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Impact of a clinical pathway on treatment outcome in patients with acute pancreatitis

World Journal of Gastroenterology 2015年第30期21卷 9150-9155页

作者： Miroslav Vujasinovic Jana Makuc Bojan Tepes Apolon Marolt Zdenko Kikec Nace Robac Department of Internal Medicine General Hospital Slovenj Gradec abakus medico diagnostic centre Rogaska

AIM:To determine the impact of a clinical pathway(CP) on acute pancreatitis(AP) treatment ***:A retrospective analysis of medical records was performed. We compared the results of AP treatment outcome over two time periods in our centre,before(2006-2007) and after(2010-2012) the implementation of a CP. The CP comprised the following indicators of quality:performance of all laboratory tests on admission(including lipids and carbohydrate deficient transferrin),determination of AP aetiology,abdomen ultrasound(US) within the first 24 h after admission,contrast-enhanced computed tomography of the abdomen in all cases of suspected pancreatic necrosis,appropriately selected and sufficiently used antibiotic therapy(if necessary),pain control,adequate hydration,control of haemodynamic parameters and transfer to the Intensive Care Unit(ICU)(if necessary),endoscopic retrograde cholangiopancreatography(ERCP) in biliary AP,surgical treatment(if necessary),and advice on outpatient follow-up after discharge. A comparison of the length of stay with that in other Slovenian hospitals was also ***:There were 139 patients treated in the three-year period after the introduction of a CP,of which 81(58.3%) were male and 58(41.7%) female. The patients' mean age was 59.6 ± 17.3 years. The most common aetiologies were alcoholism and gallstones(38.8% each),followed by unexplained(11.5%),drug-induced,hypertriglyceridemia,post ERCP(2.9% each) and tumours(2.2%). Antibiotic therapy was prescribed in 72(51.8%) patients. Abdominal US was performed in all patients within the first 24 h after admission. Thirty-two(23.0%) patients were treated in the ICU. Four patients died(2.9%). In comparison to 2006-2007,we found an increased number of alcoholic and biliary AP and an associateddecrease in the number of unexplained aetiology cases. The use of antibiotics also significantly decreased after the implementation of a CP(from 70.3% to 51.8%; P = 0.003). There was no statistically

关键词： Acute Pancreatitis Treatment Clinicalpathway Indicator Quality

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Pancreatic exocrine insufficiency, diabetes mellitus and serum nutritional markers after acute pancreatitis

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World Journal of Gastroenterology 2014年第48期20卷 18432-18438页

作者： Miroslav Vujasinovic Bojan Tepes Jana Makuc Sasa Rudolf Jelka Zaletel Tjasa Vidmar Maja Seruga Bostjan Birsa Miroslav Vujasinovic Jana Makuc Tjasa Vidmar Department of Internal Medicine Slovenj Gradec General Hospital Slovenj Gradec 2380 Slovenia abakus medico diagnostic centre Rogaska Slatina 3250 Slovenia Department of Radiology University Medical Centre Maribor Maribor 2000 Slovenia Department of Endocrinology Diabetes and Metabolic Diseases University Medical Centre Ljubljana Ljubljana 1000 Slovenia Department of Internal Medicine Murska Sobota General Hospital Murska Sobota 9001 Slovenia Department of Internal Medicine Celje General Hospital Celje 3000 Slovenia

AIM: To investigate impairment and clinical significance of exocrine and endocrine pancreatic function in patients after acute pancreatitis (AP).

关键词： Acute pancreatitis Diabetes mellitus Pancreatic exocrine insufficiency Serum nutritional markers

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Robotic radiosurgery in pancreatic cancer: A systematic review

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World Journal of Gastroenterology 2015年第31期21卷 9420-9429页

作者： Milly Buwenge Francesco Cellini Nicola Silvestris Savino Cilla Francesco Deodato Gabriella Macchia Gian C Mattiucci Vincenzo Valentini Alessio G Morganti Department of Radiation Oncology Università Cattolica del Sacro Cuore Radiation Oncology Department Policlinico Universitario Campus Bio-Medico Medical Oncology Unit National Cancer Research Centre "Giovanni Paolo Ⅱ" Department of Medical Physics Università Cattolica del Sacro Cuore Fondazione di Ricerca e Cura Radiation Oncology Unit Department of ExperimentalDiagnostic and Specialty Medicine-DIMESUniversity of BolognaS.Orsola-Malpighi Hospital

