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Aspirin interruption before neurosurgical interventions:A controversial problem

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World Journal of Cardiology 2024年第4期16卷 191-198页

作者： Alexander Kulikov Anton Konovalov pier paolo Pugnaloni Federico Bilotta Department of Anesthesiology Burdenko National Medical Research Center of NeurosurgeryMoscow 125047Russia Department of Vascular Neurosurgery Burdenko National Medical Research Center of NeurosurgeryMoscow 125047Russia Department of Anesthesiology Critical Care and Pain MedicineUniversity of Rome“Sapienza”Rome 00161Italy

Aspirin is widely used for primary or secondary prevention of ischemic events.At the same time,chronic aspirin consumption can affect blood clot formation during surgical intervention and increase intraoperative blood loss.This is especially important for high-risk surgery,including neurosurgery.Current European Society of Cardiology guidelines recommend aspirin interruption for at least 7 d before neurosurgical intervention,but this suggestion is not supported by clinical evidence.This narrative review presents evidence that challenges the necessity for aspirin interruption in neurosurgical patients,describes options for aspirin effect monitoring and the clinical implication of these methods,and summarizes current clinical data on bleeding risk associated with chronic aspirin therapy in neurosurgical patients,including brain tumor surgery,cerebrovascular procedures,and spinal surgery.

关键词： Aspirin Neurosurgery Postoperative complications Bleeding risk Brain tumor surgery Cerebrovascular surgery Spinal surgery

Role of glioma stem cells in promoting tumor chemo- and radioresistance: A systematic review of potential targeted treatments

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World Journal of Stem Cells 2024年第5期16卷 604-614页

作者： Edoardo Agosti Marco Zeppieri Mattia Ghidoni Tamara Ius Alessandro Tel Marco Maria Fontanella pier paolo Panciani Division of Neurosurgery Department of Medical and Surgical SpecialtiesRadiological Sciences and Public HealthUniversity of BresciaBrescia 25123Italy Department of Ophthalmology University Hospital of UdineUdine 33100Italy Neurosurgery Unit Department of Head-Neck and NeuroScienceUniversity Hospital of UdineUdine 33100Italy Clinic of Maxillofacial Surgery Department of Head-Neck and NeuroScienceUniversity Hospital of UdineUdine 33100Italy

BACKGROUND Gliomas pose a significant challenge to effective treatment despite advancements in chemotherapy and radiotherapy.Glioma stem cells(GSCs),a subset within tumors,contribute to resistance,tumor heterogeneity,and plasticity.Recent studies reveal GSCs’role in therapeutic resistance,driven by DNA repair mechanisms and dynamic transitions between cellular states.Resistance mechanisms can involve different cellular pathways,most of which have been recently reported in the literature.Despite progress,targeted therapeutic approaches lack consensus due to GSCs’high plasticity.AIM To analyze targeted therapies against GSC-mediated resistance to radio-and chemotherapy in gliomas,focusing on underlying mechanisms.METHODS A systematic search was conducted across major medical databases(PubMed,Embase,and Cochrane Library)up to September 30,2023.The search strategy utilized relevant Medical Subject Heading terms and keywords related to including“glioma stem cells”,“radiotherapy”,“chemotherapy”,“resistance”,and“targeted therapies”.Studies included in this review were publications focusing on targeted therapies against the molecular mechanism of GSC-mediated re-sistance to radiotherapy resistance(RTR).RESULTS In a comprehensive review of 66 studies on stem cell therapies for SCI,452 papers were initially identified,with 203 chosen for full-text analysis.Among them,201 were deemed eligible after excluding 168 for various reasons.The temporal breakdown of studies illustrates this trend:2005-2010(33.3%),2011-2015(36.4%),and 2016-2022(30.3%).Key GSC models,particularly U87(33.3%),U251(15.2%),and T98G(15.2%),emerge as significant in research,reflecting their representativeness of glioma characteristics.Pathway analysis indicates a focus on phosphoinositide 3-kinase/protein kinase B/mammalian target of rapamycin(mTOR)(27.3%)and Notch(12.1%)pathways,suggesting their crucial roles in resistance development.Targeted molecules with mTOR(18.2%),CHK1/2(15.2%),and ATP binding cassette G2(12.1%)as frequent targets underscore their im

