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Natural history of untreatable hepatocellular carcinoma:A retrospective cohort study

World Journal of Hepatology 2012年第9期4卷 256-261页

作者： Giuseppe Cabibbo Marcello Maida Chiara Genco Pietro Parisi Marco Peralta michela Antonucci Giuseppe Brancatelli Calogero Cammà Antonio Craxì Vito Di Marco Section of Gastroenterology Department of Internal Medicine and Biomedical SpecialistUniversity of PalermoPalermo 90127Italy Department of Biopathology and Biomedical Methodologies University of PalermoPalermo 90127Italy Department of Oncology Division of General Surgery and OncologyUniversity of PalermoPalermo 90127Italy Department of Radiology DIBIMEFUniversity of PalermoPalermo 90127Italy

AIM: To investigate the clinical course of untreatable hepatocellular carcinoma (HCC) identified at any stage and to identify factors associated with mortality. METHODS: From January 1999 to December 2010, 320 out of 825 consecutive patients with a diagnosis of HCC and not appropriate for curative or palliative treatments were followed and managed with supportive therapy. Cirrhosis was diagnosed by histological or clinical features and liver function was evaluated according to Child-Pugh score. The diagnosis of HCC was performed by Ultra-Sound guided biopsy or by multiphasic contrast-enhanced computed tomography or gadolinium-enhanced magnetic resonance imaging. Data were collected for each patient including all clinical, laboratory and imaging variables necessary for the outcome prediction staging systems considered. HCC staging was performed according Barcelona Clinic Liver Cancer (BCLC) and Cancer of the Liver Italian Program scores. Follow-up time was defined as the number of months from the diagnosis of HCC to death. Prognostic baseline variables were analyzed by multivariate Cox analysis to identify the independent predictors of survival. RESULTS: Seventy-five per cent of patients had hepatitis C. Ascites was present in 169 patients (53%), while hepatic encephalopathy was present in 49 patients (15%). The Child-Pugh score was class A in 105 patients (33%), class B in 142 patients (44%), and class C in 73 patients (23%). One hundred patients (31%) had macroscopic vascular invasion and/or extra-hepatic spread of the tumor. A single lesion > 10 cm was observed in 34 patients (11%), while multinodular HCC was present in 189 patients (59%). Thirty nine patients (12%) were BCLC early (A) stage, 55 (17%) were BCLC intermediate (B) stage, 124 (39%) were BCLC advanced (C) stage, and 102 (32%) were end-stage BCLC (D). At the time of this analysis (July 2011), 28 (9%) patients were still alive. Six (2%) patients who were lost during follow-up were censored at the last vi

关键词： Hepatocellular carcinoma Liver Cancer Survival Prognosis Natural history

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Intraoperative use of indocyanine green fluorescence imaging in rectal cancer surgery: The state of the art

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World Journal of Gastroenterology 2021年第38期27卷 6374-6386页

作者： Roberto Peltrini Mauro Podda Simone Castiglioni Maria michela Di Nuzzo Michele D'Ambra Ruggero Lionetti Maurizio Sodo Gaetano Luglio Felice Mucilli Salomone Di Saverio Umberto Bracale Francesco Corcione Department of Public Health University of Naples Federico IINapoli 80131Italy Department of Emergency Surgery Cagliari University Hospital"Duilio Casula"Azienda Ospedaliero-Universitaria di CagliariCagliari 09100Italy Department of Medical Oral and Biotechnological SciencesUniversity G.D’Annunzio Chieti-PescaraPescara 65100Italy Department of General Surgery University of InsubriaASST Sette LaghiVarese 21100Italy

Indocyanine green(ICG)fluorescence imaging is widely used in abdominal *** implementation of minimally invasive rectal surgery using new methods like robotics or a transanal approach required improvement of optical *** that setting,ICG fluorescence optimizes intraoperative vision of anatomical structures by improving blood and lymphatic *** purpose of this review was to summarize all potential applications of this upcoming technology in rectal cancer *** type of use has been separately addressed and the evidence was *** rectal resection,ICG fluorescence angiography is mainly used to evaluate the perfusion of the colonic stump in order to reduce the risk of anastomotic *** addition,ICG fluorescence imaging allows easy visualization of organs such as the ureter or urethra to protect them from *** intraoperative technology is a valuable tool for conducting lymph node dissection along the iliac lymphatic chain or to better identifying the rectal dissection planes when a transanal approach is *** is an overview of the applications of ICG fluorescence imaging in current surgical practice and a synthesis of the results obtained from the *** further studies are need to investigate the real clinical benefits,these findings may enhance use of ICG fluorescence in current clinical practice and stimulate future research on new applications.