AIM: To present a systematic review of techniques and clinical ***: A systematic review of published literature was performed. Only studies reporting patient outcome after radiosurgery(single fraction) delivered with robotic devices [i.e.,robotic radiosurgery(RRS)] have been ***: A total of 96 patients from 5 studies were included. The studies are characterized by small series and different methods in terms of dose,target definition,combination with chemotherapy and/or standard fractionated radiotherapy and evaluation modalities. Preliminary results are positive in terms of tumor response(ORR = 56%) and local control of the tumor(crude rate of local progressions: 19.5%).Results for median overall survival(11.4 mo) seem comparable with the ones of prolonged chemoradiation(range: 8.6-13.0 mo). However,gastrointestinal toxicity seems to be the main limitation of RRS,especially at the duodenal ***: RRS allows for local treatment in a shortened time(1 fraction) compared to traditional treatments(about 1 mo),providing the possibility for an easy integration with systemic therapies. Preliminary results did not show any outcome differences compared to standard chemoradiation. Thus,further efforts to reduce gastrointestinal toxicity are strongly needed.

关键词： Robotic Radiosurgery Pancreatic neoplasms Systemat

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The role of extracellular matrix in age-related conduction disorders： a forgotten player？

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Journal of Geriatric Cardiology 2015年第1期12卷 76-82页

作者： Cristiano Spadaccio Alberto Rainer Pamela Mozetic Marcella Trombetta Robert A Dion RaffaeleBarbato Francesco Nappi Massimo Chello Department of Cardiac Surgery Zieken Huis Oost-Limburg (ZOL) Campus' St. Jan 6 Schiepse Bos Genk 3600 Belgium Tissue Engineering Laboratory Center for Integrated Research Universith Campus Bio-Medico di Roma Via Alvaro del Portillo 200 Rome 00128 Italy Unit of Cardiovascular Surgery Center for integrated Research Universita Campus Bio-Medico di Roma Via Alvaro del Portillo 200 Rome 00128 Italy Cardiac Surgery centre Cardiologique du Nord de Saint-Denis 36 Rue des Moulins Gemeaux Saint-Denis Paris 93200 France

Cardiovascular aging is a physiological process gradually leading to structural degeneration and functional loss of all the cardiac and vascular components. Conduction system is also deeply influenced by the aging process with relevant reflexes in the clinical side. Age-related arrhythmias carry significant morbidity and mortality and represent a clinical and economical burden. An important and unjustly unrecognized actor in the pathophysiology of aging is represented by the extracellular matrix （ECM） that not only structurally supports the heart determining its mechanical and functional properties, but also sends a biological signaling regulating cellular function and maintaining tissue homeostasis. At the biophysical level, cardiac ECM exhibits a peculiar degree of anisotropy, which is among the main determinants of the conductive properties of the specialized electrical conduction system. Age-associated alterations of cardiac ECM are therefore able to profoundly affect the function of the conduction system with striking impact on the patient clinical conditions. This review will focus on the ECM changes that occur during aging in the heart conduction system and on their translation to the clinical scenario. Potential diagnostic and therapeutical perspectives arising from the knowledge on ECM age-associated alterations are further discussed.

关键词： Ageing Arrhythmia Cardiac Conduction system Extracellular matrix

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Exhaled volatile organic compounds for diagnosis and monitoring of asthma

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World Journal of Clinical Cases 2023年第21期11卷 4996-5013页

作者： Luisa Savito Simone Scarlata Andras Bikov Pierluigi Carratù Giovanna Elisiana Carpagnano Silvano Dragonieri Department of Internal Medicine Unit of Respiratory Pathophysiology and Thoracic EndoscopyFondazione Policlinico Universitario Campus Bio MedicoRome 00128Italy Wythenshawe Hospital Manchester University NHS Foundation TrustManchester Academic Health Science CentreManchester M139WLUnited Kingdom Division of Infection Immunity and Respiratory MedicineFaculty of BiologyMedicine and HealthThe University of ManchesterManchester M139PTUnited Kingdom Department of Internal Medicine"A.Murri" University of Bari"Aldo Moro"Bari 70124Italy Department of Respiratory Diseases University of BariBari 70124Italy

The asthmatic inflammatory process results in the generation of volatile organic compounds(VOCs),which are subsequently secreted by the *** study of these elements through gas chromatography-mass spectrometry(GC-MS),which can identify individual molecules with a discriminatory capacity of over 85%,and electronic-Nose(e-NOSE),which is able to perform a quick onboard pattern-recognition analysis of VOCs,has allowed new prospects for non-invasive analysis of the disease in an"omics"*** this review,we aim to collect and compare the progress made in VOCs analysis using the two methods and their instrumental *** have described the potential of GC-MS and e-NOSE in a multitude of relevant aspects of the disease in both children and adults,as well as differential diagnosis between asthma and other conditions such as wheezing,cystic fibrosis,COPD,allergic rhinitis and last but not least,the accuracy of these methods compared to other diagnostic tools such as lung function,FeNO and eosinophil *** to significant limitations of both methods,it is still necessary to improve and standardize ***,e-NOSE appears to be the most promising aid in clinical practice,whereas GC-MS,as the gold standard for the structural analysis of molecules,remains an essential tool in terms of research for further studies on the pathophysiologic pathways of the asthmatic inflammatory *** conclusion,the study of VOCs through GC-MS and e-NOSE appears to hold promise for the noninvasive diagnosis,assessment,and monitoring of asthma,as well as for further research studies on the disease.

