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neoadjuvant chemotherapy for gastric cancer. Is it a must or a fake?

World Journal of Gastroenterology 2018年第2期24卷 274-289页

作者： Rossella Reddavid silvia sofia Paolo Chiaro Fabio Colli Renza Trapani Laura Esposito Mario solej Maurizio Degiuli surgical Oncology and Digestive surgery Department of Oncology University of Turin San Luigi University Hospital Department of surgical sciences Digestive and Oncological Surgery University of Turin Molinette Hospital

AIM To investigate the neoadjuvant chemotherapy(nAC) effect on the survival of patients with proper stomach cancer submitted to D2 *** We proceeded to a review of the literature with Pub Med, Embase, AsCO and EsMO meeting abstracts as well as computerized use of the Cochrane Library for randomized controlled trials(RCTs) comparing nAC followed by surgery(nAC + s) with surgery alone(sA) for gastric cancer(GC). The primary outcome was the overall survival rate. secondary outcomes were the site of the primary tumor, extension of node dissection according to Japanese Gastric Cancer Association(JGCA) performed in both arms, disease-specific(Dss) and disease-free survival(DFs) rates, clinical and pathological response rates and resectability rates after perioperative treatment. REsULTs We identified a total of 16 randomized controlled trials comparing nAC + s(n = 1089) with sA(n = 973) published in the period from January 1993-March 2017. Only 6 of these studies were well-designed, structured trials in which the type of lymph node(Ln) dissection performed or at least suggested in the trial protocol was reported. Two out of three of the RCTs with D2 lymphadenectomy performed in almost all cases failed to show survival benefit in the nAC arm. Inthe third RCT, the survival rate was not even reported, and the primary end points were the clinical outcomes of surgery with and without nAC. In the remaining three RCTs, D2 lymph node dissection was performed in less than 50% of cases or only recommended in the "study Treatment" protocol without any description in the results of the procedure really perfomed. In one of the two studies, the benefit of nAC was evident only for esophagogastric junction(EGJ) cancers. In the second study, there was no overall survival benefit of nAC. In the last trial, which documented a survival benefit for the nAC arm, the chemotherapy effect was mostly evident for EGJ cancer, and more than one-fourth of patients did not have a proper

关键词： gastric cancer neoadjuvant chemotherapy perioperative chemotherapy D2 lymphadenectomy randomized control trial

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Bioelectrical impedance analysis-guided fluid management promotes primary fascial closure after open abdomen:a randomized controlled trial

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Military Medical research 2022年第2期9卷 193-204页

作者： Kai Wang shi-Long sun Xin-Yu Wang Cheng-nan Chu Ze-Hua Duan Chao Yang Bao-Chen Liu Wei-Wei Ding Wei-Qin Li Jie-shou Li Division of Trauma and surgical Intensive Care Unit Research Institute of General SurgeryJinling HospitalMedical School of Nanjing UniversityNo.305 East Zhongshan RoadNanjing 210002China Division of Trauma and surgical Intensive Care Unit Research Institute of General Surgerythe First School of Clinical MedicineSouthern Medical UniversityNanjing 210002China

Background:Fluid overload(FO)after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen(OA)*** impedance analysis(BIA)is a promising tool for monitoring fluid status and ***,we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA ***:A pragmatic,prospective,randomized,observer-blind,single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center.A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation(defined as BIA)protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level(HL)measured by BIA or a traditional fluid resuscitation(TRD)in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 d of intensive care unit(ICU)*** primary outcome was the 30-day primary fascial closure(PFC)*** secondary outcomes included the time to PFC,postoperative 7-day cumulative fluid balance(CFB)and adverse events within 30 d after *** Kaplan–Meier method and the log-rank test were utilized for PFC after OA.A generalized linear regression model for the time to PFC and CFB was ***:A total of 134 patients completed the trial(BIA,n=66;TRD,n=68).The BIA patients were significantly more likely to achieve PFC than the TRD patients(83.33%vs.55.88%,Pn the BIA group,the time to PFC occurred earlier than that of the TRD group by an average of 3.66 d(Pnally,the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml(Pnd fewer ***:Among postinjury OA patients in the ICU,the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complicat

关键词： Trauma Open abdomen Fluid overload Fluid resuscitation Primary fascial closure Bioelectrical impedance analysis

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Vascular endothelial growth factor and tryptase changes after chemoembolization in hepatocarcinoma patients

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World Journal of Gastroenterology 2015年第19期21卷 6018-6025页

