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Gastrointestinal motility disorders in inflammatory bowel diseases

World Journal of Gastroenterology 2014年第1期20卷 37-44页

作者： Gabrio Bassotti Elisabetta Antonelli Vincenzo Villanacci Marianna Salemme manuela Coppola Vito Annese Gastroenterology and Hepatology Section Department of Clinical and Experimental MedicineUniversity of Perugia06156 PerugiaItaly Second Pathology Section Spedali Civili of Brescia25100 BresciaItaly Gastroenterology Unit Careggi University Hospital50134 FlorenceItaly

The relationship between motility and inflammatory gastrointestinal disorders is at the same time complex and intriguing since these conditions might share some genetic, environmental, immunological and microbial predisposing factors. In addition, significant symptom overlapping may occur, muddling the waters within the clinical context. Although on one hand this represents a challenge for the clinician for a potential under- or over-treatment and diagnostic delay, on the other hand it possibly represents an opportunity for the researcher to better disclose the intimate relationship between chronic (often low-grade) inflammation, motor disorders and deranged sensory function. The best example is probably represented by Crohn’s disease and ulcerative colitis. In fact, a number of gastrointestinal motor disorders have been described in association with these diseases, disorders which span from the esophagus to the anorectum, and which will be extensively covered in this review. It is conceivable that at least part of this derangement is strictly related to inflammatory cytokine trafficking and neuromuscular changes; however, given the high prevalence of functional gastrointestinal disorders in the general population, this overlap might also be serendipitous. However, it is worth noting that literature data on this topic are relatively scarce, sometimes quite outdated, and mostly focused on the interplay between irritable bowel syndrome and inflammatory bowel disease. Nevertheless, both researchers and clinicians must be aware that symptoms related to gastrointestinal motility disorders may be highly prevalent in both active and inactive inflammatory bowel disease, correlate with greater psychological comorbidity and poorer quality of life, and may negatively influence the therapeutic approaches.

关键词： Crohn’ s disease, Gastrointestinal motility disorders, Gut, Inflammatory bowel diseases, Perception, Ulcerative colitis

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Accuracy of the automated cell counters for management of spontaneous bacterial peritonitis

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World Journal of Gastroenterology 2008年第37期14卷 5689-5694页

作者： Oliviero Riggio Stefania Angeloni Antonella Parente Cinzia Leboffe Giorgio Pinto Teresa Aronne manuela Merli Department of Clinical Medicine "Sapienza" University of RomeRome 00185 Italy

AIM： To evaluate the accuracy of automated blood cell counters for ascitic polymorphonuclear （PMN） determination for：（1） diagnosis, （2） efficacy of the ongoing antibiotic therapy, and （3） resolution of spontaneous bacterial peritonitis （SBP）. METHODS： One hundred and twelve ascitic fluid samples were collected from 52 consecutive cirrhotic patients, 16 of them with SBP. The agreement between the manual and the automated method for PMN count was assessed. The sensitivity/specificity and the positive/negative predictive value of the automated blood cell counter were also calculated by considering the manual method as the ＂gold standard＂ RESULTS： The mean ＋ SD of the difference between manual and automated measurements was 7.8 4- 58 cells/ram3, while the limits of agreement were ＋124 cells/mm3 [95% confidence interval （CI）：＋145 to ＋103] and -108 cells/mm3 （95% CI： -87 to -129）. The automated cell counter had a sensitivity of 100% and a specificity of 97.7% in diagnosing SBP, and a sensitivity of 91% and a specificity of 100% for the efficacy of the ongoing antibiotic therapy. The two methods showed a complete agreement for the resolution of infection. CONCLUSION： Automated cell counters not only have a good diagnostic accuracy, but are also very effectivein monitoring the antibiotic treatment in patients with SBP. Because of their quicker performance, they should replace the manual counting for PMN determination in the ascitic fluid of patients with SBP.

