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Advancing immunosuppression in liver transplantation: A narrative review

Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 441-448页

作者： Samuele Iesari Francesca Laura Nava Ilaria Elena Zais Laurent Coubeau Mariano Ferraresso evaldo favi Jan Lerut General Surgery and Kidney Transplantation Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico15 Via della Commenda20122 MilanItaly Institut de Recherche Expérimentale et Clinique Universitécatholique de Louvain10 Avenue Hippocrate1200 BrusselsBelgium Service de Chirurgie et Transplantation Abdominale Cliniques Universitaires Saint-Luc55 Avenue Hippocrate1200 BrusselsBelgium Department of Clinical Sciences and Community Health Universitàdegli Studi di Milano19 Via della Commenda20122 MilanItaly

Immunosuppression is essential to ensure recipient and graft survivals after liver transplantation(LT). However, our understanding and management of the immune system remain suboptimal. Current immunosuppressive therapy cannot selectively inhibit the graft-specific immune response and entails a significant risk of serious side effects, i.e., among others, de novo cancers, infections, cardiovascular events, renal failure, metabolic syndrome, and late graft fibrosis, with progressive loss of graft function. Pharmacological research, aimed to develop alternative immunosuppressive agents in LT, is behind other solidorgan transplantation subspecialties, and, therefore, the development of new compounds and strategies should get priority in LT. The research trajectories cover mechanisms to induce T-cell exhaustion, to inhibit co-stimulation, to mitigate non-antigen-specific inflammatory response, and, lastly, to minimize the development and action of donor-specific antibodies. Moreover, while cellular modulation techniques are complex, active research is underway to foster the action of T-regulatory cells, to induce tolerogenic dendritic cells, and to promote the function of B-regulatory cells. We herein discuss current lines of research in clinical immunosuppression, particularly focusing on possible applications in the LT setting.

关键词： Liver transplantation Immunosuppression Drug development Long-term results Clinical operational tolerance

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Allograft artery mycotic aneurysm after kidney transplantation: A case report and review of literature

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World Journal of Clinical Cases 2020年第5期8卷 912-921页

作者： Marco Bindi Mariano Ferraresso Maria Letizia De Simeis Nicholas Raison Laura Clementoni Serena Delbue Marta Perego evaldo favi Renal Transplantation Fondazione IRCCS Ca’Granda Ospedale Maggiore PoliclinicoMilan 20122Italy Department of Clinical Sciences and Community Health University of MilanMilan 20122Italy MRC Centre for Transplantation King’s College LondonLondon WC2R 2LSUnited Kingdom Department of Biomedical Surgical and Dental SciencesUniversity of MilanMilan 20100Italy

BACKGROUND Allograft artery mycotic aneurysm(MA)represents a rare but life-threatening complication of kidney *** is widely considered the safest *** to the rarity of the disease and the substantial risk of fatal consequences,experience with conservative strategies is *** date,only a few reports on surgical repair have been *** describe a case of true MA successfully managed by aneurysm resection and arterial *** SUMMARY An 18-year-old gentleman,on post-operative day 70 after deceased donor kidney transplantation,presented with malaise,low urinary output,and worsening renal *** organ preservation fluid cultures,collected at the time of surgery,were positive for Candida *** ultrasound and contrastenhanced computer tomography showed a 4-cm-sized,saccular aneurysm of the iuxta-anastomotic segment of the allograft artery,suspicious for *** lesion was wide-necked and extended to the distal bifurcation of the main arterial branch,thus preventing endovascular stenting and *** multidisciplinary discussion,the patient underwent surgical exploration,aneurysm excision,and re-anastomosis between the stump of the allograft artery and the internal iliac *** procedure was *** and microbiology evaluation of the surgical specimen confirmed the diagnosis of MA caused by Candida *** years after the operation,the patient is doing very well with excellent allograft function and no signs of recurrent *** Surgical repair represents a feasible option in carefully selected patients with allograft artery ***-fungal prophylaxis is advised when preservation fluid cultures are positive.

