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Downstaging disease in patients with hepatocellular carcinoma outside up-to-seven criteria: Strategies using degradable starch microspheres transcatheter arterial chemo-embolization

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World Journal of Hepatology 2015年第12期7卷 1694-1700页

作者： Antonio Orlacchio Fabrizio Chegai Stefano Merolla Simona Francioso Costantino del giudice Mario Angelico giuseppe Tisone Giovanni Simonetti Department of Diagnostic and Molecular Imaging Radiation Therapy and Interventional Radiology University Hospital Tor Vergata Liver Unit University Hospital Tor Vergata Organ Transplantation Unit University Hospital Tor Vergata

AIM: To evaluate the downstaging rates in hepatitis C virus-patients with hepatocellular carcinoma(HCC), treated with degradable starch microspheres transcatheter arterial chemoembolization(DSM-TACE), to reach new-Milan-criteria(nM C) for transplantation. METHODS: This study was approved by the Ethics Committee of our institution. From September 2013 to March 2014 eight patients(5 men and 3 women) with liver cirrhosis and multinodular HCC, that did not meet n MC at baseline, were enrolled in this study. Patients who received any other type of treatment such as termal ablation or percutaneous ethanol injection were excluded. DSM-TACE was performed in all patients using Embo Cept? S and doxorubicin. Baseline and follow-up computed tomography or magnetic resonance imaging was assessed measuring the longest enhancing axial dimension of each tumor according to the modified Response Evaluation Criteria In Solid Tumors measure-ments, and medical records were reviewed.RESULTS: DSM-TACE was successfully performed in all patients without major complication. We treated 35 lesions(mean 4.3 per patient). Six of eight patients(75%) had their HCC downstaged to meet nM C. Every patient whose disease was downstaged eventually underwent transplantation. The six patients who received transplant were still living at the time of this writing, without recurrence of HCC. Baseline age(P = 0.25), Model for End-stage Liver Disease score(P = 0. 77), and α-fetoprotein level(P = 1.00) were similar between patients with and without downstaged HCC. CONCLUSION: DSM-TACE represents a safely and effective treatment option with similar safety and efficacy of conventional chemoembolization and could be successfully performed also for downstaging disease in patients without n MC, allowing them to reach liver transplantation.

关键词： Hepatocellular carcinoma Transcatheterarterial chemoembolization Liver transplantation Degradable starch microspheres New-Milan-criteria Recurrence-free survival Locoregional therapies

A systematic review of robot-assisted partial nephrectomy outcomes for advanced indications:Large tumors(cT2-T3),solitary kidney,completely endophytic,hilar,recurrent,and multiple renal tumors

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Asian Journal of Urology 2023年第4期10卷 390-406页

作者： Savio Domenico Pandolfo Clara Cerrato Zhenjie Wu Antonio Franco Francesco del giudice Alessandro Sciarra Paolo Verze giuseppe Lucarelli Ciro Imbimbo Sisto Perdonà Edward E.Cherullo Francesco Porpiglia Ithaar H.Derweesh Riccardo Autorino Department of Urology Rush University Medical CenterChicagoILUSA Department of Neurosciences Reproductive Sciences and Odontostomatology“Federico II”UniversityNaplesItaly Department of Urology University of VeronaVeronaItaly Department of Urology Changhai HospitalNaval Medical UniversityShanghaiChina European Association of Urology(EAU)Young Academic Urologists(YAU)Renal Cancer Working Group Arnhemthe Netherlands Department of Urology Sant’Andrea HospitalLa Sapienza UniversityRomeItaly Department of Maternal-Infant and Urologic Sciences La Sapienza UniversityPoliclinico Umberto I HospitalRomeItaly Department of Medicine and Surgery Scuola Medica SalernitanaUniversity of SalernoFiscianoItaly Department of Emergency and Organ Transplantation-Urology Andrology and Kidney Transplantation UnitUniversity of BariBariItaly Department Uro-Gynecology IRCCS G.Pascale FoundationNaplesItaly Department of Urology San Luigi Gonzaga HospitalUniversity of TurinOrbassanoItaly Department of Urology University of California San DiegoLa JollaCAUSA

