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Pediatric gastrointestinal bleeding: Perspectives from the Italian Society of Pediatric Gastroenterology

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World Journal of Gastroenterology 2017年第8期23卷 1328-1337页

作者： Claudio Romano Salvatore Oliva Stefano Martellossi Erasmo Miele Serena Arrigo Maria Giovanna Graziani Sabrina Cardile Federica Gaiani gian luigi de'angelis Filippo Torroni Unit of Pediatrics Department of Human Pathology in Adulthood and Childhood“G.Barresi”University of Messina department of Pediatrics and Infantile Neuropsychiatry Pediatric Gastroenterology and Liver UnitSapienza University of Rome Institute for Maternal and Child Health IRCCS‘Burlo Garofalo’ department of Translational Medical Science Section of PediatricsUniversity of Naples“Federico II” Gastroenterology and Endoscopy Unit G.Gaslini Children’s Hospital-IRCCS Gastroenterology and Endoscopy Unit “San Giovanni Addolorata”Hospital Hepatology Gastroenterology and Nutrition UnitBambino GesùChildren’s Hospital Gastroenterology and Endoscopy Unit University of Parma department of Surgery and Transplantation Digestive Surgery and Endoscopy UnitBambino GesùChildren’s Hospital

There are many causes of gastrointestinal bleeding(GIB) in children, and this condition is not rare, having a reported incidence of 6.4%. Causes vary with age, but show considerable overlap; moreover, while many of the causes in the pediatric population are similar to those in adults, some lesions are unique to children. The diagnostic approach for pediatric GIB includes definition of the etiology, localization of the bleeding site and determination of the severity of bleeding; timely and accurate diagnosis is necessary to reduce morbidity and mortality. To assist medical care providers in the evaluation and management of children with GIB, the "Gastro-Ped Bleed Team" of the Italian Society of Pediatric Gastroenterology, Hepatology and Nutrition(SIGENP) carried out a systematic search on MEDLINE via Pub Med(http://www.***.nlm.***.gov/pubmed/) to identify all articles published in English from January 1990 to 2016; the following key words were used to conduct the electronic search: "upper GIB" and "pediatric" [all fields]; "lower GIB" and "pediatric" [all fields]; "obscure GIB" and "pediatric" [all fields]; "GIB" and "endoscopy" [all fields]; "GIB" and "therapy" [all fields]. The identified publications included articles describing randomized controlled trials, reviews, case reports, cohort studies, casecontrol studies and observational studies. References from the pertinent articles were also reviewed. This paper expresses a position statement of SIGENP that can have an immediate impact on clinical practice and for which sufficient evidence is not available in literature. The experts participating in this effort were selected according to their expertise and professional qualifications.

关键词：胃肠的流血内视镜检查法降低胃肠的流血上面的胃肠的流血小儿科

Short- and long-term efficacy of endoscopic balloon dilation in Crohn's disease strictures

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World Journal of Gastroenterology 2013年第17期19卷 2660-2667页

作者： Nicola de'angelis Maria Clotilde Carra Osvaldo Borrelli Barbara Bizzarri Francesca Vincenzi Fabiola Fornaroli Giuseppina de Caro gian luigi de'angelis department of Digestive Surgery Hopital Henri Mondor-Université Paris Est Gastroenterology and Operative Endoscopy Unit University of Parma department of Gastroenterology Great Ormond Street Hospital and UCL

AIM:To evaluate short- and long-term efficacy of endoscopic balloon dilation in a cohort of consecutive patients with symptomatic Crohn's disease (CD)-related strictures. METHODS:Twenty-six CD patients (11 men; median age 36.8 year, range 11-65 years) with 27 symptomatic strictures underwent endoscopic balloon dilation (EBD).Both naive and post-operative strictures, of any length and diameter, with or without associated fistula were included. After a clinical and radiological assessment, EBD was performed with a Microvasive Rigiflex through the scope balloon system. The procedure was considered successful if no symptom reoccurred in the following 6 mo. The long-term clinical outcome was to avoid surgery. RESULTS:The mean follow-up time was 40.7 ± 5.7 mo (range 10-94 mo). In this period, forty-six EBD were performed with a technical success of 100%. No procedure-related complication was reported. Surgery was avoided in 92.6% of the patients during the entire follow-up. Two patients, both presenting ileocecal strictures associated with fistula, failed to respond to the treatment and underwent surgical strictures resection. Of the 24 patients who did not undergo surgery, 11 patients received 1 EBD, and 13 required further dilations over time for the treatment of relapsing strictures (7 patients underwent 2 dilations, 5 patients 3 dilations, and 1 patient 4 dilations). Overall, the EBD success rate after the first dilation was 81.5%. No difference was observed between the EBD success rate for naive (n = 12) and post-operative (n = 15) CD related strictures (P > 0.05). CONCLUSION:EBD appears to be a safe and effective procedure in the therapeutic management of CD-related strictures of any origin and dimension in order to prevent surgery.

