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Neoadjuvant treatment:A window of opportunity for nutritional prehabilitation in patients with pancreatic ductal adenocarcinoma

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World Journal of Gastrointestinal Surgery 2021年第9期13卷 885-903页

作者： Ilaria Trestini Marco Cintoni Emanuele Rinninella Futura Grassi Salvatore Paiella Roberto Salvia Emilio Bria Carmelo Pozzo Sergio Alfieri Antonio Gasbarrini Giampaolo Tortora Michele Milella Maria Cristina Mele Section of Oncology Department of MedicinePancreas InstituteUniversity of Verona Hospital TrustVerona 37126Italy Scuola di Specializzazione in Scienza dell’Alimentazione Universitàdi Roma Tor VergataRoma 00133Italy UOC Nutrizione Clinica Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico A.Gemelli IRCCSRoma 00168Italy Dipartimento di Medicina e Chirurgia Traslazionale UniversitàCattolica del Sacro CuoreRoma 00168Italy General and Pancreatic Surgery Unit Pancreas InstituteUniversity of Verona Hospital TrustVerona 37126Italy Oncologia Medica Unit Comprehensive Cancer CenterFondazione Policlinico Universitario A Gemelli IRCCSRoma 00167Italy Oncologia Medica Unit UniversitàCattolica del Sacro CuoreRoma 00168Italy Digestive Surgery Unit and Pancreatic Surgery Gemelli Center Director Fondazione Policlinico Universitario A Gemelli IRCCSRoma 00167Italy UOC di Medicina Interna e gastroenterologia Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario A Gemelli IRCCSRoma 00167Italy UOSD Nutrizione Avanzata in Oncologia Dipartimento di Scienze Mediche e ChirurgicheFondazione Policlinico Universitario A Gemelli IRCCSRoma 00167Italy

Patients affected by pancreatic ductal adenocarcinoma(PDAC)frequently present with advanced disease at the time of diagnosis,limiting an upfront surgical *** treatment(NAT)has become the standard of care to downstage non-metastatic locally advanced ***,this treatment increases the risk of a nutritional status decline,which in turn,may impact therapeutic tolerance,postoperative outcomes,or even prevent the possibility of *** on prehabilitation programs on surgical PDAC patients show a reduction of postoperative complications,length of hospital stay,and readmission rate,while data on prehabilitation in NAT patients are scarce and randomized controlled trials are still ***,appropriate nutritional management represents an important therapeutic strategy to promote tissue healing and to enhance patient recovery after surgical *** this regard,NAT may represent a new interesting window of opportunity to implement a nutritional prehabilitation program,aiming to increase the PDAC patient’s capacity to complete the planned therapy and potentially improve clinical and survival *** these perspectives,this review attempts to provide an in-depth view of the nutritional derangements during NAT and nutritional prehabilitation program as well as their impact on PDAC patient outcomes.

关键词： Pancreatic cancer Neoadjuvant treatment Pancreatic cancer surgery Nutritional status Nutritional prehabilitation Malnutrition

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视频胶囊内镜对不明原因胃肠道出血的诊断作用:早期应用的有效性

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世界核心医学期刊文摘（胃肠病学分册） 2005年第10期1卷 50-50页

作者： Bresci G. Parisi G. Bertoni M. 程欣 U.O. di gastroenterologia Azienda Ospedaliera-Universitaria PisanaVia A. della Spina 11 56125 Pisa Italy

