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Robot-assisted trans-gastric drainage and debridement of walled-off pancreatic necrosis using the EndoWrist stapler for the da Vinci Xi:A case report

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World Journal of Clinical Cases 2019年第12期7卷 1461-1466页

作者： Luca Morelli niccolò furbetta Desirée Gianardi Matteo Palmeri Gregorio Di Franco Matteo Bianchini Gianni Stefanini Simone Guadagni Giulio Di Candio General Surgery Unit Department of Translational Research and New Technologies in Medicine and Surgery University of Pisa Pisa 56124 Italy EndoCAS (Center for Computer Assisted Surgery) University of Pisa Pisa 56124 Italy

BACKGROUND Walled-off pancreatic necrosis (WOPN) is a late complication of acute pancreatitis. The management of a WOPN depends on its location and on patient's symptoms. Trans-gastric drainage and debridement of WOPN represents an important surgical treatment option for selected patients. The da Vinci surgical System has been developed to allow an easy, minimally invasive and fast surgery, also in challenging abdominal procedures. We present here a case of a WOPN treated with a robotic trans-gastric drainage using the da Vinci Xi. CASE SUMMARY A 63-year-old man with an episode of acute necrotizing pancreatitis was referred to our center. Six wk after the acute episode the patient developed a walled massive fluid collection, with an extensive pancreatic necrosis, causing obstruction of the gastrointestinal tract. The patient underwent a robotic transgastric drainage and debridement of the WOPN performed with the da Vinci Xi platform. Firstly, an anterior ideal gastrotomy was carried out, guided by intraoperative ultrasound (US)-scan using the TilePro? function. Then, through the gastrotomy, the best location for drainage on the posterior gastric wall was again US-guided identified. The anastomosis between the posterior gastric wall and the walled-off necrosis wall was carried out with the new EndoWrist stapler with vascular cartridge. Debridement and washing of the cavity through the anastomosis were performed. Finally, the anterior gastrotomy was closed and the cholecystectomy was performed. The postoperative course was uneventful and a post-operative computed tomography-scan showed the collapse of the fluid collection. CONCLUSION In selected cases of WOPN the da Vinci Surgical System can be safely used as a valid surgical treatment option.

关键词： Case report da Vinci Xi EndoWrist stapler Walled-off pancreatic necrosis TilePro Minimally-invasive surgery

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Role of abdominal ultrasound for the surveillance follow-up of pancreatic cystic neoplasms: a cost-effective safe alternative to the routine use of magnetic resonance imaging

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World Journal of Gastroenterology 2019年第18期25卷 2217-2228页

作者： Luca Morelli Simone Guadagni Valerio Borrelli Roberta Pisano Gregorio Di Franco Matteo Palmeri niccolò furbetta Dario Gambaccini Santino Marchi Piero Boraschi Luca Bastiani Alessandro Campatelli Franco Mosca Giulio Di Candio General Surgery Unit Department of Surgery Translational and New Technologies in Medicine University of Pisa EndoCAS (Center for Computer Assisted Surgery) University of Pisa Diagnostic and Interventional Ultrasound in Transplants Unit Azienda Ospedaliero-Universitaria Pisana Gastroenterology Unit University of Pisa 2~(nd) Radiology Unit Department of Diagnostic Imaging Azienda Ospedaliero-Universitaria Pisana Institute of Clinical Physiology National Council of Research

BACKGROUND Patients with pancreatic cystic neoplasms(PCN), without surgical indication at the time of diagnosis according to current guidelines, require lifetime imagebased surveillance follow-up. In these patients, the current European evidencedbased guidelines advise magnetic resonance imaging(MRI) scanning every 6 mo in the first year, then annually for the next five years, without reference to any role for trans-abdominal ultrasound(US). In this study, we report on our clinical experience of a follow-up strategy of image-based surveillance with US, and restricted use of MRI every two years and for urgent evaluation whenever suspicious changes are detected by *** To report the results and cost-efficacy of a US-based surveillance follow-up for known PCNs, with restricted use of *** We retrospectively evaluated the records of all the patients treated in our institution with non-surgical PCN who received follow-up abdominal US and restricted MRI from the time of diagnosis, between January 2012 and January 2017. After US diagnosis and MRI confirmation, all patients underwent US surveillance every 6 mo for the first year, and then annually. A MRI scan was routinely performed every 2 years, or at any stage for all suspicious US *** this communication, we reported the clinical results of this alternative followup, and the results of a comparative cost-analysis between our surveillance protocol(abdominal US and restricted MRI) and the same patient cohort that has been followed-up in strict accordance with the European guidelines recommended for an exclusive MRI-based surveillance *** In the 5-year period, 200 patients entered the prescribed US-restricted MRI surveillance follow-up. Mean follow-up period was 25.1 ± 18.2 mo. Surgery was required in two patients(1%) because of the appearance of suspicious features at imaging(with complete concordance between the US scan and the on-demand MRI). During the follow-up, US revealed changes in PCN

