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Screening in liver disease

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World Journal of Gastroenterology 2006年第33期12卷 5272-5280页

作者： Paolo Del Poggio Marzio Mazzoleni Hepatology Unit Treviglio Hospital Treviglio (Bergamo) Italy General Practitioner Italian Society of Family Physicians (SIMG) Italy

A disease is suitable for screening if it is common, if the target population can be identifi ed and reached and if both a good screening test and an effective therapy are available. Of the most common liver diseases only viral hepatitis and genetic hemochromatosis partially satisfy these conditions. Hepatitis C is common, the screening test is good and the therapy eliminates the virus in half of the cases, but problems arise in the definition of the target population. In fact generalized population screening is not endorsed by international guidelines, although some recommend screening immigrants from high prevalence countries. Opportunistic screening (case finding) of individuals with classic risk factors, such as transfusion before 1992 and drug addiction, is the most frequently used strategy, but there is disagreement whether prison inmates, individuals with a history of promiscuous or traumatic sex and health care workers should be screened. In a real practice setting the performance of opportunistic screening by general practitioners is low but can be ameliorated by training programs. Screening targeted to segments of the population or mass campaigns are expensive and therefore interventions should be aimed to improve opportunistic screening and the detection skills of general practitioners. Regarding genetic hemochromatosis there is insufficient evidence for population screening, but individual physicians can decide to screen racial groups with a high prevalence of the disease, such as people in early middle age and of northern European origin. In the other cases opportunistic screening of high risk individu-als should be performed, with a high level of suspicion in case of unexplained liver disease, diabetes, juvenile artropathy, sexual dysfunction and skin pigmentation.

关键词： Screening Risk factors Hepatitis C Hepatitis B Genetic hernochromatosis

Endoscopic management of complications of chronic pancreatitis

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World Journal of Gastroenterology 2013年第42期19卷 7308-7315页

作者： Jean-Marc Dumonceau Carlos Macias-Gomez Division of Gastroenterology and Hepatology Geneva University Hospital1211 GenevaSwitzerland Gastrointestinal Endoscopy Unit Gastroenterology ServiceItalian Hospital1181 Buenos AiresArgentina

Pseudocysts and biliary obstructions will affect approximately one third of patients with chronic pancreatitis(CP).For CP-related,uncomplicated,pancreatic pseudocysts(PPC),endoscopy is the first-choice therapeutic *** advances have focused on endosonography-guided PPC transmural drainage,which tends to replace the conventional,duodenoscope-based coma immediately *** material is being tested to facilitate the endosonography-guided *** this review,the most adequate techniques depending on PPC characteristics are presented along with supporting *** CP-related biliary obstructions,endoscopy and surgery are valid therapeutic *** co-morbidities(e.g.,portal cavernoma)and expected patient compliance to repeat endoscopic procedures are important factors when selecting the most adapted *** should be reasonably ruled out before embarking on the endoscopic treatment of presumed CP-related biliary *** endoscopy,the gold standard technique consists of placing simultaneous,multiple,side-by-side,plastic stents for a oneyear *** covered self-expandable metal stents are challenging this method and have provided 50%mid-term success.

关键词： Biliary stricture Chronic pancreatitis Pseudocyst Endoscopic retrograde cholangio-pancreatography Endoscopic ultrasonography Stent

Risk of fracture in celiac disease:Gender,dietary compliance,or both?

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World Journal of Gastroenterology 2011年第25期17卷 3035-3042页

作者： María Inés Pinto Sánchez Adriana Mohaidle Andrea Baistrocchi Dolores Matoso Horacio Vázquez Andrea González Roberto Mazure Evangelina Maffei Guillermina Ferrari Edgardo Smecuol Adriana Crivelli Juan Andrés de Paula Juan C Gómez Silvia Pedreira Eduardo Maurio Julio César Bai Small Bowel Section Department of Medicine"Dr.C.Bonorino Udaondo" Gastroenterology Hospital Department of Gastroenterology German Hospital Nutritional Support Unit and Malabsortion "San Martin" HIGA1900 La PlataArgentina Department of Gastroenterology Italian Hospital