关键词： Endoscopic balloon dilation Crohn’s disease Strictures Endoscopy Gastrointestinal surgery

Preoperative colonic stents vs emergency surgery for acute left-sided malignant colonic obstruction: meta-analysis with systematic review of the literature

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World Journal of Meta-Analysis 2017年第1期5卷 1-13页

作者： Belinda de Simone Fausto Catena Federico Coccolini Salomone Di Saverio Massimo Sartelli Arianna Heyer Nicola de angelis gian luigi de angelis Luca Ansaloni department of Emergency and Trauma Surgery University Hospital of Parma department of General and Emergency Surgery Papa XXIII Hospital department of General Surgery Maggiore Hospital of Bologna department of Emergency and General Surgery Macerata’s Hospital department of Medical Sciences University of California Liver Transplantation and General Surgery Unit Henry Mondor Hospital department of Gastroenterology University Hospital of Parma

AIM To investigate by meta-analytic study and systematic review, advantages of colonic stent placement in comparison with emergency surgery.METHODS We conducted an extensive literature search by PubMed, Google Scholar, Embase and the Cochrane Libraries. We searched for all the papers in English published till February 2016, by applying combinations of the following terms: Obstructive colon cancer, colon cancer in emergency, colorectal stenting, emergency surgery for colorectal cancer, guidelines for obstructive colorectal cancer, stenting vs emergency surgery in the treatment of obstructive colorectal cancer, selfexpanding metallic stents, stenting as bridge to surgery. The study was designed following the PrismaStatement. By our search, we identified 452 studies, and 57 potentially relevant studies in full-text were reviewed by 2 investigators; ultimately, 9 randomized controlled trials were considered for meta-analysis and all the others were considered for systematic review.RESULTS In the meta-analysis, by comparing colonic stenting(CS) as bridge to surgery and emergency surgery, the pooled analysis showed no significant difference between the two techniques in terms of mortality [odds ratio(oR) = 0.91], morbidity(oR = 2.38) or permanent stoma rate(oR = 1.67); primary anastomosis was more frequent in the stent group(oR = 0.45; P = 0.004) and stoma creation was more frequent in the emergency surgery group(oR = 2.36; P = 0.002). No statistical difference was found in disease-free survival and overall survival. The pooled analysis showed a significant difference between the colonic stent and emergency surgery groups(oR = 0.37), with a significantly higher 1-year recurrence rate in the stent group(P = 0.007).CONCLUSION CS improves primary anastomosis rate with significantly high 1-year follow-up recurrence and no statistical difference in terms of disease-free survival and overall survival.

关键词： Colonic stent Self-expandable metallic stent Obstructive left colon cancer Emergency surgery Endo-laparoscopic approach Oncological outcome

Replication of interleukin 23 receptor and autophagy-related 16-like 1 association in adult-and pediatric-onset inflammatory bowel disease in Italy

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World Journal of Gastroenterology 2008年第29期14卷 4643-4651页

作者： Anna Latiano Orazio Palmieri Maria Rosa Valvano Renata D'Incà Salvatore Cucchiara Gabriele Riegler Anna Maria Staiano Sandro Ardizzone Salvatore Accomando gian luigi de angelis Giuseppe Corritore Fabrizio Bossa Vito Annese U.U. O.O. di Gastroenterologia ed Endoscopia Ospedale IRCCS-CSSSan Giovanni Rotondo (Fg) 71013 Italy Cattedra di Gastroenterologia Università di PadovaPadova 35122 Italy Clinica Pediatrica Università "La Sapienza" Roma 00185 Italy Cattedra di Gastroenterologia Università di NapoliNapoli 80131 Italy Clinica Pediatrica Università di Napoli Napoli 80131 Italy Unità di Gastroenterologia Ospedale "Sacco" Milano 20157 Italy Clinica Pediatrica Università di Palermo Palermo 90128 Italy Clinica Pediatrica Università di Parma Parma 43100 Italy