关键词： Glioma stem cells Chemoresistance Radioresistance Molecular pathways Targeted therapies Systematic review

Current status and future perspectives on stem cell transplantation for spinal cord injury

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World Journal of Transplantation 2024年第1期14卷 189-209页

作者： Edoardo Agosti Marco Zeppieri Andrea Pagnoni Marco Maria Fontanella Alessandro Fiorindi Tamara Ius pier paolo Panciani Division of Neurosurgery Department of Medical and Surgical SpecialtiesRadiological Sciences and Public HealthUniversity of BresciaBrescia 25123Italy Department of Ophthalmology University Hospital of UdineUdine 33100Italy Department of Medical and Surgical Specialties Radiological Sciencesand Public HealthUniversity of BresciaBrescia 25123BSItaly Neurosurgery Unit Head-Neck and NeuroScience DepartmentUniversity Hospital of UdineUdine 33100Italy

BACKGROUND Previous assessments of stem cell therapy for spinal cord injuries(SCI)have encountered challenges and constraints.Current research primarily emphasizes safety in early-phase clinical trials,while systematic reviews prioritize effectiveness,often overlooking safety and translational feasibility.This situation prompts inquiries regarding the readiness for clinical adoption.AIM To offer an up-to-date systematic literature review of clinical trial results concerning stem cell therapy for SCI.METHODS A systematic search was conducted across major medical databases[PubMed,Embase,Reference Citation Analysis(RCA),and Cochrane Library]up to October 14,2023.The search strategy utilized relevant Medical Subject Heading(MeSH)terms and keywords related to"spinal cord","injury","clinical trials","stem cells","functional outcomes",and"adverse events".Studies included in this review consisted of randomized controlled trials and non-randomized controlled trials reporting on the use of stem cell therapies for the treatment of SCI.RESULTS In a comprehensive review of 66 studies on stem cell therapies for SCI,496 papers were initially identified,with 237 chosen for full-text analysis.Among them,236 were deemed eligible after excluding 170 for various reasons.These studies encompassed 1086 patients with varying SCI levels,with cervical injuries being the most common(42.2%).Bone marrow stem cells were the predominant stem cell type used(71.1%),with various administration methods.Follow-up durations averaged around 84.4 months.The 32.7%of patients showed functional improvement from American spinal injury association Impairment Scale(AIS)A to B,40.8%from AIS A to C,5.3%from AIS A to D,and 2.1%from AIS B to C.Sensory improvements were observed in 30.9%of patients.A relatively small number of adverse events were recorded,including fever(15.1%),headaches(4.3%),muscle tension(3.1%),and dizziness(2.6%),highlighting the potential for SCI recovery with stem cell therapy.CONCLUSION In the realm of SCI treatment,stem cell-based thera

关键词： Spinal cord injury Stem cell therapy Adverse events Functional outcomes Systematic review

Role of advanced imaging techniques in the evaluation of oncological therapies in patients with colorectal liver metastases

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World Journal of Gastroenterology 2023年第3期29卷 521-535页

作者： Martina Caruso Arnaldo Stanzione Anna Prinster Laura Micol Pizzuti Arturo Brunetti Simone Maurea pier paolo Mainenti Department of Advanced Biomedical Sciences University of Naples"Federico II"Napoli 80131Italy Institute of Biostructures and Bioimaging National Research CouncilNapoli 80131Italy

