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Factors affecting the quality of bowel preparation for colonoscopy in hard-to-prepare patients:Evidence from the literature

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World Journal of Gastroenterology 2023年第11期29卷 1685-1707页

作者： Endrit Shahini Emanuele sinagra Alessandro Vitello Rocco Ranaldo Antonella Contaldo Antonio Facciorusso Marcello Maida Gastroenterology Unit National Institute of Gastroenterology-IRCCS“Saverio de Bellis”Castellana GrotteBari 70013Italy Gastroenterology and Endoscopy Unit Fondazione Istituto G.GiglioCefalù90015Italy Gastroenterology and Endoscopy Unit S.Elia-Raimondi HospitalCaltanissetta 93100Italy Department of Internal Medicine “Mazzolani-Vandini”HospitalDigestive EndoscopyFerrara 744011Italy Gastroenterology Unit National Institute of Gastroenterology“S de Bellis”Research HospitalBari 70013Italy Department of Medical Sciences University of FoggiaSection of GastroenterologyFoggia 71122Italy

Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma ***,almost a quarter of procedures are still carried out with suboptimal preparation,resulting in longer procedure times,higher risk of complications,and higher likelihood of missing *** guidelines recommend high-volume or low-volume polyethylene glycol(PEG)/non-PEG-based split-dose *** patients who have had insufficient bowel cleansing,the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option.A strategy that includes a prolonged low-fiber diet,a split preparation regimen,and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the ***,even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients,clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease *** with severe renal insufficiency(creatinine clearance<30 mL/min)should be prepared with isotonic high volume PEG *** data on cirrhotic patients are currently available,and no trials have been conducted in this *** accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation,especially in patients undergoing resection of left colon lesions,where intestinal preparation has a poor *** purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients,as well as strategies to improve colonoscopy preparation in these patients.

关键词： Colorectal cancer Colonoscopy Adenoma detection rate Bowel preparation Polyethylene glycol

Microbiota-gut-brain axis and its affect inflammatory bowel disease:Pathophysiological concepts and insights for clinicians

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World Journal of Clinical Cases 2020年第6期8卷 1013-1025页

作者： Emanuele sinagra Erika Utzeri Gaetano Cristian Morreale Carlo Fabbri Fabio Pace Andrea Anderloni Gastroenterology and Endoscopy Unit Fondazione Istituto Giuseppe GiglioContrada Pietra Pollastra PisciottoCefalù90015Italy Euro-Mediterranean Institute of Science and Technology Palermo 90100Italy Nuova Casa di Cura di Decimomannu Cagliari 09100Italy Section of Gastroenterology S.Elia-Raimondi HospitalCaltanissetta 93100Italy Gastroenterology and Digestive Endoscopy Unit Forlì-CesenaAzienda USL RomagnaForlì47121Italy Unit of Gastroenterology Bolognini HospitalBergamo 24100Italy Digestive Endoscopy Unit Division of GastroenterologyHumanitas Research HospitalRozzano 20089Italy

Despite the bi-directional interaction between gut microbiota and the brain not being fully understood,there is increasing evidence arising from animal and human studies that show how this intricate relationship may facilitate inflammatory bowel disease(IBD)pathogenesis,with consequent important implications on the possibility to improve the clinical outcomes of the diseases themselves,by acting on the different components of this system,mainly by modifying the *** the emergence of precision medicine,strategies in which patients with IBD might be categorized other than for standard gut symptom complexes could offer the opportunity to tailor therapies to individual *** aim of this narrative review is to elaborate on the concept of the gutbrain-microbiota axis and its clinical significance regarding IBD on the basis of recent scientific literature,and finally to focus on pharmacological therapies that could allow us to favorably modify the function of this complex system.

关键词： Irritable bowel syndrome Inflammatory bowel disease Gut-brain axis Therapy

Artificial intelligence and colorectal cancer:How far can you go?

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Artificial Intelligence in Cancer 2021年第2期2卷 7-11页

作者： Rita Alloro Emanuele sinagra Department of Surgical Oncological and Oral Sciences(Di.Chir.On.S.)Unit of General and Oncological SurgeryPaolo Giaccone University HospitalUniversity of PalermoPalermo 90127Italy Gastroenterology and Endoscopy Unit Fondazione Istituto G.GiglioPalermo 90015Italy

Artificial intelligence is an emerging technology whose application is rapidly increasing in several medical *** numerous applications of artificial intelligence in gastroenterology have shown promising results,especially in the setting of gastrointestinal ***,we would like to highlight and summarize the research progress and clinical application value of artificial intelligence in the diagnosis,treatment,and prognosis of colorectal cancer to provide evidence for its use as a promising diagnostic and therapeutic tool in this setting.