AIM: To investigate gene variants in a large Italian inflammatory bowel disease (IBD) cohort, and to analyze the correlation of sub-phenotypes (including age at diagnosis) and epistatic interaction with other IBD genes. METHODS: Total of 763 patients with Crohn's disease (CD, 189 diagnosed at age ded in the study. The rs2241880 [autophagy-related 16-like 1 (ATG16L1)], rs11209026 and rs7517847 [interleukin 23 receptor (IL23R)], rs2066844, rs2066845, rs2066847 (CARD15), rs1050152 (OCTN1), and rs2631367 (OCTN2) gene variants were genotyped. RESULTS: The frequency of G allele of ATG16L1 SNP (Ala197Thr) was increased in patients with CD compared with controls (59% vs 54% respectively) (OR = 1.25, CI = 1.08-1.45, P = 0.003), but not in UC (55%). The frequency of A and G (minor) alleles of Arg381Gln, rs11209026 and rs7517847 variants of IL23R were reduced significantly in CD (4%, OR = 0.62, CI = 0.45-0.87, P = 0.005; 28%, OR = 0.64, CI = 0.55-0.75, P demonstrated with sub-phenotypes and interaction with CARD15 , and OCTN1/2 genes, although both gene variants were associated with pediatric-onset disease. CONCLUSION: The present study confirms the association of IL23R polymorphisms with IBD, and ATG16L1 with CD, in both adult- and pediatric-onset subsets in our study population.

关键词：肠炎肠溃疡结肠疾病遗传因素

Italian survey on non-steroidal anti-inflammatory drugsand gastrointestinal bleeding in children

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World Journal of Gastroenterology 2016年第5期22卷 1877-1883页

作者： Sabrina Cardile Massimo Martinelli Arrigo Barabino Paolo Gandullia Salvatore Oliva Giovanni Di Nardo luigi Dall'Oglio Francesca Rea gian luigi de'angelis Barbara Bizzarri Graziella Guariso Enzo Masci Annamaria Staiano Erasmo Miele Claudio Romano Gastroenterology and Endoscopic Unit Department of PediatricsUniversity of Messina98100 MessinaItaly department of Translational Medical Science Section of PediatricsUniversity of Naples“Federico II”80131 NaplesItaly department of Pediatric Gastroenterology Gaslini Institute16148 GenoaItaly department of Pediatrics and Infantile Neuropsychiatry Pediatric Gastroenterology and Liver UnitSapienza University of Rome00185 RomeItaly Digestive Surgery and Endoscopy Unit Bambino GesùChildren’s Hospital00165 RomeItaly Gastroenterology and Endoscopy Service University of Parma43126 ParmaItaly Unit of Paediatric Gastroenterology Digestive EndoscopyHepatologyand Care of Children with Liver TransplantationDepartment of Women’s and Children’s HealthUniversity Hospital of Padova35128 PadovaItaly Gastrointestinal Endoscopy Azienda Ospedaliera San Paolo University HospitalUniversity of Milan20142 MilanItaly

AIM: To investigate gastrointestinal complications associated with non-steroidal anti-inflammatory drug(NSAIDs) use in children.METHODS: A retrospective, multicenter study was conducted between January 2005 and January 2013, with the participation of 8 Italian pediatric gastroenterology centers. We collected all the cases of patients who refer to emergency room for suspected gastrointestinal bleeding following NSAIDs consumption, and underwent endoscopic evaluation. Previous medical history, associated risk factors, symptoms and signs at presentation, diagnostic procedures, severity of bleeding and management of gastrointestinal bleeding were collected. In addition, data regarding type of drug used, indication, dose, duration of treatment and prescriber(physician or selfmedication) were examined. RESULTS: Fifty-one patients, including 34 males, were enrolled(median age: 7.8 years). Ibuprofen was the most used NSAID [35/51 patients(68.6%)]. Pain was the most frequent indication for NSAIDs use [29/51 patients(56.9%)]. Seven patients had positive family history of Helicobacter pylori(H. pylori) infection or peptic ulcer, and 12 had associated comorbidities. Twenty-four(47%) out of 51 patients used medication inappropriately. Hematemesis was the most frequent symptom(33.3%). Upper gastrointestinal endoscopy revealed gastric lesions in 32/51(62%) patients, duodenal lesions in 17(33%) and esophageal lesions in 8(15%). In 10/51(19.6%) patients, a diagnosis of H. pylori gastritis was made. Forty-eight(94%) patients underwent medical therapy, with spontaneous bleeding resolution, while in 3/51(6%) patients, an endoscopic hemostasis was needed.CONCLUSION: The data collected in this study confirms that adverse events with the involvement of the gastrointestinal tract secondary to NSAID use are also common in

关键词： Hematemesis Gastrointestinal bleeding non-steroidal anti-inflammatory drug Melena Pediatrics

Minimally invasive surgical therapies(MISTs)for lower urinary tract symptoms(LUTS):promise or panacea?

