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Surgery in biliary lithiasis: from the traditional “open” approach to laparoscopy and the“rendezvous” technique

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Hepatobiliary & Pancreatic Diseases International 2017年第6期16卷 595-601页

作者： giuseppe tarantino Paolo Magistri Roberto Ballarin Giacomo Assirati Antonio Di Cataldo Fabrizio Di Benedetto Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit University of Modena and Reggio Emilia 41124 ModenaItaly Department of General Surgery Sapienza-University of Rome 00189 Rome Italy Department of Surgical Sciences Organ Transplantation and Advanced Technologies University of Catania95124 Catania Italy

BACKGROUND:According to the current literature, biliary lithiasis is a worldwide-diffused condition that affects almost 20% of the general population. The rate of common bile duct stones(CBDS) in patients with symptomatic cholelithiasis is estimated to be 10% to 33%, depending on patient’s age.Compared to stones in the gallbladder, the natural history of secondary CBDS is still not completely understood. It is not clear whether an asymptomatic choledocholithiasis requires treatment or not. For many years, open cholecystectomy with choledochotomy and/or surgical sphincterotomy and cleaning of the bile duct were the gold standard to treat both pathologies. Development of both endoscopic retrograde cholangiopancreatography(ERCP) and laparoscopic surgery,together with improvements in diagnostic procedures, influenced new approaches to the management of CBDS in association with gallstones.DATA SOURCES:We decided to systematically review the literature in order to identify all the current therapeutic options for CBDS. A systematic literature search was performed independently by two authors using Pub Med, EMBASE, Scopus and the Cochrane Library Central.RESULTS:The therapeutic approach nowadays varies greatly according to the availability of experience and expertise in each center, and includes open or laparoscopic common bile duct exploration, various combinations of laparoscopic cholecystectomy and ERCP and combined laparoendoscopic rendezvous.CONCLUSIONS:Although ERCP followed by laparoscopic cholecystectomy is currently preferred in the majority of hospitals worldwide, the optimal treatment for concomitant gallstones and CBDS is still under debate, and greatly varies among different centers.

关键词： biliary obstruction bile duct stones gallstones endoscopic retrograde cholangiopancreatography laparoscopic cholecystectomy

Robotic liver surgery is the optimal approach as bridge to transplantation

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World Journal of Hepatology 2017年第4期9卷 224-226页

作者： Paolo Magistri giuseppe tarantino Roberto Ballarin Andrea Coratti Fabrizio Di Benedetto Department of Medical and Surgical Sciences and Translational Medicine Sapienza - University of Rome Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit University of Modena and Reggio Emilia Department of Oncology Division of Oncological and Robotic General Surgery Careggi University Hospital

The role of minimally invasive liver surgery as a bridge to transplantation is very promising but still underestimated. However, it should be noted that surgical approach for hepatocellular carcinomas(HCC) is not merely a technical or technological issue. Nowadays, the epidemiology of HCC is evolving due to the increasing role of non-alcoholic fatty-liver-disease, and the emerging concerns on direct-acting antivirals against hepatitis C virus in terms of HCC incidence. Therefore, a fully multidisciplinary study of the cirrhotic patient is currently more important than ever before, and the management of those patients should be reserved to tertiary referral hepatobiliary centers. In particular, minimally invasive approach to the liver showed several advantages compared to the classical open procedure, in terms of:(1) the small impact on abdominal wall;(2) the gentle manipulation on the liver;(3) the limited surgical trauma; and(4) the respect of venous shunts. Therefore, more direct indications should be outlined also in the Barcelona Clinic Liver Cancer model. We believe that treatment of HCC in cirrhotic patients should be reserved to tertiary referral hepatobiliary centers, that should offer patient-tailored approaches to the liver disease, in order to provide the best care for each case, according to the individual comorbidities, risk factors, and personal quality of life expectations.