Background:We report our preliminary experience with the use of video capsule endoscopy (VCE) in 64 patients with obscure gastrointestinal bleeding (OGIB) and suspected small intestine disease. Methods:To be eligible for VCE, patients had to have undergone upper endoscopy, small bowel series, and colonscopy without discovering any source of bleeding. To find the best timing to perform VCE, the patients were retrospectively divided in two groups of 32 cases each:group 1 with patients who had been submitted to VCE within 15 days from OGIB diagnosis, and group 2 with patients who had been submitted to VCE at least 15 days after OGIB diagnosis. Results:Lesions were found by VCE in 29 (91%) in group 1:angioectasia-like lesions of the small bowel in 12, some erosions of the ileum without signs of bleeding in 14, a polyp with erosions in 1, and a bleeding site where the surgery showed a tumor of the ileum in 2 patients. In 2 cases, VCE missed showing two small tumors that were revealed by laparoscopy in 1 case and by push enteroscopy in the other. In group 2, lesions were found by VCE in 11 (34%):angioectasia-like lesions of the small bowel in 6, some erosions in 3, a short segmental stenosis in 1, and two polyps in 1. In 1 case, VCE missed showing a small polyp in the jejunum that was revealed by push enteroscopy. In none of these cases was a bleeding site identified. VCE was well tolerated and able to acquire good images in patients with OGIB. It showed lesions in 91%of the patients in group 1 and 34%of cases in group 2. Conclusions:Our data suggest that the optimal timing to perform VCE is within a few days after the occurrence of bleeding,possibly within 2 weeks.

关键词：胶囊内镜诊断作用小肠疾病消化道内镜检查结肠镜检查黏膜糜烂肠肿瘤腹腔镜检肠息肉回肠黏膜

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失代偿性肝硬化患者管-球反馈丧失的病理生理学意义

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世界核心医学期刊文摘（胃肠病学分册） 2005年第9期1卷 11-11页

作者： Sansoè G. Silvano S. Mengozzi G. 王志宇 Divisione di gastroenterologia Ospedale Gradenigo C.so Regina Margherita 10 10 153 Torino Italy Dr.

In healthy subjects, arterial pressure reduction or renal ischemia produces renal artery dilatation through autoregulation and tubuloglomerular feedback (TuGF). Patients with decompensated cirrhosis have reduced kidney perfusion pressure but show renal vasoconstriction instead of autoregulation-mediated vasodilation. This study investigates the consequences of kidney autoregulation loss on renal perfusion, glomerular filtration rate, and tubular handling of electrolytes in both compensated and ascitic nonazotemic cirrhotic patients. Forty-two consecutive patients with diuretic-free liver cirrhosis (32 with preascitic and 10 with ascitic disease) and 10 controls were submitted to the following determinations: (a) basal plasma renin activity and aldosterone levels; (b) endogenous dopaminergic activity measured as incremental aldosterone responses during metoclopramide administration; and (c) renal clearances of sodium, potassium, inulin, para-aminohippurate and lithium. Compared with the other groups, ascitic patients showed lower renal plasma flow (P < 0.01) and lithium clearance (P < 0.05), a higher filtration fraction (P < 0.01), and secondary aldosteronism. Controls and preascitic patients displayed tubuloglomerular feedback (the mechanism increasing the glomerular filtration rate when a reduced sodium load reaches the distal tubule), as demonstrated by negative correlations between fractional excretion of lithium (an expression of fractional delivery of sodium to the distal nephron) and glomerular filtration rate (respectively, r = -0.73, P < 0.03, and r = -0.48, P < 0.01). Conversely, patients with ascites showed a positive correlation between lithium fractional excretion and glomerular filtration rate (r = 0.64,P< 0.05). Reduction in renal perfusion, increased filtration fraction, and TuGF derangement, as found in decompensated patients, are indicative of prevalent postglomerular arteriolar vasoconstriction, with ensuing stimulation of proximal tubular sodium r

关键词：失代偿性肝硬化病理生理学腹水患者醛固酮水平血浆肾素活性肾小球滤过率滤过分数排泄率肾动脉清除率

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小肠肠系膜超声造影成像评分系统:一项很有前景的乳糜泻诊断与随访方法

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世界核心医学期刊文摘（胃肠病学分册） 2006年第1期2卷 45-45页

作者： Dell’Aquila P. Pietrini L. Barone M. E. Ierardi 郑世成 Cattedra di gastroenterologia Università di Foggia c/o Ospedali Riuniti Viale L. Pinto 71 100 Foggia Italy Dr.

