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Endarterectomy for symptomatic non-stenotic carotids: a systematic review and descriptive analysis

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Stroke & Vascular Neurology 2022年第1期7卷 6-12页

作者： Anthony Larson Valentina Nardi Waleed Brinjikji John Benson Giuseppe Lanzino Luis savastano Department of Radiology Mayo ClinicRochesterMinnesotaUSA Neurosurgery Mayo ClinicRochesterMinnesotaUSA

Objective To systematically analyse prior reports of carotid endarterectomy(CEA)performed in cases of≤50%carotid stenosis in order to understand patient tolerance and potential *** A systematic review and descriptive analysis was performed in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses *** English-language search was performed of online databases using librarian-selected search *** were reviewed for relevance which included mention of carotid endarterectomy and *** or retrospective observational cohort studies that reported series of patients who underwent endarterectomy for minimal(≤50%)luminal stenosis with reported outcomes were *** Six studies(which included our institutional series)with a total of 143 patients met the inclusion *** weighted mean age at the time of CEA was 72.3 years;113(79.0%)were male.55.8%of patients with available data had recurrent ipsilateral ischaemic events despite medical *** patients out of 129 with available perioperative data(1.6%)had perioperative MRI findings of acute ischaemic stroke,both within the hemisphere contralateral to the side of *** the 138 patients with available follow-up(mean,36 months),none had recurrent ipsilateral ischaemic *** Endarterectomy for symptomatic carotid disease causing≤50%stenosis may be a potentially beneficial strategy to prevent stroke *** with robust methodology are needed to draw more definitive conclusions in terms of the safety and efficacy of endarterectomy for minimal stenosis with vulnerable features relative to intensive medical therapy.

关键词： carotid stenosis analysis

Spleen:A new role ffoorr an old player?

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World Journal of Gastroenterology 2011年第33期17卷 3776-3784页

作者： Giovanni Tarantino Silvia savastano Domenico Capone Annamaria Colao Department of Clinical and Experimental Medicine Federico Ⅱ University Medical School of NaplesVia S.Pansini 580131 NaplesItaly Department of Molecular and Clinical Endocrinology and Oncology Division of EndocrinologyFederico Ⅱ University Medical School of NaplesVia S.Pansini 580131 NaplesItaly Department of Neurosciences Unit of Clinical PharmacologyFederico Ⅱ University Medical School of Naples80131 NaplesItaly

The spleen could be considered a neglected *** date,it has been deemed an ancillary organ in portal hypertension or an organ localization in lymphoproliferative diseases,even though it has had significant attention in infectious diseases for some ***,it is thought to be central in regulating the immune system,a metabolic asset and involved in endocrine function with regard to nonalcoholic fatty liver *** main mechanisms involved in this complex network will be critically discussed in this article.

关键词： Endocrine function Immune system Metabolic asset Nonalcoholic fatty liver disease Spleen

Hepatic steatosis in overweight/obese females: New screening method for those at risk

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World Journal of Gastroenterology 2009年第45期15卷 5693-5699页

作者： Giovanni Tarantino Genoveffa Pizza Annamaria Colao Fabrizio Pasanisi Paolo Conca Patrizia Colicchio Carmine Finelli Franco Contaldo Carolina Di Somma Silvia savastano Department of Clinical and Experimental Medicine Federico Ⅱ University Medical School of Naples Department of Molecular and Clinical Endocrinology and Oncology Section of Endocrinology Federico Ⅱ University Medical School of Naples

AIM: To identify which parameters could help to distinguish the "metabolically benign obesity", which is not accompanied by insulin resistance (IR) and early ***: Eighty two of 124 overweight/obese females formed the study population, which was divided into two groups (52 and 30 subjects, respectively) with and without IR according to a HO meostatic Metabolic Assessment (HOMA) cut-off of 2, and were studied in a cross-sectional manner. The main outcome measures were waist circumference, serum uric acid, high-density lipoprotein-cholesterol and triglycerides, alanine amino-transferase, blood pressure and the two imaging para-meters, hepatic steatosis and longitudinal diameter of the spleen, which were measured in relation to the presence/absence of IR. RESULTS: A variable grade of visceral obesity was observed in all subjects with the exception of *** of a severe grade was represented more in the group of IR individuals (P = 0.01). Hepatic steatosis, revealed at ultrasound, was more pronounced in IR than in non-IR subjects (P = 0.005). The two groups also demonstrated a clear difference in longitudinal spleen diameter and blood pressure, with raised and signif icant values in the IR group. Metabolic syndrome was frequent in the IR group, and was not modified when adjusted for menopause (P = 0.001). At linear regression, the β values of waist circumference and body mass index predicting HOMA were 0.295, P = 0.007 and 0.41, P = 0.0001, respectively. Measures of spleen longitudinal diameter were well predicted by body mass index (BMI) values, β = 0.35, P = 0.01, and by HOMA, β = 0.41, P = 0.0001. Blood pressure was predicted by HOMA values, β = 0.39, P = 0.0001). HOMA and hepatic steatosis were highly associated (rho = 0.34, P = 0.002). Interestingly, IR patients were almost twice as likely to have hepatic steatosis as non-IR patients. Among the MS criteria, blood pressure was very accurate in identifying the presence of IR (AUROC for systo

