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Association between non-alcoholic fatty liver disease and obstructive sleep apnea

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World Journal of Gastroenterology 2020年第20期26卷 2669-2681页

作者： Ilaria Umbro Valerio Fabiani Mario Fabiani Francesco Angelico maria del ben Department of Anatomical HistologicalForensic Medicine and Orthopedic SciencesSapienza University of RomeRome 00161Italy Department of Neurosciences Mental Health and Sensory OrgansSapienza University of RomeRome 00123Italy Department of Sense Organs Sapienza University of RomeRome 00161Italy Department of Public Health and Infectious Diseases Sapienza University of RomeRome 00161Italy Department of Clinical InternalAnesthetic and Cardiovascular SciencesSapienza University of RomeRome 00161Italy

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is an emerging liver disease and currently the most common cause of incidental abnormal liver *** pathogenesis of NAFLD is multifactorial and many mechanisms that cause fatty liver infiltration,inflammation,oxidative stress and progressive fibrosis have been *** sleep apnea(OSA)may be linked with the pathogenesis and the severity of *** To study the association between NAFLD and OSA considering also the efficacy of continuous positive airway pressure(CPAP)*** A Pub Med search was conducted using the terms"non-alcoholic fatty liver disease AND(obstructive sleep apnea OR obstructive sleep disorders OR sleep apnea)".Research was limited to title/abstract of articles published in English in the last 5 years;animal and child studies,case reports,commentaries,letters,editorials and meeting abstracts were not *** were extracted on a standardized data collection table which included:First author,publication year,country,study design,number of patients involved,diagnosis and severity of OSA,diagnosis of NAFLD,patient characteristics,results of the *** total,132 articles were initially retrieved on Pub Med search and 77 in the last five *** removal of irrelevant studies,13 articles were included in the qualitative *** was a total of 2753 participants across all the studies with a mean age between 42 and 58 *** proportion of males ranged from21%to 87.9%and the mean body mass index ranged from 24.0 to 49.9 kg/*** results of this review showed an increased prevalence of NAFLD in patients with diagnosis of OSA,even in the absence of coexisting comorbidities such as obesity or metabolic ***,the severity of NAFLD is associated with the increase in OSA *** CPAP treatment,although not always decisive,may stabilize or slow NAFLD progression with benefits on metabolic and cardiovascular *** In

关键词： Continuous positive air pressure Non-alcoholic fatty liver disease Nonalcoholic steatohepatitis Obstructive sleep apnea Obstructive sleep disorders Sleep apnea

Reduced lysosomal acid lipase activity: A new marker of liver disease severity across the clinical continuum of non-alcoholic fatty liver disease?

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World Journal of Gastroenterology 2019年第30期25卷 4172-4180页

作者： Francesco Baratta Daniele Pastori Domenico Ferro Giovanna Carluccio Giulia Tozzi Francesco Angelico Francesco Violi maria del ben Department of Internal Medicine and Medical Specialties Sapienza-University of RomeRome 00155Italy Hepatogastroenterology and Nutrition Unit-Pediatric Department Bambino GesùChildren’s HospitalRome 00156Italy Department of Public Health and Infectious Disease Sapienza-University of RomeRome 00161Italy

Lysosomal acid lipase(LAL)plays a key role in intracellular lipid *** LAL activity promotes increased multi-organ lysosomal cholesterol ester storage,as observed in two recessive autosomal genetic diseases,Wolman disease and Cholesterol ester storage *** liver steatosis and accelerated liver fibrosis are common features in patients with genetic LAL *** contrast,few reliable data are available on the modulation of LAL activity in vivo and on the epigenetic and metabolic factors capable of regulating its activity in subjects without homozygous mutations of the Lipase A *** the last few years,a less severe and non-genetic reduction of LAL activity was reported in children and adults with non-alcoholic fatty liver disease(NAFLD),suggesting a possible role of LAL reduction in the pathogenesis and progression of the *** with NAFLD show a significant,progressive reduction of LAL activity from simple steatosis to non-alcoholic steatohepatitis and cryptogenic *** cirrhosis of different etiologies,those with cryptogenic cirrhosis show the most significant reductions of LAL *** findings suggest that the modulation of LAL activity may become a possible new therapeutic target for patients with more advanced forms of ***,the measurement of LAL activity may represent a possible new marker of disease severity in this clinical setting.