AIM:To determine the incidence of peripheral fractures in patients with celiac disease (CD) and the effect of treatment on fracture ***:We compared the incidence and risk of peripheral fractures before and after diagnosis between a cohort of 265 patients who had been diagnosed with CD at least 5 years before study entry and a cohort of 530 age-and sex-matched controls who had been diagnosed with functional gastrointestinal *** were collected through in-person interviews with an *** overall assessment window for patients was 9843 patient-years (2815 patient-years after diagnosis).RESULTS:Compared with the control group,the CD cohort showed significantly higher incidence rate and risk of first peripheral fracture before diagnosis [adjusted hazard ratio (HR):1.78,95% CI:1.23-2.56,P < 0.002] and in men (HR:2.67,95% CI:1.37-5.22,P < 0.004).Fracture risk was significantly associated with the classic CD presentation with gastrointestinal symptoms (P < 0.003).In the time period after diagnosis,the risk of fractures was comparable between the CD cohort and controls in both sexes (HR:1.08,95% CI:0.55-2.10 for women;HR:1.57,95% CI:0.57-4.26 for men).CONCLUSION:CD patients have higher prevalence of fractures in the peripheral skeleton before *** is associated with male sex and classic clinical *** fracture risk was reduced after the treatment.

关键词： Celiac disease Fracture risk Peripheralfractures Gluten-free diet Sex difference

A successful TB defaulter control in a war zone with high HIV prevalence

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Asian Pacific Journal of Tropical Medicine 2010年第1期3卷 78-80页

作者： Giovanni Landoni Chiara Pierotti Barbara Nattabi Joyce Nono Camilla Biselli Bruno Corrado AISPO(italian Association for Solidarity among People)

War zones in Sub-Saharan Africa represent a challenge for public health projects like TB control programs because planning and communication have been disrupted,doctors and medical workers flied to secure *** present a TB control program carried out by an italian NGO,italian Association for Solidarity among People(AISPO) in a referral hospital of North Uganda(Lacor H).

关键词： Community capacity domains Dengue Thailand Qualitative study

Diabetes mellitus and Parkinson's disease:dangerous liaisons between insulin and dopamine

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Neural Regeneration Research 2022年第3期17卷 523-533页

作者： Angela De Iuliis Ennio Montinaro Giuseppe Fatati Mario Plebani Carlo Colosimo Department of Medicine-DiMED University of PadovaItaly Department of Neurology Santa Maria University HospitalTerniItaly italian Obesity Network TerniItaly Department of Medicine-DiMED University of PadovaPadovaItaly/Department of Laboratory Medicine-Hospital of PadovaPadovaItaly

The relationship between diabetes mellitus and Parkinson's disease has been described in several epidemiological studies over the 1960 s to *** studies have shown the possible functional link between insulin and dopamine,as there is strong evidence demonstrating the action of dopamine in pancreatic islets,as well as the insulin effects on feeding and cognition through central nervous system mechanism,largely independent of glucose *** used for the treatment of type 2 diabetes mellitus appear to be promising candidates for symptomatic and/or disease-modifying action in neurodegenerative diseases including Parkinson's disease,while an old dopamine agonist,bromocriptine,has been repositioned for the type 2 diabetes mellitus *** review will aim at reappraising the different studies that have highlighted the dangerous liaisons between diabetes mellitus and Parkinson's disease.

关键词： dopamine GLP-1 insulin Parkinson's disease type 2 diabetes mellitus

Pre-endoscopic screening for Helicobacter pylori and celiac disease in young anemic women

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World Journal of Gastroenterology 2009年第22期15卷 2748-2753页

作者： Lucy Vannella Debora Gianni Edith Lahner Antonio Amato Enzo Grossi Gianfranco Delle Fave Bruno Annibale Department of Digestive and Liver Disease Hospital Sant'AndreaII School of Medicine University Sapienza Center for Thalassemic Disease of Rome Department of Medical Affair Italian Diagnostic Center Department of Digestive and Liver Disease Hospital Sant’AndreaII School of Medicine University Sapienza

AIM： To evaluate the usefulness of pre-endoscopic serological screening for He//cobacter py/or/ （H py/or/} infection and celiac disease in women aged 〈 50 years affected by iron-deficiency anemia （IDA）. METHODS： One hundred and fifteen women aged 〈 50 years with IDA were tested by human recombinant tissue transglutaminase IgA antibodies （tTG） and anti-H pylori IgG antibodies, tTG and H pylori IgG antibody were assessed using an enzyme-linked immunosorbent assay （ELISA）. All women were invited to undergo upper GI endoscopy. During gastroscopy, biopsies were collected from antrum （n = 3）, gastric body （n = 3） and duodenum （n = 4） in all patients, irrespective of test results. The assessment of gastritis was performed according to the Sydney system and celiac disease was classified by Marsh＇s System. RESULTS： 45.2% women were test-positive： 41 patients positive for H pylori antibodies, 9 patients for tTG and 2 patients for both. The gastroscopy compliance rate of test-positive women was significantly increased with respect to those test- negative （65.4% vs 42.8%; Fisher test P = 0.0239）. The serological results were confirmed by gastroscopy in 100% of those with positive H pylori antibodies, in 50% of those with positive tTG and in 81.5% of test- negative patient. Sensitivity and specificity were 84.8% and 100%, respectively for Hpylori infection and, 80% and 92.8% for tTG. Twenty-eight patients had positive H pylori antibodies and in all the patients, an active Hpylori infection was found. In particular, in 23 out of 28 （82%） patients with positive H pylori antibodies, a likely cause of IDA was found because of the active inflammation involving the gastric body. CONCLUSION： Anti-H pylori IgG antibody and tTG IgA antibody testing is able to select women with IDA to submit for gastroscopy to identify H pylori pangastritis and/or celiac disease, likely causes of IDA.

