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Novel classification of gastric polyps:The good,the bad and the ugly

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World Journal of Gastroenterology 2024年第31期30卷 3640-3653页

作者： Deborah Costa Daryl Ramai Alberto tringali Department of Digestive Endoscopy and Gastroenterology AULSS2Conegliano HospitalConegliano 31015Italy Department of Gastroenterology Division of Hepatology and EndoscopyBrigham and Women's HospitalBostonMA 02115United States

Gastric polyps(GPs)are increasingly *** upper endoscopy,they should be examined with white light and occasionally chromoendoscopy,and their morphology classified according to the Paris *** GPs have a typical endoscopic appearance and can be associated with diseases like Helicobacter pylori *** examination is necessary for an accurate *** most polyps are non-neoplastic and do not require treatment,some carry a risk of malignancy or are already ***,understanding the diagnosis,classification,and management of GPs is crucial for patient *** new classification categorizes GPs into"good","bad",and"ugly"based on their likelihood of becoming *** aim to provide descriptions of the endoscopic appearance,pathology,treatment,and follow-up for different GPs,as well as clinical management flowcharts.

关键词： Gastric polyps Fundic gland polyps Hyperplastic polyps Adenomas Neuroendocrine tumors Early gastric cancer

Achieving control of resistant hypertension:Not just the number of blood pressure medications

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World Journal of Hypertension 2019年第1期9卷 1-16页

作者： Kara Schmidt William Kelley Steven tringali Jian Huang Department of Internal Medicine University of California San Francisco-Fresno Medical Education Program Medicine Service VA Central California Health Care System

Resistant hypertension(RH) has a prevalence of around 12% and is associated with an increased risk of cardiovascular disease, progression to end-stage renal disease, and even mortality. In 2017, the American College of Cardiology and American Heart Association released updated guidelines that detail steps to ensure proper diagnosis of RH, including the exclusion of *** modifications, such as low salt diet and physical exercise, remain at the forefront of optimizing blood pressure control. Secondary causes of RH also need to be investigated, including screening for obstructive sleep apnea. Notably, the guidelines demonstrate a major change in medication management recommendations to include mineralocorticoid receptor antagonists. In addition to advances in medication optimization, there are several device-based therapies that have been showing efficacy in the treatment of RH. Renal denervation therapy has struggled to show efficacy for blood pressure control, but with a redesigned catheter device, it is once again being tested in clinical trials. Carotid baroreceptor activation therapy(BAT) via an implantable pulse generator has been shown to be effective in lowering blood pressure both acutely and in longterm follow up data, but there is some concern about the safety profile. Both a second-generation pulse generator and an endovascular implant are being tested in new clinical trials with hopes for improved safety profiles while maintaining therapeutic efficacy. Both renal denervation and carotid BAT need continued study before widespread clinical implementation. Central arteriovenous anastomosis has emerged as another possible therapy and is being actively explored. The ongoing pursuit of blood pressure control is a vital part of minimizing adverse patient outcomes. The future landscape appears hopeful for helping patients achieve blood pressure goals not only through the optimization of antihypertensive medications but also through device-bas

关键词： Resistant hypertension Pseudoresistance Mineralocorticoid receptor antagonists Device-based hypertension treatment Renal denervation Carotid baroreceptor activation therapy Central arteriovenous anastomosis

Endoscopic management of difficult common bile duct stones:Where are we now?A comprehensive review

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World Journal of Gastroenterology 2021年第44期27卷 7597-7611页

作者： Alberto tringali Deborah Costa Alessandro Fugazza Matteo Colombo Kareem Khalaf Alessandro Repici Andrea Anderloni Gastroenterology and Endoscopy Unit Department of MedicineConegliano HospitalULSS 2 Marca TrevigianaConegliano 31015Italy Digestive Endoscopy Unit Department of GastroenterologyHumanitas Research Hospital IRCCSRozzano 20089MilanItaly Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20072MilanItaly

