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Investigation of compensatory postures with videofluoromanometry in dysphagia patients

World Journal of Gastroenterology 2012年第23期18卷 2973-2978页

作者： Antonio Solazzo Luigi Monaco lucia del vecchio Stefania Tamburrini Francesca Iacobellis Daniela Berritto Nunzia Luisa Pizza Alfonso Reginelli Natale Di Martino Roberto Grassi Department of Radiology Magrassi-Lanzara Second University of Naples 80138 Napoli Italy Department of Gerontology Geriatrics and Metabolic Diseases Second University of Naples 80138 Napoli Italy Department of Pathology of the Head and Neck Oral Cavity and Audio-verbal Communication Second University of Naples 80138 Napoli Italy UOC Diagnostic Imaging PO Pellegrini 80134 Napoli Italy

AIM: To investigate the effectiveness of head compensatory postures to ensure safe oropharyngeal transit. METHODS: A total of 321 dysphagia patients were enrolled and assessed with videofluoromanometry (VFM). The dysphagia patients were classified as follows: safe transit; penetration without aspiration; aspiration before, during or after swallowing; multiple aspirations and no transit. The patients with aspiration or no transit were tested with VFM to determine whether compensatory postures could correct their swallowing disorder. RESULTS: VFM revealed penetration without aspiration in 71 patients (22.1%); aspiration before swallowing in 17 patients (5.3%); aspiration during swallowing in 32 patients (10%); aspiration after swallowing in 21 patients (6.5%); multiple aspirations in six patients (1.9%); no transit in five patients (1.6%); and safe transit in 169 patients (52.6%). Compensatory postures guaranteed a safe transit in 66/75 (88%) patients with aspiration or no transit. A chin-down posture achieved a safe swallow in 42/75 (56%) patients, a head-turned posture in 19/75 (25.3%) and a hyperextended head posture in 5/75 (6.7%). The compensatory postures were not effective in 9/75 (12%) cases. CONCLUSION: VFM allows the speech-language therapist to choose the most effective compensatory posture without a trial-and-error process and check the effectiveness of the posture.

关键词： Aspiration Compensatory postures Oro-pharyngeal dysphagia Videofluoromanometry Chin-down posture Head-turned Hyperextended head

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The resilience of pollination interactions: importance of temporal phases

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Journal of Plant Ecology 2019年第1期12卷 157-162页

作者： Edy Fantinato Silvia del vecchio Carlo Gaetan Gabriella Buffa Department of Environmental Sciences Informatics and StatisticsCa’Foscari University of VeniceVia Torino 15530172 VeniceItaly

Aims The loss of species that engage in close ecological interactions,such as pollination,has been shown to lead to secondary extinctions,ultimately threatening the overall ecosystem stability and *** studies are currently flourishing at all possible levels of interaction organization(i.e.,species,guild,group and network),and different methodological protocols aimed to define the resil-ience of pollination interactions have been ***,the temporal dimension of the resilience of pollination interactions has been often *** the light of these considerations,we addressed the following questions:does a temporal approach help to reveal critical moments during the flowering season,when polli-nation interactions are less resilient to perturbations?Do pollination interactions evaluated at species,guild,group and network level show different patterns when assessed through time?Methods We monitored contacts between plant and pollinator species in dry grassland communities every 15 days during the overall community flowering season(12 surveys).For each survey,we built a quantita-tive plant-pollinator interaction matrix and we calculated two sets of metrics characterizing,respectively,the diversity and the distribution of interactions across hierarchical *** describe the diversity of interactions,we calculated partner diversity(PD)at the species level,vulnerability/generality(V/G)at the guild level,and interaction diver-sity and evenness at the network *** distribution of interactions was characterized by calculating selectiveness at the species and the network level,and modularity at the group *** assessed the temporal variation of PD,V/G at the level of plants and pollinators,and species selectiveness,by means of Linear Mixed Models(LMMs).To investigate the temporal variation of indexes calculated at group and network level,we applied simple linear and quadratic regres-sions after checking for temporal autocorrelation

关键词： asymmetry complementarity ecosystems’resilience redundancy species-rich ecosystems

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Focal epithelial hyperplasia in a human immuno-deficiency virus patient treated with laser surgery

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World Journal of Clinical Cases 2014年第7期2卷 293-296页

作者： Alexandros Galanakis Gaspare Palaia Gianluca Tenore Alessandro del vecchio Umberto Romeo Department of Oral and Maxillofacial Science Sapienza University of Rome00161 RomeItaly

