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How evidence-based are current guidelines for managing patients with peptic ulcer bleeding?

World Journal of Gastrointestinal Surgery 2010年第1期2卷 9-13页

作者： Angelo Andriulli antonio Merla Fabrizio Bossa Marco Gentile giuseppe Biscaglia Nazario Caruso Division of Gastroenterology "Casa Sollievo Sofferenza" HospitalIRCCSviale Cappuccini 171013 San Giovanni RotondoItaly

Current guidelines for managing ulcer bleeding state that patients with major stigmata should be managed by dual endoscopic therapy(injection with epinephrine plus a thermal or mechanical modality) followed by a high dose intravenous infusion of proton pump inhibitors(PPIs).This paper aims to review and critically evaluate evidence supporting the purported superiority of a continuous infusion over less intensive regimens of PPIs administration and the need for adding a second hemostatic endoscopic procedure to epinephrine *** searches of PubMed,EMBASE and the Cochrane library were *** is strong evidence for an incremental benefit of PPIs over H2receptor antagonists or placebo for the outcome of patients with peptic ulcer bleeding following endoscopic ***,the benefit of PPIs is unrelated to either the dosage(intensive vs standard regimen) or the route of administration(intravenous vs oral).There is significant heterogeneity among the 15 studies that compared epinephrine with epinephrine plus a second modality,which might preclude the validity of reported summary *** without second look endoscopy plus re-treatment of re-bleeding lesions showed a signif icant benef it of adding a second endoscopic modality for hemostasis,while studies with second-look and re-treatment showed equal efficacy between endoscopic mono and dual *** experimental evidence supports the current recommendation of the use of dual endoscopic hemostatic means and infusion of high-dose PPIs as standard therapy for patients with bleeding peptic ***,the combination of epinephrine monotherapy with standard doses of PPIs constitutes an appropriate treatment for the majority of patients.

关键词： Guidelines Ulcer bleeding Peptic ulcer Endoscopic therapy Pharmacotherapy Proton pump inhibitors

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Assessment of clinical and radiological response to sorafenib in hepatocellular carcinoma patients

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World Journal of Hepatology 2015年第1期7卷 33-39页

作者： Rodolfo Sacco Valeria Mismas antonio Romano Marco Bertini Michele Bertoni Graziana Federici Salvatore Metrangolo giuseppe Parisi Emanuele Tumino Giampaolo Bresci Luca Giacomelli Sara Marceglia Irene Bargellini Dipartimento di Gastroenterologia-UO Gastroenterologia e Malattie del Ricambio Azienda Ospedaliero Universitaria Pisana56124 PisaItaly Dipartimento di Elettronica Informazione e BioingegneriaPolitecnico di Milano20100 MilanItaly Dipartimento di Radiologia-Azienda Ospedaliero Universitaria Pisana 56124 PisaItaly

Sorafenib is an effective anti-angiogenic treatment forhepatocellular carcinoma(HCC). The assessment of tumor progression in patients treated with sorafenib is crucial to help identify potentially-resistant patients,avoiding unnecessary toxicities. Traditional methods to assess tumor progression are based on variations in tumor size and provide unreliable results in patients treated with sorafenib. New methods to assess tumor progression such as the modified Response Evaluation Criteria in Solid Tumors or European Association for the Study of Liver criteria are based on imaging to measure the vascularization and tumor volume(viable or necrotic). These however fail especially when the tumor response results in irregular development of necrotic tissue. Newer assessment techniques focus on the evaluation of tumor volume,density or perfusion. Perfusion computed tomography and Dynamic ContrastEnhanced-UltraS ound can measure the vascularization of HCC lesions and help predict tumor response to antiangiogenic therapies. Mean Transit Time is a possible predictive biomarker to measure tumor response. Volumetric techniques are reliable,reproducible and time-efficient and can help measure minimal changes in viable tumor or necrotic tissue,allowing the prompt identification of non-responders. Volume ratio may be a reproducible biomarker for tumor response. Larger trials are needed to confirm the use of these techniques in the prediction of response to sorafenib.