关键词： Body mass index Cardiovascular disease Fatty liver Insulin resistance Metabolic f itness Obesity

Carotid artery endarterectomy in patients with symptomatic non-stenotic carotid artery disease

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Stroke & Vascular Neurology 2022年第3期7卷 251-257页

作者： Valentina Nardi John C Benson Anthony S Larson Waleed Brinjikji Luca Saba Fredric B Meyer Giuseppe Lanzino Amir Lerman Luis E savastano Department of Cardiovascular Diseases Mayo ClinicRochesterMinnesotaUSA Radiology Mayo ClinicRochesterMinnesotaUSA Radiology Azienda Ospedaliero UniversitariaCagliariItaly Neurosurgery Mayo ClinicRochesterMinnesotaUSA

Object We sought to determine the safety and efficacy in secondary stroke prevention of carotid endarterectomy(CEA)in patients with symptomatic non-stenotic carotid artery disease(SyNC).Methods This was a single-centre retrospective case *** patients who underwent CEA for unilateral anterior circulation cerebrovascular events with ipsilateral<50%carotid stenosis from 2002 to 2020 were *** hallmarks including the degree of luminal stenosis and the presence of various vulnerable plaque characteristics(eg,intraplaque haemorrhage(IPH)on MR angiography,ulceration or low-density plaque on CT angiography)were *** presence of vulnerable plaque characteristics was compared between arteries ipsilateral to the ischaemic event and contralateral *** prevalence of perioperative/intraoperative complications,as well as recurrent ischaemic events at follow-up was *** Thirty-two patients were included in the analysis,of which 25.0%were *** arteries ipsilateral to an ischaemic event had a significantly higher prevalence of IPH when compared with contralateral arteries(80.0%vs 0.0%;p<0.001).There were no intraoperative *** patient(3.1%)developed symptoms of transient ipsilateral ischaemia 1 day following CEA which resolved without *** a median follow-up of 18.0 months(IQR 5.0-36.0),only one patient(3.1%)experienced a transient neurologic deficit with complete resolution(annualised rate of recurrent stroke after CEA of 1.5%for a total follow-up of 788 patient-months following CEA).All other patients(31/32,96.9%)were free of recurrent ischaemic *** CEA appears to be safe and well-tolerated in patients with *** studies with larger cohorts and longer follow-up intervals are needed in order to determine the role of CEA in this patient population.

关键词： patients carotid prevention

Mechanisms of fibrinolysis resistance and potential targets for thrombolysis in acute ischaemic stroke: lessons from retrieved stroke emboli

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Stroke & Vascular Neurology 2021年第4期6卷 658-667页

作者： Waleed Brinjikji Oana Madalina Mereuta Daying Dai David F Kallmes Luis savastano Yang Liu Shahid M Nimjee Raul G Nogueira Mehdi Abbasi Ramanathan Kadirvel Radiology Mayo ClinicRochesterMinnesotaUSA Neurosurgery Mayo ClinicRochesterMinnesotaUSA Neurosurgery Ohio State University Medical CenterColumbusOhioUSA Neurology Emory University School of MedicineAtlantaGeorgiaUSA

There has been growing interest and insight into the histological composition of retrieved stroke *** of the main focuses of the stroke clot analysis literature has been the implications of clot composition on mechanical thrombectomy ***,the holy grail of clot analysis may not be in the field of clot-device interaction,but rather,in understanding mechanisms of fibrinolysis *** mechanisms underlying the low response to fibrinolytic therapy,even with the newer,more powerful agents,remain poorly *** factors such as embolus size,location and collateral status influence alteplase delivery and recanalisation rates;compositional analyses focused on histological and ultrastructural characteristics offer unique insights into mechanisms of alteplase *** this review,we strive to provide comprehensive review of current knowledge on clot composition and ultrastructural analyses that help explain resistance to fibrinolysis.