In patients with colorectal liver metastasis(CRLMs)unsuitable for surgery,oncological treatments,such as chemotherapy and targeted agents,can be performed.Cross-sectional imaging[computed tomography(CT),magnetic resonance imaging(MRI),18-fluorodexoyglucose positron emission tomography with CT/MRI]evaluates the response of CRLMs to therapy,using post-treatment lesion shrinkage as a qualitative imaging parameter.This point is critical because the risk of toxicity induced by oncological treatments is not always balanced by an effective response to them.Consequently,there is a pressing need to define biomarkers that can predict treatment responses and estimate the likelihood of drug resistance in individual patients.Advanced quantitative imaging(diffusionweighted imaging,perfusion imaging,molecular imaging)allows the in vivo evaluation of specific biological tissue features described as quantitative parameters.Furthermore,radiomics can represent large amounts of numerical and statistical information buried inside cross-sectional images as quantitative parameters.As a result,parametric analysis(PA)translates the numerical data contained in the voxels of each image into quantitative parameters representative of peculiar neoplastic features such as perfusion,structural heterogeneity,cellularity,oxygenation,and glucose consumption.PA could be a potentially useful imaging marker for predicting CRLMs treatment response.This review describes the role of PA applied to cross-sectional imaging in predicting the response to oncological therapies in patients with CRLMs.

关键词： Colorectal cancer metastases Prediction response Computed tomography Magnetic resonance imaging Positron emission tomography Parametric imaging

Congenital Absence of Pericardium:The Largest Systematic Review in the Field on 247 Worldwide Cases(1977-Now)

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Congenital Heart Disease 2023年第6期18卷 595-610页

作者： pier paolo Bassareo Aurelio Secinaro paolo Ciliberti Massimo Chessa Marco Alfonso Perrone Kevin Patrick Walsh Colin Joseph Mcmahon Mater Misericordiae University Hospital National Adult Congenital Heart Disease ServiceDublinD07 R2WYIreland Children’s Health Ireland Crumlin DublinIreland School of Medicine University College of DublinDublinIreland Advanced Cardiovascular Imaging Unit Bambino GesùChildren’s HospitalIRCCSRomeItaly Department of Cardiac Surgery CardiologyHeart and Lung Transplantation Bambino Gesu’Children’s HospitalIRCCSRomeItaly Adult Congenital Heart Disease UNIT Paediatric and Adult Congenital Heart CentreIRCCS-Policlinico San DonatoSan Donato MilaneseMilanItaly School of Medicine Vita Salute San Raffaele UniversityMilanItaly Division of Cardiology and CardioLab Department of Clinical Sciences and Translational MedicineUniversity of Rome Tor VergataRomeItaly

Background:Congenital absence of pericardium(CAP),also known as pericardial agenesis,represents an uncommon cardiac abnormality and mostly incidental finding.It can be subdivided into complete and partial(left or right-sided)forms.Because of its infrequency,just case reports and a few case series have been released so far.This paper represents the largest systematic review in the field.Nine features(age at diagnosis,type,gender,clinical presentation,electrocardiography,imaging(ultrasounds,CT/MRI),concomitant cardiac defects,and outcome)were analysed.Methods:The electronic database PubMed was investigated from its establishment up to July 15th,2023.Just case reports and case series were included.Animal studies,papers that were not in English,Spanish,and Italian,and those manuscripts not reporting at least seven of the nine analysed features.were ruled out.The analysed data were reported mostly in terms of percentage.Results:One hundred eighty studies were included encompassing 247 patients.More than half of reviewed CAP cases were in males(63.2%).The mean age at diagnosis was 31.8±19.3 years;a range of 32 weeks of gestation-81 years).23.5%of the patients did not report any symptoms.The most common clinical presentations were chest pain(35.2%)and dyspnoea(29.2%).The most commonly seen ECG changes were right axis deviation(28.7%)and right bundle branch block(23.9%).CAP was suspected or diagnosed by echocardiography in 20.1%of cases.The diagnosis was made by CT and/or MRI in 61.9%of cases.CAP was left-sided in 71.2%,complete in 23.1%,and right-sided in 5.7%.A concomitant congenital heart defect was found in 22.7%,especially in the form of atrial septal defect(6.5%)and patency of ductus arteriosus(2.8%).The pericardial repair was required in 12.9% of the incomplete forms of the disease.Never did the complete form require surgical correction.The outcome appeared favourable in the vast majority of cases,with just 18 deaths(7.3%).Discussion:The main limitation of this systematic review is that it is based just on case re