关键词： Asthma Volatile organic compounds Gas chromatography-mass spectrometry Electronic-Nose Breathomics Non-invasive diagnosis

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Clinical usefulness of adherence to gastro-esophageal reflux disease guideline by Spanish gastroenterologists

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World Journal of Gastroenterology 2012年第35期18卷 4885-4891页

作者： Fermín Mearin Julio Ponce Marta Ponce Agustín Balboa Miguel A González Javier Zapardiel Service of Gastroenterology Centro Medico Teknon Digestive Disease Unit Hospital Quiron Centro de Investigacion Biomedica en Red:Enfermedades Hepaticasy Digestivas Service of Gastroenterology Hospital Universitario La Fe Biostatistics Innovex-Grupo Quintiles Espana Medical Department AstraZeneca Farmaceutica

AIM:To investigate usefulness of adherence to gastroesophageal reflux disease(GERD) guideline established by the Spanish Association of ***:Prospective,observational and multicentre study of 301 patients with typical symptoms of GERD who should be managed in accordance with guidelines and were attended by gastroenterologists in daily ***(aged > 18 years) were eligible for inclusion if they had typical symptoms of GERD(heartburn and/or acid regurgitation) as the major complaint in the presence or absence of accompanying atypical symptoms,such as dyspeptic symptoms and/or supraesophageal *** and therapeutic decisions should be made based on specific recommendations of the Spanish clinical practice guideline for GERD which is a widely disseminated and well known instrument among Spanish in digestive disease ***:Endoscopy was indicated in 123(41%) patients:50 with alarm symptoms,32 with age > 50 years without alarm ***-two patients(58.5%) had esophagitis(grade A,23,grade B,28,grade C,18,grade D,3).In the presence of alarm symptoms,endoscopy was indicated consistently with recommendations in 98% of ***,in the absence of alarm symptoms,endoscopy was indicated in 33% of patients > 50 years(not recommended by the guideline).Adherence for proton pump inhibitors(PPIs) therapy was 80%,but doses prescribed were lower(half) in 5% of cases and higher(double) in 15%.Adherence regarding duration of PPI therapy was 69%;duration was shorter than recommended in 1%(4 wk in esophagitis grades C-D) or longer in 30%(8 wk in esophagitis grades A-B or in patients without endoscopy).Treatment response was higher when PPI doses were consistent with guidelines,although differences were not significant(95% vs 85%).CONCLUSION:GERD guideline compliance was quite good although endoscopy was over indicated in patients > 50 years without alarm symptoms;PPIs were prescribed at higher doses and longer duration.

关键词： Gastro-esophageal reflux disease Clinicalpractice guidelines Adherence to guidelines Treatmentof gastro-esophageal reflux disease

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Radiological Errors: Implications and Causes with a Focus on Mammographic Misdiagnosis

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Open Journal of Medical Imaging 2019年第1期9卷 1-17页

作者： Mohammad Rawashdeh Sarah Lewis Patrick Brennan Faculty of Applied Medical Sciences Jordan University of Science and Technology Irbid Jordan Medical Image Optimisation and Perception Group (MIOPeG) and the Brain and Mind Centre the Faculty of Health Sciences The University of Sydney Sydney Australia

Radiological diagnostic errors may have serious clinical and medico-legal implications. Previous work has reported that radiology has a reasonable incidence of error, a number of which are resulted from observer mistakes. The radiologists’ interaction with the image is critical, and studying the types of diagnostic errors to improve patient and radiologist wellbeing, reduce cost and improve the public perception of the health care system is well justified. Therefore, the aim of current review is to consider the primary types of diagnostic errors in radiology, as well as their causes and implications with a focus on mammographic misdiagnosis.

