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Rituximab-induced IgG hypogammaglobulinemia in children with nephrotic syndrome and normal pre-treatment IgG values

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World Journal of Clinical Cases 2019年第9期7卷 1021-1027页

作者： Pierluigi Marzuillo Stefano Guarino Tiziana Esposito Anna Di Sessa sara Immacolata Orsini Daniela Capalbo Emanuele Miraglia del Giudice Angela la manna Department of Woman Child and of General and Specialized Surgery Università degli Studi della Campania "Luigi Vanvitelli"

BACKGROUND In paediatric patients with complicated nephrotic syndrome(NS), rituximab(RTX) administration can induce persistent IgG hypogammaglobulinemia among subjects showing low basal immunoglobulin G(IgG) *** To evaluate the effect of RTX on IgG levels and infections in patients with complicated NS and normal basal IgG *** We consecutively enrolled all patients with complicated NS and normal basal IgG levels undergoing the first RTX infusion from January 2008 to January 2016. Basal IgG levels were dosed after 6 wk of absent proteinuria and with a maximal interval of 3 mo before RTX infusion. The primary outcome was the onset of IgG hypogammaglobulinemia during the follow-up according to the IgG normal values for age [mean ± standard deviation(SD)].RESULTS We enrolled 20 patients with mean age at NS diagnosis of 4.2 ± 3.3 years. The mean age at the first RTX infusion was 10.9 ± 3.5 years. Eleven out of twenty patients(55%) developed IgG hypogammaglobulinemia. None of these patients showed severe or recurrent infections. Only one patient suffered from recurrent acute otitis media and underwent substitutive IgG infusion. Three patients undergoing only the two "starting doses" experienced normalization of IgG levels. Using Kaplan-Meier analysis, the cumulative proportion of patients free of IgG hypogammaglobulinemia was 57.8% after the first RTX dose, 51.5% after the third dose, 44.1% after the fourth dose, and 35.5% after the fifth *** RTX can induce IgG hypogammaglobulinemia in patients with pre-RTX IgG normal values. None of the treated patients showed severe infections.

关键词： Nephrotic syndrome Rituximab IgG hypogammaglobulinemia Immunoglobulin

Benefits of minimally invasive surgery in the treatment of gastric cancer

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World Journal of Gastroenterology 2022年第30期28卷 4227-4230页

作者： Simone Sibio Francesca la Rovere sara Di Carlo Department of Surgery P.Valdoni Unit of Oncologic and Minimally Invasive SurgerySapienza University of RomeUmberto I University HospitalRome 00161Italy Minimally Invasive Surgery Unit Department of SurgeryTor Vergata UniversityRome 00133Italy

We read with great interest the article that retrospectively analyzed 814 patients with primary gastric cancer,who underwent minimally invasive R0 gastrectomy between 2009 and 2014 by grouping them in laparoscopic vs robotic *** results of the study highlighted that age,American Society of Anesthesiologists status,gastrectomy type and pathological T and N status were the main prognostic factors of minimally invasive gastrectomy and showed how the robotic approach may improve long-term outcomes of advanced gastric *** to most of the current literature,robotic surgery is associated with a statistically longer operating time when compared to open and laparoscopic surgery;however,looking at the adequacy of resection,defined by negative surgical margins and number of lymph nodes removed,it seems that robotic surgery gives better results in terms of the 5-year overall survival and recurrencefree *** robotic approach to gastric cancer surgery aims to overcome the difficulties and technical limitations of laparoscopy in major *** threedimensional vision,articulation of the instruments and good ergonomics for the surgeon allow for accurate and precise movements which facilitate the complex steps of surgery such as lymph node dissection,esophagus-jejunal anastomosis packaging and reproducing the technical accuracy of open *** the literature,as well as the analyzed study,offers us countless data regarding the short-term oncological results of robotic surgery in the treatment of gastric cancer,satisfactory data on long-term follow-up are lacking,so future studies are necessary.

