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Fecal calprotectin in coeliac disease

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World Journal of Gastroenterology 2014年第2期20卷 611-612页

作者： pietro Capone Antonio Rispo Nicola Imperatore Nicola Caporaso Raffaella Tortora Gastroenterology Department of Clinical Medicine and SurgeryUniversity "Federico Ⅱ" of Naples80131 NapoliItaly

We would like to share with the readers the results of our experience in 50 celiac disease (CD) patients, enrolled between September 2012 and April 2013, who were referred to our third-level CD Unit. The fecal calprotectin (FC) concentration of 50 adults with newly diagnosed CD was compared to that of a control group of 50 healthy subjects. FC level was determined by enzyme linked immunosorbent assay with diagnostic cut-off of 75 μg/g. In addition, we tried to correlate the FC level with symptoms, histological severity of CD (Marsh grade) and level of tissue transglutaminase antibodies (aTg) in CD patients. Finally, FC level was increased in five CD patients and in four controls (10% vs 8%, P = NS); mean FC concentration of patients and controls were 57.7 (SD ± 29.1) and 45.1 (SD ± 38.4) respectively. Furthermore, no significant correlation was seen between FC levels and symptoms/Marsh grade/aTg. The five CD patients did not show inflammatory lesions (e.g., ulcers, erosions) at upper endoscopy. The four healthy controls with positive FC were followed-up for further six months; in this observational period they did not show clinical signs of any underlying disease. On these bases, we think that FC is not able to investigate the subclinical inflammatory changes of active CD and FC should be considered a useless tool in the diagnostic work-up of uncomplicated CD but it should be accompanied by aTg when ruling out organic disease in patients with irritable bowel syndrome.

关键词： Coeliac disease Calprotectin Bowel inflammation Small bowel

Magnetic resonance imaging differential diagnosis of brainstem lesions in children

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World Journal of Radiology 2016年第1期8卷 1-20页

作者： Carlo Cosimo Quattrocchi Yuri Errante Maria Camilla Rossi Espagnet Stefania Galassi Sabino Walter Della Sala Bruno Bernardi Giuseppe Fariello Daniela Longo department of Medicine and surgery Università Campus Bio-Medico di Roma department of NESMOS Sant’ Andrea HospitalUniversità La Sapienza Unit of Neuroradiology Bambino Gesù Children’s Research Hospital IRCCS Fatebenefratelli S. pietro Hospital

Differential diagnosis of brainstem lesions,either isolated or in association with cerebellar and supra-tentorial lesions,can be challenging. Knowledge of the structural organization is crucial for the differential diagnosis and establishment of prognosis of pathologies with involvement of the brainstem. Familiarity with the location of the lesions in the brainstem is essential,especially in the pediatric population. Magnetic resonance imaging(MRI) is the most sensitive and specific imaging technique for diagnosing disorders of the posterior fossa and,particularly,the brainstem. High magnetic static field MRI allows detailed visualization of the morphology,signal intensity and metabolic content of the brainstem nuclei,together with visualization of the normal development and myelination. In this pictorial essay we review the brainstem pathology in pediatric patients and consider the MR imaging patterns that may help the radiologist to differentiate among vascular,toxico-metabolic,infectiveinflammatory,degenerative and neoplastic processes. Helpful MR tips can guide the differential diagnosis: These include the location and morphology of lesions,the brainstem vascularization territories,gray and white matter distribution and tissue selective vulnerability.

关键词： Brainstem Pediatrics Differential diagnosis Neuroradiology Magnetic resonance

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

Gut-liver axis and probiotics: Their role in non-alcoholic fatty liver disease

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World Journal of Gastroenterology 2014年第42期20卷 15518-15531页

作者： Giulia Paolella Claudia Mandato Luca Pierri Marco Poeta Martina Di Stasi pietro Vajro department of Medicine and surgery University of Salerno Pediatrics of AORN Santobono-Pausilipon ELFID European Laboratory for the Investigation of Food Induced Disease