关键词： Aneurysm Candida Kidney transplant Infection Complication Case report

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Incidence, risk factors, and outcome of BK polyomavirus infection after kidney transplantation

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World Journal of Clinical Cases 2019年第3期7卷 270-290页

作者： evaldo favi Carmelo Puliatti Rajesh Sivaprakasam Mariano Ferraresso Federico Ambrogi Serena Delbue Federico Gervasi Ilaria Salzillo Nicholas Raison Roberto Cacciola Renal Transplantation Fondazione IRCCS Ca’Granda Ospedale Maggiore Policlinico Renal Transplantation Barts Health NHS Trust Royal London Hospital Department of Clinical Sciences and Community Health University of Milan Department of Biomedical Surgical and Dental Sciences University of Milan MRC Centre for Transplantation King’s College London

BACKGROUND Polyomavirus-associated nephropathy is a leading cause of kidney allograft failure. Therapeutic options are limited and prompt reduction of the net state of immunosuppression represents the mainstay of treatment. More recent application of aggressive screening and management protocols for BK-virus infection after renal transplantation has shown encouraging results. Nevertheless,long-term outcome for patients with BK-viremia and nephropathy remains obscure. Risk factors for BK-virus infection are also *** To investigate incidence, risk factors, and outcome of BK-virus infection after kidney *** This single-centre observational study with a median follow up of 57(31-80) mo comprises 629 consecutive adult patients who underwent kidney transplantation between 2007 and 2013. Data were prospectively recorded and annually reviewed until 2016. Recipients were periodically screened for BK-virus by plasmaquantitative polymerized chain reaction. Patients with BK viral load ≥ 1000 copies/mL were diagnosed BK-viremia and underwent histological assessment to rule out nephropathy. In case of BK-viremia, immunosuppression was minimized according to a prespecified protocol. The following outcomes were evaluated: patient survival, overall graft survival, graft failure considering death as a competing risk, 30-d-event-censored graft failure, response to treatment,rejection, renal function, urologic complications, opportunistic infections, newonset diabetes after transplantation, and malignancies. We used a multivariable model to analyse risk factors for BK-viremia and *** BK-viremia was detected in 9.5% recipients. Initial viral load was high(≥ 10000 copies/mL) in 66.7% and low(< 10000 copies/mL) in 33.3% of these ***-associated nephropathy was diagnosed in 6.5% of the study population. Patients with high initial viral load were more likely to experience sustained viremia(95% vs 25%, P < 0.00001), nephropathy(92.

关键词： Polyomavirus BK virus Kidney transplantation Outcome Risk factors Immunosuppression Human leukocyte antigen Rejection Cytomegalovirus Ethnicity

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Systematic review of ablative therapy for the treatment of renal allograft neoplasms

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World Journal of Clinical Cases 2019年第17期7卷 2487-2504页

作者： evaldo favi Nicholas Raison Federico Ambrogi Serena Delbue Maria Chiara Clementi Luca Lamperti Marta Perego Matteo Bischeri Mariano Ferraresso Renal Transplantation Fondazione IRCCS Ca’ Granda Ospedale Maggiore PoliclinicoMilan 20122Italy MRC Centre for Transplantation King’s College LondonLondon WC2R 2LSUnited Kingdom Department of Clinical Sciences and Community Health University of MilanMilan 20122Italy Department of Biomedical Surgical and Dental SciencesUniversity of MilanMilan 20100Italy