关键词： Non-alcoholic fatty liver disease Non-alcoholic steatohepatitis Lysosomal acid lipase Cirrhosis Wolman disease Cholesterol ester storage disease

Solid pseudopapillary tumor of the pancreas:A systematic review of clinical,surgical and oncological characteristics of 1384 patients underwent pancreatic surgery

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Hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 331-338页

作者： Gennaro Mazzarella Edoardo maria Muttillo Diego Coletta Biagio Picardi Stefano Rossi Simone Rossi del Monte Vito Gomes Irnerio Angelo Muttillo Division of General and Emergency Surgery San Filippo Neri Hospital00136 RomeItaly Department of Surgery“Pietro Valdoni” Sapienza University of RomeViale del Policlinico 15500161 RomeItaly Surgical and Medical Department of Translational Medicine Sant’Andrea HospitalSapienza University of Rome00185 RomeItaly Department of Surgical Sciences Umberto I University HospitalSapienza University of Rome00136 RomeItaly Department of General Surgery Ospedali Riuniti Marche Nord61121 PesaroItaly Department of Pathology San Filippo Neri Hospital00136 RomeItaly

Background:Pancreatic solid pseudopapillary tumors(SPTs)are rare clinical entity,with low malignancy and still unclear *** account for less than 2%of exocrine pancreatic *** study aimed to perform a systematic review of the main clinical,surgical and oncological characteristics of pancreatic *** sources:MEDLINE/PubMed,Web of Science and Scopus databases were systematically searched for the main clinical,surgical and oncological characteristics of pancreatic SPTs up to April 2021,in accordance with the preferred reporting items for systematic reviews and meta-analyses(PRISMA)*** endpoints were to analyze treatments and oncological ***:A total of 823 studies were recorded,86 studies underwent full-text reviews and 28 met inclusion ***,1384 patients underwent pancreatic *** age was 30 years and 1181 patients(85.3%)were *** most common clinical presentation was non-specific abdominal pain(52.6%of cases).Mean overall survival was 98.1%.Mean recurrence rate was 2.8%.Mean follow-up was 4.2 ***:Pancreatic SPTs are rare,and predominantly affect young women with unclear *** resection is the gold standard of treatment achieving good oncological impact and a favorable prognosis in a yearly life-long follow-up.

关键词： Frantz’s tumor Pancreas Pancreatic neoplasms Pancreatic surgery Solid pseudopapillary tumor

Intense pulsed light‑based treatment for the improvement of symptoms in glaucoma patients treated with hypotensive eye drops

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Eye and Vision 2024年第2期10卷 12-21页

作者： Jose maria Martinez‑de‑la‑Casa Carlos Oribio‑Quinto Almudena Milans‑del‑Bosch Pilar Perez‑Garcia Laura Morales‑Fernandez Javier Garcia‑Bella Jose Manuel benitez‑del‑Castillo Julian Garcia‑Feijoo David P.Pinero Ophthalmology Unit Department of Ophthalmology and ORLFaculty of MedicineHospital Clinico San-CarlosUniversidad Complutense de MadridInstituto de Investigacion Sanitaria del Hospital Clinico San-Carlos(IdISSC)28040 MadridSpain Department of Immunology Ophthalmology and ORLSchool of MedicineInstituto de Investigaciones Oftalmologicas Ramon CastroviejoUniversidad Complutense de MadridMadridSpain Department of Optics Pharmacology and AnatomyUniversity of AlicanteAlicanteSpain

Background:Ocular surface disease in glaucoma patients is a significant ocular co-morbidity that can affect 40%to 59%of these patients *** current study was aimed at evaluating the potential clinical benefit of an intense pulsed light(IPL)-based treatment in glaucomatous patients with ocular surface disease due to prolonged hypotensive eyedrop *** our knowledge,this is the first series analyzing the therapeutic effect of this treatment option in this type of ***:This non-comparative prospective case series study enrolled a total of 30 glaucoma patients ranging in age from 57 to 94 years old and treated with hypotensive eyedrops for years with dry eye *** patients received four sessions of IPL treatment using the Optima IPL system(Lumenis,Yokneam,Israel)adjusted to the official optimized Lumenis *** in symptomatology,corneal staining,conjunctival hyperemia,non-invasive break-up time(NIBUT),tear osmolarity,tear meniscus height(TMH),meiboscore and meibomian gland expressibility was analyzed after ***:Statistically significant reductions were observed after IPL treatment in the symptomatology scores measured with different questionnaires[ocular surface disease index(OSDI),standard patient evaluation of eye dryness(SPEED)and symptom assessment questionnaire in dry eye(SANDE)]as well as with the visual analogue scale(P<0.001).Mean change in OSDI was−15.0±11.3.A significant reduction was found after treatment in the corneal staining score(P<0.001).A significant reduction was found in tear film meniscus height(P=0.012),as well as in tear film osmolarity(P=0.001).A significant reduction was also found in meibomian gland expressibility(P=0.003),changing the percentage of grade 3 eyes from 44.4%before IPL to 17.2%after ***:IPL therapy combined with meibomian gland expression(MGX)seems to be an effective option to improve symptomatology in glaucomatous patients with ocular surface diseas

关键词： Glaucoma Intense pulsed light Dry eye Meibomian glands

Surgical site infection following pancreaticoduodenectomy in a referral cancer center in Mexico