Focal epithelial hyperplasia(FEH), or Heck's disease, is a rare disease of the oral mucosa; it is mostly found in children or young adults who are immunosuppressed and who live in regions with low socioeconomic status. It is characterized by asymptomatic papules on the oral mucosa, gingiva, tongue, and lips. Healing can be spontaneous, and treatment is indicated if there are aesthetic or functional complications. Human papillomavirus, especially genotypes 13 and 32, has been associated with FEH and is detected in the majority of lesions. Histopathologically, FEH is characterized by parakeratosis, epithelial hyperplasia, focal acanthosis, and fusion and horizontal outgrowth of epithelial ridges. A 37-year-old male patient was referred to the Department of Oral and Maxillofacial Sciences at the Sapienza University of Rome, complaining of numerous exophytic lesions in his mouth. He stated that the lesions were not painful but he had experienced occasional bleeding after incidental masticatory trauma. He had received no previous treatment for the oral lesions. His medical history revealed that he was human immuno-deficiencyvirus positive and was a smoker with numerous, asymptomatic oral papules clinically and histologically corresponding to FEH. The labial and buccal mucosa were especially affected by lesions. Surgical treatment was performed using a 532-nm potassium titanyl phosphate laser(SmartLite, Deka, Florence, Italy) in continuous mode with a 300 μm fiber and power of 1.4 W(power density 1980.22 W/cm2). After anesthesia without vasoconstrictors, the lesions were tractioned with sutures or an Allis clamp and then completely excised. The lesions were preserved in 10% formalin for histological examination, which confirmed the clinical diagnosis of FEH. In this case, the laser allowed excellent control of bleeding, without postoperative sutures, and optimal wound healing.

关键词： Lasers Focal epithelial hyperplasia Mouth Human immunodeficiency virus Oral pathology

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Familial colorectal cancer screening: When and what to do?

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World Journal of Gastroenterology 2015年第26期21卷 7944-7953页

作者： Giovanna del vecchio Blanco Omero Alessandro Paoluzi Pierpaolo Sileri Piero Rossi Giuseppe Sica Francesco Pallone Department of Systems Medicine Gastroenterology UnitUniversity Tor Vergata Department of Surgery University Tor Vergata Department of Experimental Science and Surgery University Tor Vergata

Colorectal cancer(CRC) is the third leading cause of death worldwide and represents a clinical *** members of patients affected by CRC have an increased risk of CRC *** these individuals,screening is strongly recommended and should be started earlier than in the population with average risk,in order to detect neoplastic precursors,such as adenoma,advanced adenoma,and nonpolypoid adenomatous lesions of the *** occult blood test(FOBT) is a non invasive,widespread screening method that can reduce CRC-related ***,alone or in addition to FOBT,represents another screening strategy that reduces CRC *** is the best choice for screening highrisk populations,as it allows simultaneous detection and removal of preneoplastic *** choice of test depends on local health policy and varies among countries.

关键词： Colonoscopy Colorectal cancer screening Fecal occult blood test Advanced adenoma Firstdegreerelative Sigmoidoscopy

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Impairment of ghrelin synthesis in Helicobacter pyloricolonized stomach:New clues for the pathogenesis of ***-related gastric inflammation

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World Journal of Gastroenterology 2014年第3期20卷 639-646页

作者： Omero Alessandro Paoluzi Giovanna del vecchio Blanco Roberta Caruso Ivan Monteleone Giovanni Monteleone Francesco Pallone Department of Systems Medicine University of Rome "Tor Vergata"

Ghrelin,the ligand of growth hormone secretagogue receptor 1a,takes part in several functions of the digestive system,including regulation of appetite,energy homeostasis,gastric acid secretion and *** has also immunoregulatory properties and is supposed to inhibit some inflammatory pathways that can mediate gastric ***,ghrelin synthesis is reduced in the gastric mucosa of patients with Helicobacter pylori(***)infection,a worldwide condition inducing a T helper(Th)1/Th17 cell responsedriven gastritis,which may evolve towards gastric atrophy and *** this article,we review the available data on the expression of ghrelin in *** infection and discuss how the defective ghrelin synthesis may contribute to sustain the ongoing inflammatory response in this disease.

关键词： Gastritis Ghrelin Helicobacter pylori T helper 1 cells

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Platelet aggregation is affected by nitrosothiols in patients with chronic hepatitis: In vivo and in vitro studies

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World Journal of Gastroenterology 2007年第27期13卷 3677-3683页

作者： A Federico A Filippelli M Falciani C Tuccillo A Tiso A Floreani R Naccarato F Rossi C del vecchio Blanco C Loguercio Inter-University Research Centre on Foods Nutrition and Gastrointestinal Tract Gastroenterology School 2nd University of Naples Italy Department of Experimental Medicine 2nd University of Naples Italy Department of Surgical and Gastroenterological Sciences University of Padua Italy