The incidence of obesity and its related conditions, including non-alcoholic fatty liver disease (NAFLD), has dramatically increased in all age groups worldwide. Given the health consequences of these conditions, and the subsequent economic burden on healthcare systems, their prevention and treatment have become major priorities. Because standard dietary and lifestyle changes and pathogenically-oriented therapies (e.g., antioxidants, oral hypoglycemic agents, and lipid-lowering agents) often fail due to poor compliance and/or lack of efficacy, novel approaches directed toward other pathomechanisms are needed. Here we present several lines of evidence indicating that, by increasing energy extraction in some dysbiosis conditions or small intestinal bacterial overgrowth, specific gut microbiota and/or a “low bacterial richness” may play a role in obesity, metabolic syndrome, and fatty liver. Under conditions involving a damaged intestinal barrier (“leaky gut”), the gut-liver axis may enhance the natural interactions between intestinal bacteria/bacterial products and hepatic receptors (e.g., toll-like receptors), thus promoting the following cascade of events: oxidative stress, insulin-resistance, hepatic inflammation, and fibrosis. We also discuss the possible modulation of gut microbiota by probiotics, as attempted in NAFLD animal model studies and in several pilot pediatric and adult human studies. Globally, this approach appears to be a promising and innovative add-on therapeutic tool for NAFLD in the context of multi-target therapy.

关键词： Probiotics Gut-liver axis Intestinal microbiota Barrier function Small intestinal bacterial overgrowth Bacterial translocation Non-alcoholic fatty liver disease

Viral hepatitis:Milestones,unresolved issues,and future goals

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World Journal of Gastroenterology 2021年第28期27卷 4603-4638页

作者： pietro Torre Andrea Aglitti Mario Masarone Marcello Persico Internal Medicine and Hepatology Unit Department of MedicineSurgery and Dentistry“Scuola Medica Salernitana”University of SalernoSalerno 84081Italy

In this review the current overall knowledge on hepatitis A,B,C,D,and E will be *** diseases are all characterized by liver inflammation but have significant differences in distribution,transmission routes,and *** B virus and hepatitis C virus are transmitted by exposure to infected blood,and in addition to acute infection,they can cause chronic hepatitis,which in turn can evolve into *** is estimated that more than 300 million people suffer from chronic hepatitis B or C *** D virus,which is also transmitted by blood,only affects hepatitis B virus infected people,and this dual infection results in worse liver-related *** A and E spread via the fecal-oral route,which corresponds mainly to the ingestion of food or water contaminated with infected ***,in developed countries hepatitis E is predominantly a *** hepatitis A virus and hepatitis E virus are usually responsible for a self-limiting hepatitis,a serious,rarely fatal illness is also possible,and in immunosuppressed patients,such as organ transplant recipients,hepatitis E virus infection can become *** description of goals achieved,unresolved issues,and the latest research on this topic may make it possible to speculate on future scenarios in the world of viral hepatitis.

关键词： Viral hepatitis Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E

Postoperative mortality and morbidity after D2 lymphadenectomy for gastric cancer:A retrospective cohort study

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World Journal of Gastroenterology 2022年第3期28卷 381-398页

作者： Giuseppe Brisinda Maria Michela Chiarello Anna Crocco Neill James Adams pietro Fransvea Serafino Vanella Abdominal surgery Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy department of Medical and Surgical Sciences UniversitàCattolica del Sacro CuoreRome 00168Italy General surgery Operative Unit Azienda Sanitaria Provinciale di CrotoneOspedale San Giovanni di DioCrotone 88900Italy Endocrine surgery Operative Unit Istituto Nazionale TumoriIRCCS Fondazione PascaleNapoli 80100Italy Health Sciences Clinical Microbiology UnitMagna Grecia UniversityCatanzaro 88100Italy department of Emergency surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy department of General and Oncological surgery Azienda Ospedaliera San Giuseppe MoscatiAvellino 83100Italy

