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Single balloon enteroscopy: Technical aspects and clinical applications

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World Journal of Gastrointestinal Endoscopy 2012年第2期4卷 28-32页

作者： Mauro Manno Carmelo Barbera Helga Bertani raffaele Manta Vincenzo Giorgio Mirante Emanuele Dabizzi Angelo Caruso Flavia Pigo Giampiero Olivetti Rita Conigliaro Gastroenterology and digestive Endoscopy Unit New S. Agostino Estense Civil Hospital 41126 Baggiovara di Modena Italy

The small bowel has long been considered a black box for endoscopists because of its long length and the presence of multiple complex loop. Most of the small bowel is inaccessible by traditional endoscopic means. In addition, radiographic studies have significant limitations with regard to diagnostic yield, and surgery is an invasive alternative. This limitation was overcome through the development of balloon enteroscopy that becomes established throughout the world for diagnostic and therapeutic examinations of the small bowel. The single-balloon enteroscope (SBE) system (Olympus, Tokyo, Japan) was introduced into the commercial market in 2007. Several study demonstrated its efficacy and safety. Early reports on the use of singleballoon enteroscopy have suggested a high diagnostic yield and similar therapeutic potential to that of the double-balloon endoscope. SBE is viable technique for in the management of small bowel disease. Technically, it is easy to perform, may be efficient, and in the literature data available, seems to provide high diagnostic and therapeutic yield.

关键词： Single balloon enteroscopy Small bowel Enteroscopy

Monitoring recovery by physical therapists using the FIM scale during rehabilitation programs: An inter-rater and intra-rater reproducibility study

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Health 2013年第6期5卷 99-104页

作者： Tommasina Russo Giorgio Felzani Mario Giunta Cristina di Mascio Carmine Marini Casa di Cura “San raffaele” di Sulmona L’Aquila Italy Department of Medicina Interna e Sanità Pubblica University of L’Aquila L’Aquila Italy

Our aim was to evaluate the reproducibility of the Functional Independence Measure (FIM) scale when assessed by physical therapists in the routine setting of a Rehabilitation Hospital. We included a consecutive series of patients with spinal cord or cerebral lesions. Each of the 50 selected patients was evaluated by two of the 5 experienced physical therapists participating in the study. The degree of inter-rater and intrarater agreement was measured by a weighted k statistic, k for perfect agreement, and k for the agreement with tolerance. The weighted k index for inter-rater agreement on the FIM score was in the almost perfect range (k 0.87;95% CI = 0.79 - 0.95), but a 20-point tolerance was necessary to reach a k value of 0.81 (95% CI = 0.66 - 0.95). Agreement was substantial or almost perfect for most subscales, but the k index with 1-point tolerance reached the almost perfect rating for comprehension only. For intra-rater agreement, weighted k index was in the almost perfect range for the FIM score and for all subscales;kappa index reached the almost perfect range with a 4-point tolerance for FIM score and with 1-point of tolerance for all subscales except interpersonal relations. FIM is useful to monitor patient improvement during rehabilitation treatment, mostly when assessed by the same physical therapist.

关键词： Reproducibility Rehabilitation Functional Independence Measure

dilation assisted stone extraction for complex biliary lithiasis:Technical aspects and practical principles

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World Journal of Gastrointestinal Endoscopy 2021年第2期13卷 33-44页

作者： Giuseppe Grande Silvia Cocca Helga Bertani Angelo Caruso Flavia Pigo' Santi Mangiafico Salvatore Russo Marinella Lupo Graziella Masciangelo Paolo Cantu' raffaele Manta Rita Conigliaro Gastroenterology and digestive Endoscopy Unit Azienda Ospedaliero Universitaria di ModenaModena 41126Italy Gastroenterology and Endoscopy Unit Department of Pathophysiology and TransplantationFondazione IRCCS Ca’GrandaOspedale Maggiore Policlinico and Universitàdegli Studi di MilanoMilano 20122Italy Gastroenterology and digestive Endoscopy Unit General Hospital of PerugiaPerugia 06129Italy

Common bile duct stones are frequently diagnosed worldwide and are one of the main indications for endoscopic retrograde *** sphincterotomy(EST)has been used for the removal of bile duct stones for the past 40 years,providing a wide opening to allow *** to 15%of patients present with complicated *** this context,additional therapeutic approaches have been proposed such as endoscopic mechanical lithotripsy,intraductal or extracorporeal lithotripsy,or endoscopic papillary large balloon dilation(EPLBD).EPLBD combined with EST was introduced in 2003 to facilitate the passage of large or multiple bile duct stones using a balloon greater than 12 mm in *** without EST was introduced as a simplified technique in ***-assisted stone extraction(DASE)is the combination of two techniques:EPLBD and sub-maximal *** studies have reported this technique as safe and effective in patients with large bile duct stones,without any increased risk of adverse events such as pancreatitis,bleeding,or ***,it is difficult to analyze the outcomes of DASE because there are no standard techniques and definitions between *** purpose of this paper is to provide technical guidance and specific information about the main issues regarding DASE,based on current literature and daily clinical experience in biliary referral centers.

