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Endoscopic ultrasound and magnetic resonance imaging for re-staging rectal cancer after radiotherapy

World Journal of Gastroenterology 2009年第44期15卷 5563-5567页

作者： Gianni Mezzi Paolo Giorgio Arcidiacono Silvia Carrara Francesco Perri Maria Chiara Petrone Francesco De Cobelli Simone Gusmini Carlo Staudacher Alessandro Del Maschio Pier Alberto Testoni Gastroenterology and Gastrointestinal Endoscopy Unit IRCCS Vita-Salute UniversitySan Raffaele Scientific Institute20132 MilanItaly Gastroenterology Unit San Benedetto del Tronto Hospital63039 San Benedetto del Tronto (AP)Italy Alessandro Del Maschio Department of RadiologyIRCCS Vita-Salute UniversitySan Raffaele Scientific Institute20132 MilanItaly Department of Surgery IRCCS Vita-Salute UniversitySan Raffaele Scientific Institute20132 MilanItaly

AIM： To compare the sensitivity and specificity of two imaging techniques, endoscopic ultrasound （EUS） and magnetic resonance imaging （MRI）, in patients with rectal cancer after neoadjuvant chemoradiation therapy. And we compared EUS and MRI data with histological findings from surgical specimens. METHODS： Thirty-nine consecutive patients （51.3% Male; mean age： 68.2 ＋ 8.9 years） with histologically confirmed distal rectal cancer were examined for staging. All patients underwent EUS and MRI imaging before and after neoadjuvant chemoradiation therapy. RESULTS： After neoadjuvant chemoradiation, EUS and MRI correctly classified 46% （18/39） and 44% （17/39） of patients, respectively, in line with their histological T stage （P 〉 0.05）. These proportions were higher for both techniques when nodal involvement was considered： 69% （27/39） and 62% （24/39）. When patients were sorted into T and N subgroups, the diagnostic accuracy of EUS was better than MRI for patients with T0-T2 （44% vs 33%, P 〉 0.05） and NO disease （87% vs 52%, P = 0.013）. However, MRI was more accurate than EUS in T and N staging for patients with more advanced disease after radiotherapy, though these differences did not reach statistical significance. CONCLUSION： EUS and MRI are accurate imaging techniques for staging rectal cancer, However, after neoadjuvant RT-CT, the role of both methods in the assessment of residual rectal tumors remains uncertain.

关键词： Endoscopic ultrasound Magnetic resonance imaging Rectal cancer Neoadjuvant chemoradiation therapy Diagnostic accuracy

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Endoluminal vacuum-assisted therapy as a treatment for anastomotic leakage in colorectal surgery

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World Journal of Gastroenterology 2022年第28期28卷 3747-3752页

作者： Maria Michela Chiarello Valentina Bianchi Pietro Fransvea Giuseppe Brisinda Department of Surgery Azienda Sanitaria Provinciale di CosenzaCosenza 87100Italy Emergency Surgery and Trauma Center Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168taly Medical and Surgical Sciences Fondazione Policlinico Universitario A Gemelli IRCCSRome 00168Italy

Anastomotic leakage(AL)has a wide range of clinical features ranging from radiological only findings to peritonitis and sepsis with multiorgan *** early diagnosis of AL is essential in order to establish the most appropriate treatment for this *** AL continues to be a dreadful complication after colorectal surgery,there has been no consensus on its ***,based on patient’s presentation and timing of the AL,there has been a gradual shift to a more conservative management,keeping surgery as the last option Reoperation for sepsis control is rarely necessary especially in those patients who already have a diverting stoma at the time of the leak.A nonoperative management is usually preferred in these *** are several treatment options,also for patients without a stoma who do not require a reoperation for a contained pelvic leak,including recently developed endoscopic procedures,such as clip placement or endoluminal vacuum-assisted *** conservative treatments could be an option in patients who are clinically stable or in presence of a small defect.

关键词： Anastomotic leakage Colorectal cancer Colorectal surgery Mortality Morbidity

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New challenges of geriatric cardiology： from clinical to preclinical research

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Journal of Geriatric Cardiology 2017年第4期14卷 223-232页

作者： Marco Malavolta Daniele Caraceni Fabiola Olivieri Roberto Antonicelli Advanced Technology Center for Aging Research Scientific Technological Area IRCCS-INRCA Ancona Italy Department of Clinical and Molecular Sciences DISCLIMO Universit~ Politecnica delle Marche Ancona Italy Center of Clinical Pathology and Innovative Therapy INRCA Ancona Italy Department of Cardiology INRCA-IRCCS National Institute Ancona Italy

The field of geriatric cardiology reflects the evolving medical approaches tailored to address the needs of the growing population of oldest old with cardiovascular diseases （CVD）. The burden of CVD is expected to increase particularly for the most common types of chronic heart disease of the elderly including coronary artery disease, heart failure and atrial fibrillation. In this context of dramatic demographic changes, geriatric cardiologists are facing important challenges. In this review, we outline the basic concepts of geriatric cardiology and describe these challenges as well as the unmet needs around this discipline with also a focus on the translation from basic research.