Background: Small intestinal ultrasonography with anechoic contrast agents (SICUS) has been shown to have a diagnostic accuracy on small bowel morphology similar to X-ray barium follow-through. Although extremely investigated by transabdominal ultrasonography, celiac disease, a common disorder of the small bowel, has been never studied by SICUS. Aim: To asses SICUS characteristics of celiac disease patients. Patients and Methods: SICUS was performed using PEG 4000 as contrast agent. Twenty-three patients with celiac disease at the first diagnosis were enrolled and 30 healthy volunteers, matched for sex and age, were selected as control group. Celiac disease diagnosis was based on anti-gluten, anti-endomysium, and anti-transglutaminase positivity as well as jejunal histology. The following seven echographic parameters were considered: liquid endoluminal content before contrast, loop diameter, Kerckring’ s folds, peristaltic waves, ileal jejunalization, mesenteric lymphoadenomegaly,and Doppler resistance index (RI) of mesenteric superior artery. Statistical analysis was performed by Student’ s t test for unpaired data; one-way analysis of variance was used to correlate echographic and histologic pictures. Results: Loop diameter, Kerckring’ s fold number, peristaltic waves, and Doppler RI appeared to be significantly different between celiac disease patients and controls. Additionally, liquid content, ileal jejunalization, and mesenteric lymphoadenomegaly were present only in the celiacs (52.1% ,47.7% , and 95.6% , respectively), but not in controls. Only Doppler RI values significantly correlated with the histologic degree of damage. Conclusions: SICUS could be a reliable and noninvasive technique to confirm a diagnosis of celiac disease performed using conventional investigations. The possibility of investigating the whole small bowel and the safety of repeating examinations could be useful in the follow-up of celiac patients.

关键词：乳糜泻小肠病变造影成像超声检查随访方法蠕动波肠结阻力指数重复检查组织学检查

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便秘合并功能性消化不良患者的症状与病理生理学功能的相关性

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世界核心医学期刊文摘（胃肠病学分册） 2006年第1期2卷 16-16页

作者： Sarnelli G. Grasso R. Ierardi E. R. Cuomo 徐瑞 gastroenterologia Dipartimento di Medicina Clinica e Sperimentale Universit degli Studi di Napoli‘Federico II’Via Sergio Pansini 5 IT-80131 Naples Italy Dr.

Introduction: Patients with constipation often report dyspeptic symptoms, but whether constipation is associated with specific dyspeptic symptoms and altered gastrointestinal (GI) motility, remains to be established. Our aim was to study symptoms association and GI motility parameters in patients with constipation and functional dyspepsia. Patients and Method: 42 patients with different symptoms and severity of constipation and dyspepsia were enrolled. Scintigraphic gastric emptying, colonic transit time and gallbladder contraction were studied in all subjects. Results: No significant association was observed between individual symptoms of constipation and dyspepsia. Patients with more severe constipation did not have higher dyspepsia severity scores. Colonic transit time, gastric half emptying and gallbladder contraction were not significantly correlated. Although patients with severe nausea had faster colonic transit than those with absent/mild symptom (19 ± 2 vs. 48 ± 7 h; p 2 (OR1.05, CI 1- 1.1) and impaired gallbladder contraction (OR 0.94, CI 0.89- 0.99). Conclusions: Constipation was not associated with severity, or any particular dyspeptic symptom. Although motor abnormalities of both colon and proximal GI tract regions existed in the subset of constipated dyspeptic patients, they did not seem associated with the genesis of different dyspeptic symptoms.