BACKGROUND To date,there are no guidelines on the treatment of solid neoplasms in the transplanted ***,allograft nephrectomy has been considered the only reasonable *** recently,nephron-sparing surgery (NSS) and ablative therapy (AT) have been proposed as alternative procedures in selected *** To review outcomes of AT for the treatment of renal allograft *** We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2009 *** was searched in March 2019 without time restrictions for all papers reporting on radiofrequency ablation (RFA),cryoablation (CA),microwave ablation (MWA),high-intensity focused ultrasound (HIFU),and irreversible electroporation (IRE) of solid tumours of the kidney *** original manuscripts describing actual cases and edited in English were *** relevant articles were accessed in full *** searches included all pertinent *** studies were also assessed for methodological quality using a tool based on a modification of the Newcastle Ottawa *** on recipient characteristics,transplant characteristics,disease characteristics,treatment protocols,and treatment outcomes were extracted and *** the nature and the quality of the studies available (mostly retrospective case reports and small retrospective uncontrolled case series),a descriptive summary was *** Twenty-eight relevant studies were selected describing a total of 100 AT procedures in 92 *** age at diagnosis ranged from 21 to 71 years whereas time from transplant to diagnosis ranged from 0.1 to 312 *** of the neoplasms were asymptomatic and diagnosed incidentally during imaging carried out for screening purposes or for other clinical *** diagnostic modality was Doppler-ultrasound scan followed by computed tomography scan,and magnetic resonance *** tumour types were: pa

关键词： Ablative therapy Cryoablation Radiofrequency ablation Microwave ablation High-intensity focused ultrasonography Irreversible electroporation Neoplasm Kidney transplant Renal allograft Systematic review

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Treatment options for localised renal cell carcinoma of the transplanted kidney

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World Journal of Transplantation 2020年第6期10卷 147-161页

作者： Gloria Motta Mariano Ferraresso Luca Lamperti Dhanai Di Paolo Nicholas Raison Marta Perego evaldo favi Urology IRCCS Policlinico San DonatoSan Donato Milanese 27288Italy Renal Transplantation Fondazione IRCCS Ca’Granda Ospedale Maggiore PoliclinicoMilan 20122Italy Department of Clinical Sciences and Community Health University of MilanMilan 20122Italy MRC Centre for Transplantation King’s College LondonLondon WC2R 2LSUnited Kingdom

Currently,there is no consensus among the transplant community about the treatment of renal cell carcinoma(RCC)of the transplanted *** recently,graftectomy was universally considered the golden standard,regardless of the characteristics of the *** to the encouraging results observed in native kidneys,conservative options such as nephron-sparing surgery(NSS)(enucleation and partial nephrectomy)and ablative therapy(radiofrequency ablation,cryoablation,microwave ablation,high-intensity focused ultrasound,and irreversible electroporation)have been progressively used in carefully selected recipients with early-stage allograft *** reports show excellent patient survival,optimal oncological outcome,and preserved renal function with acceptable complication ***,the rarity and the heterogeneity of the disease,the number of options available,and the lack of long-term follow-up data do not allow to adequately define treatment-specific advantages and *** role of active surveillance and immunosuppression management remain also *** order to offer a better insight into this difficult topic and to help clinicians choose the best therapy for their patients,we performed and extensive review of the *** focused on epidemiology,clinical presentation,diagnostic work up,staging strategies,tumour characteristics,treatment modalities,and follow-up *** research confirms that both NSS and focal ablation represent a valuable alternative to graftectomy for kidney transplant recipients with American Joint Committee on Cancer stage T1aN0M0 *** on T1bN0M0 lesions are scarce but suggest extra *** designed multi-centre prospective clinical trials are warranted.

关键词： Renal cell carcinoma Kidney transplant Graftectomy Nephron-sparing surgery Focal ablation Review

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Emergency Care for Children and Adolescents after Sexual Violence, in Brazil’s Capital, Brasilia

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Open Journal of Epidemiology 2024年第2期14卷 397-403页

作者： evaldo Lima Da Costa Karla Simônia de Pádua Aníbal Faúndes Rui Nunes Bioethics at the School of Medicine University of Porto/Federal Council of Medicine Porto Portugal Center for Research in Women’ s Reproductive Health (CEMICAMP) Center for Integral Attention to Women (CAISM) State University of Campinas Campinas Brazil Center for Research in Women’ s Reproductive Health (CEMICAMP) State University of Campinas (UNICAMP) Campinas Brazil. The Centre of Bioethics Faculty of Medicine University of Porto Porto Portugal