Objective:Robot-assisted partial nephrectomy(RAPN)has become widely used for treatment of renal cell carcinoma and it is expanding in the field of complex renal masses.The aim of this systematic review was to analyze outcomes of RAPN for completely endophytic renal masses,large tumors(cT2-T3),renal cell carcinoma in solitary kidney,recurrent tumors,completely endophytic and hilar masses,and simultaneous and multiple tumors.Methods:A comprehensive search in the PubMed,Scopus,Web of Science,and Cochrane Central Register of Controlled Trials databases was performed in December 2022 for English language papers.The primary endpoint was to evaluate the role of RAPN in the setting of each category of complex renal masses considered.The secondary endpoint was to evaluate the surgical and functional outcomes.Results:After screening 1250 records,43 full-text manuscripts were selected,comprising over 8500 patients.Twelve and thirteen studies reported data for endophytic and hilar renal masses,respectively.Five and three studies reported outcomes for cT2-T3 and solitary kidney patients,respectively.Four studies focused on redo-RAPN for recurrent tumors.Two studies investigated simultaneous bilateral renal masses and five reports focused on multiple tumor excision in ipsilateral kidney.Conclusion:Over the past decade,evidence supporting the use of RAPN for the most challenging nephron-sparing surgery indications has continuously grown.Although limitations remain including study design and lack of detailed long-term functional and oncological outcomes,the adoption of RAPN for the included advanced indications is associated with favorable surgical outcomes with good preservation of renal function without compromising the oncological result.Certainly,a higher likelihood of complication might be expected when facing extremely challenging cases.However,none of these indications should be considered per se an exclusion criterion for performing RAPN.Ultimately,a risk-adapted approach should be employed.

关键词： Robot-assisted partial nephrectomy Complex renal mass Solitary kidney Larger tumors(cT2-T3) Endophytic and hilar mass Recurrent tumor Simultaneous and multiple tumor

Assessing the effects of alternative fuel treatments to reduce wildfire exposure

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Journal of Forestry Research 2023年第2期34卷 373-386页

作者： Roghayeh Jahdi Liliana del giudice Massimo Melis Raff aella Lovreglio Michele Salis Bachisio Arca Pierpaolo Duce Institute of BioEconomy(CNR IBE) National Research Council of ItalySassariItaly Faculty of Agriculture and Natural Resources University of Mohaghegh ArdabiliArdabilIran Sardinia Forest Service LanuseiItaly Department of Agriculture University of SassariSassariItaly

Effective landscape-scale fuel management strategies are essential for reducing wildfire risk in Mediterranean fire-prone areas.In this study,the minimum travel time(MTT)fire-spread algorithm as implemented in FlamMap was applied to assess the potential of alternative fuel treatments for lowering wildfire losses in a 5,740-ha study area in eastern Sardinia,Italy.Twenty-seven wildfires at 10-m resolution were simulated considering three wind speeds(15,18,and 21 km h-1)to compare fuel treatments:no treatment(NT),irrigated agroforestry areas with shrub clearing(T1),prescribed fire in eucalyptus stands(T2),and irrigated grasslands(T3).The simulations replicated a recent large wildfire that occurred in the study area(Orrìwildfire,2019)and considered the weather and fuel moisture conditions associated with this event.The average wildfire exposure outputs(burned area,probability of burning,conditional flame length,potential crown fire occurrence,and surfaces withflame lengths above 2.5 m)decreased after fuel treatments,compared to no treatment.T1 was the most effective strategy in mitigating wildfire hazards and provided the most significant performance for several wildfire exposure indicators.Treating only 0.5%of the study area(~30 ha)resulted in a decrease in all wildfire exposure metrics to~10%within the study area.In addition,the total surface characterized by high flame length(average>2.5 m)was the lowest in the T1 treatment.This study can help land and fire managers optimize fuel treatment opportunities and wildfire risk mitigation strategies in Mediterranean areas.

