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Perioperative chemotherapy for advanced gastric cancer - results from a tertiary-care hospital in Germany

World Journal of Gastrointestinal Oncology 2020年第5期12卷 559-568页

作者： Katrin Bauer giulia manzini Doris Henne-Bruns Peter Buechler Department for General VisceralThoracic and Paediatric SurgeryClinic of KemptenKempten 87439Germany Department of General and Visceral Surgery University Hospital of UlmUlm 89081Germany

BACKGROUND Neoadjuvant/perioperative chemotherapy is the recommended treatment for advanced stages of gastric cancer(>T2,N+)before tumour resection in many European guidelines.However,there is no consensus as to whether perioperative chemotherapy is as effective in distal as in proximal tumours,in addition to a relevant uncertainty concerning appropriate treatment modalities for elderly patients.AIM To investigate the role of perioperative chemotherapy in advanced gastric cancer in patients from a German tertiary clinic with respect to efficacy,localisation,and age.METHODS We performed a retrospective analysis of 158 patients from our clinic with adenocarcinoma of the stomach or the gastroesophageal junction who underwent resection between 2008 and 2016.The data were evaluated particularly in relation to patient age,tumour site,and perioperative therapy.RESULTS Administration of perioperative chemotherapy did not lead to a significant survival advantage in our study population.The 5-year survival rates were 40%for patients who received perioperative chemotherapy and 29%for the group without perioperative chemotherapy(P=0.125).Our patients were on average distinctly older than patients in most of the published randomised controlled trials.Patients elder than 75 years received perioperative chemotherapy far less frequently.Patients with a proximal tumour received perioperative chemotherapy much more often.CONCLUSION This analysis reconfirms our previous data concerning the effectiveness of perioperative chemotherapy for advanced gastric cancer.There is reasonable doubt that the quality of the existing randomized controlled trials is sufficient to generally justify perioperative chemotherapy in patients with advanced gastric cancer independent of tumour localization or age.

关键词： Gastric cancer Perioperative Chemotherapy Tumour localisation Age distribution Validity

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Validity of studies suggesting preoperative chemotherapy for resectable thoracic esophageal cancer:A critical appraisal of randomized trials

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World Journal of Gastrointestinal Oncology 2020年第1期12卷 113-123页

作者： giulia manzini Ursula Klotz Doris Henne-Bruns Michael Kremer Department of General and Visceral Surgery University of UlmUlm 89081Germany Department of General and Visceral Surgery Hospital of AarauAarau 5000Switzerland

BACKGROUND In 2015,Kidane published a Cochrane review and meta-analysis to summarise the impact of preoperative chemotherapy versus surgery alone on survival for resectable thoracic esophageal cancer.The authors concluded that preoperative chemotherapy improved overall survival(OS).AIM The aim of this article was to assess the validity of the three most powerful studies included in the Cochrane review and the meta-analysis supporting the advantage of preoperative chemotherapy and to investigate the impact of an exclusion of these three studies on the result of the meta-analysis.METHODS OS was selected as the endpoint of interest.Among the ten included papers which analysed this endpoint,we identified the three publications with the highest weights influencing the final result.The validity of these papers was analysed using the CONSORT checklist for randomized controlled trials.We performed a new meta-analysis without the three studies to assess their impact on the general result of the original meta-analysis.RESULTS The three analysed studies revealed several inconsistencies.Inappropriate answers were found in up to one third of the items of the CONSORT checklist.Missing information about sample-size calculation and power,unclear or inadequate randomisation,and missing blinded set-up were the most common findings.When the three criticized studies were excluded in the meta-analysis,preoperative chemotherapy showed no benefit in OS.CONCLUSION The three most powerful publications in the Cochrane review show substantial deficits.After the exclusion of these studies from the meta-analysis,preoperative chemotherapy does not seem to result in an advantage in survival.We suggest a more critical appraisal regarding the validity of single studies.

关键词： Esophageal cancer Assessment of validity Meta-analysis CONSORT Overall survival

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Adjuvant chemotherapy in curatively resected rectal cancer: How valid are the data?

