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Effect of oral mesalamine on inflammatory response in acute uncomplicated diverticulitis

World Journal of Gastroenterology 2015年第27期21卷 8366-8372页

作者： luca nespoli Giulia Lo Bianco Fabio Uggeri Fabrizio Romano Angelo nespoli Davide Paolo Bernasconi luca Gianotti Department of Surgery and Translational Medicine University of Milan-Bicocca San Gerardo Hospital Department of Health Sciences Centre of Biostatistics for Clinical Epidemiology University of Milan-Bicocca

AIM: To evaluate the impact of mesalamine administration on inflammatory response in acute uncomplicated ***: We conducted a single centre retrospective cohort study on patients admitted to our surgical department between January 2012 and May 2014 with a computed tomography-confirmed diagnosis of acute uncomplicated diverticulitis. A total of 50 patients were included in the analysis, 20(study group) had received 3.2 g/d of mesalamine starting from the day of admission in addition to the usual standard treatment, 30(control group) had received standard therapy alone. Data was retrieved from a prospective database. Our primary study endpoints were: C reactive protein mean levels over time and their variation from baseline(ΔCRP) over the first three days of treatment. Secondary end points included: mean white blood cell and neutrophile count over time, time before regaining of regular bowel movements(passing of stools), time before reintroduction of food intake, intensity of lower abdominal pain over time, analgesic consumption and length of hospital ***: Patients characteristics and inflammatoryparameters were similar at baseline in the two groups. The evaluation of CRP levels over time showed, in treated patients, a distinct trend towards a faster decrease compared to controls. This difference approached statistical significance on day 2(mean CRP 6.0 +/- 4.2 mg/d L and 10.0 +/- 6.7 mg/d L respectively in study group vs controls, P = 0.055). ΔCRP evaluation evidenced a significantly greater increment of this inflammatory marker in the control group on day 1(P = 0.03). A similar trend towards a faster resolution of inflammation was observed evaluating the total white blood cell count. Neutrophile levels were significantly lower in treated patients on day 2 and on day 3(P < 0.05 for both comparisons). Mesalamine administration was also associated with an earlier reintroduction of food intake(median 1.5 d and 3 d, study group vs controls resp

关键词： Acute diverticulitis Inflammatory boweldisease 5-ASA benign colonic disease

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Gastric Cancer Immunotherapy: An Overview

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Journal of Cancer Therapy 2013年第5期4卷 1018-1036页

作者： Fabrizio Romano Fabio Uggeri luca nespoli luca Gianotti Mattia Garancini Matteo Maternini Angelo nespoli Franco Uggeri Department of Surgery San Gerardo Hospital University of Milano-Bicocca Monza Italy

Gastric adenocarcinoma is the third most common cancer and the second most common cause of death due to cancer worldwide. Surgery is still the major prognostic factor for gastric cancer. Patients who could not be resected have a poor prognosis with survival ranging from 3 to 11 months. There is evidence that surgical operations can cause a variety of immunological disturbances in man both in vivo and in vitro. The postoperative changes in the systemic immune response are proportional to the degree of surgical trauma leading to a generalized state of immunosuppression, which is implicated in the development of septic complications and provided a “fertile soil” for tumor cell metastasis. Immunotherapy may be a potentially promising alternative strategy for gastric cancer. In early clinical trials, systemic immunotherapy included both active vaccination directed against defined tumor-associated antigens expressed in gastric carcinoma cells and passive administration of IL-2 with some evidence of regression of metastatic gastric cancer. Other studies have applied immunotherapy in the adjuvant setting with equally promising results. For example, OK-432, a streptococcal preparation, demonstrated marginal improvement in survival for patients with stage III gastric cancer and a meta-analysis of centrally randomized controlled clinical trials indicated a significant survival benefit with combination OK-432 and chemotherapy compared to chemotherapy alone (p 0.05). Additional data suggesting a biological and clinical benefit of subcutaneous, preoperative administration of low-dose IL-2 in colon cancer encouraged us to evaluate low-dose IL-2 therapy in the neoadjuvant setting for patients with gastric adenocarcinoma who undergo surgery and to evaluate its effects on systemic and tumor infiltrating lymphocyte numbers. We also sought to determine if neoadjuvant low-dose IL-2 could influence the clinical outcome for patients undergoing gastric resection for cancer. We report the b