关键词： Hepatocellular carcinoma Sorafenib ResponseEvaluation Criteria in Solid Tumors Perfusioncomputed tomography Dynamic Contrast-Enhanced-UltraSound Volumetric assessment

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World Journal of Clinical Cases 2022年第19期10卷 6370-6384页

作者： Daniela Chieffo Carla Avallone Annamaria Serio Georgios Demetrios Kotzalidis Marta Balocchi Ilaria De Luca Daniele Hirsch Angela Gonsalez del Castillo Pierluigi Lanzotti giuseppe Marano Lucio Rinaldi antonio Lanzone Eugenio Mercuri Marianna Mazza Gabriele Sani Service of Clinical Psychology Catholic University of Sacred HeartRome 00168Italy Department of Neurosciences Catholic University of Sacred HeartRome 00168Italy Department of Obstetrics and Gynaecology Catholic University of Sacred HeartRome 00168Italy Paediatric Neurology Unit Catholic University of Sacred HeartRome 00168Italy Department of Geriatrics Neuroscience and OrthopedicsFondazione Policlinico Universitario Agostino Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy

BACKGROUND The coronavirus disease 2019(COVID-19)pandemic impacted in a still undefined way pregnant women’s mental *** are reports of mood and affect changes in the general population and the suggestion that similar changes occur also in the pregnant *** greater vulnerability of women during the COVID-19 restriction period may translate into a greater risk for mental disorders in the gestational *** hypothesised that pregnant women in the prepandemic period would have less psychopathology and more psychological support than pregnant women during the pandemic restriction *** To compare pregnant women for anxiety,prenatal depression,psychopathology,and social support before and after the awareness of the *** administered to women willing to participate in their 2nd-3rd trimesters of pregnancy theEdinburgh Postnatal Depression Scale(EPDS),the State-Trait Anxiety Inventory Form Y(STAI-Y),and the Symptom CheckList-90-Revised(SCL-90R);we further collected sociodemographicvariables and explored women’s social *** comparison was *** firstsample was termed nonCOVID-19 because data were gathered before the COVID-19 outbreak(January 2020-February 2020)was declared,and the second sample termed COVID-19 becauseparticipants were already subjected to the COVID-19-related restrictive measures(January 2021-February 2021).Since normal distribution was not met(Shapiro-Wilk test applied),we appliednonparametric Mann-Whitney’s U-test to compare psychometric *** standards were *** nonCOVID-19 group reported higher support from partners only,while the COVID-19 groupreported multiple support(χ^(2)=9.7181;P=0.021);the nonCOVID-19 group scored higher than theCOVID-19 group only on state anxiety among psychometric scales[STAI-Y1,nonCOVID-19median=39(95%CI:39.19-51.10)vs COVID-19 median=32(95%CI:30.83-38.90);Mann-Whitney’sU=117.5,P=0.00596].Other measures did not differ meaningfully between the two gr

关键词： COVID-19 pandemic Pregnancy Social Support Anxiety Depression Psychopathology

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Classifying Cardiac Anomalies in Right and Left Isomerism:Concordant and Discordant Patterns

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Congenital Heart Disease 2023年第1期18卷 97-111页

作者： Lilia Oreto giuseppe Mandraffino Paolo Ciliberti Teresa P.Santangelo Placido Romeo antonio Celona Placido Gitto Lorenzo Galletti Fiore S.Iorio Alfredo Di Pino Aurelio Secinaro Paolo Guccione Robert H.Anderson Salvatore Agati Mediterranean Pediatric Cardiology Center Bambino GesùChildren’s HospitalVia SirinaTaorminaItaly Internal Medicine Unit Department of Clinical and Experimental MedicineUniversity of MessinaMessinaItaly Department of Pediatric Cardiology and Cardiac Surgery Bambino GesùChildren’s HospitalRomaItaly Advanced Cardiovascular Imaging Unit Department of ImagingBambino GesùChildren’s HospitalRomaItaly Radiology Department S.Vincenzo HospitalTaorminaItaly Biosciences Institute Newcastle UniversityNewcastle upon TyneUK