关键词： Congenital absence pericardium pericardial agenesis electrocardiography echocardiography computed tomography cardiac magnetic resonance imaging

Isolated left ventricular apical hypoplasia:Systematic review and analysis of the 37 cases reported so far

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世界临床病例杂志 2023年第23期11卷 5494-5503页

作者： pier paolo Bassareo Sophie Duignan Adam James Esme Dunne Colin J McMahon Kevin P Walsh University College of Dublin School of Medicine and Department of Cardiology at Mater Misericordiae University HospitalDublin D07 R2WYIreland Department of Cardiology Children's Health CrumlinDublin D12 N512Ireland University College of Dublin School of Medicine and Department of CardiologyChildren's Health IrelandDublin D12 N512Ireland

BACKGROUND Isolated left ventricular apical hypoplasia(ILVAH),also known as truncated left ventricle(LV),is a very unusual cardiomyopathy.It is characterised by a truncated,spherical,and non-apex forming LV.The true apex is occupied by the right ventricle.Due to the rarity of the disease,just a few case reports and limited case series have been published in the field.AIM To analysing the so far 37 reported ILVAH cases worldwide.METHODS The electronic databases PubMed and Scopus were investigated from their establishment up to December 13,2022.RESULTS The majority of cases reported occurred in males(52.7%).Mean age at diagnosis was 26.1±19.6 years.More than a third of the patients were asymptomatic(35.1%).The most usual clinical presentation was breathlessness(40.5%).The most commonly detected electrocardiogram changes were T wave abnormalities(29.7%)and right axis deviation with poor R wave progression(24.3%).Atrial fibrillation/flutter was detected in 24.3%.Echocardiography was performed in 97.3%of cases and cardiac MRI in 91.9%of cases.Ejection fraction was reduced in more than a half of patients(56.7%).An associated congenital heart disease was found in 16.2%.Heart failure therapy was administered in 35.1%of patients.The outcome was favorable in the vast majority of patients,with just one death.CONCLUSION ILVAH is a multifaceted entity with a so far unpredictable course,ranging from benign until the elderly to sudden death during adolescence.

关键词： Isolated left ventricular apical hypoplasia Truncated left ventricle Electrocardiography Echocardiography Cardiac magnetic resonance imaging Heart failure

Congruent responses of vascular plant and ant communities to pastoral land-use abandonment in mountain areas throughout different biogeographic regions

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Ecological Processes 2022年第1期11卷 469-482页

作者： Marcello Verdinelli Marco Pittarello Maria Carmela Caria Giovanna Piga pier paolo Roggero Gian Marco Marrosu Stefano Arrizza Maria Leonarda Fadda Giampiero Lombardi Michele Lonati Ginevra Nota Maria Sitzia Simonetta Bagella Institute of BioEconomy(CNR IBE) National Research Council of Italy07100 SassariItaly Department of Agricultural Forestand Food Science(DIS-AFA)University of TorinoTorinoItaly Department of Chemistry and Pharmacy University of Sassari07100 SassariItaly Department of Agricultural Sciences University of Sassari07100 SassariItaly Desertification Research Center University of Sassari07100 SassariItaly AGRIS Sardegna Loc.Bonassai07100 SassariItaly