关键词： dilation-assisted stone extraction Endoscopic papillary large balloon dilation Macrolithiasis difficult choledochiolithiasis Stone treatment Common bile duct stones Endoscopic retrograde cholangiopancreatography

Patient selection for transcatheter aortic valve replacement:A combined clinical and multimodality imaging approach

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World Journal of Cardiology 2017年第3期9卷 212-229页

作者： Rosangela Cocchia Antonello D’Andrea Marianna Conte Massimo Cavallaro Lucia Riegler Rodolfo Citro Cesare Sirignano Massimo Imbriaco Maurizio Cappelli Giovanni Gregorio raffaele Calabrò Eduardo Bossone Department of Cardiology and Cardiac Surgery San Giovanni di Dio Hospital00733 SalernItaly Integrated diagnostic Cardiology Second University of NaplesAORN“dei Colli”Monaldi Hospital80121 NaplesItaly Institute of Biostructure and Bioimaging National Research Council 80121 NaplesItaly Department of Advanced Biomedical Sciences University Federico II80121 NaplesItaly Department of Cardiology San Luca HospitalVallo della Lucania00733 SalernItaly

Transcatheter aortic valve replacement(TAVR) has been validated as a new therapy for patients affected by severe symptomatic aortic stenosis who are not eligible for surgical intervention because of major contraindication or high operative risk. Patient selection for TAVR should be based not only on accurate assessment of aortic stenosis morphology, but also on several clinical and functional data. Multi-Imaging modalities should be preferred for assessing the anatomy and the dimensions of the aortic valve and annulus before TAVR. Ultrasounds represent the first line tool in evaluation of this patients giving detailed anatomic description of aortic valve complex and allowing estimating with enough reliability the hemodynamic entity of valvular stenosis. Angiography should be used to assess coronary involvement and plan a revascularization strategy before the implant. Multislice computed tomography play a central role as it can give anatomical details in order to choice the best fitting prosthesis, evaluate the morphology of the access path and detect other relevant comorbidities. Cardiovascular magnetic resonance and positron emission tomography are emergent modality helpful in aortic stenosis evaluation. The aim of this review is to give an overview onTAVR clinical and technical aspects essential for adequate selection.

关键词： Aortic stenosis Doppler echocardiography Cardiac computed tomography Two-dimensional strain Three dimensional echocardiography Cardiac magnetic resonance Transcatheter aortic valve replacement

Enhanced characterization of solid solitary pulmonary nodules with Bayesian analysis-based computer-aided diagnosis

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World Journal of Radiology 2016年第8期8卷 729-734页

作者： Simone Perandini Gian Alberto Soardi Massimiliano Motton raffaele Augelli Chiara Dallaserra Gino Puntel Arianna Rossi Giuseppe Sala Manuel Signorini Laura Spezia Federico Zamboni Stefania Montemezzi Department of Radiology Azienda Ospedaliera Universitaria Integrata di Verona

The aim of this study was to prospectively assess the accuracy gain of Bayesian analysis-based computeraided diagnosis(CAD) vs human judgment alone in characterizing solitary pulmonary nodules(SPNs) at computed tomography(CT). The study included 100 randomly selected SPNs with a definitive diagnosis. Nodule features at first and follow-up CT scans as well as clinical data were evaluated individually on a 1 to 5 points risk chart by 7 radiologists, firstly blinded then aware of Bayesian Inference Malignancy Calculator(BIMC) model predictions. Raters' predictions were evaluated by means of receiver operating characteristic(ROC) curve analysis and decision analysis. Overall ROC area under the curve was 0.758 before and 0.803 after the disclosure of CAD predictions(P = 0.003). A net gain in diagnostic accuracy was found in 6 out of 7 readers. Mean risk class of benign nodules dropped from 2.48 to 2.29, while mean risk class of malignancies rose from 3.66 to 3.92. Awareness of CAD predictions also determined a significant drop on mean indeterminate SPNs(15 vs 23.86 SPNs) and raised the mean number of correct and confident diagnoses(mean 39.57 vs 25.71 SPNs). This study provides evidence supporting the integration of the Bayesian analysis-based BIMC model in SPN characterization.