关键词： Spontaneous bacterial peritonitis Ascites Polymorphonuclear cell count Automated cell counter Paracentesis Cirrhosis

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Comparison of outcomes between early and delayed weight bearing following lower limb free flaps:an 18-month single-center study

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Plastic and Aesthetic Research 2023年第1期10卷 656-662页

作者： Majid Al-Khalil manuela Roman Ahmed Emam Nicholas Marsden Welsh Centre for Burns&Plastic Surgery Morriston HospitalSwansea SA66NLUnited Kingdom Major Trauma Centre University Hospital of WalesCardiff CF144XWUnited Kingdom

Aim:Post-operative protocols following lower limb free flap surgery are not well defined,with a lack of consensus in the literature around limb dependency and weight *** aim was to compare the complication rate for lower limb free flaps before and after the introduction of an enhanced lower limb free flap protocol with earlier dangling(day 3 *** 4)and weight bearing(day 5 *** 14)post lower limb free flap ***:All lower limb free flaps between June 2020-January 2022 were identified from a departmental flap *** data were collected from the comprehensive lower limb free flap database,medical notes,and electronic *** prescribed an extended non-weight-bearing period due to the method of bone fixation were ***:A total of 37 patients,15 pre-and 22 post-enhanced protocol,were identified for *** mean age was 43(17-72)with a M:F of 3:*** was no difference in the type of flap reconstruction between groups,with the anterolateral thigh flap being the most common in both *** differences were identified in the number of complications related to dependency/weight bearing before and after the introduction of the enhanced protocol,with the mean length of stay reduced from 12.1 to 10.6 days(P=0.34).Conclusion:The new enhanced protocol remains the standard of care in our unit,as we demonstrated a reduction in length of stay with no difference in complication rates following early weight bearing after lower limb free flap surgery.

关键词： Lower limb reconstruction free flap free tissue transfer weight bearing post-operative complications

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Liver stiffness measurements in patients with HBV vs HCV chronic hepatitis:A comparative study

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World Journal of Gastroenterology 2010年第38期16卷 4832-4837页

作者： Ioan Sporea Roxana Sirli Alexandra Deleanu Adriana Tudora Alina Popescu manuela Curescu Simona Bota Department of Gastroenterology and Hepatology University of Medicine and Pharmacy(Timisoara) Department of Infectious Diseases University of Medicine and Pharmacy(Timisoara)

AIM:To assess the values of liver stiffness (LS) in pa-tients with hepatitis B virus (HBV) chronic hepatitis and to compare them with those in patients with hepatitis C virus (HCV) chronic hepatitis. METHODS: The study included 140 patients with HBV chronic hepatitis, and 317 patients with HCV chronic hepatitis, in which LS was measured (FibroScan-Echo-sens) and liver biopsy was performed in the same session (assessed according to the Metavir score). RESULTS:According to the Metavir score of the 140 HBV patients: one had F0,32 had F1, 67 had F2,33 had F3 and 7 had F4. Of the 317 HCV patients:5 had F0, 34 had F1, 146 had F2, 93 had F3 and 39 had F4. For the same severity of fibrosis, the mean values of LS in HBV patients were similar to those in HCV patients:F1,6.5±1.9 kPa vs 5.8±2.1 kPa (P=0.0889); F2,7.1±2 kPa vs 6.9±2.5 kPa (P = 0.3369); F3,9.1±3.6 kPa vs 9.9±5 kPa (P=0.7038); F4,19.8± 8.6 kPa vs 17.3±6.1 kPa (P=0.6574). A signif icant direct correlation between LS measurements and fibrosis was found in HCV patients (Spearman’s r=0.578, P<0.0001), as well as in HBV patients (r=0.408, P<0.0001). The correlation was more signif icant in HCV than in HBV patients (Fisher’s Z-test,Z= 2.210,P=0.0271). CONCLUSION:In our group, the mean values of LS in patients with chronic B hepatitis were similar to those in patients with chronic HCV hepatitis, for the same stage of f ibrosis. Also, LS was correlated with the severity of fibrosis both in HBV and HCV chronic hepatitis patients.

