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Evolving role of FDG-PET/CT in prognostic evaluation of resectable gastric cancer

World Journal of Gastroenterology 2017年第38期23卷 6923-6926页

作者： Emilio De Raffele Mariateresa Mirarchi Dajana Cuicchi Ferdinando Lecce Bruno Cola Unità Operativa di Chirurgia Generale Dipartimento dell’Apparato Digerente Azienda Ospedaliero-Universitaria di Bologna U.O. di Chirurgia Generale Dipartimento Strutturale Chirurgico Ospedale 'SS Antonio e Margherita'

Gastric cancer (GC) remains a leading cause of cancer death worldwide. Radical gastrectomy is the only potentially curative treatment, and perioperative adjuvant therapies may improve the prognosis after curative resection. Prognosis largely depends on the tumour stage and histology, but the host systemic inflammatory response (SIR) to GC may contribute as well, as has been determined for other malignancies. In GC patients, the potential utility of positron emission tomography/computed tomography (PET/CT) with the imaging radiopharmaceutical 18F-fluorodeoxyglucose (FDG) is still debated, due to its lower sensitivity in diagnosing and staging GC compared to other imaging modalities. There is, however, growing evidence that FDG uptake in the primary tumour and regional lymph nodes may be efficient for predicting prognosis of resected patients and for monitoring tumour response to perioperative treatments, having prognostic value in that it can change therapeutic strategies. Moreover, FDG uptake in bone marrow seems to be significantly associated with SIR to GC and to represent an efficient prognostic factor after curative surgery. In conclusion, PET/CT technology is efficient in GC patients, since it is useful to integrate other imaging modalities in staging tumours and may have prognostic value that can change therapeutic strategies. With ongoing improvements, PET/CT imaging may gain further importance in the management of GC patients.

关键词： Gastric cancer Prognosis 18F-fluorodeoxyglucose Positron emission tomography-computed tomography Bone marrow

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Simultaneous curative resection of double colorectal carcinoma with synchronous bilobar liver metastases

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World Journal of Gastrointestinal Oncology 2018年第10期10卷 293-316页

作者： Emilio De Raffele Mariateresa Mirarchi Dajana Cuicchi Ferdinando Lecce Claudio Ricci Riccardo Casadei Bruno Cola Francesco Minni Unità Operativa di Chirurgia Generale Dipartimento dell’Apparato DigerenteAzienda Ospedaliero-Universitaria di BolognaPoliclinico S.Orsola-Malpighi U.O.di Chirurgia Generale Dipartimento Strutturale Chirurgico Ospedale "Antonio e Margherita" dipartimento di Scienze Mediche e Chirurgiche (DIMEC) Alma Mater Studiorum Policlinico S.Orsola-Malpighi University of Bologna

Synchronous colorectal carcinoma(SCRC) indicates more than one primary colorectal carcinoma(CRC) discovered at the time of initial presentation, accounts for 3.1%-3.9% of CRC, and may occur either in the same or in different colorectal segments. The accurate preoperative diagnosis of SCRC is difficult and diagnostic failures may lead to inappropriate treatment and poorer prognosis. SCRC requires colorectal resections tailored to individual patients, based on the number, location, and stage of the tumours, from conventional or extended hemicolectomies to total colectomy or proctocolectomy, when established predisposing conditions exist. The overall perioperative risks of surgery for SCRC seem to be higher than for solitary CRC. Simultaneous colorectal and liver resection represents an appealing surgical strategy in selected patients with CRC and synchronous liver metastases(CRLM), even though the cumulative risks of the two procedures need to be adequately evaluated. Simultaneous resections have the noticeable advantage of avoiding a second laparotomy, give the opportunity of an earlier initiation of adjuvant therapy, and may significantly reduce the hospital costs. Because an increasing number of recent studies have shown goodresults, with morbidity, perioperative hospitalization, and mortality rates comparable to staged resections, simultaneous procedures can be selectively proposed even in case of complex colorectal resections, including those for SCRC and rectal cancer. However, in patients with multiple bilobar CRLM, major hepatectomies performed simultaneously with colorectal resection have been associated with significant perioperative risks. Conservative or parenchymal-sparing hepatectomies reduce the extent of hepatectomy while preserving oncological radicality, and may represent the best option for selected patients with multiple CRLM involving both liver lobes. Parenchymal-sparing liver resection, instead of major or two-stage hepatectomy for bilobar disea

