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Discontinuation of therapy in inflammatory bowel disease: Current views

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World Journal of Clinical Cases 2024年第10期12卷 1718-1727页

作者： antonio Meštrović Marko Kumric Josko Bozic Department of Gastroenterology University Hospital of SplitSplit 21000Croatia Department of Pathophysiology University of Split School of MedicineSplit 21000Croatia

The timely introduction and adjustment of the appropriate drug in accordance with previously well-defined treatment goals is the foundation of the approach in the treatment of inflammatory bowel disease(iBD).The therapeutic approach is still evolving in terms of the mechanism of action but also in terms of the possibility of maintaining remission.in patients with achieved long-term remission,the question of de-escalation or discontinuation of therapy arises,considering the possible side effects and economic burden of long-term therapy.For each of the drugs used in iBD(5-aminosalycaltes,immunomodulators,biological drugs,small molecules)there is a risk of relapse.Furthermore,studies show that more than 50%of patients who discontinue therapy will relapse.Based on the findings of large studies and meta-analysis,relapse of disease can be expected in about half of the patients after therapy withdrawal,in case of monotherapy with aminosalicylates,immunomodulators or biological therapy.However,longer relapse-free periods are recorded with withdrawal of medication in patients who had previously been on combination therapies immunomodulators and anti-tumor necrosis factor.it needs to be stressed that randomised clinical trials regarding withdrawal from medications are still lacking.Before making a decision on discontinuation of therapy,it is important to distinguish potential candidates and predictive factors for the possibility of disease relapse.Fecal calprotectin level has currently been identified as the strongest predictive factor for relapse.Several other predictive factors have also been identified,such as:High Crohn's disease activity index or Harvey Bradshaw index,younger age(isease duration(>40 years),smoking,young age of disease onset,steroid use 6-12 months before cessation.An important factor in the decision to withdraw medication is the success of re-treatment with the same or other drugs.The decision to discontinue therapy must be based on individual approach,taking into account the severi

关键词： inflammatory bowel disease Therapy discontinuation Therapy de-escalation Ulcerative colitis Crohn’s disease

Parallel pathways:A chronicle of evolution in rectal and breast cancer surgery

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World Journal of Gastrointestinal Oncology 2024年第4期16卷 1091-1096页

作者： antonio Pesce NicolòFabbri Diletta iovino Carlo Vittorio Feo Unit of General Surgery University of FerraraAzienda USL of FerraraFerrara 44023LagosantoItaly

in this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,accompanied by a growing emphasis on perioperative treatments aimed at enhancing surgical outcomes.All of these changes have been made possible due to an increased awareness and understanding of oncological diseases and improved perioperative treatments.

关键词： Rectal cancer History Breast surgery Demolitive treatment Conservative surgery

Storing Freshwater Versus Storing Electricity in Power Systems with High Freshwater Electric Demand

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Journal of Modern Power Systems and Clean Energy 2024年第2期12卷 323-333页

作者： Mubarak J.Al-Mubarak antonio J.Conejo Department of Electrical and Computer Engineering The Ohio State UniversityColumbusOHUSA Department of Electrical Engineering Kuwait UniversityP.O.Box 5969Safat 13060Kuwait Department of integrated Systems Engineering and the Department of Electrical and Computer Engineering The Ohio State UniversityColumbusOH 43210USA iEEE

We consider a power system whose electric demand pertaining to freshwater production is high(high freshwater electric demand),as in the Middle East,and investigate the tradeoff of storing freshwater in tanks versus storing electricity in batteries at the day-ahead operation stage.Both storing freshwater and storing electricity increase the actual electric demand at valley hours and decrease it at peak hours,which is generally beneficial in term of cost and reliability.But,to what extent?We analyze this question considering three power systems with different generation-mix configurations,i.e.,a thermal-dominated mix,a renewable-dominated one,and a fully renewable one.These generation-mix configurations are inspired by how power systems may evolve in different countries in the Middle East.Renewable production uncertainty is compactly modeled using chance constraints.We draw conclusions on how both storage facilities(freshwater and electricity)complement each other to render an optimal operation of the power system.