关键词： Gastric cancer Robotic gastrectomy laparoscopy D2 lymphadenectomy Long-term outcomes Morbidity

Serum biomarkers and risk of hepatocellular carcinoma recurrence after liver transplantation

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World Journal of Hepatology 2019年第1期11卷 50-63页

作者： Maria J Citores Jose L Lucena sara de la Fuente Valentin Cuervas-Mons Department of Internal Medicine Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana Liver Transplantation Unit Hospital Universitario Puerta de Hierro-Majadahonda Department of Surgery Hospital Universitario Puerta de Hierro-Majadahonda Valentin Cuervas-Mons Department of Internal Medicine HospitalUniversitario Puerta de Hierro-Majadahonda Department of Medicine Universidad Autónoma de Madrid

Liver transplantation(LT) is the only potentially curative treatment for selected patients with cirrhosis and hepatocellular carcinoma(HCC) who are not candidates for resection. When the Milan criteria are strictly applied, 75% to85%of 3-to 4-year actuarial survival rates are achieved, but up to 20% of the patients experience HCC recurrence after transplantation. The Milan criteria are based on the preoperative tumor macromorphology, tumor size and number on computed tomography or magnetic resonance imaging that neither correlate well with posttransplant histological study of the liver explant nor accurately predict HCC recurrence after LT, since they do not include objective measures of tumor biology. Preoperative biological markers, including alpha-fetoprotein, desgamma-carboxiprothrombin or neutrophil-to-lymphocyte ratio and platelet-tolymphocyte ratio, can predict the risk for HCC recurrence after *** biomarkers have been proposed as surrogate markers of tumor differentiation and vascular invasion, with varied risk magnitudes depending on the defined cutoffs. Different studies have shown that the combination of one or several biomarkers integrated into prognostic models predict the risk of HCC recurrence after LT more accurately than Milan criteria alone. In this review, we focus on the potential utility of these serum biological markers to improve the performance of Milan criteria to identify patients at high risk of tumoral Published online: January 27, 2019 recurrence after *** transplantation(LT) is the only potentially curative treatment for selected patients with cirrhosis and hepatocellular carcinoma(HCC) who are not candidates for resection. When the Milan criteria are strictly applied, 75% to85%of 3-to 4-year actuarial survival rates are achieved, but up to 20% of the patients experience HCC recurrence after transplantation. The Milan criteria are based on the preoperative tumor macromorphology, tumor size and number on computed t

关键词： Hepatocellular carcinoma Liver transplantation Recurrence Selection criteria Prognostic score Biomarker Alpha-fetoprotein Systemic inflammatory marker

The variability of juvenile dispersal in an opportunistic raptor

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Current Zoology 2023年第3期69卷 244-254页

作者： Jorge Garcia-Macia Gabriel Lopez-Poveda Javier De la Puente Ana Bermejo-Bermejo Manuel Galan Ernesto Alvarez sara Morollon Vicente Urios Vertebrates Zoology Research Group University of AlicanteApdo.99E-03080 AlicanteSpain SEO/BirdLife Bird Monitoring UnitC/Melquiades Biencinto34E-28053MadridSpain GREFA C/MontedelPilarS/NE-28220 MajadahondaMadridSpain

The juvenile dispersal of raptors is a crucial stage that stretches from parental independence to the establishment of the first breeding *** 2012 and 2020,44 juvenile red kites Milvus milvus from the Spanish breeding population were tagged using GPS telemetry to study their *** left the parental breeding area at the end of their first summer and performed wandering movements throughout the Iberian Peninsula,returning to the parental breeding area the following year,repeating the same pattern until they settled in their first breeding *** analyzed the mean distance from the nest,the maximum reached distances,and the traveled distances(daily and hourly)during the first 2 years of dispersal and compared *** the high individual variability,variables describing the dispersal movements of juveniles showed a decreasing trend during the second dispersal year:80% of individuals reached a shorter maximum distance in the second year,70% decreased their mean distance to the nest,65% decreased their hourly traveled distances,and 50% decreased their daily traveled *** the other hand,the red kites usually combined wandering movements with the establishment of temporary settlement areas(TSA).The average duration of settlement in the TSAs was 75±40 days(up to 182 days)and was located at 182±168 km from the *** those areas,juveniles used 781.0±1895.0 km^(2)(KDE 95%).Some of the TSAs were used by several individuals,which suggests that these areas might be good targets for conservation in future management plans.