关键词： Chronic B hepatitis Chronic C hepatitis Fibrosis Transient elastography Liver biopsy

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Normothermic regional perfusion mobile teams in controlled donation after circulatory death pathway: Evidence and peculiarities

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World Journal of Transplantation 2024年第4期14卷 78-83页

作者： Chiara Lazzeri manuela Bonizzoli Giuseppe Feltrin Adriano Peris Department of Emergency Extracorporeal Membrane Oxygenation CenterRegional Transplant CenterFlorence 50134Italy Department of Emergency Extracorporeal Membrane Oxygenation CenterFlorence 50134Italy Centro Nazionale Trapianti Roma 00161Italy

To facilitate the implementation of controlled donation after circulatory death(cDCD)programs even in hospitals not equipped with a local Extracorporeal Membrane Oxygenation(ECMO)team(Spokes),some countries and Italian Regions have launched a local cDCD network with a ECMO mobile team who move from Hub hospitals to Spokes for normothermic regional perfusion(NRP)implantation in the setting of a cDCD *** ECMO teams have been clearly defined by the Extracorporeal Life Support Organization,regarding composition,responsibilities and training programs,no clear,widely accepted indications are to date available for NRP *** existing NRP mobile networks were developed due to the urgent need to increase the number of cDCDs,there is now the necessity for transplantation medicine to identify the peculiarities and responsibility of a NRP team for all those centers launching a cDCD ***,in the present manuscript we summarized the character-istics of an ECMO mobile team,highlighting similarities and differences with the NRP mobile *** also assessed existing evidence on NRP teams with the goal of identifying the characteristic and essential features of an NRP mobile team for a cDCD program,especially for those centers who are starting the *** were identified between the mobile ECMO team and NRP mobile *** common essential feature for both mobile teams is high skills and experience to reduce complications and,in the case of cDCD,to reduce the total warm ischemic *** training programs should be developed for the launch of de novo NRP teams.

关键词： Controlled donation after circulatory death Extracorporeal membrane oxygenation Normothermic regional perfusion Mobile teams Warm ischemia time

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Optical properties of titanium oxide films obtained by cathodic arc plasma deposition

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Plasma Science and Technology 2017年第12期19卷 111-118页

作者： Vukoman JOKANOVIC Bozana COLOVIC Anka TRAJKOVSKA PETKOSKA Ana MRAKOVIC Bojan JOKANOVIC Milo NENADOVIC manuela FERRARA llija NASOV Vinca Institute of Nuclear Sciences University of BelgradeMike Petrovica Alasa 12-1411001 BelgradeSerbia ALBOS Doo Orahovacka 1911000 BelgradeSerbia University St Kliment Ohridski Faculty of Technology and Technical SciencesVelesR.Macedonia4 GL groupWemer-von-Siemens-Straβe86405 MetingenGermany GL group Wemer-von-Siemens-Straβe86405 MetingenGermany TE-STT-SCIS Laboratorio Sviluppo Componenti ed Impianti SolariPiazzale Enrico Fermi 180055Porfici(NA)Italia Plasma Doo 29 November 66/91000 SkopjeR.Macedonia

Structural and optical properties of nanometric titanium oxide（TixOy） films obtained by cathodic arc plasma deposition were investigated. Phase analysis by x-ray diffraction and Fouriertransform infrared spectroscopy showed the presence of anatase, rutile, Ti_2O_3, Ti_4O_7 and amorphous phases. Scanning electron microscopy images showed well-developed surface morphology with nano-patterns. Spectroscopic ellipsometry revealed film thicknesses of 53 and50 nm, variable refractive indices dependent on the light wavelength and close to zero extinction coefficients for wavelengths higher than 500 nm. On the basis of ultraviolet–visible spectroscopy data and using the Tauc equation, band gap values for direct and indirect electron transitions were determined.

