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Impact of centralization of pancreaticoduodenectomy coupled with fast track recovery protocol:a comparative study from India

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Hepatobiliary & Pancreatic Diseases International 2016年第5期15卷 546-552页

作者： Omar J Shah Sadaf A Bangri Manmohan Singh Reyaz A Lattoo Mohammad Y Bhat Feroze A Khan Department of surgical Gastroenterology Sher-i-Kashmir Institute of Medical Sciences

BACKGROUND: Fast track strategy in the management of patients undergoing intra-abdominal surgery of various types has emerged as a landmark approach to reduce surgical stress and accelerate recovery. This study was to evaluate the effect of fast track strategy on patients subjected to pancreaticoduo-denectomy (PD) from an individual unit during transit from low to a high volume center. METHODS: A total of 142 PD patients who had been subjected to fast track strategy between June 2008 and September 2012 were compared with 46 patients who had received convention-al surgery between January 2006 and May 2008. Comparative analysis was made of postoperative complications, postopera-tive recovery, length of hospital stay and patient readmission requirement. RESULTS: The patients subjected to fast track strategy had a faster recovery and a shorter hospital stay than those who were treated conventionally (7.8 vs 12.1 days). The intraoperative events like operative blood loss (417.9±83.8 vs 997.4 ±151.8 mL, P CONCLUSIONS: This preliminary analysis suggests that the fast track approach might be beneifcial to the well-being of the patients after PD, for it accelerates the immediate clinical recovery of patients and signiifcantly shortens their length of hospital stay.

关键词： fast track recovery pancreaticoduodenectomy

Omental flaps reduces complications after pancreaticoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2015年第3期14卷 313-319页

作者： Omar J Shah Sadaf A Bangri Manmohan Singh Reyaz A Lattoo Mohammad Y Bhat Department of surgical Gastroenterology Sher-i-Kashmir Institute of Medical Sciences

BACKGROUND： Major complications after pancreaticoduo- denectomy are usually caused by a leaking pancreaticojejunal anastomosis. Omental flaps around various anastomoses were used to prevent the formation of fistula.

关键词： pancreaticoduodenectomy omental flaps periampullary neoplasms

Parenchyma-sparing pancreatectomies for benign or border-line tumors of the pancreas

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World Journal of Gastrointestinal Oncology 2010年第6期2卷 272-281页

作者： Cosimo Sperti Valentina Beltrame Anna Caterina Milanetto Margherita Moro Sergio Pedrazzoli Department of medical and surgical sciences IV Surgical Clinic University of Padua

Standard pancreatic resections, such as pancreaticoduodenectomy, distal pancreatectomy, or total pancreatectomy, result in an important loss of normal pancreatic parenchyma and may cause impairment of exocrine and endocrine function. Whilst these procedures are mandatory for malignant tumors, they seem to be too extensive for benign or border-line tumors, especially in patients with a long life expectancy. In recent years, there has been a growing interest in parenchyma-sparing pancreatic surgery with the aim of achieving better functional results without compromising oncological radicality in patients with benign, border-line or low-grade malignant tumors. Several limited resections have been introduced for isolated or multiple pancreatic lesions, depending on the location of the tumor: central pancreatectomy, duodenum-preserving pancreatic head resection with or without segmental duodenectomy, inferior head resection, dorsal pancreatectomy, excavation of the pancreatic head, middle-preserving pancreatectomy, and other multiple segmental resections. All these procedures are technically feasible in experienced hands,with very low mortality, although with high morbidity rate when compared to standard procedures. Pancreatic endocrine and exocrine function is better preserved with good quality of life in most of the patients, and tumor recurrence is uncommon. Careful patient selection and expertise in pancreatic surgery are crucial to achieve the best results.

关键词： Middle pancreatectomy Pancreatic head resection Pancreas Pancreatectomy Limited pancreatectomy

Psycho-gastroenterological profile of an Italian population of children with disorders of gut-brain interaction:A case-control study

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World Journal of Clinical Pediatrics 2025年第1期14卷 69-77页

作者： Valentina Giorgio Ilaria Venezia Licia Pensabene Elisa Blasi Donato Rigante Paolo Mariotti Giuseppe Stella Gaia Margiotta Giovanna Quatrale Giuseppe Marano Marianna Mazza Antonio Gasbarrini Eleonora Gaetani Pediatric Unit Department of WomenChildren and Public Health SciencesFondazione Policlinico Universitario“A.Gemelli”IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy Child Neuropsychiatry Unit ASST Santi Paolo e CarloSan Paolo HospitalMilan 20142Italy Child Neuropsychiatry Unit Department of WomenChildren and Public Health SciencesFondazione Policlinico Universitario“A.Gemelli”IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy Department of medical and surgical sciences Pediatric UnitUniversity Magna GraeciaCatanzaro 88100Italy Unit of Psychiatry Fondazione Policlinico Universitario“A.Gemelli”IRCCSRome 00168Italy Department of Neurosciences UniversitàCattolica del Sacro CuoreRome 00168Italy Department of Internal Medicine and Gastroenterology Fondazione Policlinico Universitario"A.Gemelli"IRCCSRome 00168Italy Department of medical and surgical sciences Fondazione Policlinico Universitario"A.Gemelli"IRCCSUniversitàCattolica del Sacro CuoreRome 00168Italy