关键词： Hepatocellular 癌肝移植机器的外科桥牌到移植 Da vinci 巴赛隆纳诊所肝癌症耐心的安全

Successful multidisciplinary clinical approach and molecular characterization by whole transcriptome sequencing of a cardiac myxofibrosarcoma: A case report

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World Journal of Clinical Cases 2019年第19期7卷 3018-3026页

作者： Maristella Saponara Valentina Indio Carmine Pizzi Elena-Daniela Serban Milena Urbini Annalisa Astolfi Pasquale Paolisso Sofia Martin Suarez Margherita Nannini Davide Pacini Valentina Agostini Ornella Leone Valentina Ambrosini giuseppe tarantino Stefano Fanti Fabio Niro Francesco Buia Domenico Attinà Maria Abbondanza Pantaleo Department of Specialized Experimental and Diagnostic MedicineMedical Oncology UnitSant'Orsola-Malpighi HospitalUniversity of BolognaBologna 40138Italy “Giorgio Prodi”Cancer Research Center University of BolognaBologna 40138Italy Department of Specialized Experimental and Diagnostic MedicineCardiology and Transplantation UnitSant’Orsola-Malpighi HospitalUniversity of BolognaBologna 40138Italy Department of Pathology Cardiovascular Pathology UnitSant’Orsola-Malpighi HospitalUniversity of BolognaBologna 40138Italy Departments of Cardiovascular Surgery and Transplantation Sant'Orsola-Malpighi HospitalUniversity of BolognaBologna 40138Italy Department of Specialized Experimental and Diagnostic MedicineNuclear Medicine UnitSant'Orsola-Malpighi HospitalUniversity of BolognaBologna 40138Italy Department of Specialized Experimental and Diagnostic MedicineRadiology UnitSant'Orsola-Malpighi HospitalUniversity of BolognaBologna 40138Italy

BACKGROUND Cardiac tumors are rare and complex entities.Surgery represents the cornerstone of therapy,while the role of adjuvant treatment remains unclear and,in case of relapse or metastatic disease,the prognosis is very poor.Lack of prospective,randomized clinical trials hinders the generation of high level evidence for the optimal diagnostic workup and multimodal treatment of cardiac sarcomas.Herein,we describe the multidisciplinary clinical management and molecular characterization of a rare case of cardiac myxofibrosarcoma in an elderly woman.CASE SUMMARY A 73-year-old woman presented signs and symptoms of acute left-sided heart failure.Imaging examination revealed a large,left atrial mass.With suspicion of a myxoma,she underwent surgery,and symptoms were promptly relieved.Histology showed a cardiac myxofibrosarcoma,a rare histotype of cardiac sarcoma.Eight months later,disease unfortunately relapsed,and after a multidisciplinary discussion,a chemotherapy with doxorubicin and then gemcitabine was started,achieving partial radiologic and complete metabolic response,which was maintained up to 2 years and is still present.This report is focused on the entire clinical path of our patient from diagnosis to follow-up,through surgery and strategies adopted at relapse.Moreover,due to their rarity,very little is known about the molecular landscape of myxofibrosarcomas.Thus,we also performed and described preliminary genome analysis of the tumor tissue to get further insight on mechanisms involved in tumor growth,and to possibly unveil new clinically actionable targets.CONCLUSION We report a case of cardiac myxofibrosarcoma that achieved a very good prognosis due to an integrated surgical,cardiac and oncologic treatment strategy.

关键词： Cardiac sarcoma Myxofibrosarcoma Whole transcriptome sequencing Doxorubicin Gemcitabine Case report

Post-transplantation hepatocellular carcinoma recurrence: Patterns and relation between vascularity and differentiation degree

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World Journal of Hepatology 2015年第2期7卷 276-284页

作者： Annarita Pecchi Giulia Besutti Mario De Santis Cinzia Del Giovane Sofia Nosseir giuseppe tarantino Fabrizio Di Benedetto Pietro Torricelli Dipartimento di Diagnostica per Immagini Azienda Ospedaliero-Universitaria Policlinico di Modena Unità di Statistica Medica Dipartimento di Medicina Diagnostica Clinica e Sanità Pubblica Università di Modena e Reggio Emilia Dipartimento dei Laboratori Anatomia Patologica e Medicina Legale Università degli studi di Modena e Reggio Emilia Dipartimento Chirurgico Medico Odontoiatrico e di Scienze Morfologiche con interesse Trapiantologico Oncologico e di Medicina Rigenerativa Università di Modena e Reggio Emilia