关键词： Colorectal surgery Synchronous colorectal liver metastases Major hepatectomy Parenchymalsparing hepatectomy Intraoperative ultrasonography Simultaneous colorectal and liver surgery Synchronous colorectal carcinoma Ablative therapies

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Twenty-year survival after iterative surgery for metastatic renal cell carcinoma: A case report and review of literature

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World Journal of Clinical Cases 2020年第19期8卷 4450-4465页

作者： Emilio De Raffele Mariateresa Mirarchi Riccardo Casadei Claudio Ricci Eugenio Brunocilla Francesco Minni dipartimento dell'Apparato Digerente Policlinico S.Orsola-MalpighiUniversity of BolognaBologna 40138Italy dipartimento strutturale chirurgico Ospedale SS Antonio e MargheritaTortona(AL)15057Italy dipartimento di Scienze Mediche e Chirurgiche(DIMEC) Alma Mater StudiorumPoliclinico S.Orsola-MalpighiUniversity of BolognaBologna 40138Italy dipartimento di Medicina Specialistica Diagnostica e Sperimentale(DIMES)Alma Mater StudiorumPoliclinico S.Orsola-MalpighiUniversity of BolognaBologna 40138Italy

BACKGROUND The therapeutic approach of metastatic renal cell carcinoma(RCC)represents a real challenge for clinicians,because of the variable clinical course;the recent availability of numerous targeted therapies that have significantly improved overall oncological results,but still with a low percentage of complete responses;and the increasing role of metastasectomy(MSX)as an effective strategy to achieve a durable cure,or at least defer initiation of systemic therapies,in selected patients and in the context of multimodality treatment ***^E SUMMARY We report here the case of a 40-year-old man who was referred to our unit in November 2004 with lung and mediastinal lymph nodes metastases identified during periodic surveillance 6 years after a radical nephrectomy for RCC;he underwent MSX of multiple lung nodules and mediastinal lymphadenectomy,with subsequent systemic therapy with Fluorouracil,Interferon-alpha and Interleukin *** subsequent clinical course was characterized by multiple sequential abdominal and thoracic recurrences,successfully treated with multiple systemic treatments,repeated local treatments,including two pancreatic resections,conservative resection and ablation of multiple bilobar liver metastases,resection and stereotactic body radiotherapy of multiple lung *** is alive without evidence of recurrence 20 years after initial nephrectomy and sequential treatment of recurrences in multiple sites,including resection of more than 38 metastases,and 5 years after his last *** This case highlights that effective multimodality therapeutic strategies,including multiple systemic treatments and iterative aggressive surgical resection,can be safely performed with long-term survival in selected patients with multiple metachronous sequential metastases from RCC.

关键词： Renal cell carcinoma Metastases Surgery Thermal ablation Radiation Case report Systemic therapy

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Implication of the Hedgehog pathway in hepatocellular carcinoma

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World Journal of Gastroenterology 2017年第24期23卷 4330-4340页

作者： Carminia Maria Della Corte Giuseppe Viscardi Federica Papaccio Giovanna Esposito Giulia Martini Davide Ciardiello Erika Martinelli Fortunato Ciardiello Floriana Morgillo dipartimento Medico-chirurgico di Internistica Clinica e Sperimentale 'F. Magrassi e A. Lanzara' Università degli studi della Campania 'Luigi Vanvitelli'

The prognosis for patients who are diagnosed with advanced stage hepatocellular carcinoma(HCC)is poor because there are few treatment *** research has focused on the identification of novel molecular entities that can be targeted to inhibit oncogenic signals that are involved in the carcinogenesis,proliferation and progression of *** all of the pathways that are involved in the development of HCC,Hedgehog(HH)signalling has demonstrated a substantial role in hepatocarcinogenesis and HCC *** plays a physiological role in embryogenesis,through the induction of the differentiation of hepatocytes from endodermal *** re-activation of the HH pathway in chronic damaged liver is a mechanism of fibrotic degeneration and is implicated in various stages of HCC *** activation sustains the subpopulation of immature liver epithelial cells that are involved in the pathogenesis of cirrhosis and HCC,and HH itself is a mediator of the alcohol-derived malignant transformation of liver *** levels of expression of HH protein markers in liver tumour tissues are correlated with aggressive histological and biological features and a poor clinical *** vitro and in vivo inhibition models of the HH pathway confirm that HH is essential in maintaining tumour growth,metastasis and a mesenchymal phenotype.

