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Environmental Evaluation of Springs in the Intensely Cultivated and Industrialized Inland Plain of Cuneo （Northwest Italy）

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Journal of Environmental Science and Engineering(A) 2012年第1期1卷 19-24页

作者： maurizio Battegazzore Angelo Morisi Departmment of Cuneo ARPA Environmental Protection Agency ofPiemonteCuneo 1210Ira

Sixty springs of the Cuneo Province inland plains were sampled and analyzed for several chemical variables. Multi-variate analysis （PCA） of all the data was undertaken. The first principal component was positively correlated with chlorides, sulphites, hardness, and negatively correlated with altitude. The second principal component was positively correlated with DO and pH. Results showed that 4 groups of springs could be distinguished on the basis of environmental variables. A small number of springs did not group with the geographically more proximal springs but with another group due to a greater degree of affinity on the basis of the hydrochemical variables.

关键词： Springs groundwater quality Cuneo plain.

Clinical outcome in patients with hilar malignant strictures type Ⅱ Bismuth-Corlette treated by minimally invasive unilateral versus bilateral endoscopic biliary drainage

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Hepatobiliary & Pancreatic Diseases International 2012年第2期11卷 209-214页

作者： Milutin Bulajic Nikola Panic Miodrag Radunovic Radisav Scepanovic Radoslav Perunovic Predrag Stevanovic Tatjana Ille maurizio Zilli Mirko Bulajic Faculty of Medicine University of BelgradeDr Subotica 811000 BelgradeSerbia University Clinical-Hospital Center "Dragisa MisovicDedinje" Milana Tepica 111000 BelgradeSerbia General Hospital "Danilo I-Cetinje" Vuka Micunovica b.b81250 CetinjeMontenegro Department of Surgery Medical Faculty of PodgoricaUniversity of PodgoricaKrusevac b.b81000 PodgoricaMontenegro Department of Gastroenterology University Clinical Hospital "Santa Maria della Misericordia di Udine"Piazzale S.Maria della Misericorida 1533100 UdineItaly

BACKGROUND:Stenting of malignant hilar strictures remains a standard endoscopic treatment in patients with unresectable *** aim of this two-center prospective study was to compare unilateral versus bilateral drainage in hilar malignant stenosis Bismuth-Corlette type ***:During a 3-year period,a total of 49 patients with hilar tumors(Bismuth-Corlette type II) were referred for endoscopic treatment,following the criteria of ***,computed tomography scan and magnetic resonance cholangiopancreatography(MRCP) were previously performed in all patients in order to facilitate endoscopic retrograde cholangiopancreatography(ERCP).The stricture was first passed by the hydrophilic guide-wire and then contrast medium was *** bile duct dilation was performed,followed by plastic stent placement only in the liver lobe which was previously *** procedures were performed under conscious *** patients were followed up for the next 12 months with a stent exchange every 3 *** outcome was assessed by patient survival in the first 12 months after the ***:All 49 patients were treated with ERCP while 39(79.59%) had successful stent *** these,32 had hilar cholangiocarcinoma(82%) and 7(18%) had gallbladder *** groups of patients had Bismuth II strictures:A,21 patients(54%) with unilateral contrast injection and drainage,and B,18(46%) with bilateral contrast injection and drainage.A total of 57 plastic stents were used(10 Fr,89%;11.5 Fr,11%).Group B showed a lower bilirubin level 7 days after the procedure(P=0.008).Early complications were cholangitis(3 patients,2 in group A and 1 in group B) and acute pancreatitis(2 patients,1 each in A and B) with no statistical difference between the *** complications were stent migration(5 patients,1 in A and 4 in B) and stent clogging(6 patients,2 in A and 4 in B) showing a significant difference between the groups(P<0.01).The first ste

关键词： endoscopic retrograde cholangiopancreatography biliary tree stenosis stenting

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World Journal of Transplantation 2016年第4期6卷 632-645页

作者： maurizio Salvadori Elisabetta Bertoni Department of Renal Transplantation Careggi University Hospital

