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Post-hepatectomy biliary fistula: from risk factors to the role of drain placement and management—still a lot to be answered

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Hepatobiliary Surgery and Nutrition 2019年第4期8卷 417-418页

作者： Guido Costa Matteo Donadon Guido Torzilli Department of Hepatobiliary and General Surgery Humanitas University & Humanitas Clinical and Research Center – IRCCS Rozzano Milan Italy

Hepatic resection represents the gold-standard treatment for different liver diseases. Among postoperative complications, bile leak remains one of the most common sources of morbidity, which can lead to an increase of hospital stay, need of invasive procedure and potentially death (1). The definition and acknowledge of risk factors for the development of biliary fistula as well as its early detection and optimal management is, in this sense, of crucial importance.

关键词： fistula biliary death

The elegance of a macrophage

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Cellular & Molecular Immunology 2018年第3期15卷 196-198页

作者： Maria De Santis Massimo Locati Carlo Selmi Rheumatology and Clinical Immunology Humanitas Research HospitalRozzanoItaly Laboratory of Leukocyte Biology Humanitas Research HospitalRozzanoItaly BIOMETRA Department University of MilanMilanItaly

In the latest issue of Nature Immunology,Piccolo et al.1 elegantly explored the effect of coexisting interferon-γ(IFN-γ)and interleukin 4(IL-4)antagonistic signals on macrophage transcriptional and epigenetic profiles and,interestingly,identified a plastic cross-talk as opposed to mutually exclusive programs between M1 and M2 polarized *** results support the fascinating hypothesis that transcriptional and epigenetic reprogramming overcame genetics to drive the evolution of eukaryotic organisms.A rapid reshaping of chromatin acetylation redirected the expression of hundreds of genes under the control of a few transcription factors in response to two coexisting but opposing signals that indicated inflammation and its resolution simultaneously.

关键词： macrophage interferon inflammation

Surgical treatment of synchronous colorectal liver and lung metastases： the usefulness of thoracophrenolaparotomy for single stage resection

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Hepatobiliary & Pancreatic Diseases International 2016年第2期15卷 216-219页

作者： Daniele Del Fabbro Marco Alloisio Fabio Procopio Matteo Cimino Matteo Donadon Angela Palmisano Luca Viganò Guido Torzilli Department of Hepatobiliary Surgery Humanitas Research HospitalUniversity of Milan School of MedicineRozzanoMilanItaly Department of Thoracic Surgery Humanitas Research HospitalUniversity of Milan School of MedicineRozzanoMilanItaly

When suitable, surgery still remains the therapeutic option to be preferred for patients carrier of colorectal liver and lung metastases. Since thoracophrenolaparotomy should be helpful during liver resection for some of these patients, simultaneous removal of right lung metastases can be proposed through this approach. Eleven consecutive patients（median age of 53 years） carrier of colorectal liver and lung metastases, underwent single session surgical resection of both liver and right lung lesions by means of J-shaped thoracophrenolaparotomy. The median number of liver metastases removed was 5（range 2-30） and of lung metastases removed was 2（range 1-3）. Lung metastases were located in the upper lobe in 1 patient, in the middle lobe in 2, in the lower lobe in 6, and in the upper and lower lobe in 2. Mortality and major morbidity were nil. Two patients had a minor morbidity： one had wound infection and bile leakage treated conservatively and the other had transient fever. Mean overall survival was 24.4 months. An aggressive surgical approach should be undertaken for colorectal metastases： in case of multifocal liver disease with complex presentations, J-shaped thoracophrenolaparotomy could be considered as safe approach for combined liver and right lung metastasectomies.

关键词： colorectal carcinoma liver metastases lung metastases thoracophrenolaparotomy

Role of liver biopsy in hepatocellular carcinoma

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World Journal of Gastroenterology 2019年第40期25卷 6041-6052页

作者： Luca Di Tommaso Marco Spadaccini Matteo Donadon Nicola Personeni Abubaker Elamin Alessio Aghemo Ana Lleo Pathology Unit Humanitas Clinical and Research Center IRCCSRozzano 20089Italy Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20090Italy Division of Hepatobiliary and General Surgery Department of General SurgeryHumanitas Clinical and Research Center IRCCSRozzano 20089Italy Division of Medical Oncology and Hematology Humanitas Cancer CenterHumanitas Clinical and Research Center IRCCSRozzano 20089Italy Division of Internal Medicine and Hepatology Department of GastroenterologyHumanitas Clinical and Research Center IRCCSRozzano 20089Italy

