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Dual primary gastric and colorectal cancer:A complex challenge in surgical oncology

World Journal of Gastrointestinal Oncology 2023年第12期15卷 2049-2052页

作者： luigi marano Medical Department Academy of Applied Medical and Social Sciences-Akademia Medycznych i Społecznych Nauk StosowanychElbląg 82-300Poland

The intricate interplay of colorectal cancer(CRC)and gastric cancer(GC)as dual primary malignancies presents a significant challenge in surgical oncology.CRC is the most common secondary malignancy in GC patients,and vice versa,evidence highlighted by advances in diagnostic procedures and therapy modalities that impact patient survival.A recent study titled“Features of synchronous and metachronous dual primary gastric and colorectal cancer”explores this enigmatic dual malignancy,uncovering crucial insights into the clinical characteristics and prognostic distinctions between synchronous and metachronous presentations.Notably,metachronous cases with a second primary cancer discovered more than six months after the first diagnosis have a better outcome,emphasizing the importance of early detection and treatment.This study underscores the prognostic role of GC stage in patient outcomes.It also sheds light on the complexities faced by synchronous cases,often presenting with unresectable CRC.Surgery-related procedures,like gastrectomy and colon resection,stand out as important predictors of increased survival,necessitating a reevaluation of current therapeutic approaches.A tailored and patient-centered strategy,considering the health of each patient individually and the feasibility of radical treatments,is essential.Continuous follow-up and monitoring are crucial as most second primary cancers arise within five years.In conclusion,early diagnosis,surgical intervention,and watchful surveillance are pivotal in managing dual primary gastric and colorectal cancer patients.Since the incidence of gastric and colorectal cancers continues to rise,the imperative need for further research,ideally with larger sample sizes,becomes evident in our pursuit of comprehensive insights that will refine clinical approaches for this intricate dual malignancy.

关键词： Multiple primary cancers Colorectal cancer Gastric cancer Dual primary cancers Synchronous cancers Metachronous cancers

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Helicobacter pylori infection and gastric carcinoma:Not all the strains and patients are alike

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World Journal of Gastrointestinal Oncology 2016年第1期8卷 40-54页

作者： natale figura luigi marano elena moretti antonio ponzetto department of medical surgical and neurological sciencesuniversity of siena and policlinico s.maria alle scotte53100 SienaItaly general minimally invasive and robotic surgerydepartment of surgeryhospital san matteo degli infermi06049 SpoletoPerugiaItaly department of molecular and developmental medicine university of siena53100 SienaItaly department of medical sciences university of torino10126 TorinoItaly

Gastric carcinoma(GC) develops in only 1%-3% of Helicobacter pylori(H. pylori) infected people. The role in GC formation of the bacterial genotypes, gene polymorphisms and host's factors may therefore be important. The risk of GC is enhanced when individuals are infected by strains expressing the oncoprotein CagA, in particular if CagA has a high number of repeats containing the EPIYA sequence in its C'-terminal variable region or particular amino acid sequences flank the EPIYA motifs. H. pylori infection triggers an inflammatory response characterised by an increased secretion of some chemokines by immunocytes and colonised gastric epithelial cells; these molecules are especially constituted by proteins composing the interleukin-1beta(IL-1β) group and tumour necrosis factor-alpha(TNF-α). Polymorphisms in the promoter regions of genes encoding these molecules, could account for high concentrations of IL-1β and TNF-α in the gastric mucosa, which may cause hypochlorhydria and eventually GC. Inconsistent results have been attained with other haplotypes of inflammatory and anti-inflammatory cytokines. Genomic mechanisms of GC development are mainly based on chromosomal or microsatellite instability(MSI) and deregulation of signalling transduction pathways. H. pylori infection may induce DNA instability and breaks of double-strand DNA in gastric mucocytes. Different H. pylori strains seem to differently increase the risk of cancer development run by the host. Certain H. pylori genotypes(such as the cagA positive) induce high degrees of chronic inflammation and determine an increase of mutagenesis rate, oxidative-stress, mismatch repair mechanisms, down-regulation of base excision and genetic instability, as well as generation of reactive oxygen species that modulate apoptosis; these phenomena may end to trigger or concur to GC development.

