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Is there still a role for the hepatic locoregional treatment of metastatic neuroendocrine tumors in the era of systemic targeted therapies?

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World Journal of Gastroenterology 2017年第15期23卷 2640-2650页

作者： federica Cavalcoli Emanuele Rausa Dario Conte Antonio Federico Nicolini Sara Massironi Gastro-enterology and Endoscopy Unit Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico Postgraduate School of Gastroenterology Department of Pathophysiology and TransplantationUniversitàdegli Studi di Milano Department of Colorectal Diseases St.Vincent's University Hospital Department of Interventional Radiology Fondazione IRCCS Ca'Granda Ospedale Maggiore Policlinico

Gastroenteropancreatic neuroendocrine neoplasms(GEP-NENs) frequently present with distant metastases at the time of diagnosis and the liver is the most frequent site of spreading. The early identification of metastatic disease represents a major prognostic factor for GEP-NENs patients. Radical surgical resection, which is feasible for a minority of patients, is considered the only curative option, while the best management for patients with unresectable liver metastases is still being debated. In the last few years, a number of locoregional and systemic treatments has become available for GEP-NEN patients metastatic to the liver. However, to date only a few prospective studies have compared those therapies and the optimal management option is based on clinical judgement. Additionally, locoregional treatments appear feasible and safe for disease control for patients with limited liver involvement and effective in symptoms control for patients with diffuse liver metastases. Considering the lack of randomized controlled trials comparing the locoregional treatments of liver metastatic NEN patients, clinical judgment remains key to set the most appropriate therapeutic pathway. Prospective data may ultimately lead to more personalized and optimized treatments. The present review analyzes all the locoregional therapy modalities(i.e., surgery, ablative treatments and transarterial approach) and aims to provide clinicians with a useful algorithm to best treat GEP-NEN patients metastatic to the liver.

关键词： Gastroenteropancreatic neuroendocrine neoplasms Liver metastases Locoregional therapies Systemic therapies Ablation Chemoembolization

Small bowel capsule endoscopy in 2007:Indications,risks and limitations

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World Journal of Gastroenterology 2007年第46期13卷 6140-6149页

作者： Emanuele Rondonotti federica Villa Chris JJ Mulder Maarten AJM Jacobs Roberto de Franchis Università degli Studi di Milano IRCCS Fondazione PoliclinicoMangiagalliRegina Elena.UnitàOperativa di Gastroenterologia 3 via Pace 9Milano 20122Italy VU University Medical Centre Department of Gastroenterology and HepatologyBoelelaan 11171081 HV AmsterdamThe Nederlands Universitàdegli Studi di Milano IRCCS Fondazione PoliclinicoMangiagalliRegina Elena.UnitàOperativa di Gastroenterologia 3 via Pace 9Milano 20122Italy

Capsule endoscopy has revoluzionized the study of the small bowel by providing a reliable method to evaluate, endoscopically, the entire small bowel. In the last six years several papers have been published exploring the possible role of this examination in different clinical conditions. At the present time capsule endoscopy is generally recommended as a third examination, after negative bidirectional endoscopy, in patients with obscure gastrointestinal bleeding. A growing body of evidence suggests also an important role for this examination in other clinical conditions such as Crohn＇s disease, celiac disease, small bowel polyposis syndromes or small bowel tumors. The main complication of this examination is the retention of the device at the site of a previously unknown small bowel stricture. However there are also some other open issues mainly due to technical limitations of this tool （which is not driven from remote control, is unable to take biopsies, to insufflate air, to suck fluids or debris and sometimes to correctly size and locate lesions）.The recently developed double balloon enteroscope, owing to its capability to explore a large part of the small bowel and to take targeted biopsies, although being invasive and time consuming, can overcome some limitations of capsule endoscopy. At the present time, in the majority of clinical conditions （i.e. obscure GI bleeding）, the winning strategy seems to be to couple these two techniques to explore the small bowel in a painless, safe and complete way （with capsule endoscopy） and to define and treat the lesions identified （with double balloon enteroscopy）.

关键词： Capsule endoscopy Double balloon

Two elective invasive procedures after a single avatrombopag treatment in a patient with liver cirrhosis and severe thrombocytopenia

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Gastroenterology Report 2022年第1期10卷 668-670页

作者： Marco Biolato federica Vitale Giuseppe Marrone Luca Miele Antonio Grieco Internal and Liver Transplant Medicine Unit CEMADDepartment of Medical and Surgical SciencesFondazione Policlinico Universitario Agostino Gemelli IRCCSRomeItaly Institute of Internal Medicine Catholic University of the Sacred HeartRomeItaly

Introduction Severe thrombocytopenia(platelet count56×10^(9)/L[2].Observational studies found that severe thrombocytopenia may be predictive of post-procedure bleeding after liver biopsy,dental extractions,percutaneo... 详细信息