关键词： Hedgehog Epithelial-mesenchymal transition Hepatocellular carcinoma Hepatocarcinogenesis Prognosis

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Mechanical response of fabric sheets to three-dimensional bending, twisting, and stretching

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Acta Mechanica Sinica 2015年第3期31卷 373-382页

作者： David J.Steigmann Francesco dell'Isola Department of Mechanical Engineering University of California International Research Center for Mathematics and Mechanics of Complex Systems Università dell’Aquila dipartimento di Ingegneria strutturale e Geotecnica Università di Roma ‘La Sapienza’

A model for the mechanics of woven fabrics is developed in the framework of two-dimensional elastic surface theory. Thickness effects are modeled indirectly in terms of appropriate constitutive equations. The model accounts for the strain of the fabric and additional effects associated with the normal bending, geodesic bending, and twisting of the constituent fibers.

关键词： Woven fabrics Elastic surface theory Strain gradients

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Risk for gastric neoplasias in patients with chronic atrophic gastritis:A critical reappraisal

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World Journal of Gastroenterology 2012年第12期18卷 1279-1285页

作者： Lucy Vannella Edith Lahner Bruno Annibale dipartimento Medico-chirurgico di Scienze Cliniche Tecnobiomediche e Medicina TraslazionaleSant'Andrea HospitalSchool of MedicineUniversity Sapienza

Chronic atrophic gastritis （CAG） is an inflammatory condition characterized by the loss of gastric glandular structures which are replaced by connective tissue （non-metaplastic atrophy） or by glandular structures inappropriate for location （metaplastic atrophy）. Epidemiological data suggest that CAG is associated with two different types of tumors： Intestinal-type gastric cancer （GC） and type I gastric carcinoid （T I GC）. The pathophysiological mechanisms which lead to the development of these gastric tumors are different, It is accepted that a multistep process initiating from Helico- bacterpylori-related chronic inflammation of the gastric mucosa progresses to CAG, intestinal metaplasia, dysplasia and, finally, leads to the development of GC. The T I GC is a gastrin-dependent tumor and the chronic elevation of gastrin, which is associated with CAG, stimulates the growth of enterochromaffin-like cells with their hyperplasia leading to the development of T I GC. Thus, several events occur in the gastric mucosa before the development of intestinatype GC and/ or T I GC and these take several years. Knowledge ofCAG incidence from superficial gastritis, its prevalence in different clinical settings and possible risk factors as- sociated with the progression of this condition to gastric neoplasias are important issues. This editorial intends to provide a brief review of the main studies regarding incidence and prevalence of CAG and risk factors for the development of gastric neoplasias.

关键词： Chronic atrophic gastritis Gastric neoplasia Intestinal-type gastric cancer Type I gastric carcinoid Prevalence Incidence Risk factors

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Simultaneous colorectal and parenchymal-sparing liver resection for advanced colorectal carcinoma with synchronous liver metastases:Between conventional and mini-invasive approaches

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World Journal of Gastroenterology 2020年第42期26卷 6529-6555页

作者： Emilio De Raffele Mariateresa Mirarchi Dajana Cuicchi Ferdinando Lecce Riccardo Casadei Claudio Ricci Saverio Selva Francesco Minni Division of Pancreatic Surgery Department of Digestive DiseasesAzienda Ospedaliero-Universitaria di BolognaPoliclinico S.Orsola-Malpighi40138 BolognaItaly dipartimento strutturale chirurgico Ospedale SS Antonio e Margherita15057 Tortona(AL)Italy Surgery of the Alimentary Tract Department of Digestive DiseasesAzienda Ospedaliero-Universitaria di BolognaPoliclinico S.Orsola-Malpighi40138 BolognaItaly Division of Pancreatic Surgery Department of Medical and Surgical Sciences(DIMEC)Alma Mater StudiorumUniversity of Bologna40138 BolognaItaly