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Hepatobiliary & Pancreatic Diseases International 2024年第5期23卷 502-508页

作者： Rodrigo Villaseñor-Echavarri Javier Melchor-Ruan Mercedes Aranda-Audelo Gabriela Arredondo-Saldaña Patricia Volkow-Fernandez maria del Carmen Manzano-Robleda Alejandro E Padilla-Rosciano Diana Vilar-Compte Department of Infectious Diseases Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico School of Medicine Universidad PanamericanaAugusto Rodin No.498Insurgentes MixcoacBenito JuárezMexico CityMexico Department of Digestive Tube and Hepatopancreatobiliary Tumors Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico Department of Infectious Diseases Hospital Manuel Gea GonzálezCalz.de Tlalpan 4800Belisario Domínguez Secc 16TlalpanMexico CityMexico Gastrointestinal and Endoscopy Department Instituto Nacional de CancerologíaAv.San Fernando 22Belisario Domínguez Secc 16TlalpanMexico CityMexico

Background: Pancreaticoduodenectomy is the standard treatment for resectable periampullary cancer. Surgical site infections(SSI) are common complications with increased morbidity. The study aimed to describe the prevalence, risk factors, microbiology, and outcomes of SSI among patients undergoing pancreaticoduodenectomy. Methods: We conducted a retrospective study in a referral cancer center between January 2015 and June 2021. We analyzed baseline patient characteristics and SSI occurrence. Culture results and susceptibility patterns were described. Multivariate logistic regression was used to determine risk factors, proportional hazards model to evaluate mortality, and Kaplan-Meier analysis to assess long-term survival. Results: A total of 219 patients were enrolled in the study;101(46%) developed SSI. Independent factors for SSI were diabetes mellitus, preoperative albumin level, biliary drainage, biliary prostheses, and clinically relevant postoperative pancreatic fistula. The main pathogens were Enterobacteria and Enterococci. Multidrug-resistance rate in SSI was high but not associated with increased mortality. Infected patients had higher odds of sepsis, longer hospital stay and intensive care unit stay, and readmission rate. Neither 30-day mortality nor long-term survival was significantly different between infected and non-infected patients. Conclusions: SSI prevalence among patients undergoing pancreaticoduodenectomy was high and largely caused by resistant microorganisms. Most risk factors were related to preoperative instrumentation of the biliary tree. SSI was associated with greater risk of unfavorable outcomes;however, survival was unaffected.

关键词： Surgical site infection Pancreaticoduodenectomy Pancreatic cancer Endoscopic biliary drainage Biliary prosthesis

Treatment of a patient with congenital analbuminemia with atorvastatin and albumin infusion

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World Journal of Clinical Cases 2013年第1期1卷 44-48页

作者： maria del ben Francesco Angelico Lorenzo Loffredo Francesco Violi Clinica Medica I Sapienza University 00161 Rome Italy

Congenital analbuminemia is a rare autosomic recessive inherited disorder characterized by low plasma albumin and hypercholesterolemia, which may increase cardiovascular risk. Patients are essentially asymptomatic, apart from ease of fatigue, minimal ankle oedema and hypotension. There is no accepted strategy for safely treating both hypercholesterolemia and analbuminemia in order to eventually decrease the atherosclerotic risk. We report a case of congenital analbuminemia(1.0 g/dL) in a 38-year-old male with hypercholesterolemia(range: 406-475 mg/dL) and severe arterial dysfunction [no brachial artery flow-mediated dilation(FMD)]. Long-term, cholesterol-lowering treatment with atorvastatin was associated with the appearance of peripheral edema. Twomonths of infusion with albumin improved FMD(7%) and reduced serum cholesterol(273 mg/dL), supporting the hypothesis of a compensatory role of hypercholesterolemia. Statin treatment, together with periodical albumin infusions, may contribute to the safe reduction of cardiovascular risk.

关键词： Analbuminemia Hypercholesterolemia Atorvastatin Albumin infusion Endothelial dysfunction

Modern approach to the clinical management of non-alcoholic fatty liver disease

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World Journal of Gastroenterology 2014年第26期20卷 8341-8350页

作者： maria del ben Licia Polimeni Francesco Baratta Daniele Pastori Lorenzo Loffredo Francesco Angelico Department of Internal Medicine and Medical Specialities Department of Public Health and Infectious Diseases Sapienza University

