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Shear-wave elastography to predict hepatocellular carcinoma after hepatitis C virus eradication:A systematic review and meta-analysis

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World Journal of Gastroenterology 2024年第10期30卷 1450-1460页

作者： Giorgio Esposto Paolo Santini Linda Galasso Irene Mignini maria elena ainora Antonio Gasbarrini maria Assunta Zocco CEMAD Digestive Disease Center Fondazione Policlinico Universitario“A.Gemelli”IRCCSCatholic University of RomeRome 00168Italy Fondazione Policlinico Universitario Agostino Gemelli IRCCS Fondazione Policlinico Universitario Agostino Gemelli IRCCS-UniversitàCattolica del Sacro CuoreRome 00168Italy Medicina Interna e Gastroenterologia CEMAD Digestive Disease CenterUniversitàCattolica del Sacro CuoreFondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

BACKGROUND Direct-acting antiviral agents(DAAs)are highly effective treatment for chronic hepatitis C(CHC)with a significant rate of sustained virologic response(SVR).The achievement of SVR is crucial to prevent additional liver damage and slow down fibrosis *** assessment of fibrosis degree can be performed with transient elastography,magnetic resonance elastography or shear-wave elastography(SWE).Liver elastography could function as a predictor for hepato-cellular carcinoma(HCC)in CHC patients treated with *** To explore the predictive value of SWE for HCC development after complete clearance of hepatitis C virus(HCV).METHODS A comprehensive literature search of clinical studies was performed to identify the ability of SWE to predict HCC occurrence after HCV *** accordance with the study protocol,a qualitative and quantitative analysis of the evidence was *** At baseline and after 12 wk of follow-up,a trend was shown towards greater liver stiffness(LS)in those who go on to develop HCC compared to those who do not[baseline LS standardized mean difference(SMD):1.15,95%confidence interval(95%CI):020-2.50;LS SMD after 12 wk:0.83,95%CI:0.33-1.98].The absence of a statistically significant difference between the mean LS in those who developed HCC or not may be related to the inability to correct for confounding factors and the absence of raw source *** was a statist-ically significant LS SMD at 24 wk of follow-up between patients who developed HCC vs not(0.64;95%CI:0.04-1.24).CONCLUSION SWE could be a promising tool for prediction of HCC occurrence in patients treated with *** studies with larger cohorts and standardized timing of elastographic evaluation are needed to confirm these data.

关键词： Shear-wave elastography Hepatocellular carcinoma Hepatitis C virus Sustained virologic response

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Dynamic contrast enhanced ultrasound in differential diagnosis of hepatocellular carcinoma: A systematic review and meta-analysis

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World Journal of Gastrointestinal Oncology 2024年第6期16卷 2804-2815页

作者： Giorgio Esposto Paolo Santini Fabrizio Termite Linda Galasso Irene Mignini maria elena ainora Antonio Gasbarrini maria Assunta Zocco Department of CEMAD Digestive Disease Center Fondazione Policlinico Universitario A Gemelli IRCCSCatholic University of RomeRome 00168Italy Department of Fondazione Policlinico Universitario Agostino Gemelli IRCCS UniversitàCattolica del Sacro CuoreRome 00168Italy Department of Medicina Interna e Gastroenterologia CEMAD Digestive Disease CenterFondazione Policlinico Universitario A Gemelli IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy

BACKGROUND Non-invasive differential diagnosis between hepatocellular carcinoma(HCC)and other liver cancer(*** or metastasis)is highly challenging and definitive diagnosis still relies on histological *** patterns of enhancement and wash-out of liver nodules can be used to stratify the risk of malignancy only in cirrhotic patients and HCC frequently shows atypical *** contrast-enhanced ultrasound(DCEUS)with standardized software could help to overcome these obstacles,providing functional and quantitative parameters and potentially improving accuracy in the evaluation of tumor *** To explore clinical evidence regarding the application of DCEUS in the differential diagnosis of liver *** A comprehensive literature search of clinical studies was performed to identify the parameters of DCEUS that could relate to histological *** accordance with the study protocol,a qualitative and quantitative analysis of the evidence was *** Rise time was significantly higher in HCC patients with a standardized mean difference(SMD)of 0.83(95%CI:0.48-1.18).Similarly,other statistically significant parameters were mean transit time local with a SMD of 0.73(95%CI:0.20-1.27),peak enhancement with a SMD of 0.37(95%CI:0.03-0.70),area wash-in area under the curve with a SMD of 0.47(95%CI:0.13-0.81),wash-out area under the curve with a SMD of 0.55(95%CI:0.21-0.89)and wash-in and wash-out area under the curve with SMD of 0.51(95%CI:0.17-0.85).SMD resulted not significant in fall time and wash-in rate,but the latter presented a trend towards greater values in HCC compared to intrahepatic *** DCEUS could improve non-invasive diagnosis of HCC,leading to less liver biopsy and early *** quantitative analysis needs to be applied on larger cohorts to confirm these preliminary results.