关键词： Iron deficiency anemia Women Celiac disease Helicobacter pylori gastritis

Markers of inflammation and cardiovascular disease in recently diagnosed celiac disease patients

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World Journal of Cardiology 2017年第5期9卷 448-456页

作者： Walter F Tetzlaff Tomás Merono Martin Menafra Maximiliano Martin Eliana Botta Maria D Matoso Patricia Sorroche Juan A De Paula Laura E Boero Fernando Brites Department of Clinical of Biochemistry School of Pharmacy and BiochemistryUniversity of Buenos AiresINFIBIOCCONICET Service of Gastroenterology Buenos Aires Italian Hospital Central Laboratory Buenos Aires Italian Hospital

AIM To evaluate novel risk factors and biomarkers of car-diovascular disease in celiac disease(CD) patients compared with healthy controls. METHODS Twenty adult patients with recent diagnosis of CD and 20 sex, age and body mass index-matched healthy controls were recruited during a period of 12 mo. Indicators of carbohydrate metabolism, hematological parameters and high sensitive C reactive protein were determined. Moreover, lipoprotein metabolism was also explored through evaluation of the lipid profile andthe activity of cholesteryl ester transfer protein and lipoprotein associated phospholipase A2, which is also considered a specific marker of vascular inflammation. The protocol was approved by the Ethic Committee from School of Pharmacy and Biochemistry, University of Buenos Aires and from Buenos Aires italian hospital, Buenos Aires, *** Regarding the indicators of insulin resistance, CD patients showed higher plasma insulin levels [7.2(5.0-11.3) m U/L vs 4.6(2.6-6.7) m U/L, P < 0.05], increased Homeostasis Model Assessment-Insulin Resistance [1.45(1.04-2.24) vs 1.00(0.51-1.45), P < 0.05] and lower Quantitative Sensitive Check index [0.33(0.28-0.40) vs 0.42(0.34-0.65), P < 0.05] indexes. Folic acid concentration [5.4(4.4-7.9) ng/m L vs 12.2(8.0-14.2) ng/m L, P < 0.01] resulted to be lower and High-sensitivity C reactive protein levels higher(4.21 ± 6.47 mg/L vs 0.98 ± 1.13 mg/L, P < 0.01) in the patient group. With respect to the lipoprotein profile, CD patients showed lower high density lipoprotein-cholesterol(HDL-C)(45 ± 15 mg/d L vs 57 ± 17 mg/d L, P < 0.05) and apo A-I(130 ± 31 mg/d L vs 155 ± 29 mg/d L, P < 0.05) levels, as well as higher total cholesterol/HDL-C [4.19(3.11-5.00) vs 3.52(2.84-4.08), P < 0.05] and apo B/apo A-I(0.75 ± 0.25 vs 0.55 ± 0.16, P < 0.05) ratios in comparison with control subjects. No statistically significant differences were detected in lipoprotein-associated lipid transfer protein and *** The presence

关键词： Inflammation Cardiovascular disease High density lipoprotein-cholesterol Lipoproteins Celiac disease

Isolated limb infusion chemotherapy with or without hemofiltration for recurrent limb melanoma

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World Journal of Clinical Oncology 2015年第4期6卷 57-63页

作者： Sara Cecchini Donatella Sarti Stefano Ricci Ludovico Delle Vergini Manuela Sallei Stefano Serresi Giuseppe Ricotti Luca Mulazzani Fabrizia Lattanzio Giammaria Fiorentini Department of Vascular and Interventional Radiology INRCA Hospital- IRCCS Department of Oncology-Hematology "Azienda Ospedaliera Ospedali Riuniti Marche Nord" San Salvatore Hospital Unit of Dermatology INRCA Hospital-IRCCS Department of Radiology General Hospital "Azienda Ospedaliera Ospedali Riuniti Marche Nord" italian National Research Center on Aging Scientific Direction