The role of liver biopsy in the diagnosis of hepatocellular carcinoma(HCC)has been challenged over time by the ability of imaging techniques to characterize liver lesions in patients with known *** fact,in the diagnostic algorithm for this tumor,histology is currently relegated to controversial ***,the risk of complications,such as tumor seeding and bleeding,as well as inadequate sampling have further limited the use of liver biopsy for HCC ***,there is growing evidence of prognostic and therapeutic information available from microscopic and molecular analysis of HCC and,as the information content of the tissue sample increases,the advantages of liver biopsy might modify the current risk/benefit *** herein review the role and potentiality of liver biopsy in the diagnosis and management of *** the potentiality of precision medicine comes to the management of HCC,it will be crucial to have rapid pathways to define prognosis,and even treatment,by identifying the patients who could most benefit from target-driven *** of the above reasons suggest that the current role of liver biopsy in the management of HCC needs substantial reconsideration.

关键词： Hepatocellular carcinoma Liver biopsy Prognostic factors Liver cancer Recurrence Liquid biopsy

Is precision medicine for colorectal liver metastases still a utopia?New perspectives by modern biomarkers,radiomics,and artificial intelligence

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World Journal of Gastroenterology 2022年第6期28卷 608-623页

作者： Luca Viganò Visala S Jayakody Arachchige Francesco Fiz Department of Hepatobiliary and General Surgery IRCCS Humanitas Research HospitalRozzano 20089MIItaly Department of Biomedical Sciences Humanitas UniversityPieve Emanuele 20072MIItaly Nuclear Medicine IRCCS Humanitas Research HospitalRozzano 20089MIItaly

The management of patients with liver metastases from colorectal cancer is still *** therapeutic options and treatment strategies are available for an extremely heterogeneous clinical *** prediction of patients’outcomes and of the effectiveness of chemotherapy and loco-regional treatments are crucial to reach a precision medicine *** has been an unmet need for a long time,but recent studies have opened new *** morphological biomarkers have been *** dynamic evaluation of the metastases across a time interval,with or without chemotherapy,provided a reliable assessment of the tumor *** have been explored and,thanks to their strong association with prognosis,have the potential to drive treatment *** liver-tumor interface has been identified as one of the main determinants of tumor progression,and its components,in particular the immune infiltrate,are the focus of major *** mining and analyses provided new insights on tumor biology and are expected to have a relevant impact on clinical *** intelligence is a further step *** present paper depicts the evolution of clinical decision-making for patients affected by colorectal liver metastases,facing modern biomarkers and innovative opportunities that will characterize the evolution of clinical research and practice in the next few years.

关键词： Colorectal liver metastases Biomarkers Genetics Immune infiltrate Radiomics Artificial Intelligence

Is there a real survival benefit of surveillance for hepatocellular carcinoma in cirrhotic patients?

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Hepatobiliary Surgery and Nutrition 2019年第2期8卷 148-150页

作者： Massimo Colombo Ana Lleo humanitas Clinical and Research Center-IRCCS Rozzano(MI)Italy Department of Biomedical Sciences Humanitas UniversityPieve Emanuele(MI)Italy

Surveillance with abdominal ultrasound(US)of patients with chronic liver disease who are at risk of developing a hepatocellular carcinoma(HCC),has progressively emerged as a consolidated practice for achieving early diagnosis and improving treatment of liver cancer,despite the lack of robust evidence-based *** is recommended by the international societies from both hemispheres(1-3),where however recommendations from Far East voice some nuances with respect to the need for adding serum alfa fetoprotein(AFP)to US and of adopting accelerated intervals of screening for patients at very high risk of HCC,like those with viral hepatitis and multiple co-morbidities.A recent meta-analysis form the US confirms indeed a benefit in adding serum AFP to US(4).In the western world,a 6-month interval is considered more than adequate for screening patients with compensated cirrhosis of any aetiology,as several meta-analyses have reported appreciable survival benefits in those patients who had a small tumor detected with US surveillance that ultimately could access curative treatment with liver transplantation,hepatic resection or local ablation(5,6).