关键词：病理生理学胆囊收缩闪烁扫描传送时间运动异常便秘患者胃排空近端特异性多因素分析

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Microscopic enteritis:Bucharest consensus

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World Journal of Gastroenterology 2015年第9期21卷 2593-2604页

作者： Kamran Rostami David Aldulaimi Geoffrey Holmes Matt W Johnson Marie Robert Amitabh Srivastava Jean-Francois Fléjou David S Sanders Umberto Volta Mohammad H Derakhshan James J Going Gabriel Becheanu Carlo Catassi Mihai Danciu Luke Materacki Kamran Ghafarzadegan Sauid Ishaq Mohammad Rostami-Nejad A Salvador Pe?a Gabrio Bassotti Michael N Marsh Vincenzo Villanacci Department of Gastroenterology Alexandra HospitalWorcestershire B98 7UBUnited Kingdom Department of Gastroenterology Royal Derby HospitalDerby DE22 3NEUnited Kingdom Gastroenterology Unit Luton Dunstable University FT Hospital LU4 0DZUnited Kingdom Department of Pathology and Medicine Yale University School of MedicineNew HavenCT 06520United States Department of Pathology Staff PathologistBrigham and Women’s HospitalHarvard Medical School BostonBostonMA 02115United Sates Department of Pathology Serviced’Anatomie PathologiqueHopital Saint-AntoineAP-HPUniversité Pierre et Marie Curie75005 ParisFrance Department of Gastroenterology University of SheffieldSouth Yorkshire S10 2TNUnited Kingdom Department of Gastroenterology Department of Medical and Surgical SciencesUniversity of Bologna40126 BolognaItaly Section of Gastroenterology Institute of Cardiovascular and Medical SciencesUniversity of GlasgowGlasgow G12 8QQUnited Kingdom Department of Pathology Southern General HospitalLanarkshire G51 4TFUnited Kindom Department of Pathology Carol Davila Univerity of Medicine and PharmacyBucharest 050474Romania Università Politecnica delle Marche AnconaItalyPresidente Società Italiana di GastroenterologiaEpatologia e Nutrizione PediatricaCo-DirectorCenter For Celiac Research University of Maryland School of Medicine BaltimoreMD 21201United States Grigore T Popa" University of Medicine and Pharmacy Iasi 747800Romania Laboratory Department Mashad Razavi HospitalKhorasan Razavi ***Iran Dudley group of Hospitals Birmingham City UniversityBirmingham B42 2SUUnited Kindom Gastroenterology and Liver Diseases Research Institute Shahid Beheshti University of Medical SciencesTehran ***Iran Laboratory of Immunogenetics Department of Medical Microbiology and Infection ControlVrije Universiteit medical centre (VUmc)1081 HZ AmsterdamThe Netherlands Gastroenterology Section Department of MedicineUniversity of Perugia Medical School06100 PerugiaItaly Wolfson College University of OxfordOxford

Microscopic enteritis(ME) is an inflammatory condition of the small bowel that leads to gastrointestinal symptoms,nutrient and micronutrient *** is characterised by microscopic or sub-microscopic abnormalities such as microvillus changes and enterocytic alterations in the absence of definite macroscopic changes using standard modern *** work recognises a need to characterize disorders with microscopic and submicroscopic features,currently regarded as functional or non-specific entities,to obtain further understanding of their clinical *** consensus working party reviewed statements about the aetiology,diagnosis and symptoms associated with ME and proposes an algorithm for its investigation and *** the 5th International Course in Digestive Pathology in Bucharest in November 2012,an international group of 21 interested pathologists and gastroenterologists formed a working party with a view to formulating a consensus statement on ME.A five-step agreement scale(from strong agreement to strong disagreement) was used to score 21 statements,*** was strong agreement on all statements about ME histology(95%-100%).Statements concerning diagnosis achieved 85% to 100% agreement.A statement on the management of ME elicited agreement from the lowest rate(60%) up to 100%.The remaining two categories showed general agreement between experts on clinical presentation(75%-95%) and pathogenesis(80%-90%) of *** was strong agreement on the histological definition of *** agreement on management indicates a need for further investigations,better definitions and clinical trials to produce quality guidelines for *** ME consensus is a step toward greater recognition of a significant entity affecting symptomatic patients previously labelled as non-specific or functional enteropathy.