Non-alcoholic fatty liver disease(NAFLD)is the most common and emerging form of chronic liver disease *** includes a wide spectrum of liver diseases ranging from simple fatty liver to steatohepatitis,which may progress to cirrhosis,liver cancer,and liver *** metabolic diseases,which are well established cardiovascular risk factors,have been associated to NAFLD and cardiovascular disease is the single most important cause of morbidity and mortality in this patient *** pathogenesis of NAFLD appears multifactorial and many mechanisms have been proposed as possible causes of fatty liver *** of fatty liver has become a major challenge to healthcare systems as the consequence of the increasing rates of obesity ***-line management focuses on lifestyle *** weight reduction either by dietary restriction or by increased habitual physical activity is safe and highly *** therapeutic interventions have been *** include insulin sensitizer agents,lipid lowering drugs,antioxidants such as vitamin E and supplementation of vitamin ***,therapeutic strategies have been largely empirical so far,and experimental trials have mostly been carried out in uncontrolled settings with small sample *** conditions such as diabetes mellitus,obesity,hypertension and hyperlipidemia,should be strongly considered and a multidisciplinary approach should be personalized for individual *** of co-morbidities should be regarded as of paramount importance in the management of these *** purpose of this review is to examine different approaches for the clinical management of non-alcoholic fatty liver disease.

关键词： Non-alcoholic fatty liver disease Nonalcoholic ste

A comprehensive review of genetic causes of obesity

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World Journal of Pediatrics 2024年第1期20卷 26-39页

作者： Marcio Jose Concepcion-Zavaleta Juan Eduardo Quiroz-Aldave maria del Carmen Durand-Vasquez Elman Rolando Gamarra-Osorio Juan del Carmen Valencia de la Cruz Claudia Mercedes Barrueto-Callirgos Susan Luciana Puelles-Leon Elena de Jesus Alvarado-Leon Frans Leiva-Cabrera Francisca Elena Zavaleta-Gutierrez Luis Alberto Concepcion-Urteaga Jose Paz-Ibarra Universidad Cientifica del Sur Bolivar 2150 AvenuePueblo Libre15084LimaPeru Division of Medicine Hospital de Apoyo ChepénChepenPeru Division of Family Medicine Hospital de Apoyo ChepénChepenPeru Division of Endocrinology Hospital Victor Lazarte EchegarayTrujilloPeru Division of Pediatrics Hospital de Apoyo ChepenChepenPeru Division of Internal Medicine Hospital de Apoyo ChepenChepenPeru Division of Genetics Universidad Nacional de TrujilloTrujilloPeru Division of Neonatology Hospital Belen de TrujilloTrujilloPeru Division of Internal Medicine Universidad Nacional de TrujilloTrujilloPeru Department of Medicine School of MedicineUniversidad Nacional Mayor de San MarcosLimaPeru

Background Obesity is a multifactorial chronic disease with a high,increasing worldwide *** causes account for 7%of the cases in children with extreme *** sources This narrative review was conducted by searching for papers published in the PubMed/MEDLINE,Embase and SciELO databases and included 161 *** search used the following search terms:"obesity","obesity and genetics","leptin","Prader-Willi syndrome",and"melanocortins".The types of studies included were systematic reviews,clinical trials,prospective cohort studies,cross-sectional and prospective studies,narrative reviews,and case *** The leptin-melanocortin pathway is primarily responsible for the regulation of appetite and body ***,several important aspects of the pathophysiology of obesity remain *** causes of obesity can be grouped into syndromic,monogenic,and polygenic causes and should be assessed in children with extreme obesity before the age of 5 years,hyperphagia,or a family history of extreme obesity.A microarray study,an analysis of the melanocortin type 4 receptor gene mutations and leptin levels should be performed for this *** are three therapeutic levels:lifestyle modifications,pharmacological treatment,and bariatric *** Genetic study technologies are in constant development;however,we are still far from having a personalized approach to genetic causes of obesity.A significant proportion of the affected individuals are associated with genetic causes;however,there are still barriers to its approach,as it continues to be underdiagnosed.

关键词： Leptin Melanocortin Obesity Prader-Willi syndrome Precision medicine

Outpatient management of obscure gastrointestinal bleeding:A new perspective in high-risk patients

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World Journal of Gastroenterology 2024年第19期30卷 2502-2504页

作者： maria Elena Riccioni Clelia Marmo Digestive Endoscopy Unit Fondazione Policlinico Universitario Agostino GemelliIRCCSUniversitàCattolica del Sacro CuoreLargo Agostino GemelliRome 00168Italy CEMAD Centro Malattie dell’Apparato Digerente Fondazione Policlinico Universitario Agostino GemelliIRCCSUniversitàCattolica del Sacro CuoreLargo Agostino GemelliRome 00168Italy

Mid-gastrointestinal bleeding accounts for approximately 5%-10%of all gastrointestinal bleeding cases,and vascular lesions represent the most frequent *** rebleeding rate for these lesions is quite high(about 42%).We hereby recommend that scheduled outpatient management of these patients could reduce the risk of rebleeding episodes.

关键词： Gastrointestinal bleeding Small bowel bleeding Recurrent bleeding Rebleeding risk Rebleeding Outpatient management