关键词： optical materials plasma deposition thin films ellipsometry

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From landslide characterization to nature reserve management:The“Scialimata Grande di Torre Alfina”landslide Geosite(Central Apennines,Italy)

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Journal of Mountain Science 2023年第3期20卷 585-606页

作者： Gianluca TRONTI Francesca VERGARI Irene Maria BOLLATI Filippo BELISARIO Maurizio DELMONTE manuela PELFINI Paola FREDI Earth Sciences Department"Ardito Desio" University La StataleMilan 20133(MI)Italy Monte Rufeno Nature Reserve Acquapendente 01021(VT)Italy Earth Sciences Department University La SapienzaRome 00185(RM)Italy

Italy is characterized by widespread geomorphological instability,among which landslides leave impressive marks on the ***,landslide bodies may represent key sites for thematic and educational itineraries,especially in protected areas,where their management becomes an important *** study focuses on the"Monte Rufeno Nature Reserve"(Central Apennines,Italy),where iconic landslides are ***,the"Scialimata Grande di Torre Alfina"landslide(SGTA)is listed in the regional Geosite *** work aims to propose a multiscale procedure for landslide analysis,in terms of both hazard sources but also educational and geoheritage enhancement opportunities in natural *** performing a Landslide Susceptibility conditional Analysis(LSA)for the reserve territory,attention was focused on the SGTA,to define properly its features and morphodynamics.A multi-disciplinary approach was adopted,by applying both remote sensing(UAV structure from motion,Photointerpretation)and field survey(geomorphological and GPS monitoring).From the LSA,based on drainage density,curvature,and slope triggering factors,the road and trail susceptibility maps were derived,as base tools for future risk assessments and trail paths management within the *** the SGTA scale,the monitoring showed a displacement of up to 23 m during the time interval between 2015 and *** landslide dynamics seem to be driven by alternating dry and extremely wet periods;moreover,leaks from the aqueduct in the detachment area and piping effects through clays may have also decreased the substrate *** SGTA complex influence on the Paglia River valley geometry was also hypothesized,underlining the action of landslide through different spatial scales(on-site and off-site)and on different environment features(sediment connectivity,hydrology).Finally,the SGTA appears highly representative of the geomorphic dynamics within the Nature Reserve(i.e.,scientific value)and it could be

关键词： Landslides Geoheritage Geosites Nature reserves management UAV structure from motion Landslides conditional analyses

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Venous thromboembolism in patients with inflammatory bowel disease:Focus on prevention and treatment

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World Journal of Gastroenterology 2014年第12期20卷 3173-3179页

作者： Alfredo Papa Viviana Gerardi manuela Marzo Carla Felice Gian Lodovico Rapaccini Antonio Gasbarrini Internal Medicine and Gastroenterology Unit Catholic University

Inflammatory bowel disease(IBD)patients have an increased risk of venous thromboembolism(VTE),which represents a significant cause of morbidity and *** most common sites of VTE in IBD patients are the deep veins of the legs and pulmonary system,followed by the portal and mesenteric ***,other sites may also be involved,such as the cerebrovascular and retinal *** aetiology of VTE is multifactorial,including both inherited and acquired risk factors that,when simultaneously present,multiply the risk to the *** prevention involves correcting modifiable risk factors,such as disease activity,vitamin deficiency,dehydration and prolonged *** role of mechanical and pharmacological prophylaxis against VTE using anticoagulants is also ***,although guidelines recommend thromboprophylaxis for IBD patients,this method is still poorly implemented because of concerns about its safety and a lack of awareness of the magnitude of thrombotic risk in these *** efforts are required to increase the rate of pharmacological prevention of VTE in IBD patients to avoid preventable morbidity and mortality.