Endoscopic management for difficult common bile duct(CBD)stones still presents a challenge for several reasons,including anatomic anomalies,patients’individual conditions and stone *** recent years,variable methods have emerged that have attributed to higher stone removal success rates,reduced cost and lower adverse *** this review,we outline a stepwise approach in CBD stone *** first line therapy,endoscopic sphincterotomy and large balloon dilation are recommended,due to a 30%-50%reduction of the use of mechanical *** the other hand,cholangioscopy-assisted lithotripsy has been increasingly reported as an effective and safe alternative technique to mechanical lithotripsy but remains to be reserved in special settings due to limited large-scale *** discussed,findings suggest that management needs to be tailored to the patient’s characteristics and anatomical ***,we evaluate the management of CBD stones in various surgical altered anatomy(Billroth II,Roux-en-Y and Roux-en-Y gastric bypass).Moreover,we could conclude that cholangioscopy-assisted lithotripsy needs to be evaluated for primary use,rather than following a failed management *** addition,we discuss the importance of dissecting other techniques,such as the primary use of interventional endoscopic ultrasound for the management of CBD stones when other techniques have *** conclusion,we recognize that endoscopic sphincterotomy and large balloon dilation,mechanical lithotripsy and intraductal lithotripsy substantiate an indication to the management of difficult CBD stones,but emerging techniques are in rapid evolution with encouraging results.

关键词： Common bile duct stones Balloon dilation Endoscopic retrograde cholangiopancreatography Endoscopic ultrasonography Anastomoses,Roux en y Double balloon enteroscopy Mechanical lithotripsy Cholangioscopy

Safety and feasibility of thullium laser transurethral resection of prostate for the treatment of benign prostatic enlargement in overweight patients

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Asian Journal of Urology 2019年第3期6卷 270-274页

作者： luca Carmignani Maria Chiara Clementi Claudia Signorini Gloria Motta Sebastiano Nazzani Franco Palmisano Elisa De Lorenzis Michele Catellani Alessandro Francesco Mistretta Andrea Conti Valeria tringali Maria Beatrice Costa Damiano Vizziello Policlinico San Donato UrologySan DonatoMilaneseItaly Ospedale Maggiore Policlinico UrologyMilanItaly Istituto Europeo di Oncologia UrologyMilanItaly Ospedale San Giuseppe UrologyMilanItaly

Objective:We aimed to determine safety and feasibility of thulium laser transurethral vapoenucleation of prostate(ThuVEP)for treatment of obese patients affected by benign prostatic hyperplasia(BPH).Methods:We retrospectively analysed data of 452 patients with BPH who underwent ThuVEP from February 2012 to March 2016 in a single *** were divided into three groups according to body mass index(BMI,kg/m^2):Normal weight(18.5≤BMI0.05).There was no statistically significant difference among three groups as for hospital stay and days of catheterization(p>0.05).Conclusion:Our results showed that ThuVEP was safe and feasible even in overweight patients with substantially enlarged prostate.

关键词： Laser Thulium Prostate Overweight

Pediatric T-tube in adult liver transplantation:Technical refinements of insertion and removal

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World Journal of Gastrointestinal Surgery 2021年第12期13卷 1628-1637页

作者： Gabriele Spoletini Giuseppe Bianco Antonio Franco Francesco Frongillo Erida Nure Francesco Giovinazzo Federica Galiandro Andrea tringali Vincenzo Perri Guido Costamagna Alfonso Wolfango Avolio Salvatore Agnes General Surgery and Liver Transplantation Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy

BACKGROUND With the increasing use of extended-criteria donor organs,the interest around Ttubes in liver transplantation(LT)was restored whilst concerns regarding T-tuberelated complications *** To describe insertion and removal protocols implemented at our institution to safely use pediatric rubber 5-French T-tubes and subsequent outcomes in a consecutive series of adult *** Data of consecutive adult LT patients from brain-dead donors,treated from March 2017 to December 2019,were collected(i.e.,biliary complications,adverse events,treatment after T-Tube removal).Patients with upfront hepaticojejunostomy,endoscopically removed T-tubes,those who died or received retransplantation before T-tube removal were *** Seventy-two patients were included in this study;T-tubes were removed 158 d(median;IQR 128-206 d)after *** four(5.6%)patients accidental T-tube removal occurred requiring monitoring only;in 68(94.4%)patients Nelaton drain insertion was performed according to our protocol,resulting in 18(25%)patients with a biliary output,subsequently removed after 2 d(median;IQR 1-4 d).Three(4%)patients required endoscopic retrograde cholangiopancreatography(ERCP)due to persistent Nelaton drain ***(4%)patients developed suspected biliary peritonitis,requiring ERCP with sphincterotomy and nasobiliary drain insertion(only one revealing contrast extravasation);no patient required percutaneous drainage or emergency *** The use of pediatric rubber 5-French T-tubes in LT proved safe in our series after insertion and removal procedure refinements.

关键词： Liver transplantation T-tube Kehr Biliary fistula Endoscopic retrograde cholangio-pancreatography Biliary drainage

5-HTr Expression in Primary Trigeminal Neuron Following Injury

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Journal of Behavioral and Brain Science 2012年第4期2卷 427-435页

作者： Ombretta Mameli Antonella Russo Stefania Stanzani Giovanni tringali Elio Insirello Marcello Alessandro Caria Pier Luigi De Riu Department of Clinical and Experimental Medicine Human Physiology Division University of Sassari Sassari Italy Department of Physiological Sciences University of Catania Catania Italy Istituto di Ricerca Medica e Ambientale Catania Italy

Trigeminal ganglia neurons significantly affect the amplitude and type of 5-HT receptor gene expression following activation of their axon terminals and sensitisation by painful stimuli. Moreover, these neurons significantly alter gene expression in cytoskeletal proteins following injury. The aim of the present study was to determine whether peripheral and/or central deafferenting lesions affect gene expression in serotonergic receptors that are involved in pain transmission. Adult rats were subjected to unilateral ablation of the facial sensory and motor cortices. Fifteen days after the surgery, degeneration of the cortico-trigeminal pathway was observed. Presynaptic deafferentation of the primary trigeminal neurons and central afferents of the contralateral ganglia was conducted. As a consequence of the excision of the meninges covering the ablated cortices, the peripheral axotomy of the trigeminal-vascular primary neurons of the ipsi-lateral side was induced. Serotonergic receptor (5-HT5A/5B/1B/1D/1F) gene expression was analysed in both sides of the trigeminal ganglia neurons. The results of the present study showed a significant increase in 5-HT5A/5B/1B/1D receptor gene expression in the primary sensory neurons of both ganglia, with the highest levels of expression noted in the ganglia contralateral to the lesion. 5-HT1F receptor expression, however, was more strongly expressed in the ganglia ipsilateral to the lesion. Our results also confirm that the adaptive response of primary trigeminal neurons to injury involves anatomical remodelling, as well as changes in receptor gene expression involved in sensory transmission. This may explain the distortion of sensory signals observed in trigeminal neuropathic states, and may lead to the development of novel pharmacological interventions.

关键词： Sensory Neurons Plasticity Trigeminal Ganglia Neurons Axotomy Pre-Synaptic Deafferentation 5-HT Receptors

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5TH CELL的《描绘生命》

程序员（游戏创造） 2008年第5期 44-49页

作者： Joseph M. tringali 韦欢不详北方工业大学

我们在2003年成立了5TH Cell公司，目标是开发优质的原创游戏。开始时一帆风顺，尽管公司当时没有办公室也没有正式的员工，但是有3个手机游戏概念（当时手机游戏市场正在蓬勃兴起）：只要能够创作出手机游戏就不愁发行方面的问题，因... 详细信息