关键词： Ultrasound Pancreatic cystic neoplasms Magnetic resonance imaging Surveillance

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Use of zebrafish embryos as avatar of patients with pancreatic cancer:A new xenotransplantation model towards personalized medicine

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World Journal of Gastroenterology 2020年第21期26卷 2792-2809页

作者： Gregorio Di Franco Alice Usai niccola Funel Matteo Palmeri Ida Elena Rosamaria Montesanti Matteo Bianchini Desirée Gianardi niccolòfurbetta Simone Guadagni Enrico Vasile Alfredo Falcone Luca Emanuele Pollina Vittoria Raffa Luca Morelli General Surgery Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56124Italy Department of Biology University of PisaPisa 56127Italy Division of Surgical Pathology Department of Laboratory of MedicineHospital-University of PisaPisa 56124Italy Division of Medical Oncology Pisa University HospitalPisa 56124Italy Department of Translational Research and New Technologies in Medicine and Surgery University of PisaPisa 56124Italy EndoCAS(Center for Computer Assisted Surgery) University of PisaPisa 56124Italy

BACKGROUND The response to chemotherapy treatment of patients with pancreatic ductal adenocarcinoma(PDAC)is difficult to predict and the identification of patients who most likely will benefit from aggressive chemotherapy approaches is *** concept of personalized medicine has emerged in the last years with the objective to tailor the medical treatment to the individual characteristics of each patient,and particularly to the tumor biology of each *** need for invivo xenotransplantation models for cancer patients has increased exponentially,and for this reason zebrafish avatars have gained *** studies were conducted also with PDAC *** To develop a simple,not expensive,diffusible zebrafish embryo model as avatar for patients affected by *** Tumor tissue was taken from the surgical specimen by the *** its fragmentation into small pieces,they are stained with *** pieces of stained tissue were transplanted into the yolk of wt AB zebrafish embryos with a glass capillary *** were incubated at 35°C in E3 medium supplemented with 1%Pen/Strep in the presence or absence of drugs for the following days in respect of the treatment plan(Gemcitabine;Gemcitabine and Oxaliplatin;Gemcitabine and nab-Paclitaxel;5-Fluorouracil and Folinic acid and Oxaliplatin and Irinotecan).The response of zebrafish xenografts to the chemotherapy options has been analyzed by monitoring the fluorescent stained area at 2 h post injection(hpi),1 d and 2 d post injection(dpi).In each time point,the mean size of the stained area was measured by ImageJ and it was normalized with respect to the 1 dpi time point mean relative tumor area(RTA).We evaluated the effect of the chemotherapy exposition comparing the mean RTA of each treated subgroup and the control group and evaluating the percentage reduction of the mean RTA by comparing each treated subgroup with the control *** Between July 2018 and October 2019,a t

关键词： Pancreatic ductal adenocarcinoma Zebrafish embryos Personalized medicine Xenotransplantation Chemotherapy efficacy Avatar of oncological patients

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Detailing the ultrastructure’s increase of prion protein in pancreatic adenocarcinoma

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World Journal of Gastroenterology 2021年第42期27卷 7324-7339页

作者： Matteo Bianchini Maria Anita Giambelluca Maria Concetta Scavuzzo Gregorio Di Franco Simone Guadagni Matteo Palmeri niccolòfurbetta Desirée Gianardi niccola Funel Claudio Ricci Raffaele Gaeta Luca Emanuele Pollina Alfredo Falcone Caterina Vivaldi Giulio Di Candio Francesca Biagioni Carla Letizia Busceti Luca Morelli Francesco Fornai General Surgery Unit Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56124Italy Human Anatomy Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56124Italy Division of Surgical Pathology Department of SurgicalMedicalMolecular Pathology and Critical AreaUniversity of PisaPisa 56124Italy Division of Medical Oncology Department of Translational Research and New Technologies in Medicine and SurgeryUniversity of PisaPisa 56124Italy IRCCS Neuromed Istituto Neurologico MediterraneoPozzilli 86077Italy EndoCAS(Center for Computer Assisted Surgery) University of PisaPisa 56124Italy

