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Antithrombotic treatment tailoring and risk score evaluation in elderly patients diagnosed with an acute coronary syndrome

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Journal of Geriatric Cardiology 2017年第7期14卷 442-456页

作者： Alexandru Nicolae Mischie Catalina Liliana Andrei Crina Sinescu Gani Bajraktari Eugen Ivan Georgios Nikolaos Chatziathanasiou michele schiariti Invasive Cardiology Unit Centre Hospitalier de Montlufon Montlufon France Carol Davila University of Medicine and Pharmacy Bucharest Romania Clinic of Cardiology University Clinical Centre of Kosova Prishtina Republic of Kosovo Comanche Memorial Hospital Lawton USA 5Cardiology Clinic Preveza Greece Cardiology Clinic Preveza Greece Department of Cardiovascular Sciences Sapienza University of Rome Rome Italy

Age is an important prognostic factor in the outcome of acute coronary syndromes (ACS). A substantial percentage of patients who experience ACS is more than 75 years old, and they represent the fastest-growing segment of the population treated in this setting. These patients present different patterns of responses to pharmacotherapy, namely, a higher ischemic and bleeding risk than do patients under 75 years of age. Our aim was to identify whether the currently available ACS ischemic and bleeding risk scores, which has been validated for the general population, may also apply to the elderly population. The second aim was to determine whether the elderly benefit more from a specific pharmacological regimen, keeping in mind the numerous molecules of antiplatelet and antithrombotic drugs, all validated in the general population. We concluded that the GRACE (Global Registry of Acute Coronary Events) risk score has been extensively validated in the elderly. However, the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) bleeding score has a moderate correlation with outcomes in the elderly. Until now, there have not been head-to-head scores that quantify the ischemic versus hemorrhagic risk or scores that use the same end point and timeline (e.g., ischemic death rate versus bleeding death rate at one month). We also recommend that the frailty score be considered or integrated into the current existing scores to better quantify the overall patient risk. With regard to medical treatment, based on the subgroup analysis, we identified the drugs that have the least adverse effects in the elderly while maintaining optimal efficacy.

关键词：急性冠状动脉综合征药物治疗老年人评分风险患者评价抗血栓药物

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Usefulness of coronary flow reserve measured by transthoracic coronary Doppler ultrasound in the elderly

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Journal of Geriatric Cardiology 2017年第7期14卷 436-441页

作者： Danijela Trifunovic Edina Cenko Concetta Torromeo Beatrice Ricci michele schiariti Marija Zdravkovic Zorana Vasiljevic Olivia Manfrini Department of Cardiology University Clinical Center of Serbia Belgrade Serbia School of Medicine University of Belgrade Belgrade Serbia Department of Experimental Diagnostics and Specialty Medicine University of Bologna Bologna Italy Department of Cardiovascular Respiratory Nephrological Anesthesiological and Geriatric Sciences Sapienza University of Rome Italy Department of Cardiology University Hospital Medical Center "Bezanijska kosa" Belgrade Serbia

The left anterior descending (LAD) coronary artery is the main vessel of human coronary circulation, and life-threatening consequences are seen when flow in this area is impaired Noninvasive measurement of coronary flow reserve (CFR),defined as the ratio of maximal to baseline coronary blood flow, has been repeatedly shown to be a feasible technique by ultrasound transthoracic Doppler (TTD) both in the LAD and, with some limitations, in the posterior descending (PD) coronary artery. CFR by TTD offers two important pieces of information: information about patency and flow through the large epicardial coronary artery proximal to the site of CFR assessment and information about the functional integrity of coronary microcirculation distal to the site of CFR assessment. CFR by TTD is a valuable research tool for investigating the pathophysiology of coronary circulation. However, CFR by TTD is also an important clinical decision-making instrument, enabling functional assessment of epicardial coronary stenosis, particularly in cases of anatomically borderline stenosis, i.e., 50%-70% of cases. CFR by TTD enables insight downstream into coronary microvascular function that might be impaired due to primary coronary microvascular disease, as a consequence of myocardial diseases with extramural compression and microvascular remodeling and rarefaction (in left ventricular hypertrophy, dilated or hypertrophic cardiomyopathy, or aortic stenosis), or as a consequence of microvascular obstruction due to micro-embolization by plaque and thrombus debris during percutaneous coronary interventions.

关键词：冠状动脉多普勒超声血流量老年人应用储备多普勒技术 LAD

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Angiotensin-converting enzyme 2 and AMPK/mTOR pathway in the treatment of liver fibrosis:Should we consider further implications?