关键词： Dynamic contrast enhanced ultrasound Hepatocellular carcinoma Intracellular cholangiocarcinoma Quantitative ultrasound Liver cancer Time-intensity curve

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Dynamic contrast enhanced ultrasound in gastrointestinal diseases:A current trend or an indispensable tool?

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World Journal of Gastroenterology 2023年第25期29卷 4021-4035页

作者： Mattia Paratore Matteo Garcovich maria elena ainora Laura Riccardi Antonio Gasbarrini maria Assunta Zocco Medicina Interna e Gastroenterologia CEMAD Digestive Disease CenterFondazione Policlinico Universitario A.Gemelli IRCCSRome 00168Italy Medicina Interna e Gastroenterologia CEMAD Digestive Disease CenterUniversità Cattolica del Sacro CuoreFondazione Policlinico Universitario A.Gemelli IRCCSRome 00168Italy

Contrast enhanced ultrasound(CEUS)has been widely implemented in clinical practice because of the enormous quantity of information it provides,along with its low cost,reproducibility,minimal invasiveness,and safety of the secondgeneration ultrasound contrast *** overcome the limitation of CEUS given by the subjective evaluation of the contrast enhancement behaviour,quantitative analysis of contrast kinetics with generation of time-intensity curves has been introduced in recent *** quantification of perfusion parameters[named as dynamic-CEUS(D-CEUS)]has several applications in gastrointestinal neoplastic and inflammatory ***,the limited availability of large studies and the heterogeneity of the technologies employed have precluded the standardisation of D-CEUS,which potentially represents a valuable tool for clinical practice in management of gastrointestinal *** this article,we reviewed the evidence exploring the application of D-CEUS in gastrointestinal diseases,with a special focus on liver,pancreas,and inflammatory bowel diseases.

关键词： Quantitative perfusion analysis Gastrointestinal diseases Time-intensity curve Multiparametric ultrasound

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Portal vein thrombosis in cirrhosis: Why a well-known complication is still matter of debate

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World Journal of Gastroenterology 2019年第31期25卷 4437-4451页

作者： Mariella Faccia maria elena ainora Francesca Romana Ponziani Laura Riccardi Matteo Garcovich Antonio Gasbarrini Maurizio Pompili maria Assunta Zocco Department of Internal Medicine and Gastroenterology Fondazione Policlinico Universitario A.Gemelli IRCCSCatholic University

Portal vein thrombosis(PVT)represents a well-known complication during the natural course of liver cirrhosis(LC),ranging from asymptomatic cases to lifethreating conditions related to portal hypertension and hepatic *** flow stasis,complex acquired hypercoagulable disorders and exogenous factors leading to endothelial dysfunction have emerged as key factors for PVT ***,PVT occurrence remains unpredictable and many issues regarding its natural history,prognostic significance and treatment are still *** particular although spontaneous resolution or disease stability occur in most cases of PVT,factors predisposing to disease progression or recurrence after spontaneous recanalization are not clarified as ***,PVT impact on LC outcome is still debated,as PVT may represent itself a consequence of liver fibrosis and hepatic dysfunction *** and transjugular intrahepatic portosystemic shunt are considered safe and effective in this setting and are recommended in selected cases,even if the safer therapeutic option and the optimal therapy duration are still ***,their impact on mortality rates should be addressed more *** this review we present the most debated questions regarding PVT,whose answers should come from prospective cohort studies and large sample-size randomized trials.