BACKGROUND Recent evidences have shown a relationship between prion protein(PrPc)expression and pancreatic ductal adenocarcinoma(PDAC).Indeed,PrPc could be one of the markers explaining the aggressiveness of this ***,studies investigating the specific compartmentalization of increased PrPc expression within PDAC cells are lacking,as well as a correlation between ultrastructural evidence,ultrastructural morphometry of PrPc protein and clinical *** data,as well as the quantitative stoichiometry of this protein detected by immuno-gold,provide a significant advancement in understanding the biology of disease and the outcome of surgical *** To analyze quantitative stoichiometry and compartmentalization of PrPc in PDAC cells and to correlate its presence with prognostic data METHODS Between June 2018 and December 2020,samples from pancreatic tissues of 45 patients treated with pancreatic resection for a preoperative suspicion of PDAC at our Institution were *** the frozen section excluded a PDAC diagnosis,or the nodules were too small for adequate sampling,patients were ruled out from the present *** blotting was used to detect,quantify and compare the expression of PrPc in PDAC and control tissues,such as those of non-affected neighboring pancreatic tissue of the same *** quantify the increase of PrPc and to detect the subcellular compartmentalization of PrPc within PDAC cells,immuno-gold stoichiometry within specific cell compartments was analyzed with electron ***,an analysis of quantitative PrPc expression according to prognostic data,such as cancer stage,recurrence of the disease at 12 mo after surgery and recurrence during adjuvant chemotherapy was *** The amount of PrPc within specimen from 38 out of 45 patients was determined by semi-quantitative analysis by using Western blotting,which indicates that PrPc increases almost three-fold in tumor pancreatic tissue compared with healthy panc

关键词： Pancreatic ductal adenocarcinoma Prion protein Western blotting Electron microscopy Cellular compartmentalization Neuroinvasion

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Evaluating the role of 7-Tesla magnetic resonance imaging in neurosurgery: Trends in literature since clinical approval

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World Journal of Radiology 2024年第7期16卷 274-293页

作者： Arosh S Perera Molligoda Arachchige Sarah Meuli Francesca Romana Centini niccolòStomeo Federica Catapano Letterio S Politi Faculty of Medicine Humanitas UniversityPieve EmanueleMilan 20072Italy Department of Anaesthesiology and Intensive Care IRCCS Humanitas Research HospitalVia Manzoni 56RozzanoMilan 20089Italy Department of Biomedical Sciences Humanitas Universityvia Rita Levi Montalcini 420090 Pieve Emanuele-MilanItaly IRCCS Humanitas Research Hospital Via Manzoni 5620089 Rozzano-MilanItaly Department of Neuroradiology IRCCS Humanitas Research HospitalVia Manzoni 56RozzanoMilan 20089Italy

BACKGROUND After approval for clinical use in 2017,early investigations of ultra-high-field abdominal magnetic resonance imaging(MRI)have demonstrated its feasibility as well as diagnostic capabilities in ***,there are no to few systematic reviews covering the entirety of its neurosurgical applications as well as the trends in the literature with regard to the aforementioned *** To assess the impact of 7-Tesla MRI(7T MRI)on neurosurgery,focusing on its applications in diagnosis,treatment planning,and postoperative assessment,and to systematically analyze and identify patterns and trends in the existing literature related to the utilization of 7T MRI in neurosurgical *** A systematic search of PubMed was conducted for studies published between January 1,2017,and December 31,2023,using MeSH terms related to 7T MRI and *** inclusion criteria were:Studies involving patients of all ages,meta-analyses,systematic reviews,and original *** exclusion criteria were:Pre-prints,studies with insufficient data(e.g.,case reports and letters),non-English publications,and studies involving animal *** synthesis involved standardized extraction forms,and a narrative synthesis was *** We identified 219 records from PubMed within our defined period,with no duplicates or exclusions before *** screening,125 articles were excluded for not meeting inclusion criteria,leaving 94 *** these,2 were irrelevant to neurosurgery and 7 were animal studies,resulting in 85 studies included in our systematic *** were categorized by neurosurgical procedures and diseases treated using 7T *** also analyzed publications by country and the number of 7T MRI facilities per country was also ***-mental studies were classified into comparison and non-comparison studies based on whether 7T MRI was compared to lower field *** 7T MRI holds great potential in improving the

关键词： 7-Tesla Magnetic resonance imaging Neuroimaging Neurosurgery Pathologies Procedures Trends

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DICE:An open-source MATLAB application for quantification and parametrization of digital outcrop model-based fracture datasets

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Journal of Rock Mechanics and Geotechnical Engineering 2023年第5期15卷 1090-1110页

