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Prognostic impact of the Bismuth-Corlette classification:Higher rates of local unresectability in stageⅢb hilar cholangiocarcinoma

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Hepatobiliary & Pancreatic Diseases International 2020年第2期19卷 157-162页

作者： Michael J Passeri Maria R Baimas-George Jesse K Sulzer david a iannitti John B Martinie Erin H Baker Lee M Ocuin Dionisios Vrochides Division of HPB Surgery Department of SurgeryCarolinas Medical Center1025 Morehead Medical Dr.Suite 600CharlotteNC 28204USA

Background:The Bismuth-Corlette(BC)classification is used to categorize hilar cholangiocarcinoma by proximal extension along the biliary tree.As the right hepatic artery crosses just behind the left bile duct,we hypothesized that BCⅢb tumors would have a higher likelihood of local unresectability due to involvement of the contralateral artery.Methods:A retrospective review of a prospectively maintained database identified patients with hilar cholangiocarcinoma taken to the operating room for intended curative resection between April 2008 and September 2016.Cases were assigned BC stages based on preoperative imaging.Results:Sixty-eight patients were included in the study.All underwent staging laparoscopy after which 16 cases were aborted for metastatic disease.Of the remaining 52 cases,14 cases were explored and aborted for locally advanced disease.Thirty-eight underwent attempt at curative resection.After exclud-ing cases aborted for metastatic disease,the chance of proceeding with resection was 55.6%for BCⅢb staged lesions compared to 80.0%of BCⅢa lesions and to 82.4%for BCⅠ-Ⅲa staged lesions(P<0.05).About 44.4%of BCⅢb lesions were aborted for locally advanced disease versus 17.6%of remaining BC stages.Conclusions:When hilar cholangiocarcinoma is preoperatively staged as BCⅢb,surgeons should antici-pate higher rates of locally unresectable disease,likely involving the right hepatic artery.

关键词： Bismuth-Corlette stage Cholangiocarcinoma Biliary tract surgical procedures Biliary tree Liver surgery

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A ten-year experience of inferior vena cava reconstruction for malignancy:The importance of a multidisciplinary approach with hepatobiliary surgery

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Hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 396-398页

作者： Maria R.Baimas-George Ryan C.Pickens Jesse K.Sulzer Dionisios Vrochides John B.Martinie david M.Levi david A.iannitti Division of Hepatopancreatobiliary Surgery Department of SurgeryCarolinas Medical Center1025 Morehead Medical DriveSuite 600CharlotteNC 28204USA Division of Transplant Surgery Department of SurgeryCarolinas Medical CenterCharlotteNCUSA

To the Editor,Tumor invasion of the inferior vena cava(IVC)through direct erosion is a rare and poor prognostic feature of aggressive hepatic or perihepatic malignancies[1,2].Literature shows poor response to chemotherapy,such that resection often is the only option for improved survival[3].Multidisciplinary collaborations can expand technical options;incorporation of transplant techniques has led to successful R0 resection involving difficult vascular reconstruction and extended resection[4,5].This study describes and analyzes the ten-year collaborative experience of hepatobiliary(HPB)surgeons in management of malignancies involving the perihepatic IVC.

关键词： hepato hepatic invasion

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The Janus of mIS in hepatobiliary surgery:Importance of maximally invasive surgery in an era of minimally invasive surgery

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Hepatobiliary & Pancreatic Diseases International 2020年第5期19卷 409-410页

作者： Maria R.Baimas-George Christoph Tschuor John B.Martinie david A.iannitti Erin H.Baker Dionisios Vrochides Division of HPB Surgery Department of SurgeryAtrium Health-Carolinas Medical Center1025 Morehead Medical DriveSuite 600CharlotteNC 28204USA

As surgeons formidably continue to forge into the twentytwenties,after a considerably coronavirus-induced rocky start,one can predict that the era of minimally invasive surgery(mIS),an era of robotics,telehealth,and enhanced recovery after surgery(ERAS■),is not only here to stay but will continue to thrive,develop,and transform our practices.Critics of robotics platforms would be hard pressed not to indulge in this prediction.Will the satisfyingly large midline“stem to stern”,the impressing exposuregenerating Makuuchi or transverse abdominal,the Kocher,paramedian,McBurney,Chevron,and Pfannenstiel incisions begin to disappear and fade away into a scar minimizing future precluding trauma laparotomies?Most likely not.Understanding and developing the skill and technique for a minimally invasive“mIS”approach does not negate or abrogate the maximally invasive“MIS”ones.It is not one or the other;not a“to be or not to be”Shakespearean scenario.Hepatobiliary surgery is a qualified landscape upon which to illuminate and exemplify this declaration:the necessity and companionship of“mIS”and“MIS”–minimally and maximally invasive surgery.