关键词： GPS telemetry landfills movement ecology natal dispersal red kite spatial ecology

Dose escalation of adalimumab as a strategy to overcome anti-drug antibodies:A case report of infantile-onset inflammatory bowel disease

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World Journal of Gastroenterology 2023年第38期29卷 5428-5434页

作者： Silvana Ancona sara Signa Chiara Longo Giuliana Cangemi Roberta Carfora Enrico Drago Alessandro la Rosa Marco Crocco Andrea Chiaro Paolo Gandullia Serena Arrigo Dipartimento di Neuroscienze RiabilitazioneOftalmologiaGenetica e Scienze Materno-Infantili(DINOGMI)Universitàdegli Studi di GenovaGenova 16126Italy Pediatric Gastroenterology and Endoscopy Unit IRCCS Istituto Giannina GasliniGenova 16147Italy Chromatography and Mass Spectrometry Section Central Laboratory of AnalysisIRCCS Istituto Giannina GasliniGenova 16147Italy

BACKGROUND Treatment of infantile-onset inflammatory bowel disease(IO-IBD)is often challenging due to its aggressive disease course and failure of standard therapies with a need for *** loss of response is frequently caused by the production of anti-drug antibodies,a well-known problem in IBD patients on biologic *** present a case of IO-IBD treated with therapeutic drug monitoring(TDM)-guided high-dose anti-tumor necrosis factor therapy,in which dose escalation monitoring was used as a strategy to overcome anti-drug *** SUMMARY A 5-mo-old boy presented with a history of persistent hematochezia from the 10th d of life,as well as relapsing perianal abscess and growth ***,anemia,and elevated inflammatory markers were also *** assessment revealed skip lesions with deep colic ulcerations,inflammatory anal sub-stenosis,and deep fissures with persistent abscess.A diagnosis of IO-IBD Crohn-like was *** patient was initially treated with oral steroids and *** the perianal abscess healed,adalimumab(ADA)was administered with concomitant gradual tapering of *** and biochemical steroid-free remission was achieved with good trough *** 3 mo,antibodies to ADA(ATA)were found with undetectable trough levels;therefore,we optimized the therapy schedule,first administering 10 mg weekly and subsequently up to 20 mg weekly(2.8 mg/kg/dose).After 2 mo of high-dose treatment,ATA disappeared,with concomitant high trough levels and stable clinical and biochemical remission of the *** TDM-guided high-dose ADA treatment as a monotherapy overcame ATA *** strategy could be a good alternative to combination therapy,especially in very young patients.

关键词： Infantile-onset inflammatory bowel disease Adalimumab Loss of response Dose escalation Anti-drug antibodies Case report

Fuzzy-entropy based robust optimization criteria for tuned mass dampers

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Earthquake Engineering and Engineering Vibration 2010年第2期9卷 285-294页

作者： Giuseppe Carlo Marano Giuseppe Quaranta sara Sgobba Department of Environmental Engineering and Sustainable Development Technical University of Bari Department of Structural Engineering and Geotechnics University of Rome "La Sapienza" Faculty of Engineering International University UNINETTUNO

Tuned mass dampers (TMD) are well known as one of the most widely adopted devices in vibration control passive strategies. In the past few decades,many methods have been developed to find the optimal parameters of a TMD installed on a structure and subjected to a random base excitation process,but most of them are usually based on an implicit assumption that all of the structural parameters are deterministic. However,in many real cases this simplification is unacceptable,so robust optimal design criteria becomes aviable alternative to better support engineers in the design process. In Robust Design Optimization (RDO) approaches,indeed the solution must be able to not only minimize the performance but also to limitits variation induced by uncertainty. Most of the currently available RDO methods are based on a probabilistic description of the model uncertainty,even if in many cases they are not able to explicitly include the influence of all the possible sources of uncertainties. Therefore,in this study,a fuzzy version of the robust TMD design optimization problem is proposed. The consistency of the fuzzy approach is studied with respect to the available non-probabilistic formulations reported in the literature and an application to an example of a robust design of a linear TMD subjected to base random vibrations in the presence of fuzzy uncertainties. The results show that the proposed fuzzy-based approach is able to give a set of optimal solutions both in terms of structural efficiency and sensitivity to mechanical and environmental uncertainties.