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World Journal of Gastroenterology 2024年第18期30卷 2391-2396页

作者： michele Barone Section of Gastroenterology Department of Precision and Regenerative Medicine-Jonian Area-University of BariBari 70124Italy

This editorial contains comments on the article by Zhao et al in print in the World Journal of *** mechanisms responsible for hepatic fibrosis are also involved in ***,we recapitulated the complexity of the renin-angiotensin system,discussed the role of hepatic stellate cell(HSC)autophagy in liver fibrogenesis,and analyzed the possible implications in the development of hepatocarcinoma(HCC).Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers definitively contribute to reducing hepatic fibrogenesis,whereas their involvement in HCC is more evident in experimental conditions than in human ***-converting enzyme 2(ACE2),and its product Angiotensin(Ang)1-7,not only regulate HSC autophagy and liver fibrosis,but they also represent potential targets for unexplored applications in the field of ***,ACE2 overexpression inhibits HSC autophagy through the AMP-activated protein kinase(AMPK)/mammalian target of rapamycin(mTOR)*** this case,Ang 1-7 acts binding to the MasR,and its agonists could modulate this ***,since AMPK utilizes different targets to suppress the mTOR downstream complex mTOR complex 1 effectively,we still need to unravel the entire pathway to identify other potential targets for the therapy of fibrosis and liver cancer.

关键词： Renin-angiotensin system Liver fibrosis Hepatic stellate cells Autophagy Hepatocellular carcinoma

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Risk of hepatic decompensation from hepatitis B virus reactivation in hematological malignancy treatments

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World Journal of Gastroenterology 2024年第25期30卷 3147-3151页

作者： michele Barone Section of Gastroenterology Department of Precision and Regenerative Medicine-Jonian Area-University of BariBari 70124Italy

In this editorial,we discussed the apparent discrepancy between the findings described by Colapietro et al,in their case report and data found in the *** et al reported a case of hepatitis B virus(HBV)-related hepatic decompensation in a patient with chronic myeloid leukemia and a previously resolved HBV infection who was receiving Bruton’s tyrosine kinase(BTK)inhibitor *** of all,we recapitulated the main aspects of the immune system involved in the response to HBV infection in order to underline the role of the innate and adaptive response,focusing our attention on the protective role of *** then carefully analyzed literature data on the risk of HBV reactivation(HBVr)in patients with previous HBV infection who were treated with either tyrosine kinase inhibitors or BTK inhibitors for their hematologic *** on literature data,we suggested that several factors may contribute to the different risks of HBVr:The type of hematologic malignancy;the type of therapy(BTK inhibitors,especially second-generation,seem to be at a higher risk of HBVr than those with tyrosine kinase inhibitors);previous exposure to an anti-CD20 as first-line therapy;and ethnicity and HBV ***,the warning regarding HBVr in the specific setting of patients with hematologic malignancies requires further investigation.

关键词： Hematological malignancy Hepatitis Hepatitis B virus-DNA Bruton’s tyrosine kinase Previously resolved hepatitis B virus infection

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Prognostic significance of post percutaneous coronary intervention thrombocytopenia

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World Journal of Meta-Analysis 2014年第2期2卷 24-28页

作者： michele schiariti Loredana Iannetta Concetta Torromeo michele De Gregorio Paolo Emilio Puddu Laboratory of Biotechnologies Applied to Cardiovascular Medicine Department of Cardiovascular Respiratory NephrologicalAnesthesiological and Geriatrical Sciences Sapienza University of Rome Department of Medicine St. Joseph Mercy Oakland Hospital

Several definitions of post percutaneous coronary intervention(PCI)thrombocytopenia(TC)were *** studies demonstrated that a relative drop in platelet count≥25%is the most appropriate *** this definition a population is detected that is exposed not only to increased risk of hemorrhagic complications but also to increased risk of ischemic events,which may appear a *** patients with acute coronary syndromes undergoing PCI,several conditions might be associated with TC:cardiopulmonary bypass and the presence of extra corporeal membrane oxygenators,intra aortic balloon pump(IABP),cardiogenic shock,thrombolytic drugs and anticoagulant or antiplatelet *** studies demonstrated that TC and ischemic outcomes are related although it is unclear whether this is a direct relationship or TC is just a secondary effect of another cryptic *** is suggested that further investigations determine whether there is a real link between TC,a probably welldefined covariate,and ischemic outcomes or whether IABP is the joining link between these two variables and whose presence needs in any case be considered in multivariable ***-PCI TC could be only a secondary effect of IABP *** turn,the prolonged use of heparin necessarily accompanying the use of IABP,and producing a paradoxical pro-thrombotic TC,might also be implicated.