关键词： Artificial intelligence Colorectal cancer Diagnosis Treatment Prognosis

New therapeutic perspectives in irritable bowel syndrome: Targeting low-grade inflammation, immuno-neuroendocrine axis, motility, secretion and beyond

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World Journal of Gastroenterology 2017年第36期23卷 6593-6627页

作者： Emanuele sinagra Gaetano Cristian Morreale Ghazaleh Mohammadian Giorgio Fusco Valentina Guarnotta Giovanni Tomasello Francesco Cappello Francesca Rossi Georgios Amvrosiadis Dario Raimondo Gastroenterology and Endoscopy Unit Fondazione Istituto Giuseppe GiglioContrada Pietra Pollastra Pisciotto Euro-Mediterranean Institute of Science and Technology Department of Experimental Biomedicine and Clinical Neuroscience Section of Human AnatomyUniversity of Palermo Unit of Gastroenterology Ospedali Riuniti Villa Sofia-Vincenzo Cervello Department of Medicine Division of Gastroenterology and HepatologyKarolinska InstitutetKarolinska University Hospital Unit of Internal Medicine Ospedali Riuniti Villa Sofia-Vincenzo Cervello Section of Cardio-Respiratory and Endocrine-Metabolic Diseases Biomedical Department of Internal and Specialist MedicineUniversity of Palermo

Irritable bowel syndrome(IBS)is a chronic,recurring,and remitting functional disorder of the gastrointestinal tract characterized by abdominal pain,distention,and changes in bowel *** there are several drugs for IBS,effective and approved treatments for one or more of the symptoms for various IBS subtypes are *** understanding of pathophysiological mechanisms such as the role of impaired bile acid metabolism,neurohormonal regulation,immune dysfunction,the epithelial barrier and the secretory properties of the gut has led to advancements in the treatment of *** regards to therapies for restoring intestinal permeability,multiple studies with prebiotics and probiotics are ongoing,even if to date their efficacy has been *** parallel,much progress has been made in targeting low-grade inflammation,especially through the introduction of drugs such as mesalazine and rifaximin,even if a better knowledge of the mechanisms underlying the low-grade inflammation in IBS may allow the design of clinical trials that test the efficacy and safety of such *** literature review aims to summarize the findings related to new and investigational therapeutic agents for IBS,most recently developed in preclinical as well as Phase 1 and Phase 2clinical studies.

关键词： Therapy Low grade inflammation Motility Secretion Irritable bowel syndrome Immunoendocrine axis

Dismicrobism in inflammatory bowel disease and colorectal cancer: Changes in response of colocytes

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World Journal of Gastroenterology 2014年第48期20卷 18121-18130页

作者： Giovanni Tomasello Pietro Tralongo Provvidenza Damiani Emanuele sinagra Benedetto Di Trapani Marie Noelle Zeenny Inaya Hajj Hussein Abdo Jurjus Angelo Leone IEMEST Euro-Mediterranean Institute of Science and Technology 90139 Palermo Italy Department of Experimental Biomedicine and Clinical Neurosciences Section of Histology University of Palermo 90133 Palermo Italy AOUP "P Giaccone" School of Medicine University of Palermo 90139 Palermo Italy Fondazione Istituto S. Raffaele-G. Giglio Gastroenterology and Endoscopy Unit Cefalù 90146 Italy Unit of Surgery "Clinica Torina" 9010Palermo Italy Deparment of Anatomy Cell Biology and Physiology American University of Beirut Beirut 1107-2020 Lebanon Department of Biomedical Sciences Oakland University William Beaumont School of Medicine Rochester MI 48309 United States