AIM: To investigate the relationship among the number of platelets and plasma levels of S-nitrosothiols (S-NO), nitrite, total non-protein SH (NPSH), glutathione (GSH), cysteine (CYS), malondialdehyde (MDA), 4-hydroxininenal (4HNE), tumor necrosis factor-alpha (TNFα) and interleukin (IL)-6 in patients with chronic hepatitis C (CH).METHODS: In vitro the aggregation of platelets derived from controls and CH patients was evaluated before and after the addition of adenosine diphosphate (ADP) and collagen, both in basal conditions and after incubation with nitrosoglutathione (GSNO). RESULTS: In vivo , S-NO plasma levels increased significantly in CH patients and they were significantly directly correlated with platelet numbers. Patients with platelet counts 150 000/μL. In vitro, the ADP and collagen aggregation time was increased in platelets from patients and not from controls; in addition, platelets from CH patients but not from controls also showed a latency time after exposure to collagen. CONCLUSION: The incubation of platelets with GSNO improved the percentage aggregation and abolished the latency time.

关键词： Liver disease Function of platelets Hepatitis C Oxidative stress Anti-aggregant

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Lumen-apposing metal stents for malignant biliary obstruction: Is this the ultimate horizon of our experience?

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World Journal of Gastroenterology 2019年第29期25卷 3857-3869页

作者： Andrea Anderloni Edoardo Troncone Alessandro Fugazza Annalisa Cappello Giovanna del vecchio Blanco Giovanni Monteleone Alessandro Repici Digestive Endoscopy Unit Division of Gastroenterology Humanitas Research Hospital Milan 20089 Italy Department of Systems Medicine University of Rome “Tor Vergata” Rome 00133 Italy Digestive Endoscopy Unit Division of Gastroenterology Humanitas University Milan 20089 Italy

In the last years, endoscopic ultrasonography (EUS) has evolved from a purely diagnostic technique to a more and more complex interventional procedure, with the possibility to perform several type of therapeutic interventions. Among these, EUS-guided biliary drainage (BD) is gaining popularity as a therapeutic approach after failed endoscopic retrograde cholangiopancreatography in distal malignant biliary obstruction (MBO), due to the avoidance of external drainage, a lower rate of adverse events and re-interventions, and lower costs compared to percutaneous trans-hepatic BD. Initially, devices created for luminal procedures (e.g., luminal biliary stents) have been adapted to the new trans-luminal EUSguided interventions, with predictable shortcomings in technical success, outcome and adverse events. More recently, new metal stents specifically designed for transluminal drainage, namely lumen-apposing metal stents (LAMS), have been made available for EUS-guided procedures. An electrocautery enhanced delivery system (EC-LAMS), which allows direct access of the delivery system to the target lumen, has subsequently simplified the classic multi-step procedure of EUS-guided drainages. EUS-BD using LAMS and ECLAMS has been demonstrated effective and safe, and currently seems one of the most performing techniques for EUS-BD. In this Review, we summarize the evolution of the EUS-BD in distal MBO, focusing on the novelty of LAMS and analyzing the unresolved questions about the possible role of EUS as the first therapeutic option to achieve BD in this setting of patients.

关键词： Interventional endoscopic ultrasonography Endoscopic ultrasonography-guided biliary drainage Endoscopic ultrasonography-guided choledocho-duodenostomy Biliary metal stent Lumen-apposing metal stent

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Lower limb suspension induces threshold-specific alterations of motor units properties that are reversed by active recovery

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Journal of Sport and Health Science 2024年第2期13卷 264-276页

作者： Giacomo Valli Fabio Sarto Andrea Casolo Alessandro del vecchio Martino V.Franchi Marco V.Narici Giuseppe De Vito Department of Biomedical Sciences University of PadovaPadova 35131Italy Department Artificial Intelligence in Biomedical Engineering Friedrich-Alexander UniversityErlangen-Nurnberg 91052Germany

Purpose:This study aimed to non-invasively test the hypothesis that(a) short-term lower limb unloading would induce changes in the neural control of force production(based on motor units(MUs) properties) in the vastus lateralis muscle and(b) possible changes are reversed by active recovery(AR).Methods:Ten young males underwent 10 days of unilateral lower limb suspension(ULLS) followed by 21 days of *** ULLS,participants walked exclusively on crutches with the dominant leg suspended in a slightly flexed position(15°-20°) and with the contralateral foot raised by an elevated *** AR was based on resistance exercise(leg press and leg extension) and executed at 70% of each participant’s 1repetition maximum,3 times/*** voluntary isometric contraction(MVC) of knee extensors and MUs properties of the vastus lateralis muscle were measured at baseline,after ULLS,and after *** were identified using high-density electromyography during trapezoidal isometric contractions at 10%,25%,and 50% of the current MVC,and individual MUs were tracked across the 3 data collection ***:We identified 1428 unique MUs,and 270 of them(18.9%) were accurately *** ULLS,MVC decreased by 29.77%,MUs absolute recruitment/derecruitment thresholds were reduced at all contraction intensities(with changes between the 2 variables strongly correlated),while discharge rate was reduced at 10% and 25% but not at 50% *** MVC and MUs properties fully recovered to baseline levels after *** changes were observed in the pool of total as well as tracked ***:Our novel results demonstrate,non-invasively,that 10 days of ULLS affected neural control predominantly by altering the discharge rate of lower-threshold but not of higher-threshold MUs,suggesting a preferential impact of disuse on motoneurons with a lower depolarization ***,after 21 days of AR,the impaired MUs properties were fully restored to baseline levels,highlighting the plas