AIM: To evaluate the relationship between hepatocellular carcinoma(HCC) vascularity and grade; to describe patterns and vascular/histopathological variations of post-transplantation recurrence.METHODS: This retrospective study included 165 patients(143 men, 22 women; median age 56.8 years, range 28-70.4 years) transplanted for HCC who had a follow-up period longer than 2 mo. Pre-transplantation dynamic computed tomography or magnetic resonance examinations were retrospectively reviewed, classifying HCC imaging enhancement pattern into hypervascular and hypovascular based on presence of wash-in during arterial phase. All pathologic reports of the explanted livers were reviewed, collecting data about HCC differentiation degree. The association between imaging vascular pattern and pathological grade was estimated using the Fisher exact test. All follow-up clinical and imaging data were reviewed for evidence of recurrence. Recurrence rate was calculated and imaging features of recurrent tumor were collected, classifying early and late recurrences based on timing(< or ≥ 2 years after transplantation) and intrahepatic, extrahepatic and both intrahepatic and extrahepatic recurrences based onlocation. All intrahepatic recurrences were classified as hypervascular or hypovascular and the differentiation degree was collected where available. The presence of variations in imaging enhancement pattern and pathological grade between the primary tumor and the intrahepatic recurrence was evaluated and the association between imaging and histopatholgical variations was estimated by using the χ2 test. RESULTS: Of the 163 patients with imaging evidence of viable tumor, 156(95.7%) had hypervascular and 7(4.3%) hypovascular HCC. Among the 125 patients with evidence of viable tumor in the explanted liver, 19(15.2%) had grade 1, 56(44.8%) grade 2, 40(32%) grade 3 and 4(3.2%) grade 4 HCC, while the differentiation degree was not assessable for 6 patients(4.8%). A significant association was found between imaging vascularity and pathologi

关键词： Contrast media Hepatocellular carcinoma Liver transplantation Cell differentiation Recurrence

When the skin meets the bowel: About a case

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Open Journal of Gastroenterology 2013年第6期3卷 303-306页

作者： Ganzetti Giulia Campanati Anna Di Sario Antonio Rubini Corrado Zizzi Antonio tarantino giuseppe Benedetti Antonio Offidani Annamaria Anatomic Pathology Institute Department of Neurosciences Polytechnic University of Marche Ancona Italy Dermatological Clinic Department of Clinical and Molecular Medicine Polytechnic Marche University Ancona Italy Gastroenterologic Clinic Department of Clinical and Molecular Medicine Polytechnic Marche University Ancona Italy

Ulcerative colitis (UC) is a chronic relapsing inflammatory disease of the colorectal region which may be complicated by extraintestinal manifestations, as cutaneous involvement. Immune dysregulation resulting in a lymphocyte mediated destructive process has been suggested as a possible pathogenetic link between gut and skin-related manifestations. The authors describe an atypical clinical aspect of lichen ruber planus in a patient affected by vitiligo, alopecia areata and ulcerative colitis.

关键词： Ulcerative Colitis Vitiligo Lichen Ruber Planus Alopecia Areata Autoimmunity

Opportunities and challenges of implementing Pharmacogenomics in cancer drug development

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Cancer Drug Resistance 2019年第1期2卷 43-52页

作者： Paolo tarantino Dario Trapani Stefania Morganti Emanuela Ferraro Giulia Viale Paolo D’Amico Bruno Achutti Duso giuseppe Curigliano Division of Early Drug Development for Innovative Therapies IEOEuropean Institute of Oncology IRCCSMilan 20141Italy Department of Oncology and Haematology(DIPO) University of MilanMilan 20122Italy

Cancer drug development is a time and resources consuming process.Around 90%of drugs entering clinical trials fail due to lack of efficacy and/or safety issues,more often after conspicuous research and economic efforts.Part of the discarded drugs might be beneficial only in a subgroup of the study patients,and some adverse events might be prevented by identifying those patients more vulnerable to toxicities.The implementation of pharmacogenomic biomarkers allows the categorization of patients,to predict efficacy and toxicity and to optimize the drug development process.Around seventy FDA approved drugs currently present one or more genetic biomarker to keep in consideration,and with the progress of Precision Medicine tailoring therapies on individuals’genomic landscape promises to become a new standard of cancer care.In the current article we review the role of pharmacogenomics in cancer drug development,underlying the advantages and challenges of their implementation.

关键词： Pharmacogenomics cancer drug development precision medicine clinical trials

Taeniasis:A possible cause of ileal bleeding

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World Journal of Clinical Cases 2017年第12期5卷 432-436页

作者： Alessia Settesoldi Alessandro Tozzi Ottaviano tarantino Department of Gastroenterology and Digestive Endoscopy San Giuseppe Hospital Department of Gastroenterology Clinical Azienda Ospedaliero-Universitaria Careggi

Taenia spp.are flatworms of the class Cestoda,whose definitive hosts are humans and primates.Human infestation(taeniasis) results from the ingestion of raw meat contaminated with encysted larval tapeworms and is considered relatively harmless and mostly asymptomatic.Anemia is not recognized as a possible sign of taeniasis and taeniasis-induced hemorrhage is not described in medical books.Its therapy is based on anthelmintics such praziquantel,niclosamide or albendazole.Here we describe a case of acute ileal bleeding in an Italian man affected with both Taenia spp.infestation resistant to albendazole and Helicobacter pylori-associated duodenal ulcers.