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World Journal of Gastrointestinal Oncology 2020年第4期12卷 503-513页

作者： giulia manzini Fabius Hapke Ian N Hines Doris Henne-Bruns Michael Kremer Department of General and Visceral Surgery University of UlmUlm 89081Germany Department of Nutrition Science College of Allied Health SciencesEast Carolina UniversityGreenvilleNC 27834United States Department of General and Visceral Surgery Hospital of AarauAarau 5000Switzerland

BACKGROUND According to the result of the Cochrane review published in 2012,postoperative adjuvant chemotherapy(CTx)is associated with a survival benefit for rectal cancer patients operated for cure in comparison to patients who underwent only the surgical resection.AIM To analyze the quality of the data supporting the advantage of adjuvant CTx after surgery for rectal cancer.In the times of increasing health care costs,it is imperative to offer the patient an evidence-based therapy that justifies potential side effects as well as costs.METHODS Overall survival was selected as endpoint of interest.Among the 21 included papers which analyzed this endpoint,we identified those three publications which have the highest weights to influence the final result.The validity of these papers was analyzed using the CONSORT checklist for randomized controlled trials.We performed a second meta-analysis excluding the three analyzed studies(n=18)in order to assess their impact on the overall result of the original metaanalysis.Finally,we performed a third meta-analysis excluding all studies(n=16)which showed a statistically improved overall survival.RESULTS The detailed analysis of the three most relevant RCTs according to the items of the CONSORT checklist showed several pitfalls.In up to 47%of the items,inappropriate answers were found.Generally,a lack of information regarding therandomization procedure as well as the absence of allocation concealment,blinded set-up,of intention-to-treat analysis and omission of sample size calculation were common problems of the analyzed studies.The exclusion of these three studies from the meta-analysis did not affect the general result of the meta-analysis,still confirming a survival advantage after adjuvant chemotherapy.After exclusion of single studies with a statistically significant outcome improvement,the meta-analysis of the remaining 16 studies again shows a statistically significant result due in part to a large remaining sample size.CONCLUSION The three most powerful publications s

关键词： Rectal cancer Validity Meta-analysis CONSORT checklist Postoperative chemotherapy Overall survival

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Women health and microbiota:Different aspects of well-being

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World Journal of Gastroenterology 2024年第10期30卷 1287-1290页

作者： giulia Nannini Amedeo Amedei Department of Experimental and Clinical Medicine University of FlorenceFlorence 50134Italy Network of Immunity in Infection Malignancy and Autoimmunity(NIIMA)Universal Scientific Education and Research Network(USERN)Florence 50134Italy

In this editorial,we comment on the article by Marano et al recently published in the World Journal of Gastroenterology 2023;29(45):5945-5952.We focus on the role of gut microbiota(GM)in women’s health,highlighting the need to thoroughly comprehend the sex differences in microbiota.Together,the host and GM support the host’s health.The microbiota components consist of viruses,bacteria,fungi,and archaea.This complex is an essential part of the host and is involved in neu-rological development,metabolic control,immune system dynamics,and host dynamic homeostasis.It has been shown that differences in the GM of males and females can contribute to chronic diseases,such as gastrointestinal,metabolic,neurological,cardiovascular,and respiratory illnesses.These differences can also result in some sex-specific changes in immunity.Every day,research on GM reveals new and more expansive frontiers,offering a wealth of innovative oppor-tunities for preventive and precision medicine.

关键词： Gut microbiota Women Immune system Well-being Hormones Sexdifferences

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Probing the endoplasmic reticulummitochondria interaction in Alzheimer's disease:searching far and wide

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Neural Regeneration Research 2024年第10期19卷 2103-2104页

作者： giulia Dematteis Laura Tapella Dmitry Lim Department of Pharmaceutical Sciences Universitàdel Piemonte Orientale“Amedeo Avogadro”NovaraItaly

Alzheimer's disease(AD)is the most frequent,form of dementia in elderly people and is an incurable disease with an exponentially growing number of cases.Extracellular deposition of amyloid-β(Aβ)plaques and intraneur... 详细信息

关键词： Alzheimer Aβ reticulum

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Brain dysfunctions and neurotoxicity induced by psychostimulants in experimental models and humans:an overview of recent findings

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Neural Regeneration Research 2024年第9期19卷 1908-1918页

作者： Marcello Serra Nicola Simola Alexia E.Pollack giulia Costa Department of Biomedical Sciences Section of NeuroscienceUniversity of CagliariCagliariItaly Department of Biology University of Massachusetts-BostonBostonMAUSA

Preclinical and clinical studies indicate that psychostimulants,in addition to having abuse potential,may elicit brain dysfunctions and/or neurotoxic effects.Central toxicity induced by psychostimulants may pose serious health risks since the recreational use of these substances is on the rise among young people and adults.The present review provides an overview of recent research,conducted between 2018 and 2023,focusing on brain dysfunctions and neurotoxic effects elicited in experimental models and humans by amphetamine,cocaine,methamphetamine,3,4-methylenedioxymethamphetamine,methylphenidate,caffeine,and nicotine.Detailed elucidation of factors and mechanisms that underlie psychostimulant-induced brain dysfunction and neurotoxicity is crucial for understanding the acute and enduring noxious brain effects that may occur in individuals who use psychostimulants for recreational and/or therapeutic purposes.