关键词： Microscopic enteritis Enteropathy Gluten Malabsorption Non-celiac gluten Bucharest consensus

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Clinical Assessment of the Use of Propinox Hydrochloride and Scopolamine Hydrochloride in the Treatment of Abdominal Colic: A Retrospective, Comparative Study

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International Journal of Clinical Medicine 2016年第7期7卷 474-480页

作者： Helio Rzetelna Carlos Frederico Porto Alegre Rosa Mario Kirzner Lucas Pereira Jorge de Medeiros Camila Melo Marcia Gonçalves Ribeiro Lisa Oliveira José Galvão Alves Mauro Geller Gastroenterology Department Universidade Federal do Rio de Janeiro (UFRJ) Rio de Janeiro Brazil Clinical Medicine Department Centro Universitário Volta Redonda (UNIFOA) Volta Redonda Brazil Clinical Medicine and Gastroenterology Department Universidade Estácio de Sá (UNESA) Rio de Janeiro Brazil Clinical Medicine Department Escola de Medicina Souza Marques Rio de Janeiro Brazil 5Inflammatory Bowel Diseases Outpatient Unit-18 ª enfermaria da Santa Casa da Misericórdia do Rio de Janeiro Rio de Janeiro Brazil Federação Brasileira de gastroenterologia S&atildeo Paulo Brazil Grupo de Estudos de Doenças Inflamatórias Intestinais Rio de Janeiro Brazil UNESA Rio de Janeiro Brazil Gastroenterology Post-Graduation Program-PUC-Rio Rio de Janeiro Brazil Neurology Post-Graduation Program Universidade Federal do Estado do Rio de Janeiro (UERJ) Rio de Janeiro Brazil Pharmacology Department—UFRJ Rio de Janeiro Brazil Medical Genetics Service IPPMG-Universidade Federal Rio de Janeiro Rio de Janeiro Brazil Immunology Department Teresópolis Medical School (UNIFESO) Teresópolis Brazil Clinical Immunology Instituto de Pós-Gradua&ccedil&atildeo Médica Carlos Chagas (IPGMCC) Rio de Janeiro Brazil

Objectives: The purpose of this study was to evaluate and compare the use of propinox hydrochloride and scopolamine hydrochloride in patients presenting abdominal colic (abdominal pain), in terms of treatment efficacy and tolerability. Material & Methods: This was an analytical, retrospective, comparative study based on hospital records of outpatients treated at Serviço de Clínica Médica do Hospital das Clínicas Costantino Otaviano (HCTCO) and at Santa Casa de Misericórdia do Rio de Janeiro, from 1988-1998. Subjects were divided into two groups: patients from Group 1 were treated with propinox hydrochloride, while patients from Group 2 were treated with scopolamine hydrochloride. Statistical analysis was performed using GraphPad Prism version 5.0. For comparison of categorical variables, we used the chi-squared or Fisher’s test, while continuous variables were analyzed using ANOVA or the Student’s T test. Results: A total of 1042 subjects were included, of which 525 were allocated to Group 1 and 517 to Group 2. Mean treatment duration was 9.166 days (±4.208) in Group 1 and 8.795 days (±5.052) in Group 2, with no statistically significant difference in treatment duration between the two groups (p = 0.198). All subjects in Group 1 were treated with propinox 10 mg (2 coated tablets, three times per day) while all subjects in Group 2 were treated with scopolamine hydrochloride 10 mg (2 coated tablets, three times per day). There were no statistically significant between-group differences in weight, BMI, heart rate, and respiratory rate at pre- and post-treatment;with the exception of higher post-treatment systolic blood pressure in Group 1, blood pressure measures also remained homogenous. Adverse events were reported among both treatment groups with no significant between-group difference in incidence (p = 0566). At pretreatment, pain intensity was more severe in Group 1 (p = 0.0257), while at post-treatment, there was no statistically significant difference betw

关键词： Abdominal Colic Propinox Hydrochloride Scopolamine Hydrochloride

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Risk perception and knowledge of COVID-19 in patients with celiac disease

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World Journal of Gastroenterology 2021年第12期27卷 1213-1225页

