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Clinical features and natural history of cryptogenic cirrhosis compared to hepatitis C virus-related cirrhosis

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World Journal of Gastroenterology 2017年第8期23卷 1458-1468页

作者： Luca Rinaldi Fabio Nascimbeni Mauro giordano Chiara Masetti Barbara Guerrera Annalisa Amelia Maria Chiara Fascione Stefano Ballestri Dante Romagnoli Rosa Zampino Riccardo Nevola Enrica Baldelli Natalina Iuliano Valerio Rosato Amedeo Lonardo Luigi Elio Adinolfi Internal Medicine Clinical Hospital of MarcianiseSecond University of Naples Department of Medical SurgicalNeurologicalMetabolicand Geriatric SciencesSecond University of Naples Outpatient Liver Clinic and Internal Medicine NOCSAEBaggiovaraAzienda USLModena Internal Medicine Pavullo HospitalAzienda Sanitaria Locale

To characterize natural history of cryptogenic cirrhosis (CC) and compare its clinical features and outcomes to those of hepatitis C virus (HCV)-related *** prospective cohort of 102 consecutive patients at their first diagnosis of CC were enrolled in this study. The clinical data and outcomes were compared to an age- and Child-Pugh class-matched cohort of 110 patients with HCV-related cirrhosis. Diagnosis of cirrhosis was based on compatible clinical and laboratory parameters, ultrasound/endoscopic parameters and, whenever possible, on histological grounds and transient elastography. All cases of cirrhosis without a definite etiology were enrolled in the CC group. The parameters assessed were: (1) severity of liver disease at the time of first diagnosis; (2) liver decompensation during follow-up; (3) hepatocellular carcinoma (HCC); (4) orthotopic liver transplantation; and (5) death. The independent associated factors were evaluated by multiple logistic regression analysis, and survival and its determinants by the Kaplan-Meier model, log-rank test and Cox *** the first observation, median age was 66 and 65 years and male gender was 36% and 58% for CC and HCV cirrhosis, respectively. CC showed Child-Pugh class A/B/C of 47%/31%/22%, respectively. Compared to HCV cirrhosis, CC exhibited a significantly higher prevalence of metabolic syndrome (12% vs 54%, respectively), overweight/obesity, high BMI, impaired glucose tolerance, high blood pressure, dyslipidemia, hyperuricemia, cardiovascular diseases, extrahepatic cancer, and gallstones. Over a median period of 42 mo of follow-up, liver decompensation, HCC development and death for CC and HCV-related cirrhosis were 60.8%, and 54.4%, 16.7% and 17.2%, 39.2% and 30%, respectively. The median survival was 60 mo for CC. Independent predictors of death were age and Child-Pugh class at diagnosis. CC showed an approximately twofold higher incidence of HCC in Child-Pugh class ***

关键词： Liver cirrhosis Hepatocellular carcinoma Metabolic syndrome Nonalcoholic fatty liver disease Cardiovascular diseases

Pancreatic cancer:New hopes after first line treatment

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World Journal of Gastrointestinal Oncology 2016年第9期8卷 682-687页

作者： Francesca Aroldi Paola Bertocchi giordano Savelli Edoardo Rosso Alberto Zaniboni Department of Medical Oncology Poliambulanza Foundation Department of Nuclear Medicine Poliambulanza Foundation Department of General Surgery Poliambulanza Foundation

Pancreatic cancer is the fourth leading cause of cancerrelated death *** research has yielded advances in first-line treatment strategies,but there is no standardized second-line *** this review,we examine the literat... 详细信息

关键词： Nab-paclitaxel Nal-iri Pancreatic cancer Second line Algorithm

Hepatic echinococcosis:Clinical and therapeutic aspects

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World Journal of Gastroenterology 2012年第13期18卷 1448-1458页