Aims:Evidence is emerging that,in the setting of isomerism,the atrial and bronchial arrangement are not always concordant,nor are these patterns always harmonious with the arrangement of the abdominal *** aimed to evaluate the concordance between these features in a cohort of patients with cardiac malformations in the setting of known isomerism,seeking to determine whether it was feasible to assess complexity on this basis,in this regard taking note of the potential value of bronchial as opposed to appendage *** and Results:We studied 78 patients known to have isomerism of the bronchuses,43 with right and 35 with left *** anatomy could be determined in 49 cases(63%),all but one of these being concordant with bronchial *** assessing abdominal features,in only 59 cases(76%)was splenic morphology in keeping with the thoracic *** expected,right isomerism was associated with greater complexity of cardiac malformations,with an odds ratio of 6.53,with confidence intervals from 2.2–19.3(p<0.001).The odds were slightly decreased with thoraco-abdominal disharmony,when lesions shown to carry higher risk were then found in the setting of left ***:Harmony is excellent between bronchial and appendage isomerism,but less so with the arrangement of the abdominal *** isomerism in our cohort,was indicative of a sixfold increase in intracardiac *** discordance was found between the systems,however,the cardiac anomalies were less typical of the anticipated findings for right *** isomerism of the appendages.

关键词： Isomerism asplenia polysplenia congenital heart disease bronchial isomerism atrial appendages

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Monitoring of Respiratory Infections in the Intensive Area of Respiratory System Disease

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Advances in Microbiology 2014年第9期4卷 560-566页

作者： Filippo Ricciardiello Maria Cardone giuseppe Fiorentino Massimo Mesolella Flavia Oliva Annalisa Pianese Carlo antonio Leone UOC of Otorhinolaryngology “Federico II” University Naples Italy UOC of Otorhinolaryngology “Monaldi” Hospital Naples Italy UOC Respiratory Diseases Physiopathology and Rehabilitation Second University of Naples “Monaldi” Hospital Naples Italy UOC Subintensive Respiratory Therapy Unit “Monaldi” Hospital Naples Italy

Respiratory infections are the most frequent nosocomial infections after those urinaries and surgicals. We analysed respiratory infection incidences in patients treated with different kinds of respiratory assistance (non-invasive ventilation and invasive mechanical ventilation trough tracheostomy), studying 640 patients recovering in the intensive area of respiratory disease from 2010 to 2013. We had 113 cases of respiratory infections: 42.5% in patients of non-invasive ventilation group and 57.5% of patients treated with invasive ventilation with a statistically significant difference between the two groups. The patients treated with non-invasive ventilation showed a lower incidence of nosocomial respiratory infections. Prevention guidelines are important to reduce nosocomial infections frequency.

关键词： Intensive Respiratory Area Multi-Resistant Pathogens Nosocomial Infections Pneumonias Tracheostomy

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Primary sclerosing cholangitis: Updates in diagnosis and therapy

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World Journal of Gastroenterology 2005年第1期11卷 7-16页

作者： Piero Portincasa Michele Vacca antonio Moschetta Michele Petruzzelli giuseppe Palasciano Karel J.van Erpecum Gerard P.van Berge-Henegouwen Section of Internal Medicine Department of Gastroenterology and Hepatology

Primary sclerosing cholangitis (PSC) is a chronic cholestatic syndrome of unknown origin mostly found in males, and characterized by diffuse inflammation and fibrosis of both intra- and extra-hepatic bile ducts. So far, PSC is considered as an autoimmune hepatobiliary disease. In most cases the progression of PSC towards liver cirrhosis and liver failure is slow but irreversible, and liver transplantation is currently the only definitive treatment. In recent years,PSC has been an area of active research worldwide with great interest in etiology, pathogenesis, diagnosis, and therapeutic options such as hydrophilic ursodeoxycholic acid and immunosuppressive agent tacrolimus. Recent updates on clinical and therapeutic aspects of PSC are discussed in the present review.