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Asian Journal of Andrology 2024年第2期26卷 135-143页

作者： gian Maria Busetto Andrea Checchia Marco Recchia Edoardo Tocci Ugo G Falagario Gennaro Annunziata Pasquale Annese Nicola d'Altilia Vito Mancini Matteo Ferro Felice Crocetto Octavian Sabin Tataru Luca Di gianfrancesco Angelo Porreca Francesco del Giudice Ettore de Berardinis Carlo Bettocchi luigi Cormio Giuseppe Carrieri University of Foggia Foggia 71122Italy department of Urology and Renal Transplantation Policlinico of FoggiaFoggia 71122Italy Urology Unit "G.Tatarlla"HospitalCerignola 71042Italy Urology Unit European Institute of Oncology(IE0)IRCcSMilan 20141Italy University of Naples Federico Il Naples 80126Italy G.E.Palade University of Medicine PharmacyScienceand Technology of Targu MuresTargu Mures 540142Romania department of Oncological Urology Veneto Institute of Oncology(IOv)IRccSPadua 35128Italy department of Maternal-Infant and Urological Sciences Sapienza Rome UniversityRoma 00161Italy Urology Unit "L.Bonomo"HospitalAndria 76123Italy

The increasing importance of treatment of lower urinary tract symptoms(LUTS),while avoiding side effects and maintaining sexual function,has allowed for the development of minimally invasive surgical therapies(MiSTs).Recently,the European Association of Urology guidelines reported a paradigm shift from the management of benign prostatic hyperplasia(BPH)to the management of nonneurogenic male LUTS.The aim of the present review was to evaluate the efficacy and safety of the most commonly used MisTs:ablative techniques such as aquablation,prostatic artery embolization,water vapor energy,and transperineal prostate laser ablation,and nonablative techniques such as prostatic urethral lift and temporarily implanted nitinol device(iTIND).MiSTs are becoming a new promise,even if clinical trials with longer follow-up are still lacking.Most of them are still under investigation and,to date,only a few options have been given as a recommendation for use.They cannot be considered as standard of care and are not suitable for all patients.Advantages and disadvantages should be underlined,without forgetting our objective:treatment of LUTS and re-treatment avoidance.

关键词： aquablation iTIND prostatic artery embolization prostatic urethral lift transperineal prostate laser ablation water vapor energy

Antioxidant treatment foroligoasthenoteratozoospermia and varicocele:aDBPC trial to evaluate the impact of age and bodymass index

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Asian Journal of Andrology 2024年第3期26卷 239-244页

作者： gian Maria Busetto Bernarde F Rodrigues Ashraf Virmani Andrea Checchia Antonella Ninivaggi Anna Ricapito Giovanni Barbieri Piero Fischetti Ugo G Falagario Pasquale Annese Nicola d’Altilia Vito Mancini Matteo Ferro Felice Crocetto Angelo Porreca Carlo Bettocchi luigi Cormio Ashok Agarwal Giuseppe Carrieri University of Foggia Foggia 71122Italy department of Urology and Renal Transplantation Policlinico of FoggiaFoggia 71122Italy department of Urology HumanReproduction SectionFederal University of Sao PauloSao Paulo 05403-000Brazil Alfasigma Healthscience Utrecht 3528 BGThe Netherlands Urology Unit “G.Tatarella”HospitalCerignola 71042Italy Urology Unit European Institute of Oncology(IEO)IRCCSMilan 20142Italy University of Naples Federico II Naples80126Italy department of Oncological Urology Veneto Institute of Oncology(IOV)IRCCSPadua 35039Italy Urology Unit “L.Bonomo”HospitalAndria 70031Italy Global Andrology Forum Moreland HillsOH 44022USA