关键词： Radiological Errors Radiologists Breast Cancer Radiologists’ Performance

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Transperineal laser ablation of the prostate as a treatment for benign prostatic hyperplasia and prostate cancer: The results of a Delphi consensus project

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Asian Journal of Urology 2024年第2期11卷 271-279页

作者： Andrea Cocci Marta Pezzoli Fernando Bianco Franco Blefari Pierluigi Bove Francois Cornud Gaetano De Rienzo Paolo Destefanis Danilo Di Trapani Alessandro Giacobbe Luca Giovanessi Antonino Laganà Giovanni Lughezzani Guglielmo Manenti Gianluca Muto Gianluigi Patelli Novello Pinzi Stefano Regusci Giorgio I.Russo Juan I.M.Salamanca Matteo Salvi Luigi Silvestri Fabrizio Verweij Eric Walser Riccardo GBertolo Valerio Iacovelli Alessandro Bertaccini Debora Marchiori Hugo Davila Pasquale Ditonno Paolo Gontero Gennaro Iapicca Theo M De Reijke Vito Ricapito Pierluca Pellegrini Andrea Minervini Sergio Serni Francesco Sessa Department of Urology Careggi HospitalUniversity of FlorenceFlorenceItaly Urology Section University of FlorenceFlorenceItaly Urological Research Network MiamiFLUSA Urology Section Prato HospitalPratoItaly Torvergata Oncoscience Research centre of Excellence TORDepartment of Experimental MedicineUniversity of Rome Tor VergataRomeItaly Department of Urology San Carlo di Nancy HospitalRomeItaly Department of Radiology Hôpital CochinParis Descartes UniversityParisFrance Urology and Andrology Unit II Department of Emergency and Organ TransplantationUniversity of BariBariItaly Unit of Urology Cittàdella Salute e della Scienza HospitalUniversity of TurinTurinItaly Urology Unit Buccheri La Ferla Fatebenefratelli HospitalPalermoItaly Department of Urology Humanitas Gradenigo HospitalTurinItaly Urology Unit Surgical DepartmentFondazione Poliambulanza Istituto OspedalieroBresciaItaly Departement of Urology “S.Giovanni Evangelista”HospitalTivoliItaly Humanitas Clinical and Research CentereIRCCS Department of UrologyRozzanoItaly Department of Biomedical Sciences Humanitas UniversityPieve EmanueleItaly Department of Biomedicine and Prevention University of Rome“Tor Vergata”RomeItaly Department of diagnostic Imaging and Interventional Radiology University of Rome“Tor Vergata”RomeItaly Department of Interventional Radiology Pesenti-Fenaroli Hospital-ASST Bergamo EstAlzano LombardoItaly Department of Urology University of SienaSienaItaly Swiss International Prostate Center GenevaSwitzerland Clinique Générale Beaulieu GenevaSwitzerland Department of Urology University of CataniaItaly Department of Urology Puerta de Hierro-Majadahonda University HospitalMadridSpain Lyx Institute of Urology Universidad Francisco de VitoriaMadridSpain Department of medico-Surgical Sciences and Biotechnologies Sapienza University of RomeFaculty of Pharmacy and MedicineUrology Unit ICOTLatinaItaly Department of Urology European Institute of Oncology(IEO)IRCCSMilanItaly Department of Radiology D

Objective: To evaluate transperineal laser ablation (TPLA) with Echolaser® (Echolaser® TPLA, Elesta S.p.A., Calenzano, Italy) as a treatment for benign prostatic hyperplasia (BPH) and prostate cancer (PCa) using the Delphi consensus ***: Italian and international experts on BPH and PCa participated in a collaborative consensus project. During two rounds, they expressed their opinions on Echolaser® TPLA for the treatment of BPH and PCa answering online questionnaires on indications, methodology, and potential complications of this technology. Level of agreement or disagreement to reach consensus was set at 75%. If the consensus was not achieved, questions were modified after each round. A final round was performed during an online meeting, in which results were discussed and ***: Thirty-two out of forty invited experts participated and consensus was reached on all topics. Agreement was achieved on recommending Echolaser® TPLA as a treatment of BPH in patients with ample range of prostate volume, from 80 mL (80%), comorbidities (100%), antiplatelet or anticoagulant treatment (96%), indwelling catheter (77%), and strong will of preserving ejaculatory function (100%). Majority of respondents agreed that Echolaser® TPLA is a potential option for the treatment of localized PCa (78%) and recommended it for low-risk PCa (90%). During the final round, experts concluded that it can be used for intermediate-risk PCa and it should be proposed as an effective alternative to radical prostatectomy for patients with strong will of avoiding urinary incontinence and sexual dysfunction. Almost all participants agreed that the transperineal approach of this organ-sparing technique is safer than transrectal and transurethral approaches typical of other techniques (97% of agreement among experts). Pre-procedural assessment, technical aspects, post-procedural catheterization, pharmacological therapy, and expected outcomes were discussed, leading t

关键词： Transperineal laser ablation Prostatecancer Benignprostatic hyperplasia Delphi consensus

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