关键词： treatment cirrhosis liver

Liver transplantation for hepatocellular carcinoma： is zero recurrence theoretically possible？

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Hepatobiliary & Pancreatic Diseases International 2016年第2期15卷 147-151页

作者： Sabine Irtan Louise Barbier Claire Francoz federica Dondéro Francois Durand Jacques Belghiti Department of Hepato-Pancreato-Biliary Surgery Beaujon HospitalAssistance Publique Hopitaux de ParisUniversity Denis Diderot-ParisⅦClichyFrance Department of Hepatology Beaujon HospitalAssistance Publique Hopitaux de ParisUniversity Denis Diderot-ParisⅦClichyFrance

BACKGROUND： Hepatocellular carcinoma（HCC） recurrence remains a key issue after liver transplantation. This study aimed to determine a subgroup of HCC patients within the Milan criteria who could achieve a theoretical goal of zero recurrence rates after liver ***： Between 1999 and 2009, 179 patients who received liver transplantation for HCC within the Milan criteria were retrospectively included. Analysis of the factors associated with HCC recurrence was performed to determine the subgroup of patients at the lowest risk of ***： Seventy-two percent of the patients received a bridging therapy, including 54 liver resections. Eleven（6.1%） patients recurred within a delay of 19±22 months and ultimately died. Factors associated with recurrence were serum alpha-fetoprotein level 〉400 ng/m L, satellite nodules, poor differentiation, microvascular invasion and cholangiocarcinoma component. Recurrence rates decreased from 6.1% to 3.1% in patients without any of these ***： Among HCC patients within the Milan criteria, selecting patients with factors based on histology would allow tending towards zero recurrence, and prior histological assessment by liver biopsy or resection may be essential to rule out poorly differentiated tumors, microvascular invasion,and cholangiocarcinoma component.

关键词： hepatocellular carcinoma liver transplantation neoplasm recurrence survival rate

Minimum platelet count threshold before invasive procedures in cirrhosis:Evolution of the guidelines

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World Journal of Gastrointestinal Surgery 2023年第2期15卷 127-141页

作者： Marco Biolato federica Vitale Tiziano Galasso Antonio Gasbarrini Antonio Grieco Department of Medical and Surgical Sciences CEMADFondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy Department of Internal Medicine Catholic University of Sacred HeartRome 00168Italy

Cirrhotic patients with severe thrombocytopenia are at increased risk of bleeding during invasive *** need for preprocedural prophylaxis aimed at reducing the risk of bleeding in cirrhotic patients with thrombocytopenia who undergo scheduled procedures is assessed via the platelet count;however,establishing a minimum threshold considered safe is challenging.A platelet count≥50000/μL is a frequent target,but levels vary by provider,procedure,and specific *** the years,this value has changed several times according to the different guidelines proposed in the *** to the latest guidelines,many procedures can be performed at any level of platelet count,which should not necessarily be checked before the *** this review,we aim to investigate and describe how the guidelines have evolved in recent years in the evaluation of the minimum platelet count threshold required to perform different invasive procedures,according to their bleeding risk.

关键词： Liver disease Thrombocytopenia Avatrombopag Lusutrombopag Transfusion

Role of inflammatory cytokines in peripheral nerve injury

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Neural Regeneration Research 2012年第29期7卷 2259-2266页

作者： federica Fregnan Luisa Muratori Anabel Rodriguez Simǒes Maria Giuseppina Giacobini-Robecchi Stefania Raimondo Department of Clinical and Biological Sciences University of TurinOrbassano 10043 TurinItaly Neuroscience Institute of the "Cavalieri Ottolenghi" Foundation Orbassano 10043TurinItaly

Inflammatory events occurring in the distal part of an injured peripheral nerve have, nowadays, a great resonance. Investigating the timing of action of the several cytokines in the important stages of Wallerian degeneration helps to understand the regenerative process and design pharmacologic intervention that promotes and expedites recovery. The complex and synergistic action of inflammatory cytokines finally promotes axonal regeneration. Cytokines can be divided into pro- and anti-inflammatory cytokines that upregulate and downregulate, respectively, the production of inflammatory mediators. While pro-inflammatory cytokines are expressed in the first phase of Wallerian degeneration and promote the recruitment of macrophages, anti-inflammatory cytokines are expressed after this recruitment and downregulate the production of all cytokines, thus determining the end of the process. In this review, we describe the major inflammatory cytokines involved in Wallerian degeneration and the early phases of nerve regeneration. In particular, we focus on interleukin-1, interleukin-2, interleukin-6, tumor necrosis factor-β, interleukin-10 and transforming growth factor-β.