关键词： Solitary pulmonary nodule Computer-aided diagnosis Lung neoplasms Multidetector computed tomography Bayesian prediction

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钢与混凝土组合基柱连接的非弹性响应

钢结构(中英文) 2008年第1期 83-83页

作者： L.di sarno M.R.Peccea G.Fabbrocino

对部分包裹的钢-混组合柱进行了单调推倒荷载试验,并评估了结果,柱与基础块的连接采用传统的栓接钢底板和一种创新的插入式体系。试验显示,传统连接形式的结构响应受锚固螺栓性能的影响显著,锚固螺栓引起较大的固定端旋转并消耗一定的能... 详细信息

对部分包裹的钢-混组合柱进行了单调推倒荷载试验,并评估了结果,柱与基础块的连接采用传统的栓接钢底板和一种创新的插入式体系。试验显示,传统连接形式的结构响应受锚固螺栓性能的影响显著,锚固螺栓引起较大的固定端旋转并消耗一定的能量,相反地,创新型的钢-混组合基础柱插入式连接系统表现出足够的承载力、非弹性变形和能量吸收能力。而且,通过在组合柱基础的非弹性传递,插入式连接具有不破坏混凝土和构件界面的特性。新型连接形式对于框架结构满足承载设计要求,例如在地震易发区域,是可行的解决方法。

关键词：组合柱部分包裹柱基础柱节点插入式连接超高强度延性能耗

Fertility preservation in female cancer patients:a single center experience

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Chinese Journal of Cancer 2015年第1期34卷 56-60页

作者： Cristina Sigismondi Enrico Papaleo Paola Viganò Simona Vailati Massimo Candiani Jessica Ottolina Valentina E. di Mattei Giorgia Mangili Gynecology Department Preservation of Fertility Unit IRCCS San Raffaele Hospital

Advances in cancer treatment allow women to be cured and live longer. However, the necessary chemotherapy and radiotherapy regimens have a negative impact on future fertility. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer treatment and to facilitate fertility preservation, including oocyte and ovarian tissue cryopreservation. These fertility issues are often inadequately addressed, and referral rates to oncofertility centers are low. The aim of this study was to report the 3-year experience of the San raffaele Oncofertility Unit. A total of 96 patients were referred to the Oncofertility Unit for evaluation after the diagnosis of cancer and before gonadotoxic treatment between April 2011 and June 2014. Of the 96 patients, 30(31.2%) were affected by breast cancers, 20(20.8%) by sarcomas, 28(29.2%) by hematologic malignancies, 13(13.5%) by central nervous system cancers, 3(3.1%) by bowel tumors, 1(1.0%) by Wilms' tumor, and 1(1.0%) by a thyroid tumor; 47(49.0%) were referred for oocyte cryopreservation before starting chemotherapy, 20(20.8%) were referred for ovarian tissue cryopreservation, and 29(30.2%) were not recruited. The mean time between the patients' counseling and oocyte retrieval was 15 days(range, 2–37 days). The mean time between the laparoscopic surgery and the beginning of treatment was 4 days(range, 2–10 days). The number of patients who were referred increased over time, whereas the rate of patients who were not recruited decreased, showing an improvement in referrals to the Oncofertility Unit and in the patients' counseling and understanding. Our results indicate that an effective multidisciplinary oncofertility team is necessary for prompt referrals and treatment.

关键词：癌症患者生育功能癌症治疗女性冷冻保存中枢神经系统平均时间卵巢组织

海洋来源的抗肿瘤活性化合物及其作用靶点的发现

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海洋来源的抗肿瘤活性化合物及其作用靶点的发现

Effectiveness of very low-volume preparation for colonoscopy:A prospective, multicenter observational study

“全球变化下的海洋与湖沼生态安全”学术交流会

作者：孙鹏庄春林李铁军 raffaele Riccio 张文第二军医大学药学院海洋药物研究室 dipartimento di Farmacia Universita’di SalernoVia Giovanni PaoloⅡ 132 84084 Fisciano(SA)Italy

目的:海洋生物是抗肿瘤活性先导化合物的丰富来源,最近几年我们课题组一直在致力于从海洋生物中,包括海绵、珊瑚等无脊椎动物及其共附生的海洋微生物,发现具有抗肿瘤活性的先导化合物,研究发现了一些结构新颖、活性显著的活性化合物。方... 详细信息