The recurrence of renal disease after renal transplantation is becoming one of the main causes of graft loss afterkidney transplantation. This principally concerns some of the original diseases as the atypical hemolytic uremic syndrome(HUS), the membranoproliferative glomerulonephritis(MPGN), in particular the MPGN now called C3 glomerulopathy. Both this groups of renal diseases are characterized by congenital(genetic) or acquired(autoantibodies) modifications of the alternative pathway of complement. These abnormalities often remain after transplantation because they are constitutional and poorly influenced by the immunosuppression. This fact justifies the high recurrence rate of these diseases. Early diagnosis of recurrence is essential for an optimal therapeutically approach, whenever possible. Patients affected by end stage renal disease due to C3 glomerulopathies or to atypical HUS, may be transplanted with extreme caution. Living donor donation from relatives is not recommended because members of the same family may be affected by the same gene mutation. Different therapeutically approaches have been attempted either for recurrence prevention and treatment. The most promising approach is represented by complement inhibitors. Eculizumab, a monoclonal antibody against C5 convertase is the most promising drug, even if to date is not known how long the therapy should be continued and which are the best dosing. These facts face the high costs of the treatment. Eculizumab resistant patients have been described. They could benefit by a C3 convertase inhibitor, but this class of drugs is by now the object of randomized controlled trials.

关键词： Kidney disease recurrence Complement dysregulation Atypical hemolytic uremic syndrome C3 glomerulopathies Dense deposit disease Plasma therapy Eculizumab C3 glomerulonephritis

Hepatitis C and renal transplantation in era of new antiviral agents

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World Journal of Transplantation 2018年第4期8卷 84-96页

作者： maurizio Salvadori Aris Tsalouchos Department of Transplantation Renal Unit Careggi University Hospital Nephrology and Dialysis Unit Saints Cosmas and Damian Hospital

Data from World Health Organization estimates that the hepatitis C virus(HCV) prevalence is 3% and approxi-mately 71 million persons are infected worldwide. HCV infection is particularly frequent among patients affected by renal diseases and among those in dialysis treatment. In addition to produce a higher rate of any cause of death, HCV in renal patients and in renal transplanted patients produce a deterioration of liver disease and is a recognized cause of transplant glomerulopathy, new onset diabetes mellitus and lymphoproliferative disorders. Treatment of HCV infection with interferon alpha and/or ribavirin had a poor efficacy. The treatment was toxic, expensive and with limited efficacy. In the post-transplant period was also cause of severe humoral rejection. In this review we have highlighted the new direct antiviral agents that have revolutionized the treatment of HCV both in the general population and in the renal patients. Patients on dialysis or with low glomerular filtration rate were particularly resistant to the old therapies, while the direct antiviral agents allowed achieving a sustained viral response in 90%- 100% of patients with a short period of treatment. This fact to date allows HCV patients to enter the waiting list for transplantation easier than before. These new agents may be also used in renal transplant patients HCV -positive without relevant clinical risks and achieving a sustained viral response in almost all patients. New drug appears in the pipeline with increased profile of efficacy and safety. These drugs are now the object of several phases Ⅱ, Ⅲ clinical trials.

关键词： Hepatitis C virus Renal transplantation Hepatitis C virus and renal diseases Interferon based therapies Direct antiviral agents Hepatitis C viruspositive donors

Is it time to give up with calcineurin inhibitors in kidney transplantation?

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World Journal of Transplantation 2013年第2期3卷 7-25页

作者： maurizio Salvadori Elisabetta Bertoni Department of Renal Transplantation Careggi University Hospital 50139 FlorenceItaly