关键词： Power system operation freshwater production and transportation coordination day-ahead scheduling

influence of manufacturing process-induced geometrical defects on the energy absorption capacity of polymer lattice structures

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Defence Technology（防务技术） 2024年第5期35卷 47-59页

作者： Alexandre Riot Enrico Panettieri antonio Cosculluela Marco Montemurro Universite de Bordeaux Arts et Metiers Institute of TechnologyCNRSINRABordeaux INPHESAM UniversiteI2M UMR 5295F-33405 TalenceFrance French Atomic Energy Commission Route des GargailsCedexF-33114Le BarpFrance

Modern additive manufacturing processes enable fabricating architected cellular materials of complex shape,which can be used for different purposes.Among them,lattice structures are increasingly used in applications requiring a compromise among lightness and suited mechanical properties,like improved energy absorption capacity and specific stiffness-to-weight and strength-to-weight ratios.A dedicated modeling strategy to assess the energy absorption capacity of lattice structures under uni-axial compression loading is presented in this work.The numerical model is developed in a non-linear framework accounting for the strain rate effect on the mechanical responses of the lattice structure.Four geometries,i.e.,cubic body centered cell,octet cell,rhombic-dodecahedron and truncated cuboctahedron 2+,are investigated.Specifically,the influence of the relative density of the representative volume element of each geometry,the strain-rate dependency of the bulk material and of the presence of the manufacturing process-induced geometrical imperfections on the energy absorption capacity of the lattice structure is investigated.The main outcome of this study points out the importance of correctly integrating geometrical imperfections into the modeling strategy when shock absorption applications are aimed for.

关键词： Lattice structures Architected cellular materials Dynamic simulation Energy absorption Geometrical imperfection Additive manufacturing

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Oligodendroctyes:the forgotten players of diabetes pathophysiology

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Neural Regeneration Research 2024年第11期19卷 2349-2350页

作者： Juan antonio López-Villodres Beatriz García-Díaz Departamento Fisiología Humana Histología HumanaAnatomía Patológica y Educación Física y DeportivaFacultad de MedicinaUniversidad de MálagaMálagaSpain UGC Neurociencia.instituto de investigación Biomédica de Málaga y Plataforma en Nanomedicina(iBiMA Plataforma Bionand) MálagaSpain

Oligodendrocytes(OLs),glial cells that provide myelin sheaths to axons in the central nervous system(CNS),have a dual role.First,this myelin fatty cover around the axons protects the nerves and is crucial for the saltatory propagation of action potentials.Second and not less important,OLs provide trophic support to neurons and axons.Thus,OL metabolism is important for OL well-being and the proper accomplishment of their functions,and OL metabolism energetics directly affect the energy metabolism of neighboring neurons.

关键词： metabolism nerves myelin

Frequency of and reasons behind non-listing in adult patients referred for liver transplantation: Results from a retrospective study

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World Journal of Transplantation 2024年第2期14卷 99-106页

作者： Marco Biolato Luca Miele Giuseppe Marrone Claudia Tarli antonio Liguori Rosaria Calia Giovanni Addolorato Salvatore Agnes antonio Gasbarrini Maurizio Pompili antonio Grieco Department of Medical and Surgical Sciences CEMADFondazione Policlinico Universitario Agostino Gemelli IRCCSRome 00168Italy Department of Translational Medicine and Surgery Catholic University of Sacred HeartRome 00168Italy

BACKGROUND Few studies have evaluated the frequency of and the reasons behind the refusal of listing liver transplantation candidates.AiM To assess the ineligibility rate for liver transplantation and its motivations.METHODS A single-center retrospective study was conducted on adult patients which entailed a formal multidisciplinary assessment for liver transplantation eligibility.The predictors for listing were evaluated using multivariable logistic regression.RESULTS in our center,314 patients underwent multidisciplinary work-up before liver transplantation enlisting over a three-year period.The most frequent reasons for transplant evaluation were decompensated cirrhosis(51.6%)and hepatocellular carcinoma(35.7%).The non-listing rate was 53.8%and the transplant rate was 34.4%for the whole cohort.Two hundred and five motivations for ineligibility were collected.The most common contraindications were psychological(9.3%),cardiovascular(6.8%),and surgical(5.9%).inappropriate or premature referral accounted for 76(37.1%)cases.On multivariable analysis,a referral from another hospital(OR:2.113;95%Ci:1.259–3.548)served as an independent predictor of non-listing.CONCLUSiON A non-listing decision occurred in half of our cohort and was based on an inappropriate or premature referral in one case out of three.The referral from another hospital was taken as a strong predictor of non-listing.