关键词： fibrin histological resistance

Serum Bcl-2 concentrations in overweight-obese subjects with nonalcoholic fatty liver disease

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World Journal of Gastroenterology 2011年第48期17卷 5280-5288页

作者： Giovanni Tarantino Francesco Scopacasa Annamaria Colao Domenico Capone Marianna Tarantino Ernesto Grimaldi Silvia savastano Department of Clinical and Experimental Medicine Federico Ⅱ University Medical School of Naples Department of Biochemistry and Medical Biotechnology Federico Ⅱ University Medical School of Naples Department of Molecular and Clinical Endocrinology and Oncology Endocrinology UnitFederico Ⅱ University Medical School of Naples Department of Neurosciences Unit of Clinical Pharmacology Federico Ⅱ University Medical School of Naples Department of Biomorphological and Functional Sciences Federico Ⅱ University Medical School of Naples

AIM： To shed some light on the relationship between anti-apoptotic serum Bcl-2 concentrations and metabolic status, anthropometric parameters, inflammation indi- ces, and non-alcoholic fatty liver disease severity were investigated in 43 young individuals with fatty liver （FL） and 41 with nonalcoholic steatohepatitis （NASH）. METHODS： Circulating levels of Bcl-2 were detected in 84 patients with ultrasonographic findings of ＂bright liver＂ and/or hyper-transaminasemia of unknown origin and/or increase in T-glutamyl-transpeptidase （T-GT） strictly in the absence of other acute or chronic liver disease, whose age was not advanced, who gave consent to liver biopsy and were then divided on the basis of the histological results into two groups （43 with FL and 41 with NASH）. Twenty lean subjects, apparently healthy and young, were chosen as ***： Serum Bcl-2 concentrations were significantly higher in the FL group than in the NASH group. Insulin resistance and γ-GT activity were significantly higher in NASH subjects. Apoptotic hepatocytes were significantly more numerous in NASH patients. NASH patients presented with larger spleens and augmented C-reactive protein （CRP） concentrations than healthy subjects. Steatosis grade at histology was similar in both NASH and FL populations. The number of apoptotic cells was significantly related to anti-apoptotic Bcl-2 protein values in FL patients. Bcl-2 serum levels positively correlated to body mass index （BMI） values （P ~ 0.0001） but not to age of the population. Triglycerides/HDL ratio correlated well to waist circumference in males （P = 0.0008）. γ-GT activity was associated with homeostatic metabolic assessment （HOMA）（P = 0.0003） and with serum ferritin （P = 0.02）. Bcl-2 concentrations were not related to either spleen size or CRP values. NASH patients pre- sented a weak negative correlation between Iobular inflammation and Bcl-2 levels. A prediction by low values of serum Bcl-2 towards a greater presence of metaboli

关键词： Bcl-2 Nonalcoholic fatty liver disease Meta-bolically unhealthy overweight/obese

Bariatric surgery and diabetes remission: Sleeve gastrectomy or mini-gastric bypass?

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World Journal of Gastroenterology 2013年第39期19卷 6590-6597页

作者： Marco Milone Matteo Nicola Dario Di Minno Maddalena Leongito Paola Maietta Paolo Bianco Caterina Taffuri Dario Gaudioso Roberta Lupoli Silvia savastano Francesco Milone Mario Musella Department of Advanced Biomedical Science University of Naples "Federico Ⅱ"80131 NaplesItaly

AIM:To investigate the weight loss and glycemic control status[blood glucose,hemoglobin A1c(HbA1c)and hypoglycaemic treatment].METHODS:The primary risk factor for type 2 diabetes is obesity,and 90%of all patients with type 2 diabetes are overweight or *** a remarkable effect of bariatric surgery is the profound and durable resolution of type 2 diabetes clinical manifestations,little is known about the difference among various weight loss surgical procedures on diabetes *** from patients referred during a 3-year period(from January2009 to December 2011)to the University of Naples"FedericoⅡ"diagnosed with obesity and diabetes were retrieved from a prospective *** patients were split into two groups according to the surgical intervention performed[sleeve gastrectomy(SG)and mini-gastric bypass(MGB)].Weight loss and glycemic control status(blood glucose,HbA1c and hypoglycaemic treatment)were ***:A total of 53 subjects who underwent sleeve gastrectomy or mini-gastric bypass for obesity and diabetes were screened for the inclusion in this *** these,4 subjects were excluded because of surgical complications,7 subjects were omitted because young surgeons conducted the operations and 11 subjects were removed because of the lack of *** obese patients were recruited for this study.A total of 15 subjects underwent SG(48.4%),and 16underwent MGB(51.6%).After adjusting for various clinical and demographic characteristics in a multivariate logistic regression analysis,high hemoglobin A1c was determined to be a negative predictor of diabetes remission at 12 mo(OR=0.366,95%CI:0.152-0.884).Using the same regression model,MGB showed a clear trend toward higher diabetes remission rates relative to SG(OR=3.780,95%CI:0.961-14.872).CONCLUSION:Although our results are encouraging regarding the effectiveness of mini-gastric bypass on diabetes remission,further studies are needed to provide definitive conclusions in selecting th