Calcineurin inhibitors(CNIs) represent today a cornerstone for the maintenance immunosuppressive treatment in solid organ transplantation. Nevertheless, several attempts have been made either to minimize their dosage or to avoid CNIs at all because these drugs have the severe side effect of chronic nephrotoxicity. This issue represents a frontier for renal transplantation. The principal problem is to understanding whether the poor outcome over the long-term may be ascribed to CNIs nephrotoxicity or to the inability of these drugs to control the acute and chronic rejection B cells mediated. The authors analyze extensively all the international trials attempting to withdraw, minimize or avoid the use of CNIs. Few trials undertaken in low risk patients with an early conversion from CNIs to proliferation signal inhibitors were successful, but the vast majority of trials failed to improve CNIs side effects. To date the use of a new drug, a co-stimulation blocker, seems promising in avoiding CNIs with similar efficacy, better glomerular filtration rate and an improved metabolic profile. Moreover the use of this drug is not associated with the development of donorspecific anti-human leukocyte antigen antibodies. Thispoint has a particular relevance, because the failure of CNIs to realize good outcomes in renal transplantation has recently ascribed to their inability to control the acute and chronic rejections B-cell mediated. This paper analyzes all the recent studies that have been done on this issue that represents the real frontier that should be overcome to realize better results over the long-term after transplantation.

关键词： Calcineurin inhibitors nephrotoxicity Calcineurin inhibitors withdrawal Calcineurin inhibitors minimization Calcineurin inhibitors avoidance Donor specific antibodies Antibody mediated rejection New drugs in renal transplantation

Update on immunoglobulin a *** Ⅱ:Clinical,diagnostic and therapeutical aspects

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World Journal of Nephrology 2016年第1期5卷 6-19页

作者： maurizio Salvadori Giuseppina Rosso Department of Renal Transplantation and Renal Diseases Careggi University Hospital Division of Nephrology San Luca Hospital

Immunoglobulin A nephropathy （IgAN） is characterized by different clinical manifestations and by long-term different outcomes. Major problem for the physicians is to understanding which patients are at risk of a disease evolution and to prescribe the right therapy to the right patients. Indeed, in addition to patients with a stable disease with no trend to evolution or even with a spontaneous recovery, patients with an active disease and patients with a rapidly evolving glomeru-lonephritis are described. Several histopathological, biological and clinical markers have been described and are currently used to a better understanding of patients at risk, to suggest the right therapy and to monitor the therapy effect and the IgAN evolution over time. The clinical markers are the most reliable and allow to divide the IgAN patients into three categories： The low risk patients, the intermediate risk patients and the high risk patients. Accordingly, the therapeutic measures range from no therapy with the only need of repeated controls, to supportive therapy eventually associated with low dose immunosuppression, to immunosuppressive treat-ment in the attempt to avoid the evolution to end stage renal disease. However the current evidence about the different therapies is still matter of discussion. New drugs are in the pipeline and are described. They are object of randomized controlled trials, but studies with a number of patients adequately powered and with a long follow up are needed to evaluate effcacy and safety of these new drugs.

关键词： IgA nephropathy prevention and control IgA nephropathy IgA nephropathy diagnosis IgA nephropathy prognosis IgA nephropathy classifcation IgA nephropathy therapy

Pharmacogenetics of immunosuppressant drugs:A new aspect for individualized therapy

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World Journal of Transplantation 2020年第5期10卷 90-103页

作者： maurizio Salvadori Aris Tsalouchos Department of Renal Transplantation Careggi University HospitalFlorence 50139Italy Nephrology and Dialysis Unit Saints Cosmas and Damian HospitalPescia 51017Italy

In recent years,pharmacogenetics has emerged as an important tool for choosing the right immunosuppressant drug and its appropriate ***,pharmacogenetics may exert its action on immunosuppressant drugs at three *** identifies and studies the genes involved in encoding the proteins involved in drug pharmacokinetics and in encoding the enzymes involved in drug *** is also relevant in encoding the enzymes and proteins involved in codifying the transmembrane proteins involved in transmembrane passage favoring the absorption and intracellular action of several *** concern the variability of genes encoding the proteins involved as immunosuppressant triggers in the pharmacodynamic *** course,not all genes have been discovered and studied,but some of them have been clearly examined and their relevance together with other factors such as age and race has been *** genes on the basis of relevant studies have been proposed as good candidates for future ***,to date,clear conclusions may be drawn only for those drugs that are metabolized by CYP3A5 and its genotyping before kidney,heart and lung transplantation is *** conclusions of the studies on the recommended candidate genes,together with the development of omics techniques could in the future allow us to choose the right dose of the right immunosuppressant for the right patient.