BACKGROUND Disorders of gut-brain interaction(DGBI)are common,but knowledge about their physiopathology is still poor,nor valid tools have been used to evaluate them in *** To develop a psycho-gastroenterological questionnaire(PGQ)to assess the psycho-gastroenterological profile and social characteristics of a pediatric population with and without *** One hundred and nineteen Italian children(age 11-18)were included:28 outpatient patients with DGBI(Rome IV criteria)and 91 healthy *** filled the PGQ,faces pain scale revised(FPS-R),Bristol stool chart,ga-strointestinal symptoms rating scale,state-trait anxiety inventory,Toronto alexithymia scale 20,perceived self-efficacy in the management of negative emotions and expression of positive emotions(APEN-G,APEP-G),irritable bowel syndrome-quality of life questionnaire,school performances,tobacco use,early life events,degree of *** Compared to controls,patients had more medical examinations(35%of them went to the doctor more than five times),a higher school performance(23%vs 13%,Pmedical examinations rising health care costs,lower anxiety levels.

关键词： Disorders of gut-brain interaction Functional gastrointestinal disorders Psycho-gastroenterological profile Gut-brain axis Rome IV criteria Pediatric patients

Clinical and diagnostic aspects of gluten related disorders

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World Journal of Clinical Cases 2015年第3期3卷 275-284页

作者： Francesco Tovoli Chiara Masi Elena Guidetti Giulia Negrini Paola Paterini Luigi Bolondi Department of medical and surgical sciences University of Bologna

Gluten is one of the most abundant and widely distributed components of food in many areas. It can be included in wheat, barley, rye, and grains such as oats, barley, spelt, kamut, and triticale. Gluten-containinggrains are widely consumed; in particular, wheat is one of the world's primary sources of food, providing up to 50% of the caloric intake in both industrialized and developing countries. Until two decades ago, celiac disease(CD) and other gluten-related disorders were believed to be exceedingly rare outside of Europe and were relatively ignored by health professionals and the global media. In recent years, however, the discovery of important diagnostic and pathogenic milestones led CD from obscurity to global prominence. In addition, interestingly, people feeding themselves with glutenfree products greatly outnumber patients affected by CD, fuelling a global consumption of gluten-free foods with approximately $2.5 billion in United States sales each year. The acknowledgment of other medical conditions related to gluten that has arisen as health problems, providing a wide spectrum of gluten-related disorders. In February 2011, a new nomenclature for gluten-related disorders was created at a consensus conference in London. In this review, we analyse innovations in the field of research that emerged after the creation of the new classification, with particular attention to the new European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for CD and the most recent research about non-celiac gluten sensitivity.

关键词： Celiac disease Wheat allergy Gluten sensitivity Non-celiac gluten sensitivity Gluten-free diet Gluten Anti-gliadin antibodies

Enhanced recovery after surgery protocol enhances early postoperative recovery after pancreaticoduodenectomy

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Hepatobiliary & Pancreatic Diseases International 2019年第2期18卷 188-193页

作者： Ramasamy Mahendran Mallika Tewari Vinod Kumar Dixit Hari Shankar Shukla Department of surgical Oncology Institute of Medical Sciences Banaras Hindu University Department of Gastroenterology Institute of Medical Sciences Banaras Hindu University

Background: Enhanced recovery after surgery(ERAS) protocol is a multimodal, multidisciplinary and evidence-based approach to reduce surgical stress and enhance recovery in the postoperative period. This study aimed to analyze the outcome of ERAS protocol in patients after pancreaticoduodenectomy(PD). Methods: A total of 50 consecutive patients with pancreatic/periampullary cancer who underwent PD between January 2016 to August 2017 were included in the study. As per the institute ERAS protocol, nasogastric tube(NGT) was removed on postoperative day(POD) 1 if output was less than 200 mL and oral sips were allowed; oral liquids were allowed on POD2; semisolid diet by POD3; abdominal drain was removed on POD 4 if output was less than 100 mL with no evidence of postoperative pancreatic fistula(POPF); normal diet was allowed on POD5. Discharge criteria on POD6 were afebrile, tolerating oral normal diet, pain free and no surgery related complications(defined as per the ISGPS definitions). Results: NGT was removed on POD1 in 45(90%) patients, abdominal drain removed by POD4 in 41(82%) and 43(86%) patients were discharged on POD6. There was no 30-day postoperative mortality. Three(6%) patients had delayed gastric emptying(DGE). None had postoperative hemorrhage and POPF. Readmission rate was 8%. A significant relation was found between the length of hospital stay(LOS) with age( P < 0.05) and a marginal relation between LOS and postoperative albumin( P = 0.05). Conclusions: ERAS protocol can be safely followed in the perioperative care of patients who undergo PD. Early removal of NGT and allowing oral diet restore bowel function early. ERAS decreases the LOS and postoperative complications.