BACKGROUND surgery for gastric cancer is a complex procedure and lymphadenectomy is often *** mortality and morbidity after curative gastric cancer surgery is not *** To evaluate the factors determining mortality and morbidity in a population of patients undergoing R0 resection and D2 lymphadenectomy for gastric *** A retrospective analysis of clinical data and pathological characteristics(age,sex,primary site of the tumor,Lauren histotype,number of positive lymph nodes resected,number of negative lymph nodes resected,and depth of invasion as defined by the standard nomenclature)was conducted in patients with gastric *** each patient we calculated the Kattan’s *** arbitrarily divided the study population of patients into two groups based on the nomogram score(65 years),and number of lymph nodes retrieved(≤35 lymph nodes or>35 lymph nodes).Uni-and multivariate analysis of clinical and pathological findings were performed to identify the factors affecting postoperative mortality and *** One-hundred and eighty-six patients underwent a curative R0 resection with D2 *** mortality rate was 3.8%(7 patients);a higher mortality rate was observed in patients aged>65 years(P=0.002)and in N+patients(P=0.04).Following univariate analysis,mortality was related to a Kattan’s score≥100 points(P=0.04)and the presence of advanced gastric cancer(P=0.03).Morbidity rate was 21.0%(40 patients).Surgical complications were observed in 17 patients(9.1%).A higher incidence of morbidity was observed in patients where more than 35 lymph nodes were harvested(P=0.0005).CONCLUSION Mortality and morbidity rate are higher in N+and advanced gastric cancer *** removal of more than 35 lymph nodes does not lead to an increase in mortality.

关键词： Gastric cancer Total gastrectomy Subtotal gastrectomy Lymphadenectomy Kattan’s nomogram Mortality Postoperative complications Postoperative pancreatic fistula Hemoperitoneum Anastomotic leakage

3D Non-Fluoroscopic Cryoablation of Right-Sided Accessory Pathways in Children:Monocentric Study and Literature Review

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Congenital Heart Disease 2021年第6期16卷 561-572页

作者： Fabrizio Drago Irma Battipaglia pietro Paolo Tamborrino Luigina Porco Camilla Calvieri Mario Salvatore Russo Vincenzo Pazzano Romolo Remoli Massimo Stefano Silvetti Pediatric Cardiology and Cardiac Arrhythmias Unit Department of Pediatric Cardiology and Cardiac SurgeryBambino GesùChildren’s HospitalIRCCSRomeItaly

Background:Cryoablation of accessory pathways(APs)is effective and very safe in children,as previously reported by our *** aim of this retrospective study was to evaluate the current efficacy of 3D non-fluoroscopic cryoablation of right sided APs in children,comparing results obtained with the Ensite VelocityTM and the more recent Ensite PrecisionTM 3D mapping *** and Results:From January 2016 to December 2019,102 pediatric patients[mean age 12.5±2.8,62 males(61%of total cohort)]with right APs underwent 3D non-fluoroscopic transcatheter cryoablation at our ***(14.7%)patients had previously undergone catheter *** procedural success rate was 95.1%(n=97).No significant differences were detected in acute success rates achieved with Ensite Velocity^(TM)or Ensite PrecisionTM systems nor between manifest(94%)and concealed APs(100%).No permanent complications *** follow-up(428±286 days,median 396 days[interquartile range 179-713]),19 patients(19.6%)had *** were more frequent for parahissian/anterior APs compared to midseptal/posterior and lateral APs(p=0.043).Recurrences were not related to the Ensite system used.A redo ablation procedure was attempted in 13 cases,11 cryoablation and 2 radiofrequency ablations:the former was successful in 10 cases out of 11(90.9%).Conclusion:3D cryoablation of right-sided APs is associated with a very high acute success rate with limited use of fluoroscopy,resulting in great benefit to the *** rates are not high and patients can be retreated with cryo-energy with higher success rates.

关键词： 3D Mapping accessory pathway children cryoablation pediatric tachyarrhythmias

Surgical management of genital lymphoedema:experience and critical considerations from a tricenter study

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Plastic and Aesthetic Research 2023年第1期10卷 629-642页

作者： Martino Guiotto Michele Maruccia Rossella Elia Marco Fresa Lidia Molinari Marie Nicod Lalonde Corrado Campisi pietro Giovanni di Summa department of Plastic and Hand surgery Centre Hospitalier Universitaire Vaudois(CHUV)Lausanne 1011Switzerland department of Plastic surgery Bari University HospitalBari 70124Italy Angiology department Centre Hospitalier Universitaire Vaudois(CHUV)Lausanne 1011Switzerland department of Plastic surgery Lymphatic UnitSan Martino HospitalGenova 16132Italy Nuclear Medicine and Molecular Imaging Centre Hospitalier Universitaire Vaudois(CHUV)Lausanne 1011Switzerland