关键词： Taenia spp. Intestinal bleeding Irondeficiency anemia Endoscopy

Could the improvement of obesity-related co-morbidities depend on modified gut hormones secretion?

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World Journal of Gastroenterology 2014年第44期20卷 16649-16664页

作者： Carmine Finelli Maria Carmela Padula giuseppe Martelli Giovanni tarantino Center of Obesity and Eating Disorders Stella Maris Mediterraneum Foundation Department of Science University of Basilicata Potenza Department of Clinical Medicine and Surgery Federico Ⅱ University Medical School of Naples Centro Ricerche Oncologiche di Mercogliano Istituto Nazionale Per Lo Studio E La Cura Dei Tumori "Fondazione Giovanni Pascale" IRCCS

Obesity and its associated diseases are a worldwide epidemic disease. Usual weight loss cures- as diets, physical activity, behavior therapy and pharmacotherapy- have been continuously implemented but still have relatively poor long-term success and mainly scarce adherence. Bariatric surgery is to date the most effective long term treatment for morbid obesity and it has been proven to reduce obesity-related co-morbidities, among them nonalcoholic fatty liver disease, and mortality. This article summarizes such variations in gut hormones following the current metabolic surgery procedures. The profile of gut hormonal changes after bariatric surgery represents a strategy for the individuation of the most performing surgical procedures to achieve clinical results. About this topic, experts suggest that the individuation of the crosslink among the gut hormones, microbiome, the obesity and the bariatric surgery could lead to new and more specific therapeutic interventions for severe obesity and its co-morbidities, also non surgical.

关键词： Obesity Bariatric surgery Gut hormones Nonalcoholi

Ten years of hip fractures in Italy: For the first time a decreasing trend in elderly women

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World Journal of Orthopedics 2014年第3期5卷 386-391页

作者： Prisco Piscitelli Maurizio Feola Cecilia Rao Monica Celi Elena Gasbarra Cosimo Neglia giuseppe Quarta Federico Maria Liuni Simone Parri Giovanni Iolascon Maria Luisa Brandi Alessandro Distante Umberto tarantino Euro Mediterranean Scientific Biomedical Institute ISBEM Research Centre72023 BrindisiItaly Department of Biological and Environmental Sciences and Technologies University of Salento73100 LecceItaly Division of Orthopaedics and Traumatology University of Tor Vergata00133 RomeItaly Department of Translational Medicine University of Florence50134 FlorenceItaly Department of Orthopaedics and Rehabilitative Medicine Second University of Naples80138 NaplesItaly

AIM:To evaluate the hospitalization rate of femoralneck fractures in the elderly Italian population over ten years.METHODS:We analyzed national hospitalizations records collected at central level by the Ministry of Health from 2000 to 2009.Age-and sex-specific rates of fractures occurred at femoral neck in people≥65 years old.We performed a sub-analysis over a three-year period(2007-2009),presenting data per five-year age groups,in order to evaluate the incidence of the hip fracture in the oldest population.RESULTS:We estimated a total of 839008 hospitalizations due to femoral neck fractures between 2000 and2009 in people≥65,with an overall increase of 29.8%over 10 years.The incidence per 10000 inhabitants remarkably increased in people≥75,passing from158.5 to 166.8(+5.2%)and from 72.6 to 77.5(+6.8%)over the ten-year period in women and men,respectively.The oldest age group(people>85 years old)accounted for more than 42%of total hospital admissions in 2009(n=39000),despite representing only 2.5%of the Italian population.Particularly,women aged>85accounted for 30.8%of total fractures,although they represented just 1.8%of the general population.The results of this analysis indicate that the incidence of hip fractures progressively increased from 2000 to 2009,but a reduction can be observed for the first time in women≤75(-7.9%between 2004 and 2009).CONCLUSION:Incidence of hip fractures in Italy are continuously increasing,although women aged 65-74years old started showing a decreasing trend.

关键词： Femoral fractures Hip fragility fractures Osteoporosis Hospitalizations Incidence