作者： niccolò Menegoni Daniele Giordan Riccardo Inama Cesare Perotti Department of Earth and Environmental Sciences University of PaviaPavia27100Italy National Research Council of Italy Research Institute for Geo-Hydrological Protection(CNR-IRPI)Torino10135Italy Signal S.r.l. Via Fratelli Cuzio 42Pavia27100Italy

An open-source MATLAB application(app)named Discontinuity Intensity Calculator and Estimator(DICE)was developed in order to quantitatively characterize the fractures,or in more general,discontinuities within a rocky outcrop in three-dimensional(3D)digital data,such as digital outcrop model(DOM).The workflow proposed for the parametrization of the discontinuities consists of the following steps:(1)Analysis and mapping of the fractures detected within the 3D DOMs;(2)Calculation of the orientation,position and dimensions of discontinuities that are represented by best-fit circular planes;(3)Determining the discontinuity parameters(dimension,distribution,spacing and intensity)by the DICE algorithm using different 3D oriented sampling techniques(3D oriented scanline,3D oriented circular scan window and spherical scan volume).Different sampling methods were bench tested with a synthetic,as well as a natural case study,and compared in order to understand the advantages and limitations of each *** 3D oriented circular scan window appears to be the most effective method for fracture intensity estimation with high accuracy(error 0.4%)and stability with variations in scan radius.

关键词： Fracture parameter Discontinuity Fault Fracture intensity Linear fracture intensity(P10) Areal fracture intensity(P21) Volumetric fracture intensity(P32)

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Photovoltaic-thermal solar-assisted heat pump systems for building applications:Integration and design methods

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Energy and Built Environment 2023年第1期4卷 39-56页

作者： Alessandro Miglioli niccolòAste Claudio Del Pero Fabrizio Leonforte Architecture Built environment and Construction Engineering DepartmentPolitecnico di MilanoVia Ponzio 3120133 Milan Italy

The photovoltaic-thermal collector is one of the most interesting technology for solar energy conversion,com-bining electric and thermal energy production in a single ***-compression heat pump is already considered the most suitable clean technology for buildings thermal energy *** combination of these two technologies in an integrated“photovoltaic-thermal solar-assisted heat pump”(PVT-SAHP)system allows reaching a high fraction of the building thermal needs covered by renewable energy sources and to improve the performances of both the photovoltaic-thermal collector and the heat *** first is cooled down increasing its energy conversion efficiency,while providing low-temperature thermal energy to the second,which benefits from a higher evaporation *** review study presents the state-of-art of photovoltaic-thermal solar-assisted heat pump systems intended to cover thermal energy needs in buildings,with a particular focus on the integration methodologies,the possible configurations,the use of different sources and the design of sub-system *** issues are addressed by much scientific research,to improve the reliability and applicability of this technology,as an option for the building *** study aims to present PVT-SAHP systems in an organic and critical way to propose a useful tool for future research *** in detail,the work highlights the fact that the integration of photovoltaic-thermal collectors as evaporator of the heat pump in direct-expansion systems allows the highest heat recovery and ***,the distinction of the two circuits lead to more reliable,flexible and robust systems,especially when combined with a second heat source,being able to cover both heating and cooling *** implementation of real-time control strategy,as well as the continuous development of the compressor and refrigerant industries is positively influencing this technology,which is receiving more an

关键词： Solar-assisted heat pump Photovoltaic-thermal collector PVT-SAHP Renewable energy HVAC Technology review

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Competitor densities,habitat,and weather:effects on interspecific interactions between wild deer species

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Integrative Zoology 2021年第5期16卷 670-684页

作者： Francesco FERRETTI niccolòFATTORINI Research Unit of Behavioural Ecology Ethology and Wildlife ManagementDepartment of Life SciencesUniversity of SienaSienaItaly

There is a growing interest on the potential interplay between weather,habitat,and interspecific competition on population dynamics of wild *** environmental conditions may buffer the negative effects of competition;conversely,competition may be expected to be stronger under harsh environmental *** investigated relationships between competitor abundance,weather,and habitat cover on density and local distribution of a medium-sized herbivore,the roe deer Capreolus capreolus,as well as its spatial overlap with fallow deer Dama dama in a Mediterranean protected *** 11 years(2007–2017),roe deer density was not affected by spring–summer rainfall in the previous year and decreased with increasing density of fallow deer in the previous ***,over the considered temporal scale,results supported a major role of competition over weather in influencing population trends of roe *** a finer spatial scale,roe deer occupancy was negatively affected by local abundance of fallow deer,especially in“poorer”*** found a slight support for a positive effect of fallow deer density on interspecific spatial ***,fine-scale spatial overlap between deer species increased with decreasing rainfall in spring–*** deer were introduced to our study area in historical times and their role as superior competitors over roe deer has been found also in other study *** suggest a potential role of harsh weather conditions during the growing season of vegetation(*** rainfall)in triggering the potential for ecological overlap,emphasizing the negative effects of interspecific competition.