关键词： Portal vein thrombosis Liver cirrhosis Hypercoagulability Anticoagulation Direct oral anticoagulants

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Elastography as a predictor of liver cirrhosis complications after hepatitis C virus eradication in the era of direct-acting antivirals

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World Journal of Hepatology 2021年第11期13卷 1663-1676页

作者： Lucia Cerrito maria elena ainora Alberto Nicoletti Matteo Garcovich Laura Riccardi Maurizio Pompili Antonio Gasbarrini maria Assunta Zocco CEMAD Digestive Disease Center Fondazione Policlinico Universitario"A.Gemelli"IRCCSCatholic University of Rome(Italy)Rome 00168Italy

Chronic inflammation due to hepatitis C virus(HCV)infection leads to liver fibrosis and rearrangement of liver tissue,which is responsible for the development of portal hypertension(PH)and hepatocellular carcinoma(HCC).The advent of direct-acting antiviral drugs has revolutionized the natural history of HCV infection,providing an overall eradication rate of over 90%.Despite a significant decrease after sustained virological response(SVR),the rate of HCC and liver-related complications is not completely eliminated in patients with advanced liver *** the reasons are still unclear,cirrhosis itself has a residual risk for the development of HCC and other PH-related *** elastography is a recently developed non-invasive technique for the assessment of liver *** the achievement of SVR,liver stiffness(LS)usually decreases,as a consequence of reduced inflammation and,possibly,*** studies emphasized the application of LS assessment in the management of patients with SVR in order to define the risk for developing the complications of chronic liver disease(functional decompensation,gastrointestinal bleeding,HCC)and to optimize long-term prognostic outcomes in clinical practice.

关键词： Direct-acting antiviral agents Liver stiffness Portal hypertension Hepatocellular carcinoma

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Diagnosis of bowel diseases:The role of imaging and ultrasonography

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World Journal of Gastroenterology 2013年第14期19卷 2144-2153页

作者： Davide Roccarina Matteo Garcovich maria elena ainora Gianluigi Caracciolo Francesca Ponziani Antonio Gasbarrini maria Assunta Zocco Department of Internal Medicine Catholic University of Rome

Examinations with a visualisation of the anatomy and pathology of the gastrointestinal(GI) tract are often necessary for the diagnosis of GI *** radiology played a crucial role for many ***,despite some limitations,remains the main technique in the differential diagnosis and treatment of GI *** the last decades,the introduction of,and advances in,non-invasive cross-sectional imaging modalities,including ultrasound(US),computed tomography(CT),positron-emission tomography(PET),and magnetic resonance imaging,as well as improvements in the resolution of imaging data,the acquisition of 3D images,and the introduction of contrast-enhancement,have modified the approach to the examination of the GI ***,additional co-registration techniques,such as PET-CT and PET-MRI,allow multimodal data acquisition with better sensitivity and specificity in the study of tissue *** has had a growing role in the development and application of the techniques for diagnosis and management of GI diseases because it is inexpensive,non-invasive,and more comfortable for the patient,and it has sufficient diagnostic accuracy toprovide the clinician with image data of high temporal and spatial ***,Doppler and contrastenhanced ultrasound(CEUS) add important information about blood *** article provides a general review of the current literature regarding imaging modalities used for the evaluation of bowel diseases,highlighting the role of US and recent developments in CEUS.

关键词： Gastrointestinal tract Bowel Imaging Ultrasound Colour-Doppler Contrast-enhancement Time-intensity curve

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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

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Usefulness of contrast enhanced ultrasound in monitoring therapeutic response after hepatocellular carcinoma treatment

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World Journal of Hepatology 2015年第14期7卷 1866-1874页

作者： Davide Roccarina Matteo Garcovich maria elena ainora Laura Riccardi Maurizio Pompili Antonio Gasbarrini maria Assunta Zocco Department of Internal Medicine Catholic University of Sacred Heart

In the last years, the development in the oncology field has been huge and rapid. In particular, the evaluation of response to anti-tumour treatments has been being object of intense research, producing significant changes. Response assessment after therapy in solid neoplasias has always used radiological imaging techniques, with tumour size reduction representing a presumed therapeutic efficacy. However, with the introduction of anti-angiogenetic drugs the evaluation of tumour size has become unsuitable because some tumours, under treatment, show only tumour perfusion changes rather than lesion shrinkage. Between different imaging techniques with contrast-enhancement, contrastenhanced ultrasound(CEUS) and, in particular, dynamic CEUS have arisen as a promising and non-invasive device for monitoring cancer treatments. Moreover, the introduction of perfusion software has even more refined the technique since it is able to provide quantitative parameters related to blood flow and blood volume that can be associated with tumour response and clinical outcome such as the progression free survival and the overall survival. Here, we give an overview of the current status of CEUS in monitoring hepatocellular carcinoma response to different kind of treatments.