作者： Jamie Zhen Juan Pablo Stefanolo María de la Paz Temprano Caroline L Seiler Alberto Caminero Enrique de-Madaria Miguel Montoro Huguet Vivas Santiago Sonia Isabel Niveloni Edgardo Gustavo Smecuol Luis Uzcanga Dominguez Elena Trucco Virginia Lopez Carolina Olano Pasquale Mansueto Antonio Carroccio Peter H Green Donald Duerksen Andrew S Day Jason A Tye-Din Julio César Bai Carolina Ciacci Elena F Verdú Benjamin Lebwohl M Ines Pinto-Sanchez Department of Medicine Farncombe Family Digestive Health Research InstituteMcMaster University Medical CenterHamilton Health SciencesHamilton L8S4K1ONCanada Department of Medicine Dr.C.Bonorino Udaondo Gastroenterology HospitalBuenos Aires 1264Argentina Department of Pancreatic Unit Hospital General Universitario de AlicanteAlicante 03010Spain Department of Medicine Instituto Aragonés de Ciencias de la Salud(IACS)Zaragoza 50009Spain Department of Medicine Hospital Universitario San Jorge.HuescaZaragoza 50004Spain Department of Gastroenterology Univ Hosp LeonGastroenterol UnitAltos de Nava S-NLeon 24071Spain Department of Medicine Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico DF 14080Mexico Department of Medicine Universidad de la RepublicMontevideo 11800Uruguay Department of Internal Medicine PROMISE DepartmentUniversity of PalermoPalermo 90127Italy Department of Internal Medicine V.Cervello HospitalPROMISE DepartmentUniversity of PalermoPalermo 90127Italy Celiac Disease Center Columbia University Medical CenterColumbia UnivCeliac Dis CtrDiv Digest and Liver DisNew YorkNY 10032United States Department of Medicine St Boniface Gen HospUniversity of ManitobaWinnipeg R2H 2A6Canada Department of Paediatrics University of Otago ChristchurchChristchurch 8041New Zealand Department of Gastroenterology Royal Melbourne HospitalImmunology DivisionWalter and Eliza Hall InstituteMelbourne 3052Australia Department of Medicine Surgery and DentryScuola Medica SalernitanaUniversity of SalernoCeliac Center at the University Hospital San Giovanni di Dio e Ruggi di AragonaSalerno 84131Italy Department of Medicine Farncombe Family Digestive Research InstituteMcMaster UniversityHamilton L8S4K1ONCanada The Celiac Disease Center Columbia UniversityNew YorkNY 10032United States

BACKGROUND We recently demonstrated that the odds of contracting coronavirus disease 2019(COVID-19)in patients with celiac disease(CeD)is similar to that of the general ***,how patients with CeD perceive their COVID-19 risk may differ from their actual *** To investigate risk perceptions of contracting COVID-19 in patients with CeD and determine the factors that may influence their *** We distributed a survey throughout 10 countries between March and June 2020 and collected data on demographics,diet,COVID-19 testing,and risk perceptions of COVID-19 in patients with *** were recruited through various celiac associations,clinic visits,and social *** perception was assessed by asking individuals whether they believe patients with CeD are at an increased risk of contracting COVID-19 when compared to the general *** regression was used to determine the influencing factors associated with COVID-19 risk perception,such as age,sex,adherence to a gluten-free diet(GFD),and comorbidities such as cardiac conditions,respiratory conditions,and *** was presented as adjusted odds ratios(aORs)RESULTS A total of 10737 participants with CeD completed the *** them,6019(56.1%)patients with CeD perceived they were at a higher risk or were unsure if they were at a higher risk of contracting COVID-19 compared to the non-CeD population.A greater proportion of patients with CeD perceived an increased risk of contracting COVID-19 when compared to infections in general due to their CeD(56.1%vs 26.7%,P2 to 0.96,P=0.007)were associated

关键词： Celiac disease Gluten Risk Infection Knowledge Perception Coronavirus COVID-19

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