关键词： Controindication Eligibility Evaluation Referral Personalized medicine

Climate change and human health: Last call to arms for us

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World Journal of Clinical Cases 2024年第11期12卷 1870-1874页

作者： antonio Corrente Maria Caterina Pace Marco Fiore Department of Anaesthesiology and intensive Care Medicine The Anastasia Guerriero HospitalMarcianise 81025CasertaItaly Department of Women Child and General and Specialized SurgeryUniversity of Campania“Luigi Vanvitelli”Naples 80138Italy

Climate change,now the foremost global health hazard,poses multifaceted challenges to human health.This editorial elucidates the extensive impact of climate change on health,emphasising the increasing burden of diseases and the exacerbation of health disparities.it highlights the critical role of the healthcare sector,particularly anaesthesia,in both contributing to and mitigating climate change.it is a call to action for the medical community to recognise and respond to the health challenges posed by climate change.

关键词： Climate change Carbon footprint Sustainability Greenhouse gases Anaesthetic gases Environmental impact Disposable laryngoscope blades

Physical exercise and synaptic protection in human and pre-clinical models of multiple sclerosis

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Neural Regeneration Research 2024年第8期19卷 1768-1771页

作者： Federica Azzolini Ettore Dolcetti antonio Bruno Valentina Rovella Diego Centonze Fabio Buttari Unit of Neurology IRCCS NeuromedPozzilliItaly Department of System Medicine University of Tor VergataRomeItaly Synaptic immunopathology Lab Department of Systems MedicineTor Vergata UniversityRomeItaly

in multiple sclerosis,only immunomodulato ry and immunosuppressive drugs are recognized as disease-modifying therapies.Howeve r,in recent years,several data from pre-clinical and clinical studies suggested a possible role of physical exe rcise as disease-modifying therapy in multiple sclerosis.Current evidence is sparse and often conflicting,and the mechanisms underlying the neuroprotective and antinflammatory role of exercise in multiple sclerosis have not been fully elucidated.Data,mainly derived from pre-clinical studies,suggest that exe rcise could enhance longterm potentiation and thus neuroplasticity,could reduce neuroinflammation and synaptopathy,and dampen astrogliosis and microgliosis.in humans,most trials focused on direct clinical and MRi outcomes,as investigating synaptic,neuroinflammato ry,and pathological changes is not straightfo rward compared to animal models.The present review analyzed current evidence and limitations in research concerning the potential disease-modifying therapy effects of exercise in multiple sclerosis in animal models and human studies.

关键词： disease-modifying behaviour endocannabinoid system long-term potentiation multiple sclerosis neuroplasticity neuroprotection physical exercise synaptopathy

Management of cerebral amyloid angiopathy and atrial fibrillation:We are still far from precision medicine

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World Journal of Cardiology 2024年第5期16卷 231-239页

作者： Liuba Fusco Zefferino Palamà antonio Scarà Alessio Borrelli antonio Gianluca Robles Gabriele De Masi DeLuca Silvio Romano Luigi Sciarra Department of Cardiology University Hospital of NorthamptonshireNorthampton NN15BDUnited Kingdom Department of Cardiology Casa di Cura Villa VerdeTaranto 70124Italy Department of Life Health and Environmental SciencesUniversity of l'AquilaL'Aquila 67100Italy Department of Cardiology GVM Care and ResearchSan Carlo di Nancy HospitalRome 00100Italy

The use of anticoagulation therapy could prove to be controversial when trying to balance ischemic stroke and intracranial bleeding risks in patients with concurrent cerebral amyloid angiopathy(CAA)and atrial fibrillation(AF).in fact,CAA is an age-related cerebral vasculopathy that predisposes patients to intracerebral hemorrhage.Nevertheless,many AF patients require oral systemic dose-adjusted warfarin,direct oral anticoagulants(such as factor Xa inhibitors)or direct thrombin inhibitors to control often associated with cardioembolic stroke risk.The prevalence of both CAA and AF is expected to rise,due to the aging of the population.This clinical dilemma is becoming increasingly common.in patients with coexisting AF and CAA,the risks/benefits profile of anticoagulant therapy must be assessed for each patient individually due to the lack of a clear-cut consensus with regard to its risks in scientific literature.This review aims to provide an overview of the management of patients with concomitant AF and CAA and proposes the implementation of a risk-based decision-making algorithm.

关键词： Anticoagulation Atrial fibrillation Cerebral amyloid angiopathy intracerebral hemorrhage Stroke Watchman Secondary prevention Left atrial appendage closure