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Pancreatic transplant surgery and stem cell therapy:Finding the balance between therapeutic advances and ethical principles

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World Journal of Stem Cells 2022年第8期14卷 577-586页

作者： Martina Padovano Matteo Scopetti Federico Manetti Donato Morena Davide Radaelli Stefano D’Errico nicola di fazio Paola Frati Vittorio Fineschi Department of Anatomical HistologicalForensic and Orthopaedic SciencesSapienza University of RomeRome 00185Italy Department of Medical Surgical Sciences and Translational Medicine Sapienza University of RomeRome 00189Italy Department of Medicine Surgery and HealthUniversity of TriesteTrieste 34149Italy

The latest achievements in the field of pancreas transplantation and stem cell therapy require an effort by the scientific community to clarify the ethical implications of pioneering treatments,often characterized by high complexity from a surgical point of view,due to transplantation of multiple organs at the same time or at different times,and from an immunological point of view for stem cell *** fundamental value in the field of organ transplants is,of course,a solidarity principle,namely that of protecting the health and life of people for whom transplantation is a condition of functional recovery,or even of *** nature of this value is that of a concept to which the legal discipline of transplants entrusts its own ethical dignity and for which it has ensured a constitutional recognition in different *** general principle of respect for human life,both of the donor and of the recipient,evokes the need not to put oneself and one’s neighbor in dangerous *** present ethical reflection aims to find a balance between the latest therapeutic advances and several concepts including the idea of the person,the respect due to the dead,the voluntary nature of the donation and the consent to the same,the gratuitousness of the donation,the scientific progress and the development of surgical techniques,and the policies of health promotion.

关键词： Pancreas transplantation Multi-organ transplants Stem cell therapy Ethical principles Donor Recipient

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Watch and wait policy in advanced neuroendocrine tumors: What does it mean?

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World Journal of Clinical Oncology 2017年第2期8卷 96-99页

作者： nicola fazio Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors European Institute of Oncology

Neuroendocrine neoplasms(NENs) are a group of rare and heterogeneous malignancies, which can develop in various organs. The clinical course of NENs is quite heterogeneous, with different spontaneous growth rates after diagnosis, and different degrees of sensitivity to the same therapy even when they have similar characteristics. Watch and wait(W and W), is a term coined to indicate observation being conducted to assess the evolution of the tumor without administering any anti-tumor therapy. It has been applied to NENs since in extremely rare cases they tend to remain stable for a long time. Although W and W has been reported in several guidelines and recommendations it has never been validated, nor has it been specifically investigated. Furthermore it is not standardized. Therefore its application in clinical practice can differ in terms of tumor status assessment, type and timing of imaging or other exams utilized. In conclusion, while undertaking W and W to delay the first-line therapy by some weeks may be justified in good performance asymptomatic patients with low-grade NENs in order to usefully characterize the disease and patient and thereby choose the best therapy and therapeutic strategy, it seems to be far more difficult to justify W and W with the intent of avoiding an anti-tumor treatment. It should be considered that not only do NENs tend to grow even when they have very favorable biological characteristics but also that the alternative to W and W is most commonly a low toxic and effective treatment with somatostatin analogs.

关键词： Observation Wait and see Watch and wait Surveillance Neuroendocrine tumors

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Looking for the right TNM staging system for pancreatic neuroendocrine tumors

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Hepatobiliary Surgery and Nutrition 2021年第3期10卷 382-384页

作者： nicola fazio Francesca Spada Emilio Bertani division of Gastrointestinal Medical Oncology and Neuroendocrine Tumors European Institute of OncologyIEOIRCCSMilanItaly division of digestive Surgery European Institute of OncologyIEOIRCCSMilanItaly

Pancreatic neuroendocrine tumors(panNETs)represent a rare subgroup of neuroendocrine neoplasms(NENs)which showed an impressive increase of incidence over the last decade(1).As over the same period particularly low sta... 详细信息

关键词： neuroendocrine neoplasms tumors

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Wearable devices and IoT applications for symptom detection, infection tracking, and diffusion containment of the COVID-19 pandemic: a survey

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Frontiers of Information Technology & Electronic Engineering 2021年第11期22卷 1413-1442页

作者： Roberto DEfazio nicola Ivan GIANNOCCARO Miguel CARRASCO Ramiro VELAZQUEZ Paolo VISCONTI Department of Innovation Engineering University of SalentoLecce73100Italy Facultad de Ingeniería y Ciencias Universidad Adolfo IbáñezPeñalolénSantiago7941169Chile Facultad de Ingeniería Universidad PanamericanaAguascalientes20290Mexico

Until a safe and effective vaccine to fight the SARS-CoV-2 virus is developed and available for the global population, preventive measures, such as wearable tracking and monitoring systems supported by Internet of Things(IoT) infrastructures, are valuable tools for containing the pandemic. In this review paper we analyze innovative wearable systems for limiting the virus spread, early detection of the first symptoms of the coronavirus disease COVID-19 infection, and remote monitoring of the health conditions of infected patients during the quarantine. The attention is focused on systems allowing quick user screening through ready-to-use hardware and software components. Such sensor-based systems monitor the principal vital signs, detect symptoms related to COVID-19 early, and alert patients and medical staff. Novel wearable devices for complying with social distancing rules and limiting interpersonal contagion(such as smart masks) are investigated and analyzed. In addition, an overview of implantable devices for monitoring the effects of COVID-19 on the cardiovascular system is presented. Then we report an overview of tracing strategies and technologies for containing the COVID-19 pandemic based on IoT technologies, wearable devices, and cloud computing. In detail, we demonstrate the potential of radio frequency based signal technology, including Bluetooth Low Energy(BLE), Wi-Fi, and radio frequency identification(RFID), often combined with Apps and cloud technology. Finally, critical analysis and comparisons of the different discussed solutions are presented, highlighting their potential and providing new insights for developing innovative tools for facing future pandemics.