Oxidative stress is one of the main mechanisms responsible for male infertility.Various conditions such as varicocele,obesity,advanced age,and lifestyle can lead to an increase in reactive oxygen species,causing an oxidative imbalance in the reproductiveenvironment.Spermatozoa are sensitive to reactive oxygen species and require energy to carry out their main function of fertilizingthe egg.Excessive reactive oxygen species can affect sperm metabolism,leading to immobility,impaired acrosome reaction,and celldeath,thereby impairing reproductive success.This double-blind randomized study evaluated the effect of supplementation withL-carnitine,acetyl-L-carnitine,vitamins,and other nutrients on semen quality in 104 infertile patients with or without varicocele,while also investigating the impact of factors such as obesity and advanced age on treatment.Sperm concentration significantlyincreased in the supplemented group compared to the placebo group(P=0.0186).Total sperm count also significantly increasedin the supplemented group(P=0.0117),as did sperm motility(P=0.0120).The treatment had a positive effect on patients upto 35 years of age in terms of sperm concentration(P=0.0352),while a body mass index(BMI)above 25 kg m−2 had a negativeeffect on sperm concentration(P=0.0110).Results were not showing a net benefit in stratifying patients in accordance withtheir BMI since sperm quality increase was not affected by this parameter.In conclusion,antioxidant supplementation may bebeneficial for infertile patients and has a more positive effect on younger patients with a normal weight.

关键词： aging antioxidants body mass index oligoasthenoteratozoospermia varicocele

AFM Measurements and Tip Characterization of Nanoparticles with Different Shapes

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Nanomanufacturing and Metrology 2022年第2期5卷 127-138页

作者： Roberto Bellotti gian Bartolo Picotto luigi Ribotta Istituto Nazionale di Ricerca Metrologica(INRiM) Strada delle Cacce 9110135TorinoItaly Politecnico di Torino Corso Duca degli Abruzzi 2410129TorinoItaly

Unambiguous identification of the measurement methodologies is fundamental to reduce the uncertainty and support traceability of particle shape and size at the nanoscale. In this work, the critical aspects in atomic force microscopy measurements, that is, drawbacks on sample preparation, instrumental parameters, image pre-processing, size reconstruction, and tip enlargement, are discussed in reference to quantitative dimensional measurements on different kinds of nanoparticles (inorganic and biological) with different shapes (spherical, cylindrical, complex geometry). Once the cross-section profile is extracted, top-height measurements on isolated nanoparticles of any shape can be achieved with sub-nanometer accuracy. Lateral resolution is affected by the pixel size and shape of the probe, causing dilation in the atomic force microscopy image. For the reconstruction of critical sizes of inorganic non-spherical nanoparticles, a geometric approach that considers the nominal shape because of the synthesis conditions is presented and discussed.

关键词： Nanoparticles(NPs) Atomic force microscopy(AFM) Size reconstruction Spherical shape Complex shape AFM probe Uncertainty

indocyanine green-based fluorescence imaging in visceral and hepatobiliary and pancreatic surgery:State of the art and future directions

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World Journal of Gastroenterology 2018年第27期24卷 2921-2930页

作者： gian Luca Baiocchi Michele Diana luigi Boni department of Clinical and Experimental Sciences University of BresciaBrescia 25125Italy IHU-Strasbourg Institute of Image-Guided SurgeryStrasbourg 67000France General and Emergency Surgery IRCCS-Ca’Granda-Policlinico HospitalMilan 20122Italy

In recent years, the use of fluorescence-guided surgery(FGS) to treat benign and malignant visceral, hepatobiliary and pancreatic neoplasms has significantly increased. FGS relies on the fluorescence signal emitted by injected substances(fluorophores) after being illuminated by ad hoc laser sources to help guide the surgical procedure and provide the surgeon with real-time visualization of the fluorescent structures of interest that would be otherwise invisible. This review surveys and discusses the most common and emerging clinical applications of indocyanine green(ICG)-based fluorescence in visceral, hepatobiliary and pancreatic surgery. The analysis, findings, and discussion presented here rely on the authors' significant experience with this technique in their medical institutions, an up-to-date review of the most relevant articles published on this topic between 2014 and 2018, and lengthy discussions with key opinion leaders in the field during recent conferences and congresses. For each application, the benefits and limitations of this technique, as well as applicable future directions, are described. The imaging of fluorescence emitted by ICG is a simple, fast,relatively inexpensive, and harmless tool with numerous different applications in surgery for both neoplasms and benign pathologies of the visceral and hepatobiliary systems. The ever-increasing availability of visual systems that can utilize this tool will transform some of these applications into the standard of care in the near future. Further studies are needed to evaluate the strengths and weaknesses of each application of ICG-based fluorescence imaging in abdominal surgery.

关键词： indocyanine green fluorescence imaging gastrointestinal surgery liver surgery biliary surgery pancreatic surgery visceral perfusion biliary anatomy peritoneal carcinomatosis