AIM: To better define the efficacy and the safety of intra-arterial infusion performed with or without hemofiltration for recurrent limb melanoma. METHODS: Patients with the following characteristics were included in the study: recurrent limb melanoma not indicated for surgical resection, measurable disease in the extremity, > 18 years, performances status(Eastern Cooperative Oncology Group) was 0-1 and life expectancy of at least 6 mo. Twenty nine consecutive patients were enrolled in the study. Patients underwent fluoroscopic placement of angiographic arterial and venous catheters to infuse the drug in the artery [isolated limb infusion(ILI)], and to stop the out flow(venous). Melphalan was rapidly infused into the isolated limb via the arterial catheter after the inflation of venous balloon catheter. Then the circulation of the limb was completely blocked with a pneumatic cuff at the root of the limb. Haemofiltration(HF) was available only in the main center, and was performed with an extracorporeal perfusion system, in order to reduce high systemic toxic peaks of ***: Thirty seven ILI were done in 29 cases(31 ILI-HF and 6 ILI) between 2001 and 2014 at Ancona and Pesaro hospitals, Italy. Clinical outcomes were monitored 30 d after treatment. Eleven patients(38%) received infusion of melphalan alone, 7(24%) melphalan associated to mitomicin C and 7(24%) melphalan associated to cisplatin, the remaining 4 were treated with cisplatin, melphalan and epirubicin or cisplatin and mitomicin C. The overall response rate was 66%, in particular, 3 patients(10%) were complete responders and 16(56%) were partial responders; whereas 7 patients(24%) had stable disease, and 3(10%) showed progressive disease. Limb toxicity was assessed adopting Wieberdink scale, with evidence of 90% of low grade(I and II) ***: ILI-HF and ILI are effective and safe treatments for recurrent non-resectable limb melanoma. They present evidence of favorable clinical benefit and

关键词： Metastatic melanoma Melphalan Intraarterial infusion Hemofiltration

Prognostic relevance of normocytic anemia in elderly patients affected by cardiovascular disease

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Journal of Geriatric Cardiology 2021年第8期18卷 654-662页

作者： Liana Spazzafumo Fabiola Olivieri Jacopo Sabbatinelli Roberta Galeazzi Rina Recchioni Fiorella Marcheselli Paola Tamburrini Roberto Antonicelli Epidemiologic Observatory Regional Health AgencyRegione MarcheAnconaItaly Department of Clinical and Molecular Sciences UniversitàPolitecnica delle MarcheAnconaItaly Center of Clinical Pathology and Innovative Therapy Italian National Research Centre on AgingIRCCS INRCAAnconaItaly SOD Medicina di Laboratorio Azienda Ospedaliero Universitaria Ospedali RiunitiAnconaItaly Clinical Laboratory and Molecular Diagnostic Italian National Research Center on AgingIRCCS INRCAAnconaItaly Department of Cardiology-CCU Italian National Research Centre on AgingIRCCS INRCAAnconaItaly

BACKGROUND Anemia associated with cardiovascular diseases(CVD) is a common condition in older persons. Prevalence and prognostic role of anemia were extensively studied in patients with myocardial infarction(MI) or congestive heart failure(CHF) whereas limited data were available on patients with atrial fibrillation(AF). This study was conducted to assess the clinical prevalence and prognostic relevance of anemia in elderly patients affected by AF and other *** A total of 866 elderly patients(430 men and 436 women, age: 65-98 years, mean age: 85 ± 10 years) were *** these patients, 267 patients had acute non-ST-segment elevation MI(NSTEMI), 176 patients had acute CHF, 194 patients had acute AF and 229 patients were aged-matched healthy persons(CTR). All parameters were measured at the hospital admission and cardiovascular mortality was assessed during twenty-four months of *** The prevalence of anemia was higher in NSTEMI, CHF and AF patients compared to CTR subjects(50% vs. 15%, P <0.05), with normocytic anemia being the most prevalent type(90%). Adjusted mortality risk was higher in anemic patient versus non-anemic patient in all the groups of patients [NSTEMI: hazard ratio(HR) = 1.81, 95% CI: 1.06-2.13;CHF: HR = 2.49, 95% CI:1.31-4.75;AF: HR = 1.98, 95% CI: 1.01-3.88]. Decreased hemoglobin levels(P = 0.001) and high reticulocyte index(P = 0.023) were associated with higher mortality in CVD *** The significant associations between CVD and anemia and the prognostic relevance of anemia for elderly patients with CVD were confirmed in this study. The presence of anemia in AF patients is associated with a two-fold increased mortality risk compared with non-anemic AF patients. Low hemoglobin and high reticulocyte count independently predict mortality in elderly patients with CVD.

关键词： patients anemia cardiovascular