Aim:Genital lymphoedema(GL)is a chronic and debilitating disease,which can severely affect the patient’s quality of life with significant socio-economic ***,no gold standard algorithm exists for GL from diagnosis to *** study proposes our therapeutic flowchart based on the three senior consultants’experience in lymphatic ***:A retrospective investigation was conducted on a prospectively maintained database(2018-2022).Inclusion criteria involved all patients who underwent surgical procedures for treating GL in three plastic surgery departments(Lausanne,Bari,and Genova).Outcomes were assessed in terms of oedema reduction,stage regression,and functional reported ***:16 patients with GL were included:50%underwent debulking surgery,18.8%microsurgery,and 31.2%debulking+*** recorded a significant regression of the GL stage:62.5%shifted from stage II/III to postoperative stage ***,we found an infection recurrency resolution in 50%,a scrotal oedema reduction in 62.5%,and a scrotal oedema resolution in 37.5%of the patients *** almost half of the patients(53.3%)with associated penile oedema described persistent postoperative penile oedema,only two patients complained of persistent ***:According to our clinical experience,preoperative and postoperative physical functional therapy is always *** stages I and IIA,after the failure of the conservative treatment,lymph-venous shunts and lymph node transplantation surgery are proposed at the early *** GL is already diagnosed at stages IIB and III,the debulking surgery,together with functional procedures,represents our first approach.

关键词： Genital lymphoedema debulking surgery functional surgery microsurgery lymphatic venous anastomosis multi lymphatic-venous anastomoses lymph node transplantation

Three-dimensional automatic artificial intelligence driven augmented-reality selective biopsy during nerve-sparing robot-assisted radical prostatectomy:A feasibility and accuracy study

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Asian Journal of Urology 2023年第4期10卷 407-415页

作者： Enrico Checcucci Alberto Piana Gabriele Volpi pietro Piazzolla Daniele Amparore Sabrina De Cillis Federico Piramide Cecilia Gatti Ilaria Stura Enrico Bollito Federica Massa Michele Di Dio Cristian Fiori Francesco Porpiglia department of surgery Candiolo Cancer InstituteFPO-IRCCSCandioloTurinItaly department of Oncology Division of UrologyUniversity of TurinSan Luigi Gonzaga HospitalOrbassanoToItaly department of Mechanical Engineering Politecnico di MilanoMilanItaly department of Public Health and Pediatric Sciences School of MedicineUniversity of TurinItaly department of Pathology San Luigi Gonzaga HospitalUniversity of TurinOrbassanoItaly SS Annunziata Hospital Department of SurgeryDivision of UrologyCosenzaItaly

Objective:To evaluate the accuracy of our new three-dimensional(3D)automatic augmented reality(AAR)system guided by artificial intelligence in the identification of tumour’s location at the level of the preserved neurovascular bundle(NVB)at the end of the extirpative phase of nerve-sparing robot-assisted radical ***:In this prospective study,we enrolled patients with prostate cancer(clinical stages cT1ce3,cN0,and cM0)with a positive index lesion at target biopsy,suspicious for capsular contact or extracapsular extension at preoperative multiparametric magnetic resonance *** underwent robot-assisted radical prostatectomy at San Luigi Gonzaga Hospital(Orbassano,Turin,Italy),from December 2020 to December *** the end of extirpative phase,thanks to our new AAR artificial intelligence driven system,the virtual prostate 3D model allowed to identify the tumour’s location at the level of the preserved NVB and to perform a selective excisional biopsy,sparing the remaining portion of the *** and postoperative data were evaluated,especially focusing on the positive surgical margin(PSM)rates,potency,continence recovery,and biochemical ***:Thirty-four patients were *** 15(44.1%)cases,the target lesion was in contact with the prostatic capsule at multiparametric magnetic resonance imaging(Wheeler grade L2)while in 19(55.9%)cases extracapsular extension was detected(Wheeler grade L3).3D AAR guided biopsies were negative in all pathological tumour stage 2(pT2)patients while they revealed the presence of cancer in 14 cases in the pT3 cohort(14/16;87.5%).PSM rates were 0%and 7.1%in the pathological stages pT2 and pT3(<3 mm,Gleason score 3),***:With the proposed 3D AAR system,it is possible to correctly identify the lesion’s location on the NVB in 87.5%of pT3 patients and perform a 3D-guided tailored nerve-sparing even in locally advanced diseases,without compromising the oncological safety

关键词： Prostate cancer Augmented reality Artificial intelligence Robotics Radical prostatectomy