Objective: Sexual violence affects women of all ages but, more commonly, children and adolescents. This study aimed to identify the extent to which services are being provided at the hospitals responsible for the emergency care of children and adolescents who have suffered sexual violence and to determine whether there is any difference in the provision of such services as a function of the victim’s age. Method: This cross-sectional study investigated differences in the care received by female children and adolescents who are victims of sexual violence in a capital city, comparing the treatment given to girls under 15 with that given to adolescents of 15 to 19 years of age. The data were extracted from the State Department of Health database between 01/01/2012 and 31/12/2016. Results: Children under 15 were much less likely to receive prophylaxis against HIV, sexually transmitted infections and hepatitis B, with the number of adolescent girls treated adequately corresponding to between twice and almost three times the number of children treated prophylactically. Only 10% of girls under 15 received emergency contraception. Conclusion: The lack of standard care established by the Ministry of Health highlights the need for urgent debates both locally and probably throughout the country, as the situation may be similar in other regions of the country.

关键词： Aggressors Children Sexual Violence Teenagers

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Morphological characterization and habitat suitability modeling of the goat population of Benin under climate change scenarios

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Ecological Processes 2022年第1期11卷 631-653页

作者： Habib Rainier Vihotogbe Whannou Cossi Ulriche Afatondji Côme Agossa Linsoussi Gnimansou Abraham favi Thanh Thi Nguyen Marcel Romuald Benjamin Houinato Luc Hippolyte Dossa Ecole des Sciences et Techniques de Production Animale Facultédes Sci-ences AgronomiquesUniversitéd’Abomey-CalaviAbomey-CalaviBénin Laboratoire d’Ecologie Appliquée Facultédes Sciences AgronomiquesUni-versitéd’Abomey-CalaviAbomey-CalaviBénin Laboratoire de Botanique et Ecologie Végétale Facultédes Sciences et TechniquesUniversitéd’Abomey-CalaviAbomey-CalaviBénin Organic Plant Production and Agroecosys-tems Research in the Tropics and Subtropics Organic Agricultural SciencesUniversity of KasselWitzenhausenGermany.

Background:Insufficient knowledge of the genetic and phenotypic diversity in the local Beninese goat population combined with the lack of understanding of its adaptive capacity to ongoing environmental and societal changes hampers the development of strategies for better management and genetic *** objective of this study was to establish the current geographical distribution of goats in Benin based on their morphology and model the potential habitat suitability of the three known main goat phenotypes(i.e.,Djallonkégoat or TypeⅠ,Sahelian goat or TypeⅡ,and their Crossbreeds or TypeⅢ)under climate change *** qualitative and 26 linear body measurements were taken on 2114 adult female goats sampled across the three vegetation zones of the *** ratios were generated from the quantitative *** data were analyzed using generalized linear model procedures followed by multiple comparisons of least-squares means and multivariate analytical methods,including canonical discrimination analysis and hierarchical ascendant *** goat was then assigned to one of the three aforementioned main goat phenotypes following its morphological characteristics and according to the a priori cluster membership defined in the previous *** Maximum Entropy algorithm was used to model the current and future distribution of the three goat phenotypes under climate change scenario using the Representative Conservation Pathways 4.5 and ***:All linear body measurements varied among vegetation *** the discriminant function analysis,71%of the measured individuals were correctly classified in their vegetation zone of origin by seven measured variables and three *** cluster procedure analysis revealed two groups of goats subdivided into the three main *** modeling results showed that the currently highly favorable habitats were distributed in the South for TypeⅠ,in the North for TypeⅡ,and both South and North for Type

关键词： Capra hircus Climate change Ecological niche modeling Farm animal species MaxEnt model Morphology

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Looking at the Statistical Texture Approach Applied to Weather Radar Rainfall Fields

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Journal of Geographic Information System 2022年第1期14卷 29-39页

作者： evaldo Araújo de Oliveira Augusto José Pereira Filho Department of Physics Federal University of Sao Paulo Diadema Brazil Department of Atmospheric Sciences University of Sao Paulo Sao Paulo Brazil