关键词： Fuel treatment strategies Fire prevention Mediterranean areas Minimum travel time(MTT) Wildfi re exposure

血管生成素在淀粉样沉积症中发挥作用吗?（英文）

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中国生物化学与分子生物学报 2015年第12期31卷 1276-1283页

作者： Rita del giudice Daria Maria Monti 那不勒斯菲里德里克第二大学化学科学系意大利那不勒斯80126

淀粉样沉积症是致命性的疾病,可以是神经退行性的,也可以是系统性的.该疾病以错误折叠蛋白质的堆积、缠绕成纤维为特征,最终导致受累组织、器官的渐进性坏死.目前,没有有效的治疗手段可以阻止该类疾病的进程.错误折叠蛋白质的累积诱导... 详细信息

淀粉样沉积症是致命性的疾病,可以是神经退行性的,也可以是系统性的.该疾病以错误折叠蛋白质的堆积、缠绕成纤维为特征,最终导致受累组织、器官的渐进性坏死.目前,没有有效的治疗手段可以阻止该类疾病的进程.错误折叠蛋白质的累积诱导内质网应激,被认为是退行性疾病的标志.血管生成素不仅可以调节细胞生长和增殖,也在应激条件下细胞存活中发挥作用.最近,发现血管生成素介导的应激反应可以减轻蛋白聚积造成的损伤,提示该蛋白可能在退行性疾病中具有新功能.本综述概述了血管生成素在淀粉样沉积症中的研究进展,特别是描述了血管生成素失调与该类疾病的起始和进展间的关系.我们认为,深入了解血管生成素失调的分子基础有助于发展与蛋白质错误折叠和聚积相关的退行性疾病的治疗方法.

关键词：血管生成素神经退行性疾病系统性淀粉样沉积症

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

Pediatric fatty liver disease:Role of ethnicity and genetics

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World Journal of Gastroenterology 2014年第23期20卷 7347-7355页

作者： Pierluigi Marzuillo Emanuele Miraglia del giudice Nicola Santoro Department of Women and Children and General and Specialized Surgery Seconda Università degli Studi di Napoli80138 NaplesItaly Department of Pediatrics Yale University School of MedicineNew HavenCT 06520United States

Non-alcoholic fatty liver disease(NAFLD)comprehends a wide range of conditions,encompassing from fatty liver or steatohepatitis with or without fibrosis,to cirrhosis and its complications.NAFLD has become the most common form of liver disease in childhood as its prevalence has more than doubled over the past 20years,paralleling the increased prevalence of childhood obesity.It currently affects between 3%and11%of the pediatric population reaching the rate of46%among overweight and obese children and adolescents.The prevalence of hepatic steatosis varies among different ethnic groups.The ethnic group with the highest prevalence is the Hispanic one followed by the Caucasian and the African-American.This evidence suggests that there is a strong genetic background in the predisposition to fatty liver.In fact,since 2008several common gene variants have been implicated in the pathogenesis of fatty liver disease.The most important is probably the patatin like phospholipase containing domain 3 gene(PNPLA3)discovered by the Hobbs’group in 2008.This article reviews the current knowledge regarding the role of ethnicity and genetics in pathogenesis of pediatric fatty liver.

关键词： Non alcoholic fatty liver disease Ethnicity Patati

Understanding the pathophysiological mechanisms in the pediatric non-alcoholic fatty liver disease: The role of genetics

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World Journal of Hepatology 2015年第11期7卷 1439-1443页

作者： Pierluigi Marzuillo Anna Grandone Laura Perrone Emanuele Miraglia del giudice Department of Women and Children and General and Specialized Surgery Seconda Università degli Studi di Napoli