关键词： Indocyanine green Fluorescence imaging Near infrared Rectal cancer Total mesorectal excision Anastomotic leakage

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2D vs 3D laparoscopic right colectomy:A propensity score-matching comparison of personal experience with systematic review and meta-analysis

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World Journal of Gastrointestinal Surgery 2021年第6期13卷 597-619页

作者： Gianluca Costa Pietro Fransvea Luca Lepre Fabio Rondelli Alessandro Costa michela Campanelli Giorgio Lisi Maria Rosaria Mastrangeli Giovanni Guglielmo Laracca Giovanni Maria Garbarino Graziano Ceccarelli Surgery Center Campus Bio-MedicoRome 00128Italy Department of Emergency and Trauma Surgery Fondazione Policlinico Universitario A.Gemelli IRCCSRome 00168Italy General Surgery Unit Santo Spirito in Sassia HospitalRome 00193Italy Department of Surgical Science University of PerugiaSanta Maria Teaching HospitalTerni 05100Italy Catholic University“Our Lady of Good Council”School of Medicine Tirane 1023Albania Department of Emergency Surgery Tor Vergata University HospitalRome 00133Italy Department of General Surgery Sant'Eugenio HospitalRome 00144Italy Department of Medical Surgical Science and Translational Medicine Sapienza University of RomeSant'Andrea HospitalRome 00189Italy General Surgery Unit San Giovanni Battista HospitalFoligno 06034Italy

BACKGROUND The benefits of laparoscopic approach for right colectomy have been well ***,the technical difficulty to construct the intra-corporeal anastomosis is still *** To analyze the results of 3D and 2D laparoscopic right colectomy and to compare it to the published series through a systematic review and *** A retrospective study with propensity score matching analysis of patients undergoing laparoscopic right colectomy at Umbria2 Hospitals from January 2014 to March 2020 was performed.A systematic review was accomplished comparing 2D and 3D right *** In the personal series 47 patients of the 2D group were matched to 47 patients of the 3D *** 3D group showed a favorable trend in terms of mean operative time(170.7±32.9 min vs 183.8±35.4 min;P=0.053)and a significant lower anastomotic time(16.9±2.3 min vs 19.6±2.9 min,P<0.001).The complete mesocolic excision(CME)subgroups analysis showed a shorter anastomotic time(16.5±1.8 min vs 19.9±3.0 min;P<0.001)and operative time(175.0±38.5 min vs 193.7±37.1 min;P=0.063)in the 3D *** studies and our series were included in the meta-analysis with 551 patients(2D group:291;3D group:260).The pooled analysis demonstrated a significant difference in favour of the 3D group regarding the operative time(P<0.001)and the anastomotic time(P<0.001)while no differences were identified between groups in terms of blood loss(P=0.827),LNH yield(P=0.243),time to first flatus(P=0.333),postoperative complications(P=0.718)and length of stay(P=0.835).CONCLUSION The meta-analysis results showed that 3D laparoscopic right colectomy shortens operative and anastomotic time without affecting the standard *** our series,the advantage of the 3D system becomes evident when CME and/or more complex associated procedure are requested significantly reducing both the total operative and the anastomotic time.

关键词： Colon cancer Right colectomy Laparoscopy Complete mesocolic excision Two-dimensional Three-dimensional

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Response rates to direct antiviral agents among hepatitis C virus infected patients who develop hepatocellular carcinoma following direct antiviral agents treatment

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Hepatoma Research 2020年第2期6卷 1-10页

作者： michela Emma Burlone Stefano Fangazio Alessandro Croce Elisa Ceriani Rachele Rapetti Cristina Rigamonti Carlo Smirne Stelvio Tonello Paolo Ravanini Rosalba Minisini Mario Pirisi Internal Medicine Azienda Ospedaliero-Universitaria Maggiore della CaritàNovara 28100Italy Department of Translational Medicine Universitàdel Piemonte OrientaleNovara 28100Italy Laboratory of Virology Azienda Ospedaliero-Universitaria Maggiore della CaritàNovara 28100Italy