Background:There is a long-term trend towards the abandonment of agro-pastoral activities in the mountain areas of Europe:the following encroachment process of semi-natural grasslands by shrubs is one of the main severe threats to the conservation of biodiversity in mountain environments.To better understand the impact of land abandonment,we analysed the reliability of plant functional groups,ant traits,and ant functional groups as indicators of land use changes.We carried out the research in Italy at four sites along a latitudinal/altitudinal gradient in three biogeo-graphic regions(Mediterranean,Continental,Alpine).We identified three stages of a chronosequence at each site as representative of the plant succession in response to pastoral land-use abandonment.Results:As expected,both the plant and ant assemblages considerably differed across sites at the species level and,within each site,among the three stages.This trend was found also using ant traits,functional groups of ants,and plant functional groups.Ant and plant communities were related in terms of composition and functionality.Harvester ants and ants with collective foraging strategy were associated with annual legumes and grasses(Therophytes);ants with a strictly individual foraging strategy with Phanerophytes.Ant traits and plant functional groups indicated significant differences among the three stages of the chronosequence.However,ant functional groups could not discriminate between the stages represented by secondary grasslands currently grazed and shrub-encroached grasslands ungrazed.Conclusion:Despite some limitations of ant functional groups in explaining the succession stages of land abandonment,our results suggest that ants are a good surrogate taxon and might be used as bioindicators of land-use changes and ecosystem functioning.Furthermore,our findings indicate that the functional group approach should be applied to other European ecosystems.Finally,reducing the taxonomic complexity could contribute to developing predictive models to detect

关键词： Biodiversity conservation Bioindicators Cross-taxon congruence Functional groups Land abandonment Monitoring Mountain pastures

The reuse of abandoned Acquaresi mine voids for storage of the Masua flotation tailings

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International Journal of Coal Science & Technology 2014年第2期1卷 213-220页

作者： pier paolo Manca paolo Desogus Giampaolo Orru DICAAR Department of Civil EngineeringEnvironmental and ArchitectureUniversity of CagliariCagliariItaly

Often in abandoned mine sites are present both underground voids produced by mining and the tailings of treatment plant.An interesting solution for the rehabilitation of the sites would be to place the tailings of the process in the underground mining voids,thus obtaining the reclamation of surface areas and the stabilization of abandoned voids to prevent the dangerous phenomena of subsidence.However,these operations require inert waste,which must not be source of pollution,and the choice of a water/solid optimum to ensure good conditions of pumpability.

关键词： Acquaresi mine Mine voids Masua Flotation tailings

Radiomics and machine learning applications in rectal cancer:Current update and future perspectives

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World Journal of Gastroenterology 2021年第32期27卷 5306-5321页

作者： Arnaldo Stanzione Francesco Verde Valeria Romeo Francesca Boccadifuoco pier paolo Mainenti Simone Maurea Department of Advanced Biomedical Sciences University of Naples"Federico II"Naples 80131Italy Institute of Biostructures and Bioimaging National Council of ResearchNapoli 80131Italy

The high incidence of rectal cancer in both sexes makes it one of the most common tumors,with significant morbidity and mortality rates.To define the best treatment option and optimize patient outcome,several rectal cancer biological variables must be evaluated.Currently,medical imaging plays a crucial role in the characterization of this disease,and it often requires a multimodal approach.Magnetic resonance imaging is the first-choice imaging modality for local staging and restaging and can be used to detect high-risk prognostic factors.Computed tomography is widely adopted for the detection of distant metastases.However,conventional imaging has recognized limitations,and many rectal cancer characteristics remain assessable only after surgery and histopathology evaluation.There is a growing interest in artificial intelligence applications in medicine,and imaging is by no means an exception.The introduction of radiomics,which allows the extraction of quantitative features that reflect tumor heterogeneity,allows the mining of data in medical images and paved the way for the identification of potential new imaging biomarkers.To manage such a huge amount of data,the use of machine learning algorithms has been proposed.Indeed,without prior explicit programming,they can be employed to build prediction models to support clinical decision making.In this review,current applications and future perspectives of artificial intelligence in medical imaging of rectal cancer are presented,with an imaging modality-based approach and a keen eye on unsolved issues.The results are promising,but the road ahead for translation in clinical practice is rather long.

关键词： Rectal cancer Radiomics Radiogenomics Artificial intelligence Machine learning Deep learning