Patients with inflammatory bowel disease (IBD) have an increased risk of 10%-15% developing colorectal cancer (CRC) that is a common disease of high economic costs in developed countries. The CRC has been increasing in recent years and its mortality rates are very high. Multiple biological and biochemical factors are responsible for the onset and progression of this pathology. Moreover, it appears absolutely necessary to investigate the environmental factors favoring the onset of CRC and the promotion of colonic health. The gut microflora, or microbiota, has an extensive diversity both quantitatively and qualitatively. In utero, the intestine of the mammalian fetus is sterile. At birth, the intestinal microbiota is acquired by ingesting maternal anal or vaginal organisms, ultimately developing into a stable community, with marked variations in microbial composition between individuals. The development of IBD is often associated with qualitative and quantitative disorders of the intestinal microbial flora (dysbiosis). The healthy human gut harbours about 10 different bacterial species distributed in colony forming units which colonize the gastrointestinal tract. The intestinal microbiota plays a fundamental role in health and in the progression of diseases such as IBD and CRC. In healthy subjects, the main control of intestinal bacterial colonization occurs through gastric acidity but other factors such as endoluminal temperature, competition between different bacterial strains, peristalsis and drugs can influence the intestinal microenvironment. The microbiota exerts diverse physiological functions to include: growth inhibition of pathogenic microorganisms, synthesis of compounds useful for the trophism of colonic mucosa, regulation of intestinal lymphoid tissue and synthesis of amino acids. Furthermore, mucus seems to play an important role in protecting the intestinal mucosa and maintaining its integrity. Changes in the microbiota composition are mainly influenced

关键词： Dismicrobism Inflammatory bowel disease Colorectal Cancer Dysbiosis Eubiosis Heat shock proteins

Use of artificial intelligence in improving adenoma detection rate during colonoscopy:Might both endoscopists and pathologists be further helped

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World Journal of Gastroenterology 2020年第39期26卷 5911-5918页

作者： Emanuele sinagra Matteo Badalamenti Marcello Maida Marco Spadaccini Roberta Maselli Francesca Rossi Giuseppe Conoscenti Dario Raimondo Socrate Pallio Alessandro Repici Andrea Anderloni Gastroenterology and Endoscopy Unit Fondazione Istituto San Raffaele GiglioCefalù90015Italy Digestive Endoscopy Unit Division of GastroenterologyHumanitas Clinical and Research Center IRCCSRozzano 20089Italy Gastroenterology and Endoscopy Unit S.Elia-Raimondi HospitalCaltanissetta 93100Italy Endoscopy Unit AOUP Policlinico G.MartinoMessina 98125Italy

Colonoscopy remains the standard strategy for screening for colorectal cancer around the world due to its efficacy in both detecting adenomatous or precancerous lesions and the capacity to remove them *** detection and diagnosis(CAD),thanks to the brand new developed innovations of artificial intelligence,and especially deep-learning techniques,leads to a promising solution to human biases in performance by guarantying decision support during *** application of CAD on real-time colonoscopy helps increasing the adenoma detection rate,and therefore contributes to reduce the incidence of interval cancers improving the effectiveness of colonoscopy screening on critical outcome such as colorectal cancer related ***,a significant reduction in costs is also *** addition,the assistance of the machine will lead to a reduction of the examination time and therefore an optimization of the endoscopic *** aim of this opinion review is to analyze the clinical applications of CAD and artificial intelligence in colonoscopy,as it is reported in literature,addressing evidence,limitations,and future prospects.

关键词： Colonoscopy Artificial intelligence Adenoma detection rate Pathology Endoscopy Computer-aided detection and diagnosis

Arrhythmogenic right ventricular cardiomyopathy: From genetics to diagnostic and therapeutic challenges

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World Journal of Cardiology 2014年第12期6卷 1234-1244页

作者： Bruno Pinamonti Francesca Brun Luisa Mestroni Gianfranco sinagra Cardiovascular Department Ospedali Riuniti of Trieste34100Trieste Italy Cardiovascular Institute and Adult Medical Genetics Program University of Colorado Denver AMC Aurora CO 80045-2507 United States