作者： Girolamo Ranieri Michele Ammendola Ilaria Marech Annamaria Laterza Ines Abbate Caroline Oakley Angelo Vacca Rosario sacco Cosmo Damiano Gadaleta Diagnostic and Interventional Radiology Unit with Integrated section of Translational Medical Oncology National Cancer Research Centre Department of Medical and surgical sciences Clinical Surgery Unit University of "Magna Graecia" Department of experimental Oncology Laboratory of Analyses Cancer Institute "Giovanni Paolo II" Department of Internal Medicine and Clinical Oncology University of Bari Medical School

AIM: To evaluate vascular endothelial growth factor(VEGF) and tryptase in hepatocellular cancer(HCC)before and after trans-arterial chemoembolization(TACE).METHODs: VEGF and tryptase serum concentrations were assessed from 71 unresectable HCC patients before and after hepatic TACE performed by binding DC-Beads?to doxorubicin. VEGF levels were examined for each serum sample using the Quantikine Human VEGF-enzyme-linked immuno-absorbent assay(ELIsA),whereas tryptase serum concentrations were assessed for each serum sample by means of fluoro-enzyme immunoassay(FEIA) using the Uni-CAP100 *** between serum VEGF and tryptase values before and after TACE were evaluated using student t test. Person's correlation was used to assess the degree of association between the two ***: VEGF levels and serum tryptase in HCCpatients before TACE had a mean value and standard deviation(sD) of 114.31 ± 79.58 pg/mL and 8.13± 3.61 μg/L, respectively. The mean levels and sD of VEGF levels and serum tryptase in HCC patients after TACE were 238.14 ± 109.41 pg/mL and 4.02 ±3.03 μg/L. The changes between the mean values of concentration of VEGF and tryptase before treatment and after treatment was statistically significant(P nd P n-Mann-Whitney respectively). A significant correlation between VEGF levels before and after TACE and between tryptase levels before and after TACE was demonstrated(r =0.68, P = 0.003; r = 0.84, P = 0.000 respectively).COnCLUsIOn: Our pilot results suggest that the higher serum VEGF levels and the lower tryptase levels following TACE may be potential biomarkers changing in response to therapy.

关键词： serum levels Tryptase Vascular endothelialgrowth factor Hepatocellular cancer Chemoembolization

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Advances in microsurgery for upper and lower extremity reconstruction and limb preservation

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Plastic and Aesthetic research 2019年第10期6卷 1-14页

作者： Alberto Bolletta Rubino Corrado Hung-Chi Chen Department of Plastic surgery China Medical University HospitalTaichung 404Taiwan Department of Medical Surgical and Experimental SciencesUHT of SassariPlastic Surgery UnitUniversity of SassariSassari 07100Italy

In the recent decades,microsurgical reconstruction has evolved from simple survival of the affected extremity to the improvement of functional and aesthetic *** review retraces the main contributions to the advances of microsurgery for reconstruction of upper and lower extremities and limb *** the upper extremity,it is important to restore fine motility,together with allowing prompt *** the lower limb,care must be taken in the reconstruction of weight-bearing areas and the aim must be proper ambulation and shoe *** perforator flaps can be considered for medium size *** provide thin coverage and can be performed in short operating *** use,though,is often limited by tissue *** flaps allow to overcome this problem and,thanks to the recent development in the study of perforator vessels,the microsurgeon can choose the flap with the most appropriate *** flaps can accomplish simultaneous reconstruction of different tissue components and large bone defects often require vascularized bone *** dealing with limb preservation it is very important to consider residual *** muscle transfer and targeted muscle re-innervation can be performed in these cases.A useful reconstructive tool in severely damaged limbs with limited blood supply is the use of cross-leg free *** conclusion,extremity reconstruction and limb preservation are reaching new heights thanks,not only to the work of plastic surgeons,but also to the new developments in other fields of study such as oncology,traumatology,radiology and medical engineering.

关键词： Extremity reconstruction functional and aesthetic outcome limb salvage perforator flaps free flaps weight-bearing areas cross-leg flaps

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Use of the impedance threshold device in cardiopulmonary resuscitation

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World Journal of Cardiology 2010年第2期2卷 19-26页

作者： Theano D Demestiha Ioannis n Pantazopoulos Theodoros T Xanthos Department of Anatomy University of AthensMedical School11527AthensGreece Department of experimental surgery and surgical research University of AthensMedical School11527AthensGreece Department of experimental surgery and surgical research University of AthensMedical School 11527AthensGreece