关键词： Immunosuppressant pharmacokinetics Immunosuppressant pharmacodynamics Immunosuppressant pharmacogenetics Immunosuppressant pharmacogenomics Transplantation Immunosuppressant drugs

Does needle calibre affect pain and complication rates in patients undergoing transperineal prostate biopsy？ A prospective, randomized trial

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Asian Journal of Andrology 2009年第6期11卷 678-682页

作者： Saredi Giovanni Maria Chiara Sighinolfi Fidanza Francesco De Stefani Stefano Micali Salvatore maurizio Paterlini Roberto D＇Amico Bianchi Giampaolo Department of Urology University of Modena and Reggio Emilia Modena 41100 Italy Department of Oncology University of Modena and Reggio Emilia Modena 41100 Italy

Transperineal prostate biopsy is a procedure that can be used to obtain histological samples from the prostate. To improve both the quality of the biopsy core samples and prostate cancer detection, we are currently performing a prospective, randomized trial comparing prostate biopsy samples obtained using an 18 G-needle to those obtained using a 16 G-needle. The aim of this preliminary study was to evaluate pain and complication rates in both groups in order to assess whether performing a prostate biopsy with a larger calibre needle is a feasible procedure. One hundred and eighty-seven patients undergoing transperineal prostate biopsy were prospectively evaluated and divided into two groups. The first group （94 patients, Group A） received a transperineal prostate biopsy using a 16 G-needle and the second group （93 patients, Group B） underwent transperineal prostate biopsy with an 18 G-needle. Anaesthesia was obtained with a single perineal injection at the prostatic apex in all subjects. A visual analogue scale （VAS） and facial expression scale （FES） were used to assess pain during multiple steps of the procedure in each group. A detailed questionnaire was used to obtain information about drug use because it could potentially influence the pain and complications that patients experienced. Two weeks after the procedure, early and late complications were evaluated. Statistical analysis was carried out using non-parametric tests. Prostate Specific Antigen （PSA） and drug use were similar at baseline between the two groups. Pain during prostate biopsy, which was measured with both the VAS and FES instruments, did not differ significantly between the 18- and 16 G-needle groups, and no significant differences were found in early or late complication rates between the groups. Transperineal prostate biopsy with a 16 G-needle is a feasible Further studies with larger patient populations are required to prostate cancer detection rates. procedure in terms of pain and complicati

关键词： needle calibre prostatic biopsy side effects

Biomarkers in renal transplantation:An updated review

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World Journal of Transplantation 2017年第3期7卷 161-178页

作者： maurizio Salvadori Aris Tsalouchos Renal Unit Department of TransplantationCareggi University Hospital Division of Nephrology Careggi University Hospital

Genomics, proteomics and molecular biology lead to tremendous advances in all fields of medical sciences. Among these the finding of biomarkers as non invasiveindicators of biologic processes represents a useful tool in the field of transplantation. In addition to define the principal characteristics of the biomarkers, this review will examine the biomarker usefulness in the different clinical phases following renal transplantation. Biomarkers of ischemia-reperfusion injury and of delayed graft function are extremely important for an early diagnosis of these complications and for optimizing the treatment. Biomarkers predicting or diagnosing acute rejection either cell-mediated or antibody-mediated allow a risk stratification of the recipient, a prompt diagnosis in an early phase when the histology is still unremarkable. The kidney solid organ response test detects renal transplant recipients at high risk for acute rejection with a very high sensitivity and is also able to make diagnosis of subclinical acute rejection. Other biomarkers are able to detect chronic allograft dysfunction in an early phase and to differentiate the true chronic rejection from other forms of chronic allograft nephropathies no immune related. Finally biomarkers recently discovered identify patients tolerant or almost tolerant. This fact allows to safely reduce or withdrawn the immunosuppressive therapy.

关键词： Renal transplantation Biomarkers Genomic Proteomics Transplant outcome Molecular signatures