关键词： Thrombocytopenia Outcome Percutaneous coronary intervention Intra aortic balloon pump

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Metabolomic evidence of independent biotransformation pathways for terpenes in two specialist mammalian herbivores (genus Neotoma)

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Integrative Zoology 2024年第1期19卷 143-155页

作者： Katharina SCHRAMM michele SKOPEC Denise DEARING Department of Biology University of UtahSalt Lake CityUtahUSA Department of Zoology Weber State UniversityOgdenUtahUSA

Herbivory is common in mammals,yet our understanding of detoxification processes used by mammals to biotrans-form plant secondary compounds(PSCs)is *** herbivores are thought to have evolved detoxifica-tion mechanisms that rely more heavily on energetically cheap Phase I biotransformation reactions to process high levels of PSCs in their *** explored this hypothesis by comparing the urinary metabolite patterns of two spe-cialist herbivores(genus Neotoma).Neotoma stephensi is an obligate specialist on one-seeded juniper(Juniperus monosperma).Neotoma lepida is a generalist forager across its range,yet populations in the Great Basin specialize on Utah juniper(***).While both juniper species have high levels of terpenes,the terpene profiles and quantities differ between the *** from both woodrat species were fed diets of each juniper in a cross-over ***,collected over a 24-h period,was extracted and analyzed in an untargeted metabolomics approach using both GC-MS and HPLC-MS/*** obligate specialist *** excreted a unique pattern of Phase I metabolites when fed its native juniper,while *** excreted a unique pattern of Phase II metabolites when fed its native *** woodrat species utilized the Phase II metabolic pathway of glucuronidation more heavily when consuming the more chemically diverse ***,and *** utilized less glucuronida-tion than *** when consuming *** results are consistent with the hypothesis that obligate specialists may have evolved unique and efficient biotransformation mechanisms for dealing with PSCs in their diet.

关键词： dietary specialization herbivory juniper metabolomics Neotoma

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Colon and rectal cancer:An emergent public health problem

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World Journal of Gastroenterology 2024年第7期30卷 644-651页

作者： Marina Pinheiro David Nascimento Moreira michele Ghidini LAQV REQUIMTEDepartment of ChemistryFaculty of PharmacyUniversity of Porto4050-313 PortoPortugal Unidade de Saúde Pública Unidade Local de Saúde Barcelos/EsposendeBarcelinhos 4755-069BragaPortugal Medical Oncology Unit Fondazione IRCCS Ca’Granda Ospedale Maggiore PoliclinicoMilan 20122Italy

Colorectal cancer ranks third globally,with a high mortality *** the United States,and different countries in Europe,organized population screenings exist and include people between 50 and 74 years of *** screenings have allowed an early diagnosis and consequently an improvement in health *** and rectal cancer(CRC)is a disease of particular interest due to the high global burden associated with it and the role attributed to prevention and early diagnosis in reducing morbidity and *** study is a review of CRC pathology and includes the most recent scientific evidence regarding this pathology,as well as a diagnosis of the epidemiological situation of ***,the recommendation from a public health perspective will be discussed in detail taking into account the context and the most current recommendations.

关键词： Colon and rectal neoplasia Colon and rectal tumor Mortality Morbidity

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Therapeutic advances in neural regeneration for Huntington’s disease

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Neural Regeneration Research 2024年第9期19卷 1991-1997页

作者： Francesco D’Egidio Vanessa Castelli Giorgia Lombardozzi Fabrizio Ammannito Annamaria Cimini michele d’Angelo Department of Life Health and Environmental SciencesUniversity of L’AquilaL’AquilaItaly