Aim:Patients with chronic hepatitis C virus(HCV)infection who develop hepatocellular carcinoma(HCC)soon after treatment with direct antiviral agents(DAA)may have been harboring hitherto hidden *** this were true,they should have a lower sustained viral response(SVR)rate,since active HCC hampers DAA *** aimed to verify this ***:We included all patients who attended an HCV clinic,provided that they:(1)had no previous history of HCC;(2)had received at least one DAA dose;and(3)had been followed-up clinically and ultrasonographically for at least six months after concluding ***:The study population included n=789 patients(55%males,median age 62 years).A median of 9.3 months(8.8-11.9)after concluding DAA,n=19(2.4%)patients were discovered to harbor *** comparison to all others,patients with HCC were more commonly male(84%vs.54%,P=0.009),obese(47%vs.17%,P=0.002),and cirrhotic(95%vs.35%,P<0.001)and had less commonly achieved an SVR(68%vs.98%,P<0.001).Moreover,they had a trend for being less commonly treatment na?ve(58%vs.67%,P=0.051).Based on multivariate analysis, ;the independent predictors of HCC were male sex(P=0.031),cirrhosis(P=0.004),obesity(P=0.006),and failure to achieve an SVR(P<0.001).Conclusion:Lack of achieving SVR is a strong independent predictor of development of HCC early after treatment of hepatitis C with *** failure should further alert clinicians to the possibility of this dreadful complication.

关键词： Chronic hepatitis C direct antiviral agent sustained viral response hepatocellular carcinoma obesity cirrhosis

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看乐高如何玩转客户共创

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商业评论 2024年第1期 109-115页

作者：米凯拉·贝雷塔(michela Beretta) 利努斯·达兰德(Linus Dahlander) 拉尔斯·弗雷泽里克森(Lars Frederiksen) 阿尔内·托马斯(Arne Thomas) 石小竹丹麦奥胡斯大学(Aar-hus University) 欧洲管理技术学院(ESMT) 奥胡斯大学阿姆斯特丹商学院(Amsterdam Business School)

能从顾客创意中获得持续商业回报的企业可谓凤毛麟角.事实上,源自顾客的创意往往是一时新鲜,后续多半难以为继.然而,此类创意一旦成功,就能创造新的收入来源,大大超越内部产生的创意,并在顾客群体当中建立更高的忠诚度——这便解释了众...

能从顾客创意中获得持续商业回报的企业可谓凤毛麟角.事实上,源自顾客的创意往往是一时新鲜,后续多半难以为继.然而,此类创意一旦成功,就能创造新的收入来源,大大超越内部产生的创意,并在顾客群体当中建立更高的忠诚度——这便解释了众多企业领导者为何会孜孜以求地追寻这种创意路径.

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Legionella from Environmental and Clinical Homes for the Mentally Disabled and Comparison of Their Sequence Types

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Journal of Life Sciences 2011年第1期5卷 53-58页

作者： Annalisa Bianchi Marina Tesauro michela Consonni Fabrizio Pregliasco Maria Gabriella Galli Department of Public Health Microbiology and Virology Universita degli Studi di Milano Milano 20133 Italy

In this study the authors compared the sequence types （STs） designed by sequence based typing （SBT） of 4 clinical and 12 environmental strains of Legionella pneumophila serogroup 1 （LP1） which were isolated from hospital facilities for the mentally disabled. The strains were selected after a retrospective surveillance of 565 clinical records （2002-2009） and investigations of water circuit. It was possible to correlate two clinical strains with the corresponding environment, which were collected from showers that had exposed the patients （ST685, ST16） and two clinical strains present in the same structure （STI）. The other environmental strains were isolated from water in the department with confirmed or suspected clinical cases. All the strains （seven） from the first structure had ST188; two from the second structure had ST34; and the last from the third structure, gave an ST694. The results were compared with the European Working Group for Legionella Infections （EWGLI） database： the ST 1, 16, 34 and 188 were already known in literature, among clinical and nosocomial cases, especially for ST 1, the most distributed worldwide. Two STs were new to the database. ST685 was isolated both from a patient and from the water; ST694, which was found exclusively in the environmental compartment of a control structure （no cases of legionellosis and low number of nosocomial pneumonia）, was unknown in the literature and the authors could only speculate on its possible minor virulence and/or distribution. The implementation of SBT and international comparisons may be useful to gain genotypic knowledge of circulating environmental strains, also verifying their presence in the clinical setting.

关键词： Legionella pneumophila genotyping sequence based typing nosocomial infections.