The optimal timing of surgery in case of synchronous presentation of colorectal cancer and liver metastases is still under *** approach,with initial colorectal resection followed by liver resection(LR),or even the reverse,liver-first approach in specific situations,is traditionally *** resections,however,represent an appealing strategy,because may have perioperative risks comparable to staged resections in appropriately selected patients,while avoiding a second surgical *** patients with larger or multiple synchronous presentation of colorectal cancer and liver metastases,simultaneous major hepatectomies may determine worse perioperative outcomes,so that parenchymal-sparing LR should represent the most appropriate option whenever ***-invasive colorectal surgery has experienced rapid spread in the last decades,while laparoscopic LR has progressed much slower,and is usually reserved for limited tumours in favourable ***,mini-invasive parenchymal-sparing LR is more complex,especially for larger or multiple tumours in difficult *** remains to be established if simultaneous resections are presently feasible with mini-invasive approaches or if we need further technological advances and surgical expertise,at least for more complex *** review aims to critically analyze the current status and future perspectives of simultaneous resections,and the present role of the available miniinvasive techniques.

关键词： Synchronous colorectal liver metastases Colorectal surgery Liver surgery Simultaneous resection Parenchymal-sparing liver resection Mini-invasive surgery Intraoperative ultrasonography

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Intratumoral sampling variability in hepatocellular carcinoma: A case report

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World Journal of Gastroenterology 2007年第29期13卷 4019-4021页

作者： Giancarlo Senes Daniela Fanni Alessandro Cois Alessandro Uccheddu Gavino Faa dipartimento di Citomorfologia Divisione di Anatomia Patologica University of Cagliari Cagliari Italy dipartimento chirurgico Materno Infantile e di Scienze delle Immagini Clinica Chirurgica University of Cagliari Cagliari Italy

The differential diagnosis between hepatocellular carcinoma （HCC） and regenerative liver nodules and other primary liver tumors may be very difficult, particularly when performed on liver biopsies. Difficulties in histological typing may be often minimized by immunohistochemistry. Among the numerous markers proposed, CK18, Hep Par1 and glypican 3 （GPC3） are considered the most useful in HCC diagnosis. Here we report a case of HCC in a 72-year-old male with HBV- related chronic liver disease, characterized by a marked morphological and immunohistochemical intratumoral variability. In this case, tumor grading ranged from areas extremely well differentiated, similar to regenerative nodule, to undifferentiated regions, with large atypical multinucleated cells. While almost all sub nodules were immunostained by Hep Par 1, immunoreactivity for glypican 3 and for Ckl8 was patchy, with negative tumor region adjacent to the highly immunoreactive areas. Our case stresses the relevance of sampling variability in the diagnosis of HCC, and indicates that caution should be taken in grading an HCC and in the interpretation of immunohistochemical stains when only small core biopsies from liver nodules are available.

关键词： Liver Hepatocellular carcinoma Sampling variability Hep Par 1 GPC3 Differentiation

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Karyological and morphometric variation of the North African green frog Pelophylax saharicus (Anura) in northeastern Africa

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Current Zoology 2010年第6期56卷 678-686页

作者： Nabil AMOR Sarra FARJALLAH Slim Ben-YacouB Paolo MERELLA Khaled SAID Unité de Recherche:Génétique Biodiversité et Valorisation des Bioressources UR/09-30Institut Supérieur de Biotechnologie de Monastir dipartimento di Biologia strutturale e Funzionale Università di Napoli Federico Ⅱ Laboratory of Terrestrial and Aquatic Systems Ecology. University BADJI Mokhtar Annaba Sezione di Parassitologia e Malattie Parassitarie dipartimento di Biologia Animale Università degli Studi di Sassar