关键词： Sclerosing cholangitis Diagnosis Therapy

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Briganti’s 2012 nomogram is an independent predictor of prostate cancer progression in EAU intermediate-risk class:results from 527 patients treated with robotic surgery

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Asian Journal of Andrology 2024年第6期26卷 587-591页

作者： antonio Benito Porcaro Francesca Montanaro Alberto Baielli Francesco Artoni Claudio Brancelli Sonia Costantino Andrea Franceschini Sebastian Gallina Alberto Bianchi Emanuele Serafin Alessandro Veccia Riccardo Rizzetto Matteo Brunelli Filippo Migliorini Salvatore Siracusano Maria Angela Cerruto Riccardo giuseppe Bertolo Alessandro Antonelli Department of Urology University of VeronaIntegrated University HospitalVerona 37126Italy Department of Pathology University of VeronaIntegrated University HospitalVerona 37126Italy Department of Life Health and Environmental SciencesUniversity of L’AquilaL’Aquila 67100Italy

The study aimed to test if Briganti’s 2012 nomogram could be associated with the risk of prostate cancer (PCa) progression in European Association of Urology (EAU) intermediate-risk patients treated with robotic surgery. From January 2013 to December 2021, 527 consecutive patients belonging to the EAU intermediate-risk class were selected. Briganti’s 2012 nomogram, which predicts the risk of pelvic lymph node invasion (PLNI), was assessed as a continuous and dichotomous variable that categorized up to the median of 3.0%. Disease progression defined as biochemical recurrence and/or metastatic progression was evaluated by Cox proportional hazards (univariate and multivariate analysis). After a median follow-up of 95.0 months (95% confidence interval [CI]: 78.5–111.4), PCa progression occurred in 108 (20.5%) patients who were more likely to present with an unfavorable nomogram risk score, independently by the occurrence of unfavorable pathology including tumor upgrading and upstaging as well as PLNI. Accordingly, as Briganti’s 2012 risk score increased, patients were more likely to experience disease progression (hazard ratio [HR] = 1.060;95% CI: 1.021–1.100;P = 0.002);moreover, it also remained significant when dichotomized above a risk score of 3.0% (HR = 2.052;95% CI: 1.298–3.243;P < 0.0001) after adjustment for clinical factors. In the studied risk population, PCa progression was independently predicted by Briganti’s 2012 nomogram. Specifically, we found that patients were more likely to experience disease progression as their risk score increased. Because of the significant association between risk score and tumor behavior, the nomogram can further stratify intermediate-risk PCa patients, who represent a heterogeneous risk category for which different treatment paradigms exist.

关键词： biochemical recurrence Briganti’s 2012 nomogram intermediate-risk prostate cancer pelvic lymph node invasion prostate cancer progression robot-assisted radical prostatectomy

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Reorganization of the intravitreal therapy service with the use of a scoring system during Coronavirus disease 2019 pandemic in a tertiary referral center in Milan,Italy

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Annals of Eye Science 2020年第4期 80-82页

作者： Stefano Erba Manuela Mambretti Giada Ruggi Federica Borgaro Alessandro David antonio Scialdone giuseppe Casalino Oftalmico Hospital ASST Fatebenefratelli SaccoMilanItaly

With the recent Coronavirus disease(COVID-19)pandemic we have experienced a sudden and dramatic change of our scheduled work in every field of medicine,including ophthalmology(1-3).Our Medical Retina(MR)service is usually overbooked because of the increasing demand of intravitreal treatments for exudative maculopathy(4,5).However with the ongoing pandemic and the restrictive measures adopted by our Government to limit the spread of the COVID-19 outbreak,only urgent cases have been allowed to attend the clinic during the pandemic ***,we had to swiftly reorganise and reschedule the planned activity of our *** electronic medical records(EMR),clinical notes and retinal imaging of patients booked in our MR service were reviewed in order to assess the eligibility of patients to attend the Clinic.