关键词： Helicobacter pylori infection CagA CagAgene polymorphism Haplotype Human gene mutation Genemethylation Gastriccarcinoma Inflammatorycytokine

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Laparoscopic calibrated total vs partial fundoplication following Heller myotomy for oesophageal achalasia

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World Journal of Gastroenterology 2011年第29期17卷 3431-3440页

作者： Natale Di Martino Antonio Brillantino luigi Monaco luigi marano Michele Schettino Raffaele Porfidia Giuseppe Izzo Angelo Cosenza VIII Department of General and Gastrointestinal Surgery School of MedicineSecond University of NaplesPiazza Miraglia 280138 NaplesItaly

AIM:To compare the mid-term outcomes of laparoscopic calibrated Nissen-Rossetti fundoplication with Dor fundoplication performed after Heller myotomy for oesophageal achalasia.METHODS:Fifty-six patients(26 men,30 women;mean age 42.8±14.7 years)presenting for minimally invasive surgery for oesophageal achalasia,were enrolled.All patients underwent laparoscopic Heller myotomy followed by a 180°anterior partial fundoplication in 30 cases(group 1)and calibrated NissenRossetti fundoplication in 26(group 2).Intraoperative endoscopy and manometry were used to calibrate the myotomy and fundoplication.A 6-mo follow-up period with symptomatic evaluation and barium swallow was undertaken.One and two years after surgery,the patients underwent symptom questionnaires,endoscopy,oesophageal manometry and 24 h oesophago-gastric pH monitoring.RESULTS:At the 2-year follow-up,no significant difference in the median symptom score was observed between the 2 groups(P=0.66;Mann-WhitneyU-test).The median percentage time with oesophageal pH< 4 was significantly higher in the Dor group compared to the Nissen-Rossetti group(2;range 0.8-10 vs 0.35;range 0-2)(P<0.0001;Mann-WhitneyU-test).CONCLUSION:Laparoscopic Dor and calibrated Nissen-Rossetti fundoplication achieved similar results in the resolution of dysphagia.Nissen-Rossetti fundoplication seems to be more effective in suppressing oesophageal acid exposure.

关键词：胃镜检查腹腔镜食管校准弛缓 VS 微创手术平均年龄

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Reconsidering the role of depression and common psychiatric disorders as partners in the type 2 diabetes epidemic

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World Journal of Diabetes 2024年第6期15卷 1374-1380页

作者： Angelo Emilio Claro Clelia Palanza Marianna Mazza Alessandro Rizzi Andrea Corsello Linda Tartaglione Giuseppe marano Giovanna Elsa Ute Muti Schuenemann Marta Rigoni Alfredo Pontecorvi luigi Janiri Paola Muti Dario Pitocco Diabetes Care Unit Department of Medical and Surgical SciencesFondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy Department of Biomedical Surgical and Dental SciencesUniversity of MilanMilan 20122Italy Istituto Italiano di Antropologia ISItARome 00100Italy Unit of Psychiatry Department of NeurosciencesFondazione Policlinico Universitario A Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy Dipartimento di Medicina e Chirurgia Traslazionale UniversitàCattolica del Sacro CuoreRome 00168Italy Health Research Methods Evidence and Impact DepartmentMcMaster UniversityOntario 1280Canada Department of Endocrine-Metabolic and Dermo-Rheumatology Fondazione Policlinico Universitario A Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy

Common psychiatric disorders(CPDs)and depression contribute significantly to the global epidemic of type 2 diabetes(T2D).We postulated a possible pathophysiological mechanism that through Bridge-Symptoms present in depression and CPDs,promotes the establishment of emotional eating,activation of the reward system,onset of overweight and obesity and,ultimately the increased risk of developing T2D.The plausibility of the proposed pathophysiological mechanism is supported by the mechanism of action of drugs such as naltrexonebupropion currently approved for the treatment of both obesity/overweight with T2D and as separate active pharmaceutical ingredients in drug addiction,but also from initial evidence that is emerging regarding glucagon-like peptide 1 receptor agonists that appear to be effective in the treatment of drug addiction.We hope that our hypothesis may be useful in interpreting the higher prevalence of CPDs and depression in patients with T2D compared with the general population and may help refine the integrated psychiatric-diabetic therapy approach to improve the treatment and or remission of T2D.