Arrhythmogenic right ventricular cardiomyopathy(ARVC) is a genetic disease characterized by myocyte loss and fibro-fatty tissue replacement. Diagnosis of ARVC remains a clinical challenge mainly at its early stages and in patients with minimal echocardiographic right ventricular(RV) abnormalities. ARVC shares some common features with other cardiac diseases, such as RV outflow ventricular tachycardia, Brugada syndrome, and myocarditis, due to arrhythmic expressivity and biventricular involvement. The identification of ARVC can be often challenging, because of the heterogeneous clinical presentation, highly variable intra- and inter-family expressivity and incomplete penetrance. This genotypephenotype "plasticity" is largely unexplained. A familial history of ARVC is present in 30% to 50% of cases, and the disease is considered a genetic cardiomyopathy, usually inherited in an autosomal dominant pattern with variable penetrance and expressivity; in addition, autosomal recessive forms have been reported(Naxos disease and Carvajal syndrome). Diagnosis of ARVC relays on a scoring system, with major or minorcriteria on the Revised Task Force Criteria. Implantable cardioverter defibrillators(ICDs) are increasingly utilized in patients with ARVC who have survived sudden death(SD)(secondary prevention). However, there are few data available to help identifying ARVC patients in whom the prophylactic implantation of an ICD is truly warranted. Prevention of SD is the primary goal of management. Pharmacologic treatment of arrhythmias, catheter ablation of ventricular tachycardia, and ICD are the mainstay of treatment of ARVC.

关键词： Arrhythmogenic right ventricular cardiomyopathy Sudden cardiac death Risk stratification Genetic Implantable cardioverter-defibrillator

Acquired double pylorus,due to penetrating gastric ulcer,presenting with melena

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World Journal of Gastrointestinal Endoscopy 2012年第3期4卷 94-95页

作者： Cristina Linea Emanuele sinagra Francesco La Seta Marco Giunta Operative Unit of Gastroenterology Palermo UniversityV Cervello Hospital Operative Unit of Gastroenterology and Hepatology Palermo UniversityAOUP Paolo GiacconePiazza delle Cliniche 290100 PalermoItaly Radiology Unit Palermo UniversityV Cervello Hospital

Acquired double pylorus (DP) is an uncommon condition consisting of two communicating channels between the gastric antrum and the first part of *** is known about the origin of *** there is no specific gastrointestinal symptom due to DP,most often it is diagnosed by gastroscopy while performing for other indicationsFew data are also known about the clinical course of *** the patients with peptic ulcer symptoms,the pyloroplasty-like drainage effect,improving gastric emptying after the estabilishment of the fistula,could relieve these *** represents an unresolved issues about the necessity of repeating endoscopy to document in the patients with DP its final outcome,as the risk of ulcer *** describe a case of a 76-years-old woman admitted to our department for hyposideremic anemia associated to a recent history of melena.

关键词： Double pylorus Gastric ulcer

Treatment of Supraventricular Arrhythmias by Transcatheter Radiofrequency Ablation： The Experience of the Electrophysiology Unit of the University Hospital

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Journal of Pharmacy and Pharmacology 2017年第1期5卷 5-8页

作者： Zecchin Massimo Porto Andrea Bianco Elisabetta Gianfranco sinagra Stroili Manuela Cardiovascular Department ASU1 of Trieste Trieste 34149 Italy Department of Technology Assessment ASU1 of Trieste Trieste 34125Italy

TC-RF （transcatheter radiofrequency） ablation has an important role in the treatment ofSVA （supraventricular arrhythmias）. The indication to TC-RF ablation is usually made to improve the patient＇s quality of life through the elimination of the arrhythmic substrate. The objective of this study is to make a brief review of the literature and to report the Electrophysiology Unit experience of the Cardiovascular Department of the University Hospital of Trieste. From the study, it can be found that about one thousand of patients are visited annually in the Cardiovascular Department of the University Hospital of Trieste （1,019 ± 71/year over the past five years）. The acute success rate of atrial fibrillation and flutter ablation procedures was respectively 93.9% and 97.9% with a relapse rate of 30% and 10% at 12 month. Accessory pathways and nodal atrio ventricular re-entry tachycardia ablation procedures had an acute success rate of respectively 91.1% and 96.6% with a relapse rate of 10% at 12 months. The overall complication rate was 5%. Catheter ablation is an effective therapy for SVA treatment. It can often be definitive, and it is generally superior to drug therapy, with a low complication rate. The improvement in patients＇ quality of life is associated with a reduced need for access to health services.

关键词： TC-RF (transcatheter radiofrequency) ablation SVA (supraventricular arrhythmias) atrial fibrillation atrial flutter atrio-ventricular re-entry tachycardia atrio-ventricular nodal re-entry tachycardia technology assessment.