Huntington’s disease is a neurodegenerative disease caused by the expansion mutation of a cytosine-adenine-guanine triplet in the exon 1 of the HTT gene which is responsible for the production of the huntingtin (Htt) protein. In physiological conditions, Htt is involved in many cellular processes such as cell signaling, transcriptional regulation, energy metabolism regulation, DNA maintenance, axonal trafficking, and antiapoptotic activity. When the genetic alteration is present, the production of a mutant version of Htt (mHtt) occurs, which is characterized by a plethora of pathogenic activities that, finally, lead to cell death. Among all the cells in which mHtt exerts its dangerous activity, the GABAergic Medium Spiny Neurons seem to be the most affected by the mHtt-induced excitotoxicity both in the cortex and in the striatum. However, as the neurodegeneration proceeds ahead the neuronal loss grows also in other brain areas such as the cerebellum, hypothalamus, thalamus, subthalamic nucleus, globus pallidus, and substantia nigra, determining the variety of symptoms that characterize Huntington’s disease. From a clinical point of view, Huntington’s disease is characterized by a wide spectrum of symptoms spanning from motor impairment to cognitive disorders and dementia. Huntington’s disease shows a prevalence of around 3.92 cases every 100,000 worldwide and an incidence of 0.48 new cases every 100,000/year. To date, there is no available cure for Huntington’s disease. Several treatments have been developed so far, aiming to reduce the severity of one or more symptoms to slow down the inexorable decline caused by the disease. In this context, the search for reliable strategies to target the different aspects of Huntington’s disease become of the utmost interest. In recent years, a variety of studies demonstrated the detrimental role of neuronal loss in Huntington’s disease condition highlighting how the replacement of lost cells would be a reasonable strategy to o

关键词： cell therapy exosomes extracellular vesicles Huntingtin Huntington’s disease medium spiny neurons neurodegenerative disease neurogenesis neuronal loss stem cells

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Close relationship between mediators of inflammation and pancreatic cancer:Our experience

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World Journal of Gastroenterology 2024年第23期30卷 2927-2930页

作者： Francesca Vescio michele Ammendola Giuseppe Currò Silvia Curcio Department General Surgery UnitUniversity“Magna Graecia”Medical SchoolUniversity Hospital“R.Dulbecco”Catanzaro 88100Italy Science of Health Department Digestive Surgery UnitUniversity“Magna Graecia”Medical SchoolUniversity Hospital“R.Dulbecco”Catanzaro 88100Italy

In this editorial,we focus specifically on the mechanisms by which pancreatic inflammation affects pancreatic *** of the pancreas remains one of the deadliest cancer *** highest incidence and mortality rates of pancreatic cancer are found in developed *** of pancreatic cancer incidence and mortality vary considerably worldwide.A better understanding of the etiology and identification of the risk factors is essential for the primary prevention of this *** tumors are characterized by a complex microenvironment that orchestrates metabolic alterations and supports a milieu of interactions among various cell types within this *** this editorial,we highlight the foundational studies that have driven our understanding of these *** our experimental center,we have carefully studied the mechanisms of that link pancreatic inflammation and pancreatic *** focused on the role of mast cells(MCs).MCs contain pro-angiogenic factors,including tryptase,that are associated with increased angiogenesis in various *** this editorial,we address the role of MCs in angiogenesis in both pancreatic ductal adenocarcinoma tissue and adjacent normal *** assessment includes the density of c-Kit receptor-positive MCs,the density of tryptase-positive MCs,the area of tryptasepositive MCs,and angiogenesis in terms of microvascularization density.

关键词： Mast cells C-Kit receptor Tryptase Angiogenesis Microvascular density Endothelial area Pancreatic tumor tissue Adjacent normal tissue

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Potential of GSHP coupled with PV systems for retrofitting urban areas in different European climates based on archetypes definition

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Energy and Built Environment 2024年第3期5卷 374-392页

作者： Laura Carnieletto Antonino Di Bella Davide Quaggiotto Giuseppe Emmi Adriana Bernardi michele De Carli Department of Industrial Engineering–DII University of Padovavia Venezia 1PadovaItaly University of Ferrara Italy CNR–National Research Council PadovaItaly

According to the recent policies regarding energy use in buildings and the need of retrofit strategies,the aim of this work is to support policies concerning the installation of ground source heat exchangers in urban and historical areas,raising the awareness on the potential energy saving achievable with optimal sizing and limited impact on the urban *** have been developed distinguishing among existing and historic buildings,focusing on single-family terrace houses,which are the typical residential buildings in European historic centres.A methodology for the optimal sizing of ground source heat pumps,eventually considering dual-source system or air system has been developed combining simulations of a photovoltaic system to estimate the self-sufficiency and the self-consumption for five orientations of the *** results have been obtained for warm cli-mates,with negligible heating energy demand and possibly free cooling systems rather than traditional cooling systems needed in *** temperature was acceptable despite unbalanced energy *** proper inclination,photovoltaic systems could provide up to 40%of self-sufficiency share also in northern *** energy-economic analysis was carried out obtaining a variety of cases representing a general overview of the European building stock and the potential benefits achievable in terms of renewable energy share,energy savings and economic investments needed to be extended to simulations at urban scale.

关键词： Energy use database Ground source heat exchangers Urban context Energy retrofit Integrated renewables

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