关键词： Aging Cardiovascular Diseases Geriatric Cardiology Senescence

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Molecular mechMolecular mechanism of glucocorticoid resistance in inflammatory bowel disease

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World Journal of Gastroenterology 2011年第9期17卷 1095-1108页

作者： Sara De Iudicibus Raffaella Franca Stefano Martelossi Alessandro Ventura Giuliana Decorti Department of Reproduction and Development University of Trieste Institute for Maternal and Child Health irccs Burlo Garofolo Department of Life Sciences University of Trieste

Natural and synthetic glucocorticoids (GCs) are widely employed in a number of inflammatory, autoimmune and neoplastic diseases, and, despite the introduction of novel therapies, remain the first-line treatment for inducing remission in moderate to severe active Crohn’s disease and ulcerative colitis. Despite their extensive therapeutic use and the proven effectiveness, considerable clinical evidence of wide inter-individual differences in GC efficacy among patients has been reported, in particular when these agents are used in inflammatory diseases. In recent years, a detailed knowledge of the GC mechanism of action and of the genetic variants affecting GC activity at the molecular level has arisen from several studies. GCs interact with their cytoplasmic receptor, and are able to repress inflammatory gene expression through several distinct mechanisms. The glucocorticoid receptor (GR) is therefore crucial for the effects of these agents: mutations in the GR gene (NR3C1, nuclear receptor subfamily 3, group C, member 1) are the primary cause of a rare, inherited form of GC resistance; in addition, several polymorphisms of this gene have been described and associated with GC response and ***, the GR is not self-standing in the cell and the receptor-mediated functions are the result of a complex interplay of GR and many other cellular partners. The latter comprise several chaperonins of the large cooperative hetero-oligomeric complex that binds the hormonefree GR in the cytosol, and several factors involved in the transcriptional machinery and chromatin remodeling, that are critical for the hormonal control of target genes transcription in the nucleus. Furthermore, variants in the principal effectors of GCs (e.g. cytokines and their regulators) have also to be taken into account for a comprehensive evaluation of the variability in GC response. Polymorphisms in genes involved in the transport and/or metabolism of these hormones have also been suggested as

关键词： Glucocorticoids Inflammatory bowel disease Pharmacogenomics

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Anticoagulation in frail older people

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Journal of Geriatric Cardiology 2019年第11期16卷 844-846页

作者： Sarah Damanti Simon Braham Luca Pasina Geriatric Unit IRCCS Ca’Granda Ospedale Maggiore PoliclinicoMilanItaly Nutritional Sciences PhD Univeristy of MilanMilanItaly Angelo Bianchi Bonomi Hemophilia and Thrombosis Center IRCCS CàGranda Maggiore Hospital FoundationMilanItaly Pharmacotherapy and Appropriateness of Drug Prescription Unit Istituto Di Ricerche Farmacologiche Mario Negri IRCCSVia Giuseppe La MasaMilanItaly

Frailty is a multidimensional dynamic condition characterized by decreased physiological reserves. Therefore,frail people are more vulnerable to ***,minor stimuli,like a new drug prescription,can alter their homeostatic equilibrium determining adverse clinical outcomes(i.e.,falls,institutionalization,disability,and death).[1,2]Since the risk of atrial fibrillation[3]and venous thromboembolism[4]increase with ageing,frail people might require long term anticoagulation.

关键词： Anticoagulation Frailty The elderly

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Relief of jaundice in malignant biliary obstruction:When should we consider endoscopic ultrasonography-guided hepaticogastrostomy as an option?

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Hepatobiliary & Pancreatic Diseases International 2022年第3期21卷 234-240页

作者： Alessandro Fugazza Matteo Colombo Marco Spadaccini Edoardo Vespa Roberto Gabbiadini Antonio Capogreco Alessandro Repici Andrea Anderloni Division of Gastroenterology and Digestive Endoscopy Humanitas Research Hospital-IRCCSMilanItaly Department of Biomedical Sciences Humanitas UniversityMilanItaly