关键词： Dynamic contrast-enhanced ultrasound Hepatocellular carcinoma Ablative treatment Antiangiogeneticdrugs Time-intensitive curve

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Plasticity of photorespiratory carbon concentration mechanism in Sedobassia sedoides(Pall.)Freitag&*** under elevated CO_(2)concentration and salinity

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Journal of Arid Land 2024年第7期16卷 963-982页

作者： Zulfira RAKHMANKULOVA elena SHUYSKAYA maria PROKOFIEVA Kristina TODERICH Pavel VORONIN Timiryazev Institute of Plant Physiology Russian Academy of SciencesMoscow 127276Russia Graduate School of Bioresources Mie University1577 KurimamachiyaTsu 514-8507Japan

Rising atmospheric CO_(2)(carbon dioxide)concentrations and salinization are manifestations of climate change that affect plant growth and *** with an intermediate C_(3)-C_(4)type of photosynthesis live in a wide range of precipitation,temperature,and soil quality,but are more often found in warm and dry *** of the intermediate C_(3)-C_(4)photosynthetic type is C_(2)photosynthesis with a carbon concentration mechanism(CCM)that reassimilates CO_(2)released via ***,the ecological significance under which C_(2)photosynthesis has advantages over C_(3)and C_(4)plants remains largely *** tolerance and functioning of CCM were studied in plants from two populations(P1 and P2)of Sedobassia sedoides(Pall.)Freitag&*** *** with C_(2)photosynthesis exposed to 4 d and 10 d salinity(200 mM NaCl)at ambient(785.7 mg/m^(3),aCO_(2)and elevated(1571.4 mg/m^(3),eCO_(2))CO_(2).On the fourth day of salinity,an increase in Na+content,activity catalase,and superoxide dismutase was observed in both populations.P2 plants showed an increase in proline content and a decrease in photosynthetic enzyme content:rubisco,phosphoenolpyruvate carboxylase(PEPC),and glycine decarboxylase(GDC),which indicated a weakening of C_(2)and C_(4)characteristics under *** under 10 d salinity led to an increased Na^(+)content and activity of cyclic electron flow around photosystem I(PSI CEF),a decreased content of K^(+)and GDC in both populations.P1 plants showed greater salt tolerance,which was assessed by the degree of reduction in photosynthetic enzyme content,PSI CEF activity,and changes in relative growth rate(RGR).Differences between populations were evident under the combination of eCO_(2)and *** long-term salinity and eCO_(2),more salt-tolerant P1 plants had a higher dry biomass(DW),which was positively correlated with PSI CEF *** less salt-tolerant P2 plants,DW correlated with transpiration and dark

关键词： photosystemsⅠandⅡ carbon-concentrating mechanism glycine decarboxylase rubisco phosphoenolpyruvate carboxylase(PEPC) cyclic electron flow salinity stress drylands

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Calcium-sensitive protein MLC1 as a possible modulator of the astrocyte functional state

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Neural Regeneration Research 2025年第7期20卷 2008-2010页

作者： elena Ambrosini Angela Lanciotti maria Stefania Brignone Department of Neuroscience Istituto Superiore di SanitàRomeItaly

Astrocytes,the main population of glial cells in the central nervous system(CNS),exert essential tasks for the control of brain tissue homeostasis,supporting neuron and other glial cell activity from the developmental stage to adult *** maintain the optimal functionality of the brain,astroglial cells are particularly committed to reacting to every change in tissue homeostatic conditions,from mild modifications of the physiological environment,a process called astrocyte activation,to the more severe alterations occurring in pathological situations causing astrocyte reactivity or reactive astrogliosis(Escartin et al.,2021).During these reactive states,astrocytes mount an active,progressive response encompassing morphological,molecular,and interactional remodeling,leading to the acquisition of new functions and the loss of others,whose intensity,duration,and reversibility are dependent on the nature of the stimulus and regulated in a context-specific manner.

关键词： alterations modulator maintain

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