关键词： tuned mass damper random vibration robust design fuzzy variable expected value fuzzy entropy

latest developments on the mechanism of action of membrane disrupting peptides

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Biophysics Reports 2021年第3期7卷 173-184页

作者： sara Pandidan Adam Mechler la Trobe Institute for Molecular Science La Trobe University

Antimicrobial peptides(AMPs) are integral components of the innate immune defence system of all complex organisms including plants, insects, and mammals. They have wide range of antibacterial, antifungal, antiviral, and even anticancer activities, therefore AMPs are attractive candidates for developing novel therapeutic approaches. Cationic α-helical membrane disrupting peptides are perhaps the most widely studied subclass of AMPs due to their common fundamental characteristics that allow for detailed structure-function analysis and therefore offer a promising solution to the threat of multidrug resistant strains of bacteria. The majority of the studies of AMP activity focused on the biological and biophysical aspects of membrane disruption; the understanding of the molecular mechanism of action from the physicochemical point of view forms a relatively small subfield. This review will provide an overview of these works, focusing on the empirical and thermodynamic models of AMP action.

关键词： Antimicrobial peptides (AMPs) Membrane disrupting peptides Empirical models Thermodynamic models

Osteopontin and the immune system:another brick in the wall

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Cellular & Molecular Immunology 2018年第4期15卷 405-407页

作者： sara Caputo Matteo Bellone Cellular Immunology Unit Department of ImmunologyTransplantation and Infectious DiseasesSan Raffaele Scientific Institute20132 MilanItaly

The innate and adaptive arms of the immune system are finely tuned to efficiently react to either endogenous or exogenous noxiae that perturb the function of our tissues and organs,thus rapidly returning to homeostasis with minimal collateral *** molecular mechanisms by which this occurs have been only partially *** work by Kanayama et al.1 contributes to the building of this wall of knowledge by adding an important *** show that osteopontin(OPN),a phosphorylated protein of the extracellular matrix(ECM),has a dominant role in balancing lymphoid and myeloid cells during emergency granulopoiesis(that is,an increased cellular output from the bone marrow to meet the acute demand for the respective blood cell type).2 OPN that is produced and released by bone marrow(BM)stromal cells negatively impacts the pool size of hematopoietic stem cells(that is,Lin−Sca-1+c-kit+).

关键词： organs al. endogenous

Factors influencing response to ingenol mebutate therapy for actinic keratosis of face and scalp

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World Journal of Clinical Oncology 2017年第5期8卷 405-411页

作者： Nevena Skroza Ilaria Proietti Nicoletta Bernardini Veronica Balduzzi Alessandra Mambrin Anna Marchesiello Ersilia Tolino sara Zuber Giuseppe la Torre Concetta Potenza Dermatology Unit "Daniele Innocenzi" Department of Medical and Surgical Sciences and BiotechnologiesSapienza University of Rome Department of Public Health and Infectious Diseases Sapienza University of Rome

AIM To determine factors independently influencing response to ingenol mebutate therapy and assess efficacy on clinical setting of non-hypertrophic non-hyperkeratotic actinic keratosis (AK).METHODS Consecutive patients affected by non-hypertrophic non-hyperkeratotic AKs of the face or scalp were enrolled to receive ingenol mebutate 0.015% gel on a selected skin area of 25 cm^2 for 3 consecutive *** skin reactions were calculated at each follow up visit using a validated composite *** was evaluated by the comparison of clinical and dermoscopic pictures before the treatment and at day 57,and classified as complete,partial and poor *** A number of 130 patients were enrolled,of which 101(77.7%) were treated on the face,while 29 (22.3%) on the *** great majority of our study population (n = 119,91.5%) reached at least a 75% clearance of AKs and,in particular,58 patients (44.6%) achieved a complete response while 61(46.9%) a partial *** backward multivariate analysis showed that facial localization,level of local skin reaction (LSR) at day 2,the highest LSR values and level of crusts at day 8 were factors independently associated with the achievement of a complete *** Ingenol mebutate 0.015% gel,when properly applied,is more effective on the face than on the scalp and efficacy is directly associated to LSR score.

关键词： Ingenol mebutate Actinic keratosis Facial and scalp lesions Skin reactions Dermoscopic feature