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Sources of Variability in the Use of Standardized Perfusion Value for HCC Studies

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Open Journal of Medical Imaging 2012年第2期2卷 33-40页

作者： michela D’Antò Mario Cesarelli Francesco Fiore Maria Romano Paolo Bifulco Department of Biomedical Electronic and Telecommunication Engineering University “Federico II” Naples Italy National Cancer Institute “Pascale Foundation” Naples Italy

Hepatocellular carcinoma (HCC) is one of the world’s most common malignant tumours. As known, liver tumour tissue is characterised by an increased blood supply related to neoangionesis which causes an increased arterial vascularisation. CT Perfusion Imaging is an important, non invasive, technique for qualitative assessment of tissue perfusion after contrast agent administration. Nevertheless, being able to reliably quantifying angiogenesis is increasingly important to both the evaluation of the disease progression and monitoring of the therapeutic response of HCC. With this in mind, we believe that could be helpful to employ Standardised Perfusion Value (SPV), which has the potential to be a useful non-invasive marker of HCC angiogenesis. However, before using SPV in clinical practice, we need to verify its reliability. There are different causes of variability in applying the SPV index, e.g., the technical specifications of the CT system employed and the image processing system. In this paper the authors will analyse the variability of the BFa estimates and the variability due to the calibration procedure of the CT system, this with the objective of verifying how these factors affects SPV values. In our case, perfusion MDCT images of seventeen HCC patients were analysed. A software application, based on maximum slope method, was developed to compute BFa and SPV values. Four radiologists were involved in images processing evaluating variability related to ROI selection;each radiologist repeated the ROI drawing four times on the same image set. We computed the k calibration factor in order to evaluate SPV variability due to calibration protocol of CT systems. Results show that calibration factor variance, due to the position in the gantry, is less than BFa variability. So, we conclude that, when daily calibration is preferred, a simplified protocol, which neglects the dependence of K factor from the position, may be utilised;at least until the intrinsic variability

关键词： CT Perfusion Calibration Liver Tumour

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Typical and atypical COVID-19 computed tomography findings

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World Journal of Clinical Cases 2020年第15期8卷 3177-3187页

作者： Damiano Caruso Tiziano Polidori Gisella Guido Matteo Nicolai Benedetta Bracci Antonio Cremona MartaZerunian michela Polici Francesco Pucciarelli Carlotta Rucci Chiara De Dominicis Marco Di Girolamo Giuseppe Argento Daniela Sergi Andrea Laghi Department of Surgical and Medical Sciences and Translational Medicine “Sapienza”-University of RomeSant'Andrea University HospitalAOU Sant’AndreaRome 00189Italy

In December 2019 a novel coronavirus,named severe acute respiratory syndrome coronavirus 2 was identified and the disease associated was named coronavirus disease 2019(COVID-19).Fever,cough,myalgia,fatigue associated to dyspnea represent most common clinical symptoms of the *** reference standard for diagnosis of severe acute respiratory syndrome coronavirus 2 infection is real time reverse-transcription polymerase chain reaction test applied on respiratory tract *** of lower specificity,chest computed tomography(CT),as reported in manifold scientific studies,showed high sensitivity,therefore it may help in the early detection,management and follow-up of COVID-19 *** affected by COVID-19 pneumonia usually showed on chest CT some typical features,such as:Bilateral ground glass opacities characterized by multilobe involvement with posterior and peripheral distribution;parenchymal consolidations with or without air bronchogram;interlobular septal thickening;crazy paving pattern,represented by interlobular and intralobular septal thickening surrounded by ground-glass opacities;subsegmental pulmonary vessels enlargement(>3 mm).Halo sign,reversed halo sign,cavitation and pleural or pericardial effusion represent some of atypical findings of COVID-19 *** the other hand lymphadenopathy’s and bronchiectasis’frequency is unclear,indeed conflicting data emerged in *** play a key role in recognition of high suspicious findings of COVID-19 on chest CT,both typical and atypical ***,the aim of this review is to illustrate typical and atypical CT findings of COVID-19.