Morphometric variation ofPelophylax saharicus was analysed using univariate and multivariate statistics, with both traditional and geometric morphometrics, based on 148 specimens from four different geographical localities in Tunisia and Algeria. The results show the existence of three morphotypes in Tunisia and one in Algeria, and indicate a significant degree of variation in morphometric characters between regions. Specimens from the southernmost region have the smallest body size and the greatest morphometrie divergence from other populations. This pattern of morphometric variation probably results from phenotypic plasticity in response to local environmental factors. The results of our chromosomal study （C-, Ag-NOR-, endonuclease digestion, DAPI, CMA3 and Q-banding） reveal this species to exhibit the plesiomorphic Pelophylax karyotype of 2n=26 biarmed chromosomes and NORs on the eleventh pair. Similarities and differences of the North African green frog are discussed in relation to the different forms of data collected （chromosomal, morphometric, ecological） [Current Zoology 56 （6）： 678~586, 2010].

关键词： Green frog Pelophylax saharicus Karyology Morphometric variation Tunisia Algeria

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Boceprevir is highly effective in treatment-experienced hepatitis C virus-positive genotype-1 menopausal women

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World Journal of Gastroenterology 2014年第44期20卷 16726-16733页

作者： Veronica Bernabucci Alessia Ciancio Salvatore Petta Aimilia Karampatou Laura Turco Silvia Strona Rosina Critelli Paola Todesca Caterina Cerami Caterina Sagnelli Mario Rizzetto Calogero Cammà Erica Villa Division of Gastroenterology Azienda Ospedaliero-Universitaria Policlinico di Modena Italy Università degli Studi di Modena e Reggio Emilia Division of Gastroenterology University of Turin Division of Gastroenterology Di Bi MIS University of Palermo dipartimento Medico-chirurgico di Internistica Clinica e Sperimentale "F. Magrassi-A. Lanzara" Second University of Naples

AIM: To investigate the safety/efficacy of Boceprevirbased triple therapy in hepatitis C virus(HCV)-G1 menopausal women who were historic relapsers, partial-responders and null-responders. METHODS: In this single-assignment, unblinded study, we treated fifty-six menopausal women with HCV-G1, 46% F3-F4, and previous PEG-α/RBV failure(7% null, 41% non-responder, and 52% relapser) with 4 wk lead-in with PEG-IFNα2b/RBV followed by PEGIFNα2b/RBV+Boceprevir for 32 wk, with an additional 12 wk of PEG-IFN-α-2b/RBV if patients were HCV-RNApositive by week 8. In previous null-responders, 44 wk of triple therapy was used. The primary objective of retreatment was to verify whether a sustained virological response(SVR)(HCV RNA undetectable at 24 wk of follow-up) rate of at least 20% could be obtained. The secondary objective was the evaluation of the percent of patients with negative HCV RNA at week 4(RVR), 8(RVR BOC), 12(EVR), or at the end-of-treatment(ETR) that reached SVR. To assess the relationship between SVR and clinical and biochemical parameters, multiple logistic regression analysis was ***: After lead-in, only two patients had RVR; HCV-RNA was unchanged in all but 62% who had ≤1 log10 decrease. After Boceprevir, HCV RNA became undetectable at week 8 in 32/56(57.1%) and at week 12 in 41/56(73.2%). Of these, 53.8% and 52.0%, respectively, achieved SVR. Overall, SVR was obtained in 25/56(44.6%). SVR was achieved in 55% previous relapsers vs. 41% non-responders(P = 0.250), in 44% F0-F2 vs 54% F3-F4(P = 0.488), and in 11/19(57.9%) of patients with cirrhosis. At univariate analysis for baseline predictors of SVR, only previous response to antiviral therapy(OR = 2.662, 95%CI: 0.957-6.881, P = 0.043), was related with SVR. When considering "on treatment" factors, 1 log10 HCV RNA decline at week 4(3.733, 95%CI: 1.676-12.658, P = 0.034) and achievement of RVR BOC(7.347, 95%CI: 2.156-25.035, P = 0.001) were significantly related with the SVR, although RVR BOC only(6.794

关键词： Hepatitis C virus treatment Pegylated In-terferon Viral Hepatitis Menopause Genotype 1

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