作者： Giuseppe Nunnari Marilia R Pinzone Salvatore Gruttadauria Benedetto M Celesia giordano Madeddu Giulia Malaguarnera Piero Pavone Alessandro Cappellani Bruno Cacopardo Department of Clinical and Molecular Biomedicine Division of Infectious DiseasesUniversity of Catania95125 CataniaItaly Department of Microbiology and Immunology Jefferson Medical CollegeThomas Jefferson University19107 PhiladelphiaUnited States Department of Surgery University of Catania95100 CataniaItaly Department of Clinical Experimental and Oncological MedicineDivision of Infectious DiseasesUniversity of Sassari07100 SassariItaly Department of Biomedical Sciences University of Catania95100 CataniaItaly Department of Pediatrics and Pediatric Neurology Azienda Ospedaliera Universitaria OVE-PoliclinicoUniversity of Catania95100 CataniaItaly Department of Surgery General Surgery and Senology UnitUniversity of Catania95100 CataniaItaly

Echinococcosis or hydatid disease （HD） is a zoonosis caused by the larval stages of taeniid cestodes belong- ing to the genus Echinococcus. Hepatic echinococcosis is a life-threatening disease, mainly differentiated into alveolar and cystic forms, associated with Echinoc- cus multilocularis （E. multi/ocular/s） and Echinococcus granulosus （E. granulosus） infection, respectively. Cys- tic echinococcosis （CE） has a worldwide distribution, while hepatic alveolar echinococcosis （AE） is endemic in the Northern hemisphere, including North America and several Asian and European countries, like France, Germany and Austria. E. granulosus young cysts are spherical, unilocular vesicles, consisting of an internal germinal layer and an outer acellular layer. Cyst expansion is associated with a host immune reaction and the subsequent development of a fibrous layer, called the per/cyst; old cysts typically present internal septa- tions and daughter cysts. E. multilocularis has a tumor-like, infiltrative behavior, which is responsible for tissue destruction and finally for liver failure. The liver is the main site of HD involvement, for both alveolar and cystic hydatidosis. HD is usually asymptomatic for a long period of time, because cyst growth is commonly slow; the most frequent symptoms are fatigue and abdominal pain. Patients may also present jaundice, hepatomegaly or anaphylaxis, due to cyst leakage or rupture. HD diagnosis is usually accomplished with the combined use of ultrasonography and immunodiagnosis; furthermore, the improvement of surgical techniques, the introduction of minimally invasive treatments [such as puncture, aspiration, injection, re-aspiration （PAIR）] and more effective drugs （such as benzoimidazoles） have deeply changed life expectancy and quality of life of patients with HD. The aim of this article is to provide an up-to-date review of biological, diagnostic, clinical and therapeutic aspects of hepatic echinococcosis.

关键词： Hydatidosis Cystic echinococcosis Alveolarechinococcosis Liver PAIR Albendazole Treatment Diagnosis

陆军现有的和未来的电-光、红外与射频对抗措施

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系统工程与电子技术 1983年第12期 62-69页

作者： Robert giordano ,峻崖

序言最近几年内,电子战在美国陆军中的重要性显著提高。在向“2000年陆空联合作战”设想前进时,攻防双方对电子战的需求都将增加。描述特定的设备和能力之前,先了解

关键词：电子战系统电子对抗系统电子对抗电磁斗争对抗措施红外干扰机雷达对抗设备多重调制火力反击敌方雷达箔条飞行器陆军

Contrast-enhanced ultrasound Liver Imaging Reporting and Data System:Lights and shadows in hepatocellular carcinoma and cholangiocellular carcinoma diagnosis

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World Journal of Gastroenterology 2022年第27期28卷 3488-3502页

作者： Gianpaolo Vidili Marco Arru Giuliana Solinas Diego Francesco Calvisi Pierluigi Meloni Assunta Sauchella Davide Turilli Claudio Fabio Antonio Cossu giordano Madeddu Sergio Babudieri Maria Assunta Zocco Giovanni Iannetti Enza Di Lembo Alessandro Palmerio Delitala Roberto Manetti Department of Medical Surgical and Experimental SciencesUniversity of SassariSassari 07100Italy Department of Biomedical Sciences Public Health-Laboratory of BiostatisticsUniversity of SassariSassari 07100Italy Department of Internal Medicine and Gastroenterology Fondazione Policlinico Universitario A.Gemelli IRCCSCatholic UniversityRome 00168Italy Ultrasound Unit Ospedale S.SpiritoPescara 65123Italy