关键词： surgery maximal continue

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Hyperspectral Imaging Based on Compressive Sensing: Determining Cancer Margins in Human Pancreatic Tissue <i>ex Vivo</i>, a Pilot Study

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Open Journal of Medical Imaging 2021年第4期11卷 115-131页

作者： Joseph Peller Cobey L. McGinnis Kyle J. Thompson Imran Siddiqui John Martinie david A. iannitti Susan R. Trammell Department of Physics and Optical Science University of North Carolina at Charlotte Charlotte USA Carolinas Medical Center Charlotte USA

Cancer is the second-leading cause of death in the United State and surgery remains the primary treatment for most solid mass tumors. However, accurately identifying tumor margins in real-time remains a challenge. In this study, the design and testing of hyperspectral imaging (HSI) system based on a single-pixel camera engine is discussed. The primary advantage of a single pixel architecture over traditional scanning HSI techniques is its high sensitivity and potential to function at low light levels. The objective for the imaging system described here is to detect changes in the reflectance spectra of tissue and to use these differences to delineate tumor margins. This paper presents the results of a 19-patient pilot study that assesses the ability of the HSI system to use reflectance imaging to delineate adenocarcinoma tumor margins in human pancreatic tissue imaged ex vivo. Pancreatic tissue excised during pancreatectomy was imaged immediately after being sent to the pathology lab. A pathologist sectioned the tissue and placed samples into standard tissue embedding cassettes. These tissue samples were then imaged using the HSI system. After imaging, the samples were returned to the pathologist for processing and analysis. The HSI was later compared to the histological analysis. The spectral angle mapping (SAM) and support vector machine (SVM) algorithms were used to classify pixels in the HSI images as healthy or unhealthy in order to delineate margins. Good agreement between margins determined via HSI (using both SAM and SVM) and histology/white light imaging was found.

关键词： Hyperspectral Imaging Cancer Detection Reflectance Spectroscopy Single Pixel Camera

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Dectin- 1 isoforms contribute to distinct Th 1/Th 17 cell activation in mucosal candidiasis

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Cellular & Molecular Immunology 2012年第3期9卷 276-286页

作者： Agostinho Carvalho Gloria Giovannini AntoneUa De Luca Carmen D＇Angelo Andrea Casagrande Rossana G iannitti Giovanni Ricci Cristina Cunha Luigina Romani Department of Experimental Medicine and Biochemical Sciences University of Perugia Perugia Italy Life and Health Sciences Research Institute （ICVS） School of Health Sciences University of Minho Braga Portugal CVS/3B＇s--PT Government Associate Laboratory Braga/Guimaraes Portugal

The recognition of p-glucans by dectin-1 has been shown to mediate cell activation, cytokine production and a variety of antifungal responses. Here, we report that the functional activity of dectin-1 in mucosal immunity to Candida albicans is influenced by the genetic background of the host. Dectin-1 was required for the proper control of gastrointestinal and vaginal candidiasis in C57BIJ6, but not BALB/c mice; in fact, the latter showed increased resistance in the absence of dectin-1. The susceptibility of dectin-l-deficient C57BL/6 mice to infection was associated with defects in IL-17A and aryl hydrocarbon receptor-dependent IL-22 production and in adaptive Th I responses. In contrast, the resistance of dectin- 1-deficient BALB/c mice was associated with increased IL-17A and IL-22 production and the skewing towards Thl/Treg immune responses that provide immunological memory. Disparate canonical/ noncanonical NF-KB signaling pathways downstream of dectin-1 were activated in the two different mouse strains. Thus, the net activity of dectin-1 in antifungal mucosal immunity is dependent on the host＇s genetic background, which affects both the innate cytokine production and the adaptive Th1/Th17 cell activation upon dectin-1 signaling.

关键词： Dectin-1 Mucosal candidiasis, Th1/Th17, 11-22, genetic background

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CT结肠成像前肠道清洁:两种简化方案间的比较

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国际医学放射学杂志 2015年第2期 192-192页

作者： F.Iafrate M.iannitti M.Ciolina P.Baldassari A.Pichi A.Laghi 赵芳 Department of Radiological Oncological and Pathological Sciences “Sapienza” University of Rome Rome Italy

摘要目的比较CT结肠成像(CTC)的两种简化肠道准备和粪便存留的方案。材料与方法对连续52名成年人进行单中心、前瞻性、随机性、非劣效性的常规CT结肠成像研究。

关键词：结肠成像肠道清洁碘帕醇 CT

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