关键词： 3,4-methylenedioxymethamphetamine amphetamine caffeine cell cultures cocaine methamphetamine methylphenidate neurotoxicity nicotine

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Autoimmune pancreatitis:Cornerstones and future perspectives

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World Journal of Gastroenterology 2024年第8期30卷 817-832页

作者： Camilla Gallo giulia Dispinzieri Nicola Zucchini Pietro Invernizzi Sara Massironi Division of Gastroenterology and Center for Autoimmune Liver Diseases Department of Medicine and SurgeryFondazione IRCCS San Gerardo dei TintoriUniversity of Milano-BicoccaMonza 20900Italy Department of Pathology Fondazione IRCCS San Gerardo dei TintoriMonza 20900Italy

Autoimmune pancreatitis(AIP)is an autoimmune subtype of chronic pancreatitis resulting from the aberrant immune response against the pancreas,leading to inflammation and fibrosis.Although AIP is rare,its incidence is increasing and is often misdiagnosed as other pancreatic diseases.AIP is commonly classified into two types.Type 1 AIP(AIP-1)is typically associated with elevated serum immunoglobulin G4(IgG4)levels and systemic manifestations,while type 2 AIP is typically a more localized form of the disease,and may coexist with other autoimmune disorders,especially inflammatory bowel diseases.Additionally,there is emerging recognition of a third type(type 3 AIP),which refers to immunotherapy-triggered AIP,although this classification is still gaining acceptance in medical literature.The clinical manifestations of AIP mainly include painless jaundice and weight loss.Elevated serum IgG4 levels are particularly characteristic of AIP-1.Diagnosis relies on a combination of clinical,laboratory,radiological,and histological findings,given the similarity of AIP symptoms to other pancreatic disorders.The mainstay of treatment for AIP is steroid therapy,which is effective in most cases.Severe cases might require additional imm-unosuppressive agents.This review aims to summarize the current knowledge of AIP,encompassing its epidemiology,etiology,clinical presentation,diagnosis,and treatment options.We also address the challenges and controversies in diagnosing and treating AIP,such as distinguishing it from pancreatic cancer and managing long-term treatment,highlighting the need for increased awareness and knowledge of this complex disease.

关键词： Autoimmunity Pancreatitis Autoimmune pancreatitis Immunoglobulin G4 Steroids Relapse

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Economic Risk Assessment of Future Debris Flows by Machine Learning Method

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International Journal of Disaster Risk Science 2024年第1期15卷 149-164页

作者： Chenchen Qiu Lijun Su Alessandro Pasuto giulia Bossi Xueyu Geng School of Engineering University of WarwickCoventry CV47ALUK Key Laboratory of Mountain Hazards and Earth Surface Process Institute of Mountain Hazards and EnvironmentChinese Academy of SciencesChengdu 610041China Research Institute for Geo-Hydrological Protection(IRPI-CNR) National Research Council of ItalyPadova 35127Italy

A reliable economic risk map is critical for effective debris-flow mitigation.However,the uncertainties surrounding future scenarios in debris-flow frequency and magnitude restrict its application.To estimate the economic risks caused by future debris flows,a machine learning-based method was proposed to generate an economic risk map by multiplying a debris-flow hazard map and an economic vulnerability map.We selected the Gyirong Zangbo Basin as the study area because frequent severe debris flows impact the area every year.The debris-flow hazard map was developed through the multiplication of the annual probability of spatial impact,temporal probability,and annual susceptibility.We employed a hybrid machine learning model-certainty factor-genetic algorithm-support vector classification-to calculate susceptibilities.Simultaneously,a Poisson model was applied for temporal probabilities,while the determination of annual probability of spatial impact relied on statistical results.Additionally,four major elements at risk were selected for the generation of an economic loss map:roads,vegetation-covered land,residential buildings,and farmland.The economic loss of elements at risk was calculated based on physical vulnerabilities and their economic values.Therefore,we proposed a physical vulnerability matrix for residential buildings,factoring in impact pressure on buildings and their horizontal distance and vertical distance to debrisflow channels.In this context,an ensemble model(XGBoost) was used to predict debris-flow volumes to calculate impact pressures on buildings.The results show that residential buildings occupy 76.7% of the total economic risk,while roadcovered areas contribute approximately 6.85%.Vegetation-covered land and farmland collectively represent 16.45% of the entire risk.These findings can provide a scientific support for the effective mitigation of future debris flows.