关键词： interspecific competition deer niche partitioning rainfall ungulates Dama dama Capreolus capreolus

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Bow hunter’s syndrome successfully treated with a posterior surgical decompression approach:A case report and review of literature

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World Journal of Clinical Cases 2022年第14期10卷 4494-4501页

作者： niccolòOrlandi Francesco Cavallieri Ilaria Grisendi Antonio Romano Reza Ghadirpour Manuela Napoli Claudio Moratti Matteo Zanichelli Rosario Pascarella Franco Valzania Marialuisa Zedde Department of Biomedical Metabolic and Neural SciencesCenter for Neuroscience and NeurotechnologyUniversity of Modena and Reggio EmiliaModena 41121Italy Neurology Unit Neuromotor and Rehabilitation DepartmentAzienda USL-IRCCS di Reggio EmiliaReggio Emilia 42123Italy Clinical and Experimental Medicine PhD Program University of Modena and Reggio EmiliaModena 41121Italy Neurosurgery Unit Neuromotor and Rehabilitation DepartmentAzienda USL-IRCCS di Reggio EmiliaReggio Emilia 42123Italy Neuroradiology Unit Department of Diagnostic Imaging and Laboratory MedicineAzienda USL-IRCCS di Reggio EmiliaReggio Emilia 41123Italy

BACKGROUND Bow hunter’s syndrome(BHS)is a rare but surgically treatable cause of vertebrobasilar insufficiency due to dynamic rotational occlusion of the vertebral ***,patients present with posterior circulation transient ischaemic symptoms such as presyncope,syncope,vertigo,diplopia,and horizontal nystagmus,but irreversible deficits,including medullary and cerebellar infarctions,have also been *** SUMMARY A 70-year-old patient presented an acute onset of vertigo and gait instability triggered by right head *** medical history included previous episodes of unilateral left neck and occipital pain followed by light-headedness,sweating,and blurred vision when turning his head,and these episodes were associated with severe degenerative changes in the atlanto-dens and left atlanto-axial facet joints and right rotation of the C2 cervical *** magnetic resonance imaging revealed the presence of acute bilateral cerebellar ischaemic lesions,while static vascular imaging did not reveal any vertebral artery *** ultrasonography and angiography were performed and confirmed the presence of a dynamic occlusion of the vertebral artery V3-V4 segment when the head was rotated to the right secondary to left C1-C2 bone spur *** decompression led to complete resolution of paroxysmal symptoms without neurological *** BHS should be considered in cases of repeated posterior circulation transient ischaemic attack or ischaemic stroke,particularly when associated with high cervical spine abnormalities.

关键词： Bow hunter’s syndrome Stroke Non-invasive duplex ultrasonography Dynamic angiography Neurosurgery Case report

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Chronic total occlusion revascularization:A complex piece to"complete"the puzzle

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World Journal of Cardiology 2022年第1期14卷 13-28页

作者： Iacopo Muraca Nazario Carrabba Giacomo Virgili Filippo Bruscoli Angela Migliorini Matteo Pennesi Giulia Pontecorboli niccolò Marchionni Renato Valenti Cardiovascular Department Careggi University HospitalFlorence 50134Italy

Treatment of coronary chronic total occlusion(CTO)with percutaneous coronary intervention(PCI)has rapidly increased during the past *** strategies and approach were developed in the recent past years leading to an increase in CTO-PCI procedural *** goal to achieve an extended revascularization with a high rate of completeness is now supported by strong scientific evidences and consequently,has led to an exponential increase in the number of CTO-PCI procedures,even if are still *** has been widely demonstrated that complete coronary revascularization,achieved by either coronary artery bypass graft or PCI,is associated with prognostic improvement,in terms of increased survival and reduction of major adverse cardiovascular *** application of“contemporary”strategies aimed to obtain a state-of-the-art revascularization by PCI allows to achieve long-term clinical benefit,even in highrisk patients or complex coronary anatomy with *** increasing success of CTO-PCI,allowing a complete or reasonable incomplete coronary revascularization,is enabling to overcome the last great challenge of interventional cardiology,adding a“complex”piece to“complete”the puzzle.

关键词： Chronic total occlusion Percutaneous coronary intervention Complete revascularization Prognosis Coronary artery disease

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