Texture analysis methods have been used in a variety of applications, for instance in remote sensing. Though widely used in electrical engineering, its application in atmospheric sciences is still limited. This paper reviews some concepts of digital texture and statistical texture approach, applying them to a set of specific maps to analyze the correlation between texture measurements used in most papers. It is also proposed an improvement of the method by setting free a distance parameter and the use of a new texture measurement based on the Kullback-Leibler divergence. Eight statistical measurements were used: mean, contrast, standard deviation, cluster shade, cluster prominence, angular second moment, local homogeneity and Shannon entropy. The above statistical measurements were applied to simple maps and a set of rainfall fields measured with weather radar. The results indicate some high correlations, e.g. between the mean and the contrast or between the angular second moment, local homogeneity and the Shannon entropy, besides the potentiality of the method to discriminate maps.

关键词： Image Classification Density Weather Maps Statistical Texture Approach

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Preoperative trans-jugular porto-systemic shunt for oncological gastric surgery in a cirrhotic patient

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World Journal of Gastroenterology 2015年第3期21卷 997-100页

作者： Andrea Liverani Luigi Solinas Tatiana Di Cesare Luca Velari Tiziano Neri Francesco Cilurso Francesco favi Giancarlo Bizzarri Department of General Surgery Regina Apostolorum Hospital00100 RomeItaly Department of Radiology Regina Apostolorum Hospital00100 RomeItaly

Abdominal surgery in cirrhotic patients with portal hypertension is associated with high incidence ofdisease and *** these patients,oncological gastric procedures with lymph-nodes dissection show much higher complication rates than in normotensive portal vein ***,normalization of portal vein pressure may be a favorable determinant factor to reduce *** report a case of a patient with hepatitis C virus-related hepatic cirrhosis,esophageal varices,portal hypertension and gastric *** demonstrated the efficacy of a preoperative trans-jugular porto-systemic shunt to perform oncological radical resection more *** retained preoperative the trans-jugular porto-systemic shunt in the patients with elevated portal pressure and gastric cancer to perform a gastrectomy more safely and to decrease morbidity and mortality of these cases.

关键词： Gastric cancer Cirrhotic patients Esophageal varic

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种子库和植被物种之间的差异有助于保持新热带稀树草原的功能多样性

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Journal of Plant Ecology 2021年第4期14卷 605-615页

作者： evaldo Bde Souza Francielli Bao Geraldo A.Damasceno Junior Arnildo Pott Programa de Pos-graduacao em Ecologia e Conservacao Instituto de BiocienciasUniversidade Federal de Mato Grosso do SulCampo GrandeBrazil Programa de Pos-graduacao em Biologia Vegetal Instituto de BiocienciasUniversidade Estadual PaulistaRio ClaroSPBrazil Programa de Pos-graduacao em Biologia Vegetal Instituto de BiociênciasUniversidade Federal de Mato Grosso do SulCampo GrandeBrazil

本研究的目的是量化种子库和建立的植被对物种组成、功能组成和多样性的贡献,并讨论这些差异对冲积平原植物群落更新和稳定性的影响。我们在巴西潘塔纳尔湿地的一个周期性洪水泛滥的稀树大草原上,在旱季和雨季对分布在5个地点的25个地块... 详细信息

本研究的目的是量化种子库和建立的植被对物种组成、功能组成和多样性的贡献,并讨论这些差异对冲积平原植物群落更新和稳定性的影响。我们在巴西潘塔纳尔湿地的一个周期性洪水泛滥的稀树大草原上,在旱季和雨季对分布在5个地点的25个地块(10 m×1 m)的1.5 m高度的地面覆盖植被和种子库进行了采样。采用出苗法对土壤种子库进行了评价。研究结果表明,种子库物种具有赋予群落更新的特征,而植被则具有稳定性特征。种子库的功能丰富度高于植被,而功能均匀度则低于植被。由于种子库和植被的植物特征不同,使得具有不同功能稳定性和更新特性的物种得以共存,这将有助于维持植物的功能多样性。这可能会让植物种群在应对干旱、火灾和洪水等不同的环境选择时更具有弹性。

关键词：环境选择功能多样性水溶扩散潘塔纳尔湿地稳定性更新

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