关键词： Depression Glucagon-like peptide-1 receptor agonists Diabetes mellitus type 2 Stress psychological Sleep wake disorders Food addiction

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Large symptomatic gastric diverticula:Two case reports and a brief review of literature

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World Journal of Gastroenterology 2013年第36期19卷 6114-6117页

作者： luigi marano Gianmarco Reda Raffaele Porfidia Michele Grassia Marianna Petrillo Giuseppe Esposito Francesco Torelli Angelo Cosenza Giuseppe Izzo Natale Di Martino 8~(th) General and Gastrointestinal Surgery Department of Internal Medicine Surgical Neurological Metabolic Disease and Geriatric Medicine Second University of Naples

Gastric diverticula are rare and uncommon conditions.Most gastric diverticula are asymptomatic.When symptoms arise,they are most commonly upper abdominal pain,nausea and emesis,while dyspepsia and vomiting are less common.Occasionally,patients with gastric diverticula can have dramatic presentations related to massive bleeding or perforation.The diagnosis may be difficult,as symptoms can be caused by more common gastrointestinal pathologies and only aggravated by diverticula.The appropriate management of diverticula depends mainly on the symptom pattern and as well as diverticulum size.There is no specific therapeutic strategy for an asymptomatic diverticulum.Although some authors support conservative therapy with antacids,this provides only temporary symptom relief since it is not able to resolve the underlying pathology.Surgical resection is the mainstay of treatment when the diverticulum is large,symptomatic or complicated by bleeding,perforation or malignancy,with over two-thirds of patients remaining symptom-free after surgery,while laparoscopic resection,combined with intraoperative endoscopy,is a safe and feasible approach with excellent outcomes.Here,we present two cases of uncommon large symptomatic gastric diverticula with a discussion of the cornerstones in management and report a minimally invasive solution,with a brief review of the literature.

关键词： Gastric diverticulum Laparoscopic gastric diverticulectomy Abdominal pain Dysphagia Gastric Diverticulum

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Curved footbridges supported by a shell obtained through thrust network analysis

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Journal of Traffic and Transportation Engineering(English Edition) 2019年第1期6卷 65-75页

作者： luigi Fenu Eleonora Congiu Davide Lavorato Bruno Briseghella Giuseppe Carlo marano Department of Civil and Environmental Engineering and Architecture University of Cagliari Department of Architecture University of Roma Tre College of Civil Engineering Fuzhou University Department of Sciences of Civil Engineering and Architecture Polytechnic University of Bari

After Maillart's concrete curved arch bridges were built before the Second World War, in the second half of the past century and this century, many curved bridges have been built with both steel and concrete. Conversely, since the construction of Musmeci's shell supported bridge in Potenza, few shell bridges have been constructed. This paper explains how to design a curved footbridge supported by an anticlastic shell by shaping the shell via a thrust network analysis(TNA). By taking advantage of the peculiar properties of anticlastic membranes, the unconventional method of shaping a shell by a TNA is illustrated. The shell top edge that supports the deck has an assigned layout, which is provided by the road curved layout. The form of the bottom edge is obtained by the form-finding procedure as a thrust line, by applying the thrust network analysis(TNA) in a non-standard manner,shaping the shell by applying the boundary conditions and allowing relaxation. The influence of the boundary conditions on the bridge shape obtained as an envelope of thrust lines is investigated. A finite element analysis was performed. The results indicate that the obtained shell form is effective in transferring deck loads to foundations via compressive stresses and taking advantage of concrete mechanical properties.