关键词： Wearable devices IoT health-monitoring applications Medical sensors COVID-19 pandemic Symptom detection

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Neuroendocrine tumors resistant to mammalian target of rapamycin inhibitors:A difficult conversion from biology to the clinic

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World Journal of Clinical Oncology 2015年第6期6卷 194-197页

作者： nicola fazio Unit of Gastrointestinal Medical Oncology and Neuroendocrine Tumors European Institute of Oncology

Deregulation of the phosphoinositide 3-kinase(PI3K)/protein kinase B(Akt)- mammalian target of rapamycin(m TOR) signaling pathway is one of the most commonlyinvolved pathways in tumorigenesis. It has also been reported as altered in neuroendocrine tumors(NETs). m TOR inhibitors used in clinical practice are derived from rapamycin,an anti-cancer agent also used as an immunosuppressor after organ transplantation. Everolimus and temsirolimus are the two rapamycin-derived m TOR inhibitors used in NETs. Notably everolimus has been approved in advanced progressive well/moderatelydifferentiated pancreatic NETs(p NETs). It inhibits specifically the m TORC1 subunit of m TOR,not interacting with m TORC2. Although everolimus produced a significant prolongation of progression-free survival a number of patients with p NETs do not benefit from the drug due to early or late progression. Two supposed mechanisms of resistance to m TOR inhibitors are Akt and PI3 K activation,by means of m TORC2 and insulin growth factor(IGF)- IGF receptor signaling,respectively. BEZ235 is a multi-targeted inhibitor binding to PI3 K,m TORC1 and m TORC2,therefore potentially turning off all the supposed molecular targets of resistance to everolimus. The two clinical trials designed in p NETs were stopped early due to unmet statistical endpoint and the global clinical development of BEZ235 was also halted. Tolerability of this drug was challenging and conditioned the feasibility of therapy. The BEZ experience is an example of the huge difference between the preclinical and clinical setting and prompts us to pay more attention to the phase Ⅰ step of clinical development and the design of phase Ⅱ clinical trials.

关键词： Everolimus BEZ235 Mammalian target of rapamycin Phosphoinositide 3-kinase Mammalian target of rapamycin C Resistance Mammalian target of rapamycin inhibitor

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Surgical outcome after docetaxel-based neoadjuvant chemotherapy in locally-advanced gastric cancer

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World Journal of Gastroenterology 2010年第7期16卷 868-874页

作者： Roberto Biffi nicola fazio Fabrizio Luca Antonio Chiappa Bruno Andreoni Maria Giulia Zampino Arnaud Roth Jan Christian Schuller Giancarla Fiori Franco Orsi Guido Bonomo Cristiano Crosta Olivier Huber division of Abdomino-pelvic Surgery European Institute of Oncology20141 MilanItaly division of Medical Oncology European Institute of Oncology20141 MilanItaly division of General and Laparoscopic Surgery European Institute of Oncology20141 MilanItaly Department of Oncosurgery Geneva University Hospitals1211 GenevaSwitzerland Statistics Unit SAKK(Swiss Group for Clinical Cancer Research)3000 BernSwitzerland division of Endoscopy European Institute of Oncology20141 MilanItaly Interventional Radiology Unit European Institute of Oncology20141 MilanItaly Department of Surgery Geneva University Hospitals1211 GenevaSwitzerland

AIM:To investigate feasibility,morbidity and surgical mortality of a docetaxel-based chemotherapy regimen randomly administered before or after gastrectomy in patients suffering from locally-advanced resectable gastric ***:Patients suffering from locally-advanced(T3-4 any N M0 or any T N1-3 M0)gastric carcinoma,staged with endoscopic ultrasound,bone scan,computed tomography,and laparoscopy,were assigned to receive four 21 d/cycles of TCF(docetaxel 75 mg/m 2 day 1,cisplatin 75 mg/m 2 day 1,and fluorouracil 300 mg/m 2 per day for days 1-14),either before(Arm A)or after(Arm B)*** morbidity,overall mortality,and severe adverse events were compared by intention-to-treat ***:From November 1999 to November 2005,70 patients were *** preoperative TCF(Arm A),thirty-two(94%)resections were performed,85% of which were *** response was complete in 4 patients(11.7%),and partial in 18(55%).No surgical mortality and 28.5%morbidity rate were observed,similar to those of immediate surgery arm(P= 0.86).Serious chemotherapy adverse events tended to be more frequent in arm B(23%vs 11%,P=0.07),with a single death per ***:Surgery following docetaxel-based chemotherapy was safe and with similar morbidity to immediate surgery in patients with locally-advanced resectable gastric carcinoma.

关键词： Gastric cancer Docetaxel Neoadjuvant chemotherapy Laparoscopy Endoscopic ultrasonography Morbidity

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