我们在2003年成立了5TH Cell公司，目标是开发优质的原创游戏。开始时一帆风顺，尽管公司当时没有办公室也没有正式的员工，但是有3个手机游戏概念（当时手机游戏市场正在蓬勃兴起）：只要能够创作出手机游戏就不愁发行方面的问题，因此公司很容易就得到了开发第一款授权游戏的机会。这在当时是进入游戏圈的必经之路，但这一步也使我们偏离了最初的理想轨道。我们租了一间办公室并雇佣了几名员工，

关键词： CELL 手机游戏生命描绘 Cell 一帆风顺游戏市场办公室

Effects of cigarette smoking on the evolution of hearing loss caused by industrial noise

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Health 2010年第10期2卷 1163-1169页

作者： Abbate Carmelo Giorgianni Concetto Zirilli Agata tringali Maria Antonietta D’Arrigo Graziella Brecciaroli Renato Abbate Adriana Salmaso Luigi 不详

The few studies evaluating the changes caused by cigarette smoking on hearing loss induced by occupational exposure to noise have reached discordant conclusions. The aim of this study is to investigate the interactions between cigarette smoking and occupational exposure to noise as risk factors in the onset and development of hearing loss. The study was performed on a sample of 557 shipyard workers exposed to noise at an Equivalent Level (Leq) of 93 dBA. On the basis of their smoking habits, they were divided into three groups: group (A), non-smokers;group (B), smokers (15-30 cigarettes per day);and group (C), heavy smokers (over 30 cigarettes per day). The study focussed on the audiometric responses of the subjects at the frequencies of 500, 1000, 2000, 3000 and 4000 Hz. The results were then compared using statistical techniquees (Internal correlation coefficient, exponential model, ANCOVA, NPC test). Comparison of the audiometric responses showed statistically significant differences between the three groups. Non-parametric analysis, performed using the NPC test, highlighted that the interaction between smoking and exposure to noise has an influence on hearing loss at all frequencies, and particularly at high frequencies (3000-4000 Hz). The data obtained from the examined sample show that smoking and exposure to noise cause an increase in occupational hearing loss and that this is directly related to the number of cigarettes smoked.

关键词： Smoking Hearing Loss Noise Audiometric Test Non Parametric Test

Reduction of diastolic blood pressure: Should hypertension guidelines include a lower threshold target?

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World Journal of Hypertension 2017年第1期7卷 1-9页

作者： Steven tringali Jian Huang Department of Medicine Uni-versity of California San Francisco-Fresno Medical Education Program Department of Medicine Veterans Administration Central California Health Care System

Reduction of diastolic blood pressure to less than 60-80 mm Hg does not improve mortality and may lead to adversecardiovascular events in high risk patient populations. Despite a growing body of evidence supporting the J-curve phenomenon, no major society guidelines on hypertension include a lower threshold target for diastolic blood pressure. Many major society guidelines for hypertension have been updated in the last 5 years. Some guidelines include goals specific to age and co-morbid conditions. The Sixth Joint Task Force of the European Society of Cardiology and the Canadian Hypertension Education Program are the only guidelines to date that have recommended a lower threshold target, with the Canadian guidelines recommending a caution against diastolic blood pressure less than or equal to 60 mm Hg in patients with coronary artery disease. While systolic blood pressure has been proven to be the overriding risk factor in hypertensive patients over the age of 50 years, diastolic blood pressure is an important predictor of mortality in younger adults. Post hoc data analysis of previous clinical trials regarding safe lower diastolic blood pressure threshold remains inconsistent. Randomized clinical trials designed to determine the appropriate diastolic blood pressure targets among different age groups and populations with different comorbidities are warranted. Hypertension guideline goals should be based on an individual's age, level of risk, and certain co-morbid conditions, especially coronary artery disease, stroke, chronic kidney disease, and diabetes.

关键词： Blood pressure Guideline J-curve Hypertension Diastolic pressure