关键词： Bariatric surgery Sleeve Bypass Obesity and diabetes

Treatment of gastric cancer

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World Journal of Gastroenterology 2014年第7期20卷 1635-1649页

作者： Michele Orditura Gennaro Galizia Vincenzo Sforza Valentina Gambardella Alessio Fabozzi Maria Maddalena Laterza Francesca Andreozzi Jole Ventriglia Beatrice savastano Andrea Mabilia Eva Lieto Fortunato Ciardiello Ferdinando De Vita Division of Medical Oncology Dipartimento di MedicinaClinica e Sperimentale ‘F. Magrassi-A. Lanzara’Seconda Università degli Studi di Napoli80131 NaplesItaly Divisione di Chirurgia Oncologia Dipartimento di Scienze AnestesiologicheChirurgiche e delle EmergenzeSeconda Università degli Studi di Napoli80131 NaplesItaly

The authors focused on the current surgical treatment of resectable gastric cancer, and significance of peri- and post-operative chemo or chemoradiation. Gastric cancer is the 4th most commonly diagnosed cancer and the second leading cause of cancer death worldwide. Surgery remains the only curative therapy, while perioperative and adjuvant chemotherapy, as well as chemoradiation, can improve outcome of resectable gastric cancer with extended lymph node dissection. More than half of radically resected gastric cancer patients relapse locally or with distant metastases, or receive the diagnosis of gastric cancer when tumor is disseminated; therefore, median survival rarely exceeds 12 mo, and 5-years survival is less than 10%. Cisplatin and fluoropyrimidine-based chemotherapy, with addition of trastuzumab in human epidermal growth factor receptor 2 positive patients, is the widely used treatment in stage IV patients fit for chemotherapy. Recent evidence supports the use of second-line chemotherapy after progression in patients with good performance status

关键词： Gastric cancer Surgery Radiotherapy Adjuvant chemotherapy Palliative chemotherapy Chemoradiation

Clinical management of advanced gastric cancer: The role of new molecular drugs

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World Journal of Gastroenterology 2014年第40期20卷 14537-14558页

作者： Ferdinando De Vita Natale Di Martino Alessio Fabozzi Maria Maddalena Laterza Jole Ventriglia Beatrice savastano Angelica Petrillo Valentina Gambardella Vincenzo Sforza Luigi Marano Annamaria Auricchio Gennaro Galizia Fortunato Ciardiello Michele Orditura Division of Medical Oncology Department of Clinical and Experimental Medicine and Surgery Second University of Naples School of Medicine 80131 Naples Italy Ⅷ General and Gastrointestinal Surgery School of Medicine Second University of Naples School of Medicine 80138 Naples Italy Divisions of Surgical Oncology Department of Clinical and Experimental Medicine and Surgery Second University of Naples School of Medicine 80131 Naples Italy

Gastric cancer is the fourth most common malignant neoplasm and the second leading cause of death for cancer in Western countries with more than 20000 new cases yearly diagnosed in the United States. Surgery represents the main approach for this disease but, notwithstanding the advances in surgical techniques, we observed a minimal improvement in terms of overall survival with a significant increasing of relapsing disease rates. Despite the development of new drugs has significantly improved the effectiveness of chemotherapy, the prognosis of patients with unresectable or metastatic gastric adenocarcinoma remains poor. Recently, several molecular target agents have been investigated; in particular, trastuzumab represents the first target molecule showing improvements in overall survival in human epithelial growth factor 2-positive gastric cancer patients. New molecules targeting vascular epithelial growth factor, mammalian target of rapamycin, and anti hepatocyte growth factor-c-Met pathway are also under investigation, with interesting results. Anyway, it seems necessary to select more accurately the population to treat with new agents by the identification of new biomarkers in order to optimize the results. In this paper we review the actual “scenario” of targeted treatments, also focusing on the new agents in development for gastric cancer and gastro-esophageal carcinoma, discussing their efficacy and potential applications in clinical practice.

关键词： Advanced gastric cancer Gastrointestinal cancer Targeted therapy Monoclonal antibodies Tyrosine-kinase inhibitor Gastric cancer