关键词： Enhanced recovery protocol Pancreatic cancer Periampullary cancer Pancreaticoduodenectomy Early discharge

Nuclear factor erythroid 2-related factor 2-mediated signaling and metabolic associated fatty liver disease

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World Journal of Gastroenterology 2022年第48期28卷 6909-6921页

作者： Vidyasagar Naik Bukke Archana Moola Gaetano Serviddio Gianluigi Vendemiale Francesco Bellanti Department of medical and surgical sciences University of FoggiaFoggia 71122Italy

Oxidative stress is a key driver in the development and progression of several diseases,including metabolic associated fatty liver disease(MAFLD).This condition includes a wide spectrum of pathological injuries,extending from simple steatosis to inflammation,fibrosis,cirrhosis,and hepatocellular *** buildup of lipids in the liver is strictly related to oxidative stress in MAFLD,progressing to liver fibrosis and *** nuclear factor erythroid 2-related factor 2(NRF2)is a master regulator of redox ***2 plays an important role for cellular protection by inducing the expression of genes related to antioxidant,anti-inflammatory,and cytoprotective *** evidence demonstrates that NRF2 is involved in every step of MAFLD development,from simple steatosis to inflammation,advanced fibrosis,and initiation/progression of hepatocellular ***2 activators regulate lipid metabolism and oxidative stress alleviating the fatty liver disease by inducing the expression of cytoprotective ***,modulating NRF2 activation is crucial not only in understanding specific mechanisms underlying MAFLD progression but also to characterize effective therapeutic *** review outlined the current knowledge on the effects of NRF2 pathway,modulators,and mechanisms involved in the therapeutic implications of liver steatosis,inflammation,and fibrosis in MAFLD.

关键词： Nonalcoholic fatty liver disease Metabolic-associated fatty liver disease Nuclear factor erythroid 2-related factor 2 Oxidative stress Antioxidants Liver injury

Helicobacter species and pathogenesis of gallbladder cancer

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Hepatobiliary & Pancreatic Diseases International 2010年第2期9卷 129-134页

作者： Raghvendra Raman Mishra Mallika Tewari Hari S.Shukla Department of surgical Oncology Institute of Medical SciencesBanaras Hindu University

BACKGROUND:Gallbladder cancer(GBC)is a rare disease but a leading cause of cancer-related death worldwide.A number of etiological factors have been implicated in the causation of GBC and pathogenic infection by bacteria is one of these. DATA SOURCES:A PubMed search on'helicobacter','gall- bladder cancer',and'biliary tract malignancies'was done on the topic,and the relevant data were collected,reviewed,and analyzed. RESULTS:Helicobacter is an epsilon proteobacterium that infects the mucosal lining of the human gastrobiliary system. Infection with helicobacter is an important risk factor for the development of cancer and the bacterium has been categorized as a group-Ⅰcarcinogen by the International Agency for Research on Cancer(IARC).These microbes enter the human body by means of contaminated food and *** they invade the tissues and produce chemical carcinogens that lead to DNA damage and subsequently a series of gene mutations transform normal cells into cancer *** this review,we focus our attention on the role of helicobacter in the causation of biliary tract malignancies. CONCLUSIONS:The review attempts to summarize the current available data on the role of helicobacter in the causation of *** are accountable data available to suggest the role of helicobacter species in the causation of GBC although larger studies are urgently required for confirmation.

关键词： helicobacter genus gallbladder cancer DNA damage carcinogen pathogenesis

Why is early detection of colon cancer still not possible in 2023?

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World Journal of Gastroenterology 2024年第3期30卷 211-224页

作者： Valeria Tonini Manuel Zanni Department of medical and surgical sciences University of BolognaBologna 40138Italy

Colorectal cancer(CRC)screening is a fundamental tool in the prevention and early detection of one of the most prevalent and lethal *** the years,screening,particularly in those settings where it is well organized,has succeeded in reducing the incidence of colon and rectal cancer and improving the prognosis related to *** considerable advancements in screening technologies and strategies,the effectiveness of CRC screening programs remains less than *** paper examined the multifaceted reasons behind the persistent lack of effect-iveness in CRC screening *** a critical analysis of current methodologies,technological limitations,patient-related factors,and systemic challenges,we elucidated the complex interplay that hampers the successful reduction of CRC morbidity and mortality *** acknowledging the ad-vancements that have improved aspects of screening,we emphasized the necessity of addressing the identified barriers *** study aimed to raise awareness of how important CRC screening is in reducing costs for this *** and early diagnosis are not only important in improving the prognosis of patients with CRC but can lead to an important reduction in the cost of treating a disease that is often diagnosed at an advanced *** more sooner can mean saving money later.

关键词： Colorectal cancer Colorectal cancer screening Colorectal screening test Colon and rectal cancer