关键词： Shell footbridges Cantilevered deck Anticlastic shell Thrust network analysis(TNA) Concrete

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Clinical management of advanced gastric cancer: The role of new molecular drugs

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World Journal of Gastroenterology 2014年第40期20卷 14537-14558页

作者： Ferdinando De Vita Natale Di Martino Alessio Fabozzi Maria Maddalena Laterza Jole Ventriglia Beatrice Savastano Angelica Petrillo Valentina Gambardella Vincenzo Sforza luigi marano Annamaria Auricchio Gennaro Galizia Fortunato Ciardiello Michele Orditura Division of Medical Oncology Department of Clinical and Experimental Medicine and Surgery Second University of Naples School of Medicine 80131 Naples Italy Ⅷ General and Gastrointestinal Surgery School of Medicine Second University of Naples School of Medicine 80138 Naples Italy Divisions of Surgical Oncology Department of Clinical and Experimental Medicine and Surgery Second University of Naples School of Medicine 80131 Naples Italy

Gastric cancer is the fourth most common malignant neoplasm and the second leading cause of death for cancer in Western countries with more than 20000 new cases yearly diagnosed in the United States.Surgery represents the main approach for this disease but,notwithstanding the advances in surgical techniques,we observed a minimal improvement in terms of overall survival with a significant increasing of relapsing disease rates.Despite the development of new drugs has significantly improved the effectiveness of chemothera-py,the prognosis of patients with unresectable or metastatic gastric adenocarcinoma remains poor.Recently,several molecular target agents have been investigated;in particular,trastuzumab represents the first target molecule showing improvements in overall survival in human epithelial growth factor 2-positive gastric cancer patients.New molecules targeting vascular epithelial growth factor,mammalian target of rapamycin,and anti hepatocyte growth factor-c-Met pathway are also under investigation,with interesting results.Anyway,it seems necessary to select more accurately the population to treat with new agents by the identification of new biomarkers in order to optimize the results.In this paper we review the actual"scenario"of targeted treatments,also focusing on the new agents in development for gastric cancer and gastro-esophageal carcinoma,discussing their efficacy and potential applications in clinical practice.

关键词： Advanced gastric cancer Gastrointestinal cancer Ta

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Why do we not reverse the path?Stress can cause depression,reduction of brain-derived neurotrophic factor and increased inflammation

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World Journal of Psychiatry 2022年第9期12卷 1264-1267页

作者： Angelo Emilio Claro Clelia Palanza Marianna Mazza Alessandro Rizzi Linda Tartaglione Giuseppe marano Giovanna Muti-Schuenemann Marta Rigoni Paola Muti Alfredo Pontecorvi luigi Janiri Gabriele Sani Dario Pitocco Department of Geriatrics Neuroscience and OrthopedicsFondazione Policlinico Universitario A.Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy Istituto Italiano di Antropologia IsiTaRome 00185Italy Department of Medical and Surgical Sciences Policlinico Universitario A.Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy Health Research Methods Evidence and Impact DepartmentMcMaster UniversityOntario K9V 0A0Canada Department of Biomedical Surgical and Dental SciencesUniversity of MilanMilan 20126Italy Department of Endocrine-Metabolic and Dermo-Rheumatology Fondazione Policlinico Universitario A.Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy Department of Medical and Surgical Sciences Fondazione Policlinico Universitario A.Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy

The aim of this paper is to describe the direction of the link between stress,depression,increased inflammation and brain-derived neurotrophic factor(BDNF)reduction.We hypothesize that severe stress or prolonged stress can be the driving factor that promote the onset of depression.Both stress and depression,if not resolved over time,activate the production of transcription factors that will switch on pro-inflammatory genes and translate them into cytokines.This cascade fosters systemic chronic inflammation and reduced plasma BDNF levels.Since people with depression have a 60%increased risk of developing type 2diabetes(T2D)and show high levels of inflammation and low levels of BDNF,we hypothesize possible reasons that might explain why T2D,depression and dementia are often associated in the same patient.

关键词： Depression Inflammation Brain-derived neurotrophic factor Type 2 diabetes mellitus Dementia Psychological stress

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