关键词： patients adding benefit

lmmunotherapy in hepatobiliary tumors: search for the missing pieces of the puzzle

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Hepatobiliary Surgery and Nutrition 2020年第1期9卷 86-88页

作者： Matteo Donadon Federica Marchesi Lorenza Rimassa Guido Torzilli Department of Hepatobiliary and General Surgery Humanitas Clinical and Research Center-IRCCSRozzanoMilanItaly Department of Biomedical Sciences Humanitas UniversityPieve EmanueleMilanItaly Department of Immunology and Inflammation Humanitas Clinical and Research Center-IRCCSRozzanoMilanItaly Department of Biotechnology and Translational Medicine University of MilanMilanItaly humanitas Cancer Center Humanitas Clinical and Research Center-IRCCSRozzanoMilanItaly

In the current era of immunotherapy, the treatment of hepatobiliary cancers is rapidly evolving. The use of immunotherapeutic approaches, which include peptide-based vaccines, checkpoint inhibitors and antibodies, particularly applies to advanced hepatobiliary cancers, for which the availability of limited therapeutic options encourages the adoption of alternative strategies. Thanks to the published/presented, although conflicting, results of some of the clinical trials on this topic together with the incoming results of some other trials, clinicians involved in the cure of hepatobiliary cancer patients need to understand the basic and advanced applications of immunotherapies (1-6).

关键词： hepato biliary therapeutic

Artificial intelligence and inflammatory bowel disease: Where are we going?

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World Journal of Gastroenterology 2023年第3期29卷 508-520页

作者： Leonardo Da Rio Marco Spadaccini Tommaso Lorenzo Parigi Roberto Gabbiadini Arianna Dal Buono Anita Busacca Roberta Maselli Alessandro Fugazza Matteo Colombo Silvia Carrara Gianluca Franchellucci Ludovico Alfarone Antonio Facciorusso Cesare Hassan Alessandro Repici Alessandro Armuzzi Department of Endoscopy Humanitas Research HospitalIRCCSRozzano 20089MilanoItaly Department of Biomedical Sciences Humanitas UniversityRozzano 20089MilanoItaly IBD Center Humanitas Research HospitalIRCCSRozzano 20089MilanoItaly Gastroenterology Unit Department of Medical SciencesUniversity of FoggiaFoggia 71122FoggiaItaly

Inflammatory bowel diseases,namely ulcerative colitis and Crohn’s disease,are chronic and relapsing conditions that pose a growing burden on healthcare systems *** of their complex and partly unknown etiology and pathogenesis,the management of ulcerative colitis and Crohn’s disease can prove challenging not only from a clinical point of view but also for resource *** intelligence,an umbrella term that encompasses any cognitive function developed by machines for learning or problem solving,and its subsets machine learning and deep learning are becoming ever more essential tools with a plethora of applications in most medical *** this regard gastroenterology is no exception,and due to the importance of endoscopy and imaging numerous clinical studies have been gradually highlighting the relevant role that artificial intelligence has in inflammatory bowel diseases as *** aim of this review was to summarize the most recent evidence on the use of artificial intelligence in inflammatory bowel diseases in various contexts such as diagnosis,follow-up,treatment,prognosis,cancer surveillance,data collection,and ***,insights into the potential further developments in this field and their effects on future clinical practice were discussed.

关键词： Inflammatory bowel disease Artificial intelligence Machine learning Crohn’s disease Ulcerative colitis Computer-aided diagnosis

Tumor-associated myeloid cells:diversity and therapeutic targeting

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Cellular & Molecular Immunology 2021年第3期18卷 566-578页

作者： Alberto Mantovani Federica Marchesi Sebastien Jaillon Cecilia Garlanda Paola Allavena Department of Immunology and Inflammation Humanitas Clinical and Research Center-IRCCSRozzanoItaly Department of Biomedical Science Humanitas UniversityRozzanoItaly The William Harvey Research Institute Queen Mary University of LondonLondonUK Department of Biotechnology and Translational Medicine University of MilanMilanItaly

Myeloid cells in tumor tissues constitute a dynamic immune population characterized by a non-uniform phenotype and diverse functional *** tumor-associated macrophages(TAMs),which are more abundantly represented,and tumor-associated neutrophils(TANs)are known to sustain tumor cell growth and invasion,support neoangiogenesis and suppress anticancer adaptive immune *** recent decades,several therapeutic approaches have been implemented in preclinical cancer models to neutralize the tumor-promoting roles of both TAMs and *** of the most successful strategies have now reached the clinic and are being investigated in clinical *** this review,we provide an overview of the recent literature on the evergrowing complexity of the biology of TAMs and TANs and the development of the most promising approaches to target these populations therapeutically in cancer patients.

关键词： tumor-associated macrophages tumor microenvironment macrophage targeting