of treatment,remains unclear,especially for patients receiving prolonged total neoadjuvant therapy.The timely identification of patients who are radioresistant and at risk of disease progression remains challenging.

关键词： Locally advanced rectal cancer Restaging Pelvic magnetic resonance imaging Endorectal ultrasound Computed tomography scan Colonoscopy

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Depression among medical students in Tunisia:Prevalence and associated factors

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World Journal of Psychiatry 2023年第10期13卷 772-783页

作者： badii Amamou Sondess Alouani Amjed Ben Haouala Saoussen Alouani Mohamed Ayoub Tlili Ahmed Mhalla Ferid Zaafrane Lotfi Gaha Department of Psychiatry Fattouma Bourguiba University Hospital of MonastirMonastir 5000Tunisia Department of Family and Community Medicine Faculty of Medicine of SousseSousse 4002Tunisia

BACKGROUND Medical school is known for its lengthy process,which is both physically and emotionally draining.Students’mental balance would shrink as they progress in their medical training.A systematic review and meta-analysis reported that the prevalence of depressive symptoms among medical students remained relatively constant at 27.2%.AIM To assess the prevalence of depressive symptoms among Tunisian medical students and evaluate its associated factors.METHODS This is a descriptive cross-sectional study that was carried out in the second semester of the academic year 2017/2018,between April 2018 and July 2018 among 1138 medical students.Data were collected using a socio-demographic questionnaire and the Beck Depression Inventory-II(BDI-II).RESULTS Sixty-four percent(n=728)of the participants had depressive symptoms,of which 266(23.4%)met the criteria for mild,271(23.8%)for moderate,and 191(16.8%)for severe depressive symptoms.Female gender,low socio-economic level,smoking habits and history of mental disorder,performing leisure and physical activities,satisfaction toward a career choice,and happiness perception were the main prognostic factors for depression among medical students.Although academic grades may not be considered a prognostic factor,final-year students appeared to be less depressive than their colleagues.CONCLUSION These findings give insight into mental health issues and comorbidities among Tunisian medical students.It is a hopeful request for decision-makers and academic authorities to set serious measures and draw effective interventions to minimize the currency of psychological distress among this subpopulation.

关键词： Depression Psychiatry Medical students Mental health Beck Depression Inventory Tunisia

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