BACKGROUND Contrast-enhanced ultrasound(CEUS)is considered a secondary examination compared to computed tomography(CT)and magnetic resonance imaging(MRI)in the diagnosis of hepatocellular carcinoma(HCC),due to the risk of misdiagnosing intrahepatic cholangiocarcinoma(ICC).The introduction of CEUS Liver Imaging Reporting and Data System(CEUS LI-RADS)might overcome this *** though data from the literature seems promising,its reliability in real-life context has not been well-established *** To test the accuracy of CEUS LI-RADS for correctly diagnosing HCC and ICC in *** CEUS LI-RADS class was retrospectively assigned to 511 nodules identified in 269 patients suffering from liver *** diagnostic standard for all nodules was either biopsy(102 nodules)or CT/MRI(409 nodules).Common diagnostic accuracy indexes such as sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)were assessed for the following associations:CEUS LR-5 and HCC;CEUS LR-4 and 5 merged class and HCC;CEUS LR-M and ICC;and CEUS LR-3 and *** frequency of malignant lesions in CEUS LR-3 subgroups with different CEUS patterns was also ***-rater agreement for CEUS LI-RADS class assignment and for major CEUS pattern identification was *** CEUS LR-5 predicted HCC with a 67.6%sensitivity,97.7%specificity,and 99.3%PPV(P<0.001).The merging of LR-4 and 5 offered an improved 93.9%sensitivity in HCC diagnosis with a 94.3%specificity and 98.8%PPV(P<0.001).CEUS LR-M predicted ICC with a 91.3%sensitivity,96.7%specificity,and 99.6%NPV(P<0.001).CEUS LR-3 predominantly included benign lesions(only 28.8%of malignancies).In this class,the hypo-hypo pattern showed a much higher rate of malignant lesions(73.3%)than the iso-iso pattern(2.6%).Inter-rater agreement between internal raters for CEUS-LR class assignment was almost perfect(n=511,k=0.94,P<0.001),while the agreement among raters from separate centres was subst

关键词： Contrast-enhanced ultrasound Liver Imaging Reporting and Data System Hepatocellular carcinoma Intrahepatic cholangiocarcinoma Cirrhosis Contrast-enhanced ultrasound Liver

L-carnitine supplementation improves hematological pattern in patients affected by HCV treated with Peg interferon-α 2b plus ribavirin

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World Journal of Gastroenterology 2011年第39期17卷 4414-4420页

作者： Michele Malaguarnera Marco Vacante Maria giordano Massimo Motta Gaetano Bertino Manuela Pennisi Sergio Neri Mariano Malaguarnera Giovanni Li Volti Fabio Galvano Department of Biological Chemistry Medical Chemistry and Molecular BiologyUniversity of Catania Department of Internal Medicine and Systemic Disease University of Catania Research Center"The Great Senescence" University of Catania

AIM：To evaluate the efficacy of L-carnitine on alleviating anemia,thrombocytopenia and leukopenia,and minimizing dose reductions in patients with chronic hepatitis C virus（HCV）in treatment with Interferonα（IFN-α）plus ***：Sixty-nine patients with chronic hepatitis C were enrolled in the study and divided into two *** A（n=35）received Peg-IFN-α2b plus ribavirin plus L-carnitine,and group B（n=34）received Peg-IFN-αand ribavirin for 12 *** patients underwent laboratory investigations including：red cell count,he-moglobin,white cell count,platelets,bilirubin,alanineaminotransferase（ALT）,aspartate aminotransferase（AST）,and ***：After 12 mo in group A compared to group B we observed significant differences in AST 108.8 vs 76.8（IU/L;P0.001）,ALT *** 112.3（IU/L;P 0.001）,viremia 4.04 vs 2.36（106 copies/mL;P 0.001）,Hb 1 vs 3.5（g/dL;P0.05）,red blood cells 0.3 vs 1.1（1012/L;P0.001）,white blood cells 1.5 vs 3（10/L;P0.001）and platelets 86 vs 85（×10/L;P0.001）.The end treatment responders were 18 vs 12（60%vs 44%）and the non responders were 12 vs 15（40%vs 50%）[odds ratio（OR）1.65,5%CI =0.65-5.37,*** group A compared to group B there was a significant improvement of sustained vi-rological response in 15 vs 7 patients（50%vs25%）,while the relapsers were 3 vs 5（10%vs 18%）（OR 3.57,5%CI=0.65-1.3,P0.001）.CONCLUSION：L-carnitine supplementations modulate erythropoiesis,leucopoiesis and thrombocytopoiesis,and may be useful in patients treated for HCV.L-carni-tine treatment offers the possibility of achieving a sus-tained virological response while preventing overtreat-ment.