关键词： Gastric Cancer Immunotherapy IL-2

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A randomized double-blind trial on perioperative administration of probiotics in colorectal cancer patients

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World Journal of Gastroenterology 2010年第2期16卷 167-175页

作者： luca Gianotti Lorenzo Morelli Francesca Galbiati Simona Rocchetti Sara Coppola Aldo Beneduce Cristina Gilardini Daniela Zonenschain Angelo nespoli Marco Braga Department of Surgery Milano-Bicocca University San Gerardo Hopsital Department of Microbiology Università Cattolica Sacro Cuore Department of Surgery San Raffaele University

AIM:To investigate whether probiotic bacteria,given perioperatively,might adhere to the colonic mucosa, reduce concentration of pathogens in stools,and modulate the local immune function. METHODS:A randomized,double-blind clinical trial was carried out in 31 subjects undergoing elective colorectal resection for *** were allocated to receive either a placebo(group A,n=10),or a dose of 10 7 of a mixture of Bifidobacterium longum(BB536) and Lactobacillus johnsonii(La1)(group B,n=11),or the same mixture at a concentration of 10 9 (group C,n=10).Probiotics,or a placebo,were given orally 2 doses/d for 3 d before *** same treatment continued postoperatively from day two to day four. Stools were collected before treatment,during surgery (day 0)and 5 d after *** the operation, colonic mucosa samples were harvested to evaluate bacterial adherence and to assess the phenotype of dendritic cells(DCs)and lymphocyte subsets by surface antigen expression(flow cytometry).The presence of BB536 and La1 was evaluated by the random amplified polymorphism DNA method with specific polymerase chain reaction probes. RESULTS:The three groups were balanced for baseline and surgical ***536 was never found at any time-points *** day 0,La1 was present in 6/10(60%)patients in either stools or by biopsy in group C,in 3/11(27.2%)in group B,and none in the placebo group(P=0.02,C vs A).There was a linear correlation between dose given and number of adher- ent La1(P=0.01).The rate of mucosal colonization by enterobacteriacae was 30%(3/10)in C,81.8%(9/11) in B and 70%(7/10)in A(P=0.03,C vs B).The Enterobacteriacae count in stools was 2.4(log10 scale) in C,4.6 in B,and 4.5 in A(P=0.07,C vs A and B). The same trend was observed for colonizing enterococ- ***1 was not found at day+*** observed greater expression of CD3,CD4,CD8,and naive and memory lymphocyte subsets in group C than in group A with a dose response trend(C>B>A).Treatment didnot affect DC

关键词： Probiotic Dendritic cell Microbiota Colon cancer Lymphocyte Surgery Intestinal immunity

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Hepatic resection beyond barcelona clinic liver cancer indication:When and how

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World Journal of Hepatology 2016年第11期8卷 513-519页

作者： Mattia Garancini Enrico Pinotti Stefano nespoli Fabrizio Romano luca Gianotti Vittorio Giardini Department of Surgery Hepatobiliopancreatic UnitSan Gerardo HospitalUniversity of Milano Bicocca

Hepatocellular carcinoma(HCC)is the main common primary tumour of the liver and it is usually associated with *** barcelona clinic liver cancer(BCLC)classification has been approved as guidance for HCC treatment algorithms by the European Association for the Study of Liver and the American Association for the Study of Liver *** to this algorithm,hepatic resection should be performed only in patients with small single tumours of 2-3 cm without signs of portal hypertension(PHT)or *** classification has been criticised and many studies have shown that multiple tumors and large tumors,as wide as those with macrovascular infiltration and PHT,could benefit from liver ***,treatment guidelines should be revised and patients with intermediate/advanced stage HCC,when technically resectable,should receive the opportunity to be treated with radical surgical ***,the surgical treatment of HCC on cirrhosis is complex:The goal to be oncologically radical has always to be balanced with the necessity to minimize organ *** aim of this review was to analyze when and how liver resection could be indicated beyond BCLC *** particular,the role of multidisciplinary approach to assure a proper indication,of the intraoperative ultrasound for intraoperative restaging and resection guidance and of laparoscopy to minimize surgical trauma have been enhanced.

关键词： Hepatocellular carcinoma Liver surgery Hepatic resection Multiple hepatocellular carcinoma Cirrhosis Barcelona clinic liver cancer Multidisciplinary approach Intraoperative ultrasound Laparoscopy Portal hypertension

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