关键词： pro-inflammatory cytokines anti-inflammatory cytokines inflammatory reaction peripheral nervoussystem nerve injury wallerian degeneration Schwann cells macrophage axonal regeneration myelin neural regeneration

Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: A few lights and many shadows

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World Journal of Gastroenterology 2018年第24期24卷 2582-2595页

作者： Maria Guarino Anna Sessa Valentina Cossiga federica Morando Nicola Caporaso Filomena Morisco Gastroenterology Unit Department of Clinical Medicine and SurgeryUniversity of Naples Federico Ⅱ

With the introduction of direct-acting antiviral agents(DAA), the rate of sustained virological response(SVR) in the treatment of hepatitis C virus(HCV) has radically improved to over 95%. Robust scientific evidence supports a beneficial role of SVR after interferon therapy in the progression of cirrhosis, resulting in a decreased incidence of hepatocellular carcinoma(HCC). However, a debate on the impact of DAAs on the development of HCC is ongoing. This review aimed to analyse the scientific literature regarding the risk of HCC in terms of its recurrence and occurrence after the use of DAAs to eradicate HCV infection. Among 11 studies examining HCC occurrence, the de novo incidence rate ranged from 0 to 7.4%(maximum follow-up: 18 mo). Among 18 studies regarding HCC recurrence, the rate ranged from 0 to 54.4%(maximum "not well-defined" followup: 32 mo). This review highlights the major difficulties in interpreting data and reconciling the results of the included studies. These difficulties include heterogeneous cohorts, potential misclassifications of HCC prior to DAA therapy, the absence of an adequate control group, short follow-up times and different kinds of follow-up. Moreover, no clinical feature-based scoring system accounts for the molecular characteristics and pathobiology of the tumours. Nonetheless, this review does not suggest that there is a higher rate of de novo HCC occurrence or recurrence after DAA therapy in patients with previous HCV infection.

关键词： hepatocellular carcinoma hepatitis C virus direct-acting antiviral agents occurrence recurrence

Highly selective sorting of semiconducting single wall carbon nanotubes exhibiting light emission at telecom wavelengths

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Nano Research 2016年第8期9卷 2478-2486页

作者： Francesco Sarti Francesco Biccari federica Fioravanti Ughetta Torrini Anna Vinattieri Vincent Derycke Massimo Gurioli Arianna Filoramo Department of Physics and LENS University of Florence Via Sansone 1 50019 Sesto Fiorentino Italy LICSEN NIMBE CEA CNRS University Paris-Saclay CEA Saclay 91191 Gif sur Yvette CEDEX France

Single wail carbon nanotubes （SWNTs） are known for their exceptional electronic properties. However, most of the synthesis methods lead to the production of a mixture of carbon nanotubes having different chiralities associated with metallic （m-SWNTs） and semiconducting （s-SWNTs） characteristics. For application purposes, effective methods for separating these species are highly desired. Here, we report a protocol for achieving a highly selective separation of s-SWNTs that exhibit a fundamental optical transition centered at 1,550 nm. We employ a polymer assisted sorting approach, and the influence of preparation methods on the optical and transport performances of the separated nanotubes is analyzed. As even traces of m-SWNTs can critically affect performances, we aim to produce samples that do not contain any detectable fraction of residual m-SWNTs.

关键词： single wall carbonnanotube (SWNT) sorting optical properties field effect transistors

Probability distributions of arsenic in soil from brownfield sites in Beijing （China）： statistical characterization of the background populations and implications for site assessment studies

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Frontiers of Environmental Science & Engineering 2015年第3期9卷 465-474页

作者： Marina ACCORNERO Lin JIANG Eugenio NAPOLI Marco CREMONINI Giovanni FERRO federica BELLORO Maosheng ZHONG D'Appolonia S.p.A. Genoa 16145 Italy Beijing Municipal Institute of Environmental Protection Beijing 100037 China Ingegneria e Servizi Ambientali Ferro S.r.l. Savorta 17100 Italy

A probabilistic analysis was performed on soil arsenic concentration data from 4 brownfield sites at Beijing （Chaoyang and Haidian Districts）, involved in environmental assessment studies. The available data sets were processed to provide a statistical characterization of the background populations and differentiate ＂anomalous data＂ from the natural range of variation of arsenic concentrations in soil. The site-specific background distributions and the existing wide-scale background values defined for the Beijing area were compared, discussing related implications for the definition of metal contamination soil screening levels （SSLs） in site assess- ment studies. The statistical analysis of As data sets discriminated site-specific background populations, encompassing 88% to 94% of the sample data, from oufliers values, associated with either subsoil natural enrichments or possible anthropogenic releases. Upper Baseline Concentration （UBC） limits （＋ 2σ level）, including most of the site-specific metal background variability, were derived based on the statistical characterization of the background populations. Sites in the Chaoyang South District area had UBC values in the range 10.4-12.6mg·kg^-1. These ranges provide meaningful SSL values to be adopted for As in local site assessment studies. Using the wide-scale background value for the Beijing area would have erroneously classified most of the areas in the subject sites as potentially contaminated.

关键词： arsenic probability plot upper baseline con-centration site assessment