Background:Since it was first described in 2001,endoscopic ultrasonography-guided biliary drainage(EUS-BD)has emerged as an alternative procedure for achieving an endoscopic internal drainage in case of endoscopic retrograde cholangiopancreatography(ERCP)*** drainage can be achieved by either a transduodenal extrahepatic approach through EUS-guided choledochoduodenostomy(EUS-CDS),or a transgastric intrahepatic approach,namely EUS-guided hepaticogastrostomy(EUS-HGS)which already holds a remarkable place in the treatment of patients with malignant biliary *** sources:For this review we did a comprehensive search of PubMed/MEDLINE from inception to May 31,2021 for papers with a significant sample size(at least 20 patients enrolled)dealing with *** on technical success,clinical success and rate of adverse events were ***:A total of 22 studies with different design,com prising 874 patients,were *** success was achieved in about 96% of cases(ranging from 65% to 100%).Clinical success was obtained in almost 91% of cases(ranging from 76% to 100%).Overall rate of adverse events was 19%(ranging from 0% to 35%).Abdominal pain,self-limiting pneumoperitoneum,bile leak,cholangitis,bleeding,perforation and intraperitoneal migration of the stent were the most ***:Despite both safety and efficacy profile,at the moment HGS still remains a challenging procedure at every single step and must therefore be conducted by a very experienced endoscopist in interventional EUS and ERCP procedures,who is able to deal with the possible severe adverse events of this procedure.A rapid introduction in clinical practice of dedicated devices is desiderable.

关键词： EUS-guided hepaticogastrostomy EUS-guided biliary drainage Hepaticogastrostomy Interventional EUS

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Tumor microenvironment in primary liver tumors: A challenging role of natural killer cells

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World Journal of Gastroenterology 2020年第33期26卷 4900-4918页

作者： Michela Anna Polidoro Joanna Mikulak Valentina Cazzetta Ana Lleo Domenico Mavilio Guido Torzilli Matteo Donadon Hepatobiliary Immunopathology Laboratory Humanitas Clinical and Research Center–IRCCSRozzano 20089MilanItaly Laboratory of Clinical and Experimental Immunology Humanitas Clinical and Research Center-IRCCSRozzano 20089MilanItaly Department of Medical Biotechnologies and Translational Medicine(BioMeTra) University of MilanRozzano 20089MilanItaly Department of Biomedical Science Humanitas UniversityPieve Emanuele 20090MilanItaly Department of Internal Medicine Humanitas Clinical and Research Center–IRCCSRozzano 20089MilanItaly Department of Hepatobiliary and General Surgery Humanitas Clinical and Research Center-IRCCSRozzano 20089MilanItaly

In the last years,several studies have been focused on elucidate the role of tumor microenvironment(TME)in cancer development and *** TME,cells from adaptive and innate immune system are one of the main abundant *** dynamic interactions between immune and cancer cells lead to the activation of complex molecular mechanisms that sustain tumor *** important cross-talk has been elucidate for several kind of tumors and occurs also in patients with liver cancer,such as hepatocellular carcinoma(HCC)and intrahepatic cholangiocarcinoma(iCCA).Liver is well-known to be an important immunological organ with unique ***,in normal conditions,the rich immune-infiltrating cells cooperate with non-parenchymal cells,such as liver sinusoidal endothelial cells and Kupffer cells,favoring self-tolerance against gut *** presence of underling liver immunosuppressive microenvironment highlights the importance to dissect the interaction between HCC and iCCA cells with immune infiltrating cells,in order to understand how this cross-talk promotes tumor *** attention is,in fact,focused on immune-based therapy for these tumors,as promising approach to counteract the intrinsic anti-tumor activity of this *** this review,we will examine the key pathways underlying TME cell-cell communications,with deeper focus on the role of natural killer cells in primary liver tumors,such as HCC and iCCA,as new opportunities for immune-based therapeutic strategies.

关键词： Primary liver cancer Natural killer cells Tumor microenvironment Hepatocellular carcinoma Intrahepatic cholangiocarcinoma Immune cells

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Renewed considerations on the utility(or the futility)of hepatic resections for breast cancer liver metastases

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Hepatobiliary Surgery and Nutrition 2021年第1期10卷 49-58页

作者： Gian Luca Grazi Hepatobiliary Biliary Pancreatic Surgery IRCCS Regina Elena National Cancer InstituteRomeItaly

Importance:Indication for liver resection(LR)for localized hepatic metastases from breast cancer(BC)is still a matter of ***:A literature review of recent scientific papers pertaining to hepatectomies for BC liver metastases(LM).Evidence Review:We based our systematic review on case series on literature reviews,comparative studies and cost-utility analysis which have been selected based on criteria regarding surgery,possible prognostic factors and evaluation of long-term ***:There is a strong inhomogeneity in the reported data,with 5-year survivals ranging from 21%to 58%.There is no agreement in the evaluation of prognostic variables predicting good survival,with the only exception of the time of treatment of the primary BC until the diagnosis of *** out of the four comparative studies report better survivals for patients who underwent a hepatectomy in comparison to those treated with chemotherapy alone,but their strength in terms of scientific evidence is *** only cost-utility analysis revealed that 2 out of the 3 scenarios considered were in favor of the treatment with surgery followed by conventional ***:There is no definitive proof on the effectiveness of LRs for BC *** can be proposed when it is possible to perform radical surgery,with R0 margins and saving at least 30%of the liver with its vascular and biliary *** skeletal metastases are not a *** interval between treatment of the primary location and diagnosis of hepatic metastases is the only prognosis criteria available.