关键词： Economic risk Future debris fows Gyirong Zangbo Basin Machine learning model Physical vulnerability matrix Southwest Tibet,China

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Application of ultrasonography-elastography score to suspect porto-sinusoidal vascular disease in patients with portal vein thrombosis

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Hepatobiliary & Pancreatic Diseases International 2024年第1期23卷 20-24页

作者： Stefania Gioia Adriano De Santis giulia d’Amati Silvia Nardelli Alessandra Spagnoli Arianna Di Rocco Lorenzo Ridola Oliviero Riggio Department of Translational and Precision Medicine Sapienza University of RomeRomeItaly Department of Radiological Oncologicaland Pathological SciencesSapienza University of RomeRomeItaly Department of Public Health and Infectious Diseases Sapienza University of RomeRomeItaly

Background:Porto-sinusoidal vascular disease(PSVD)and portal vein thrombosis(PVT)are causes of portal hypertension characterized respectively by an intrahepatic and a pre-hepatic obstacle to the flow in the portal system.As PVT may be a consequence of PSVD,in PVT patients at presentation,a pre-existing PSVD should be suspected.In these patients the identification of an underlying PSVD would have relevant implication regarding follow-up and therapeutic management,but it could be challenging.In this setting ultrasonography may be valuable in differential diagnosis.The aim of the study was to use ultrasonography to identify parameters to discriminate between PSVD and“pure”PVT and then to suspect PVT secondary to a pre-existing PSVD.Methods:Fifty-three patients with histologically proven PSVD and forty-eight patients affected by chronic PVT were enrolled and submitted to abdominal ultrasonography with elastography by acoustic radiation force impulse(ARFI).Results:ARFI was higher and superior mesenteric vein(SMV)diameter was wider in PSVD patients than in PVT patients.Thus,a prognostic score was obtained as linear combinations of the two parameters with a good discrimination capacity between PSVD and PVT(the area under the curve=0.780;95%confidence interval:0.690-0.869).Conclusions:A score based on ARFI and SMV diameter may be useful to suspect an underlying PSVD in patients with PVT and to identify a subgroup of patients to be submitted to liver biopsy.

关键词： Non-cirrhotic portal hypertension Porto-sinusoidal vascular disease Chronic portal vein thrombosis Liver stiffness Portal hypertension Acoustic radiation force impulse

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Use of bio-based products towards more sustainable road paving binders: A state-of-the-art review

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Journal of Road Engineering 2024年第2期4卷 151-162页

作者： Alessio Musco giulia Tarsi Piergiorgio Tataranni Ernesto Salzano Cesare Sangiorgi Department of Civil ChemicalEnvironmental and Materials Engineering(DICAM)Alma Mater Studiorum-University of BolognaBologna 40131Italy

Many industrial sectors exploit fossil sources to develop useful and necessary materials for our needs,such as bituminous paving materials.Bitumen,a key component of asphalt mixtures,is derived from oil refining and its properties are influenced by the crude oil source and refining process,resulting in a significant carbon footprint.With growing awareness of resource depletion and environmental concerns,pavement researchers are exploring sustainable alternatives to reduce dependence on fossil sources.This includes a rising trend in using renewable materials like biomasses to produce bio-based binders as substitutes for bitumen,aiming for a more sustainable approach.Biomasses,including vegetal and animal wastes,and waste cooking oils,as substitutes for crude oil in the production of bio-binders.Through thermochemical conversion(TCC),such as pyrolysis,biomasses can be converted into bio-char and bio-oils,which can replace fossil-based components in binders.Researchers have utilized these bio-products to reduce the dependency on fossil fuels in binders.However,there are no set minimum requirements for bio-components in bio-based binders.As the percentage of replaced bitumen increases,various types of binders are produced,including modified bitumen,extended bitumen,and alternative binders,where the fossil replacement is gradual.Overall rheological tests on bio-binders,reveal that those containing biochar exhibit increased viscosity,stiffness,rutting resistance,and sometimes antioxidant properties.Conversely,bio-binders with bio-oils as bitumen substitutes show poorer performance at high temperatures but improved behavior at low temperatures.These results suggest that bio-binders could provide versatile solutions for various climatic and loading conditions in road construction.However,the development of pavement mixtures based on bio-binders has not been studied in depth and requires further attention to unlock its full potential.As sustainability considerations,including life cycle assessments(LCA)and life cycle cost

关键词： Biomass Chemical process Bitumen replacement Bio-binder Paving material

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