目的:海洋生物是抗肿瘤活性先导化合物的丰富来源,最近几年我们课题组一直在致力于从海洋生物中,包括海绵、珊瑚等无脊椎动物及其共附生的海洋微生物,发现具有抗肿瘤活性的先导化合物,研究发现了一些结构新颖、活性显著的活性化合物。方法:这些化合物大多具有新颖的结构,不少具有柔性的大环分子骨架。我们综合采用NMR波谱解析、单晶X-ray衍射、改良Mosher法、TDDFT/ECD计算以及化学沟通等多种方法,确定了它们的化学结构和绝对构型。含量低是海洋天然产物的一个显著特点,这限制了广泛的活性筛选和作用机制研究,也大大影响了全面的药效评价,如何研究这些微量化合物的的作用靶点是大家普遍面临的难点问题。结果:最近我们采用计算机辅助的反向虚拟筛选技术来预测新天然产物的可能结合蛋白,在这个方面取得了一些突破。例如,我们从海绵Theonella swinhoei中发现了一类结构新颖的重排甾体新骨架swinhoeisterols A和B,利用反向虚拟筛选技术成功预测到了它的蛋白作用靶点为h（P300）,并进行了生物学实验验证。结论:这一方法为开发海洋抗肿瘤先导化合物提供了一种天然产物发现和计算机辅助技术相整合的新策略。

关键词：海洋无脊椎动物抗肿瘤靶点发现绝对构型反向虚拟筛选

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World Journal of Gastroenterology 2020年第16期26卷 1950-1961页

作者： Marcello Maida Emanuele Sinagra Gaetano Cristian Morreale Sandro Sferrazza Giuseppe Scalisi Dario Schillaci Marco Ventimiglia Fabio Salvatore Macaluso Giovanni Vettori Giuseppe Conoscenti Concetta di Bartolo Serena Garufi Domenico Catarella Michele Manganaro Clara Maria Virgilio Salvatore Camilleri Gastroenterology and Endoscopy Unit S.Elia-Raimondi HospitalCaltanissetta 93100Italy Gastroenterology and Endoscopy Unit Istituto San Raffaele GiglioCefalu 90015Italy Gastroenterology and Endoscopy Unit Santa Chiara HospitalTrento 38014Italy Gastroenterology Unit ARNAS GaribaldiCatania 95100Italy Gastroenterology Unit Basarocco HospitalNiscemi 93015CaltanissettaItaly Department of Internal Medicine Villa Sofia-Cervello HospitalPalermo 90100Italy

BACKGROUND The effectiveness of colonoscopy strictly depends on adequate bowel ***,a 1 L polyethylene glycol plus ascorbate(PEG-ASC)solution(Plenvu;Norgine,Harefield,United Kingdom)has been introduced on the evidence of three phase-3 randomized controlled trials,but it had never been tested in the *** To assess the effectiveness and tolerability of the 1 L preparation compared to 4 L and 2 L-PEG solutions in a real-life *** All patients undergoing a screening or diagnostic colonoscopy after a 4,2 or 1 L PEG preparation,were consecutively enrolled in 5 Italian centers from September 2018 to February *** primary endpoints of the study were the assessment of bowel cleansing success and high-quality cleansing of the right *** secondary endpoints were the evaluation of tolerability,adherence and safety of the different bowel *** cleansing was assessed through the Boston Bowel Preparation *** was defined as consumption of at least 75%of each dose,while tolerability was evaluated through a semiquantitative *** was systematically monitored through adverse events *** Overall,1289 met the inclusion criteria and were enrolled in the *** these,490 patients performed a 4 L-PEG preparation(Selgesse^■),566 a 2 L-PEG cleansing(Moviprep^■or Clensia^■)and 233 a 1 L-PEG preparation(Plenvu^■).Bowel cleansing by Boston Bowel Preparation Scale was 6.5±1.5 overall and 6.3±1.5,6.2±1.5,7.3±1.5(P<0.001)in the subgroups of 4 L,2 L and 1 L-PEG preparation,*** success was achieved in 72.4%,74.1%and 90.1%(P<0.001),while a high-quality cleansing of the right colon in 15.9%,12.0%and 41.4%(P<0.001)for 4 L,2 L and 1 L-PEG preparation groups,*** 1 L preparation was the most tolerated compared to the 2 and 4 L-PEG solutions in the absence of serious adverse events within any of the three *** regression models confirmed 1 L PEG-ASC preparation as an independ

关键词： Colonoscopy Bowel preparation Polyethylene glycol Polyethylene glycolplus ascorbate Effectiveness Tolerability