Classically, the non-alcoholic fatty liver disease(NAFLD) physiopathology and progression has been summarized in the two hits hypothesis. The first hit is represented by the action of hyperinsulinemia and insulin resistance, accompanying obesity, that leads to liver steatosis increasing the absolute non esterified fatty acids uptake in the liver and the esterification to form triacylglycerol. The oxidative stress is involved in the second hit leading to the progression to nonalcoholic steatohepatitis(NASH) because of its harmful action on steatosic hepatocytes. However, at the present time, the two hits hypothesis needs to be updated because of the discover of genetic polymorphisms involved both in the liver fat accumulation and progression to NASH that make more intriguing understanding the NAFLD pathophysiological mechanisms. In this editorial, we want to underline the role of PNPLA3 I148 M, GPR120 R270 H and TM6SF2 E167 K in the pediatric NAFLD development because they add new pieces to the comprehension of the NAFLD pathophysiological puzzle. The PNPLA3 I148 M polymorphism encodes for an abnormal protein which predisposes to intrahepatic triglycerides accumulation both for a loss-of-function of its triglyceride hydrolase activity and for a gain-of-function of its lipogenic activity.Therefore, it is involved in the first hit, such as TM6SF2 E167 K polymorphisms that lead to intrahepatic fat accumulation through a reduced very low density lipoprotein secretion. On the other hand, the GPR120 R270 H variant, reducing the anti-inflammatory action of the GPR120 receptor expressed by Kuppfer cells, is involved in the second hit leading to the liver injury.

关键词： Pediatric non-alcoholic fatty liver disease GPR120 PNPLA3 TM6SF2 Alanine transaminase

A systematic review and meta-analysis of clinical trials implementing aromatase inhibitors to treat male infertility

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Asian Journal of Andrology 2020年第4期22卷 360-367页

作者： Francesco del giudice Gian Maria Busetto Ettore De Berardinis Isabella Sperduti Matteo Ferro Martina Maggi Martin S Gross Alessandro Sciarra Michael L Eisenberg Department of Urology Sapienza Rome UniversityPoliclinico Umberto IRome 00161Italy Biostatistical Unit IRCCSRegina Elena National Cancer InstituteRome 00128Italy Division of Urology European Institute of OncologyMilan 20141Italy Section of Urology Dartmouth-Hitchcock Medical CenterLebanonNH 03766USA Department of Urology Stanford UniversitySchool of MedicineStanfordCA 94305USA

Aromatase activity has commonly been associated with male infertility characterized by testicular dysfunction with low serum testosterone and/or testosterone to estradiol ratio.In this subset of patients,and particularly in those with hypogonadism,elevated levels of circulating estradiol may establish a negative feedback on the hypothalamic–pituitary–testicular axis by suppressing follicle-stimulating hormone(FSH)and luteinizing hormone(LH)production and impaired spermatogenesis.Hormonal manipulation via different agents such as selective estrogen modulators or aromatase inhibitors to increase endogenous testosterone production and improve spermatogenesis in the setting of infertility is an off-label option for treatment.We carried out a systematic review and meta-analysis of the literature of the past 30 years in order to evaluate the benefits of the use of aromatase inhibitors in the medical management of infertile/hypoandrogenic males.Overall,eight original articles were included and critically evaluated.Either steroidal(Testolactone)or nonsteroidal(Anastrozole and Letrozole)aromatase inhibitors were found to statistically improve all the evaluated hormonal and seminal outcomes with a safe tolerability profile.While the evidence is promising,future prospective randomized placebo-controlled multicenter trials are necessary to better define the efficacy of these medications.

关键词： aromatase inhibitor hypogonadism male infertility meta-analysis systematic review

From the liver to the heart: Cardiac dysfunction in obese children with non-alcoholic fatty liver disease

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World Journal of Hepatology 2017年第2期9卷 69-73页

作者： Anna Di Sessa Giuseppina Rosaria Umano Emanuele Miraglia del giudice Nicola Santoro Department of Woman and Child and General and Specialized Surgery Seconda Università degli Studi di Napoli Department of Pediatrics Yale University School of Medicine

In the last decades the prevalence of non-alcoholic fatty liver disease(NAFLD) has increased as a consequence of the childhood obesity world epidemic. The liver damage occurring in NAFLD ranges from simple steatosis to steatohepatitis, fibrosis and cirrhosis. Recent findings reported that fatty liver disease is related to early atherosclerosis and cardiac dysfunction even in the pediatric population. Moreover, some authors have shown an association between liver steatosis and cardiac abnormalities, including rise in left ventricular mass, systolic and diastolic dysfunction and epicardial adipose tissue thickness. In this editorial, we provide a brief overview of the current knowledge concerning the association between NAFLD and cardiac dysfunction.

关键词：心脏的机能障碍非酒精的脂肪肝疾病动脉粥样硬化孩子心血管的风险