关键词： service Corona attend

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Origin of celiac disease:How old are predisposing haplotypes?

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World Journal of Gastroenterology 2012年第37期18卷 5300-5304页

作者： Giovanni Gasbarrini Olga Rickards Cristina Martínez-Labarga Elsa Pacciani Filiberto Chilleri Lucrezia Laterza giuseppe Marangi Franco Scaldaferri antonio Gasbarrini Ricerca in Medicina Foundation NGO Falcone and Borsellino Gallery Center of Molecular Anthropology for Ancient DNA Studies Department of BiologyUniversity of Rome Tor Vergata Superintendence for the Archaeological Heritage of Tuscany Division of Gastroenterology Department Internal MedicineCatholic University of Sacred Heart Institute of Genetics Catholic University of Sacred Heart

We recently presented the case of a first century AD young woman, found in the archaeological site of Cosa, showing clinical signs of malnutrition, such as short height, osteoporosis, dental enamel hypoplasia and cribra orbitalia, indirect sign of anemia, all strongly suggestive for celiac disease (CD). However, whether these findings were actually associated to CD was not shown based on genetic parameters. To investigate her human leukocyte antigen (HLA) class Ⅱ polymorphism, we extracted DNA from a bone sample and a tooth and genotyped HLA using three HLA-tagging single nucleotide polymorphisms for DQ8, DQ2.2 and DQ2.5, specifically associated to CD. She displayed HLA DQ 2.5, the haplotype associated to the highest risk of CD. This isthe first report showing the presence of a HLA haplotype compatible for CD in archaeological specimens.

关键词： Celiac disease Human leukocyte antigen hap-Iotype Ancient DNA Single nucleotide polymorphisms Malabsorption

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Patients’ Expectations in a Geriatric Rehabilitation Ward: Matching with Actual Outcomes

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Health 2017年第11期9卷 1597-1604页

作者： Mauro Colombo Carla Facchini Achim Rusu Eleonora Marelli giuseppe Procino Rosella Capuano Cristina Miramonti antonio Guaita Geriatric Rehabilitation Unit/Intermediate Care Geriatric Institute “Camillo Golgi” Agency for Services to Persons (ASP) Golgi Redaelli Milano Italy Golgi Cenci Foundation Abbiategrasso Italy Sociology Department University of Milan Milano Italy

Aim: Person-centered care is a core issue in rehabilitation;the study aims at: 1) enquiring the outcome expectations of patients in a geriatric rehabilitation ward;2) matching outcome expectations with actual outcomes. Methods: Expectations of 186 patients [79.4 (8.7) years, 70% females] analyzed through a questionnaire. 80.6% of patients were discharged home;functional recovery = 17.7 (22) points in Barthel Index total score, and 5 (4.2) points in Barthel Index walking subscore;also conditions with nursing needs improved significantly. Results: Patients’ expectations were coded as: functional (31.4%), overall (29.6%), and clinical improvement (21.5%), discharge home (7%);no answers or explicit lack of expectations (7.5%). Walking ability recovery differed according to outcome expectations. Highest improvements were achieved by patients wishing clinical improvement, followed by those expecting functional or overall improvement (5 points) [p = 0.009 (Welch)/p = 0.041 (Brown- Forsythe)];worst improvement in walking ability (2.8 points) were got by patients faulting or declaring explicit failure of expectations. Conditions with nursing needs improved most in those expecting clinical improvements [p = 0.029 (Brown-Forsythe)], and less in case of expectation default. No further matching was found. Conclusions: Improvement in actual outcomes matched expected improvements in two circumstances: recovery in walking ability and in conditions with nursing needs. The high yield of different favorable outcomes may have masked the statistical significance for correspondence between actual and expected results. Special attention is worthy towards patients short of expectations, as their actual outcomes result poorer.

关键词： Expectations Outcomes Geriatric Rehabilitation Person-Centered Care

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