关键词： Breast cancer(BC) liver metastases(LM) liver surgery hepatectomy

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Minimally invasive surgical treatment of intrahepatic cholangiocarcinoma:A systematic review

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World Journal of Gastrointestinal Oncology 2021年第12期13卷 2203-2215页

作者： Renato Patrone Francesco Izzo Raffaele Palaia Vincenza Granata Guglielmo Nasti Alessandro Ottaiano Gilda Pasta Andrea Belli University of Naples Federico II Naples 80100Italy Department of Abdominal Oncology Division of Hepatobiliary Surgical OncologyIstituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy Division of Radiology Istituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy SSD-Innovative Therapies for Abdominal Metastases Clinical and Experimental Abdominal OncologyIstituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy Division of Anesthesia Pain medicine and Supportive CareIstituto Nazionale TumoriFondazione G.PascaleIRCCSNaples 80131Italy

BACKGROUND Intrahepatic cholangiocarcinoma(ICC)is the second most common primary liver cancer and is characterized by an aggressive behavior and a dismal *** surgical resection represents the only potentially curative *** the increasing acceptance of laparoscopic liver resection for surgical treatment of malignant liver diseases,its use for ICC is not commonly *** fact,to achieve surgical free margins a major resection and/or vascular and/or biliary reconstructions is often needed,as well as an associated lymph node *** To review and summarize the current evidences on the minimally invasive resection of *** A systematic review of the literature based on the criteria predetermined by the investigators was performed from the 1st of January 2009 up to the 1st of January2021 in 4 databases(PubMed,Scopus,Google Scholar,and Cochrane databases).All retrospective and prospective studies reporting on the comparative outcomes of open vs minimally invasive treatment of ICC were *** evaluation of manuscripts quality was achieved using Methodological Index for Non-Randomized Studies criteria and Newcastle-Ottawa *** After a systematic search 9 studies fulfilled the inclusion *** the all 3012 included patients,2450 were operated by an open approach and 562 by a minimally invasive(laparoscopic)*** characteristics,tumor characteristics,surgical outcomes and oncological outcomes were collected and analyzed,highlighting values with a statistical significant difference between patients treated with open or laparoscopic *** hospital stay and lower intraoperative blood losses were reported by some Authors in minimally invasive surgery,on the contrary,in the open group there was a higher number of lymphadenectomies and a higher percentage of major *** Minimally invasive resection of ICC has some short-term benefits and it is safe and feasible only in select

关键词： Cholangiocarcinoma Minimally invasive Laparoscopic Liver resection Hepatectomy Biliary neoplasm

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Anxiety,depression,and quality of life in Parkinson's disease:the implications of multidisciplinary treatment

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Neural Regeneration Research 2021年第3期16卷 587-590页

作者： Viviana Lo Buono Rosanna Palmeri Simona De Salvo Matteo Berenati Agata Greco Rosella Ciurleo Chiara Sorbera Vincenzo Cimino Francesco Corallo Placido Bramanti Silvia Marino Giuseppe Di Lorenzo Lilla Bonanno Department of Neurobioimaging Istituto di Ricovero e Cura a Carattere Scientifico IRCCS Centro Neurolesi Bonino-PulejoMessinaItaly

Anxiety and depression in Parkinson's disease(PD)reduce well-being of the *** alterations influence motor skills and cognitive performance;moreover,they contribute significantly and independently to worsen rehabilitative treatment *** investigated anxiety,depression,and quality of life in PD patients subjected to multidisciplinary rehabilitative *** self-controlled study included 100 PD patients(49 males and 51 females with the mean age of 64.66 years)admitted to 60 days hospitalization rehabilitative program,between January 2017 and December ***,cognitive,linguistic abilities,and functional independence were evaluated at admission(T0 baseline visit)and 60 days after(T1)the multidisciplinary rehabilitation including motor exercises,speech therapies,and cognitive *** multidisciplinary rehabilitation improved functional status in PD patients and exerted its positive effects on mood,motor abilities,autonomy in the activities of daily life,perception of quality of life,cognitive performance and speech ***-motor symptoms may worsen severe disability and reduce quality of *** are often poorly recognized and inadequately ***,multidisciplinary rehabilitative training represents an optimal strategy to improve disease *** study was approved by Istituito di Ricovero e Cura a Carattere Scientifico(irccs)Centro Neurolesi"Bonino-Pulejo"Ethical Committee(approval No.6/2016)in June 2016.

关键词： anxiety depression multidisciplinary rehabilitation Parkinson's disease

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