关键词： Disuse High-density EMG Muscle disuse Neural impairment Neuromuscular degeneration

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Low efficacy of levofloxacin-doxycycline-based third-line triple therapy for Helicobacter pylori eradication in Italy

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World Journal of Gastroenterology 2015年第21期21卷 6698-6705页

作者： Omero Alessandro Paoluzi Giovanna del vecchio Blanco Emanuela Visconti Manuela Coppola Carla Fontana Marco Favaro Francesco Pallone Gastroenterology Unit Department of Internal MedicineUniversity Tor Vergata Department of Experimental Medicine and Surgery University Tor Vergata

AIM:To evaluate a levofloxacin-doxycycline-based triple therapy with or without a susceptibility culture test in non-responders to Helicobacter pylori(***) ***:A total of 142(99 women,43 men; mean 53.0 ± 12.7 years) non-responders to more than two *** eradication therapies underwent susceptibility culture tests or were treated with a seven-day triple therapy consisting of esomeprazole,20 mg b.i.d.,levofloxacin,500 mg b.i.d.,and doxycycline,100 mg b.i.d.,randomly associated with(n = 71) or without(n = 71) Lactobacillus casei *** status was checked in all patients at enrollment and at least 8 wk after the end of *** and tolerability of regimens were also ***:*** eradication was achieved in < 50% of patients [per prototol(PP) = 49%; intention to treat(ITT) = 46%].Eradication rate was higher in patients administered probiotics than in those without(PP = 55% vs 43%; ITT = 54% vs 40%).Estimated primary resistance to levofloxacin was 18% and multiple resistance was 31%.Therapy was well tolerated,and side effects were generally mild,with only one patient experiencing severe ***:Third-line levofloxacin-doxycycline triple therapy had a low *** eradication efficacy,though the success and tolerability of this treatment may be enhanced with probiotics.

关键词： Doxycycline Eradication therapy Urea breath test Esomeprazole Levofloxacin Helicobacter pylori

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Malignant gastric outlet obstruction:Which is the best therapeutic option?

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World Journal of Gastroenterology 2020年第16期26卷 1847-1860页

作者： Edoardo Troncone Alessandro Fugazza Annalisa Cappello Giovanna del vecchio Blanco Giovanni Monteleone Alessandro Repici Anthony Yuen Bun Teoh Andrea Anderloni Department of Systems Medicine University of Rome“Tor Vergata”Rome 00133Italy Endoscopy Unit Humanitas Clinical and Research Center–IRCCS-via Manzoni 5620089 Rozzano(Mi)Italy Humanitas University Department of Biomedical SciencesVia Rita Levi Montalcini 420090 Pieve EmanueleMilanItaly Department of Surgery Prince of Wales HospitalChinese University of Hong KongHong Kong 999077China

Malignant gastric outlet obstruction(MGOO)is a clinical condition characterized by the mechanical obstruction of the pylorus or the duodenum due to tumor compression/infiltration,with consequent reduction or impossibility of an adequate oral *** is mainly secondary to advanced pancreatic or gastric cancers,and significantly impacts on patients’survival and quality of *** suffering from this condition often present with intractable vomiting and severe malnutrition,which further compromise therapeutic ***,palliative strategies are based primarily on surgical gastrojejunostomy and endoscopic enteral stenting with self-expanding metal *** studies have shown that surgical approach has the advantage of a more durable relief of symptoms and the need of fewer re-interventions,at the cost of higher procedure-related risks and longer hospital *** the other hand,enteral stenting provides rapid clinical improvement,but have the limit of higher stent dysfunction rate due to tumor ingrowth and a subsequent need of frequent ***,a third way has come from interventional endoscopic ultrasound,through the development of endoscopic ultrasound-guided gastroenterostomy technique with lumen-apposing metal *** new technique may ideally encompass the minimal invasiveness of an endoscopic procedure and the long-lasting effect of the surgical gastrojejunostomy,and brought encouraging results so far,even if prospective comparative trial are still *** this Review,we described technical aspects and clinical outcomes of the above-cited therapeutic approaches,and discussed the open questions about the current management of MGOO.

关键词： Gastrojejunostomy Self-expanding metal stent Enteral stent Interventional endoscopic ultrasonography Endoscopic ultrasound-guided gastroenterostomy Pancreatic cancer Gastric cancer Duodenal stricture

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