关键词： Inflammatory bowel disease Venous thromboembolism Thromboembolic prophylaxis Anticoagulants Unfractionated heparin Low molecular weight heparin

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Changes in nutritional status after liver transplantation

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World Journal of Gastroenterology 2014年第31期20卷 10682-10690页

作者： Michela Giusto Barbara Lattanzi Vincenza Di Gregorio Valerio Giannelli Cristina Lucidi manuela Merli Ⅱ Gastroenterologia Dipartimento di Medicina Clinica "Sapienza" Università di Roma00185 Roma Italy

Chronic liver disease has an important effect on nutritional status, and malnourishment is almost universally present in patients with end-stage liver disease who undergo liver transplantation. During recent decades,a trend has been reported that shows an increase in number of patients with end-stage liver disease and obesity in developed countries. The importance of carefully assessing the nutritional status during the workup of patients who are candidates for liver replacement is widely recognised. Cirrhotic patients with depleted lean body mass(sarcopenia) and fat deposits have an increased surgical risk; malnutrition may further impact morbidity, mortality and costs in the post-transplantation setting. After transplantation and liver function is restored, many metabolic alterations are corrected,dietary intake is progressively normalised, and lifestyle changes may improve physical activity. Few studies have examined the modifications in body composition that occur in liver recipients. During the first 12 mo, the fat mass progressively increases in those patients who had previously depleted body mass, and the muscle mass recovery is subtle and non-significant by the end of the first year. In some patients, unregulated weight gain may lead to obesity and may promote metabolicdisorders in the long term. Careful monitoring of nutritional changes will help identify the patients who are at risk for malnutrition or over-weight after liver transplantation. Physical and nutritional interventions must be investigated to evaluate their potential beneficial effect on body composition and muscle function after liver transplantation.

关键词： Liver transplantation Sarcopenia Malnutrition Obesity Metabolic syndrome Outcome Survival

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Nutritional issues in patients with obesity and cirrhosis

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World Journal of Gastroenterology 2018年第30期24卷 3330-3346页

作者： Luigi Schiavo Luca Busetto manuela Cesaretti Shira Zelber-Sagi Liat Deutsch Antonio Iannelli Department of Translational Medical Science University of Campania“Luigi Vanvitelli”Naples 80131Italy Ⅸ Division of General Surgery Vascular Surgery and Applied BiotechnologyNaples University PoliclinicNaples 80131Italy Department of Medicine University of PaduaPadua 35128Italy Center for the Study and the Integrated Management of Obesity University Hospital of PaduaPadua 35128Italy Department of HPB Surgery and Liver Transplantation Hopital BeaujonAP-HPClichy 92110France Department of Nanophysics Italian Institute of TechnologyGenova 16163Italy School of Public Health University of HaifaHaifa 3498838Israel Department of Gastroenterology and Liver disease Tel Aviv Medical Center62431Tel-Aviv 62431Israel The Sackler Faculty of Medicine Tel-Aviv UniversityTel-Aviv 62431Israel Digestive Unit Archet 2 HospitalUniversity Hospital of NiceF-06202NiceFrance Inserm U1065Team 8“Hepatic complications of obesity”Nice F-06204France University of Nice Sophia-Antipolis Nice F-06107France

Obesity and metabolic syndrome are considered as responsible for a condition known as the non-alcoholic fatty liver disease that goes from simple accumulation of triglycerides to hepatic inflammation and may progress to *** with obesity also have an increased risk of primary liver malignancies and increased body mass index is a predictor of decompensation of liver *** obesity confers a risk of physical impairment and disability that is significantly higher than the risk induced by each of the two conditions alone as it has been shown to be an independent risk factor for chronicliver disease in patients with obesity and a prognostic negative marker for the evolution of liver cirrhosis and the results of liver *** patients with obesity are at high risk for depletion of various fat-soluble,water-soluble vitamins and trace elements and should be supplemented ***,physical activity and protein intake should be carefully monitored in these fragile patients according to recent *** surgery is sporadically used in patients with morbid obesity and cirrhosis also in the setting of liver *** risk of sarcopenia,micronutrient status,and the recommended supplementation in patients with obesity and cirrhosis are discussed in this ***,the indications and contraindications of bariatric surgery-induced weight loss in the cirrhotic patient with obesity are discussed.

关键词： obesity cirrhosis sarcopenia malnutrition bariatric surgery

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