关键词： L-carnitine Chronic hepatitis C Anemia In-terferon

Triage and Risk Concept: Application Proposal for Pre-Hospital Emergencies in a Psychiatric Ambulance in the City of Buenos Aires

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Open Journal of Emergency Medicine 2023年第1期11卷 21-31页

作者： Mazzoglio Y. Nabar Martín Javier Rubén Daniel Algieri Gabriel Schraier Blanca Lopez Sergio giordano Department of Psychiatric Emergencies “Torcuato de Alvear” Psychiatric Emergency Hospital Buenos Aires Argentina

The heterogeneity of clinical presentations in psychiatric emergencies creates difficulties in the response by interdisciplinary Mental Health teams. This is aggravated and difficult when the care is carried out on public roads or the patient’s home, that is, it is a pre-hospital context. Our Psychiatric Emergency Hospital, located in the City of Buenos Aires, provides pre-hospital care with a psychiatric ambulance, which is then referred to general hospitals or other health system providers. Not all effectors in the network have the same resources and, at the time of the emergency, the reasons for consultation such as the patient’s clinic are heterogeneous and require the greatest effectiveness in the intervention that is taken. The triage system is a resource that allows the systematization of approaches against the multiplicity of reasons for consultation and presentation of mental pathologies in the emergency room, in addition to providing greater effectiveness in interventions, homogeneity for the health system and consensus among the health effectors. Framed in the Mental Health Law, and especially in the concept of risk, a triage proposal was designed for pre-hospital interventions by the psychiatric ambulance dependent on Hospital Alvear and under current legal regulations with the aim of homogenizing care and referrals with the highest rate of effectiveness to provide quality interdisciplinary medicine.

关键词： Psychiatry Ambulance Emergencies Triage

Endozepine-4 levels are increased in hepatic coma

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World Journal of Gastroenterology 2015年第30期21卷 9103-9110页

作者： Giulia Malaguarnera Marco Vacante Filippo Drago Gaetano Bertino Massimo Motta Maria giordano Michele Malaguarnera Research Center "The Great Senescence" Hospital of Cannizzaro University of Catania Department of Clinical and Experimental Medicine University of Catania Department of Biomedical and Biotechnological Sciences Section of PharmacologySchool of MedicineUniversity of Catania Gerontology and Bone Metabolic Disease Section Department of Medical SciencesUniversity of Torino

AIM:To evaluate the serum levels of endozepine-4,their relation with ammonia serum levels,the grading of coma and the severity of cirrhosis,in patients with hepatic coma. METHODS:In this study we included 20 subjects with Hepatic coma,20 subjects with minimal hepatic encephalopathy(MHE) and 20 subjects control. All subjects underwent blood analysis,Child Pugh and Model for End- stage liver disease(MELD) assessment,endozepine-4 analysis. RESULTS:Subjects with hepatic coma showed significant difference in endozepine-4(P < 0.001) and NH3 levels(P < 0.001) compared both to MHE and controls patients. Between NH3 and endozepine-4 we observed a significant correlation(P = 0.009; Pearson correlation 0.570). There was a significant correlation between endozepine-4 and MELD(P = 0.017; Pearsoncorrelation = 0.529). In our study blood ammonia concentration was noted to be raised in patients with hepatic coma,with the highest ammonia levels being found in those who were comatose. We also found a high correlation between endozepine-4 and ammonia(P < 0.001). In patients with grade Ⅳ hepatic coma,endozepine levels were significantly higher compared to other groups. CONCLUSION:This study suggests that an increased level of endozepine in subjects with higher levels of MELD was observed. In conclusion,data concerning involvement of the GABA-ergic system in HE coma could be explained by stage-specific alterations.

关键词： Endozepine-4 Hepatic encephalopathy Hepatic coma Cirrhosis, Benzodiazepine Peripheralbenzodiazepine receptor Model for End - stage liverdisease Glutamate-related neurotoxicity which in turnmay alter the γ-aminobutyric acid

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决战前夜

红领巾(萌芽) 2015年第4期 56-57页

作者： Chloe giordano Baku Maeda

关键词：树叶天神