关键词： SARS-CoV-2 COVID-19 Chest computed tomography Interstitial pneumonia Ground-glass opacities

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Accuracy of a predictive model for severe hepatic fibrosis or cirrhosis in chronic hepatitis C

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World Journal of Gastroenterology 2005年第46期11卷 7318-7322页

作者： Agostino Colli Alice Colucci Silvia Paggi Mirella Fraquelli Sara Massironi Marco Andreoletti Vittorio michela Dario Conte Department of Internal MedicineOspedale "A.Manzoni" 23900 LeccoItaly Postgraduate School of GastroenterologyIRCCS Ospedale Maggiore 20122 MilanItaly

AIM: To assess the accuracy of a model in diagnosing severe fibrosis/cirrhosis in chronic hepatitis C virus (HCV)***: The model, based on the sequential combination of the Bonacini score (BS: ALT/AST ratio,platelet count and INR) and ultrasonography liver surface characteristics, was applied to 176 patients with chronic HCV infection. Assuming a pre-test probability of 35%,the model defined four levels of post-test probability of severe fibrosis/cirrhosis: 90% (almost absolute).The predicted probabilities were compared with the observed patients' distribution according to the histology (METAVIR).RESULTS: Severe fibrosis/cirrhosis was found in 67 patients (38%). The model discriminated patients in three comparable groups: 34% with a very high (>90%)or low (75%) or low (<10%) probability of cirrhosis, leaving only 33% of the patients still requiring liver biopsy.

关键词： Liver fibrosis Ultrasonography Bonacini score Liver biopsy Hepatitis C

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Mangrove forests as a nature-based solution for coastal flood protection:Biophysical and ecological considerations

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Water Science and Engineering 2023年第1期16卷 1-13页

作者： Rosanna van Hespen Zhan Hu Bas Borsje michela De Dominicis Daniel AFriess Svetlana Jevrejeva Maarten GKleinhans Maria Maza Celine EJvan Bijsterveldt Tom Van der Stocken Bregje van Wesenbeeck Danghan Xie Tjeerd JBouma NIOZ Royal Netherlands Institute for Sea Research Department of Estuarine and Delta SystemsP.O.Box 1404400 AC Yersekethe Netherlands Faculty of Geosciences Department of Physical GeographyUtrecht UniversityP.O.Box 80.1153508 TC Utrechtthe Netherlands School of Marine Science Sun Yat-Sen University Zhuhai Campus2 University RoadZhuhai 519000China Guangdong Provincial Key Laboratory of Marine Resources and Coastal Engineering Guangzhou 510275China Pearl River Estuary Marine Ecosystem Research Station Ministry of EducationZhuhai 519082China Water Engineering&Management University of TwenteP.O.Box 2177500 AE Enschedethe Netherlands National Oceanography Centre Joseph Proudman Building6 Brownlow StreetLiverpool L35DAUK Department of Geography National University of Singapore1 Arts LinkSingapore 117570Singapore Centre for Nature-based Climate Solutions National University of Singapore16 Science Drive 4Singapore 117558Singapore Instituto de Hidraulica Ambiental de La Universidad de Cantabria(IHCantabria) Isabel Torres 1539011 SantanderSpain Wetlands International P.O.Box 4716700 AL Wageningenthe Netherlands Ecology and Biodiversity Group Department of BiologyVrije Universiteit BrusselPleinlaan 2B-1050 BrusselsBelgium Earth Science Section Jet Propulsion LaboratoryCalifornia Institute of Technology4800 Oak Grove DrivePasadenaCA 91109USA Unit for Marine and Coastal Systems Deltares2600 MH Delftthe Netherlands Department of Hydraulic Engineering Delft University of Technology2600 GA Delftthe Netherlands

Nature-based coastal protection is increasingly recognised as a potentially sustainable and cost-effective solution to reduce coastal flood *** uses coastal ecosystems such as mangrove forests to create resilient designs for coastal flood ***,to use mangroves effectively as a nature-based measure for flood risk reduction,we must understand the biophysical processes that govern risk reduction capacity through mangrove ecosystem size and *** this perspective,we evaluate the current state of knowledge on local physical drivers and ecological processes that determine mangrove functioning as part of a nature-based flood *** show that the forest properties that comprise coastal flood protection are well-known,but models cannot yet pinpoint how spatial heterogeneity of the forest structure affects the capacity for wave or surge ***,there is relatively good understanding of the ecological processes that drive forest structure and size,but there is a lack of knowledge on how daily bed-level dynamics link to long-term biogeomorphic forest dynamics,and on the role of combined stressors influencing forest *** simulation models of forest structure under changing physical(*** to sea-level change)and ecological drivers with hydrodynamic attenuation models will allow for better projections of long-term natural coastal protection.

关键词： Forest dynamics Seedling establishment Hydrodynamic energy attenuation Bed-level dynamics Forest structure Mangrove tree mortality

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