Although approximately one million sudden cardiac deaths occur yearly in the Us and Europe,cardiac arrest (CA)remains a clinical condition still characterized by a poor *** an effort to improve the cardio- pulmonary resuscitation(CPR)technique,the 2005 American Heart Association(AHA)Guidelines for CPR gave the impedance threshold device(ITD)a Class IIa *** AHA recommendation means that there is strong evidence to demonstrate that ITD enhances circulation,improves hemodynamics and increases the likelihood of resuscitation in patients in *** standard CPR,venous blood return to the heart relies on the natural elastic recoil of the chest which creates a transient decrease in intrathoracic *** ITD further decreases intrathoracic pressure by preventing respiratory gases from entering the lungs during the decompression phase of CPR. Thus,although ITD is placed into the respiratory circuit it works as a circulatory enhancer device that provides its therapeutic benefit with each chest decompression. The ease of use of this device,its ability to be incor- porated into a mask and other airway devices,the absence of device-related adverse effects and few requirements in additional training,suggest that ITD may be a favorable new device for improving CPR *** the literature is short of studies with clinically meaningful outcomes such as neurological outcome and long term survival,further evidence is still needed.

关键词： Cardiopulmonary resuscitation Coronary perfusion pressure Impedance threshold device Return of spontaneous circulation survival

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Healing of stoma After Magnetic Biliary-Enteric Anastomosis in Canine Peritonitis Models

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Chinese Medical sciences Journal 2014年第2期29卷 91-97页

作者： Jian-hui Li Long Guo Wei-jie Yao Zhi-yong Zhang shan-pei Wang shi-qi Liu Zhi-min Geng Xiao-ping song Yi Lv Department of surgical Oncology Shaanxi Provincial People’s Hospital (The Third Affiliated Hospital of the School of Medicine Xi’an Jiaotong University) research Institute of Advanced surgical Technology and Engineering Xi’an Jiaotong University Department of Hepatobiliary surgery The First Affiliated Hospital of Xi’an Jiaotong University

Objective To assese the healing of stoma after magnetic anastomosis for the reconstruction of biliary-enteric continuity under severe inflammation. Methods Acute bile duct injury was constructed as a bile peritonitis model in mongrel dogs(n=32). Magnetic anastomosis(group A, n=16) and traditional suture anastomosis(group B, n=16) were performed to reconstruct the biliary-enteric continuity in one stage. Half of the dogs in each group were euthanized on the 30 th postoperative day, and the other half on the 90 th postoperative day to harvest the stoma region. The healing conditions of the stoma after the 2 anastomotic approaches were observed with naked eyes, under light microscope and scanning electron microscope. Results The stoma leakage rate(50% versus 0% on the 30 th postoperative day, 37.5% versus 12.5% on the 90 th postoperative day, both Pnd stenosis degree(13.9%±0.3% versus 7.1%±0.3% on the 30 th postoperative day, 17.2%±0.4% versus 9.4%±0.4% on the 90 th postoperative day, both Psignificantly higher in group B than in group A. Compared with traditional manual anastomoses, the histological analysis under light and electron microscope showed a more continuous stoma with more regular epithelium proliferation and collagen arrangement, less inflammation in group A. Conclusions Magnetic anastomosis stent ensures better healing of the stoma even under the circumstance of severe inflammation.

关键词： magnetic anastomosis biliary-enteric anastomosis bile duct injury cholangiojejunostomy histological study stoma healing

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Does an extended mediastinal lymphadenectomy improve outcome after R0 resection in lung cancer?

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Chinese Journal of Cancer research 2014年第2期26卷 183-191页

作者： nan Wu shi Yan Chao Lv shaolei Li Yuan Feng Yuzhao Wang Jia Wang Qingfeng Zheng Yue Yang Key laboratory of Carcinogenesis and Translational research (Ministry of Education) Department of Thoracic Surgery II Peking University Cancer Hospital & Institute

Objective： This retrospective study was conducted to investigate the impact of more extended mediastinal lymphadenectomy on the outcome of lung cancer patients treated with R0 resection. Methods： During the investigation period, 325 lung cancer cases were enlisted and 278 cases entered the analysis. The patients were divided into Control group （n=116） and research group （n=162） according to the different extents of mediastinal lymph node clearance at different time periods. Three major parameters were retrospectively assessed to compare the quality of surgical care： extent of lymph node clearance, resection volume, and postoperative recovery process and common complications. Comparison of the outcome between two groups was carried out. Results： research group showed a significant quality improvement of lymphadenectomy, such as more mediastinal node stations investigated （more than 3 n2 stations investigated： research group, 90.7% vs. Control group, 55.2%; P=0.001） and more nodes collection （total nodes 26.1±10.0 vs. 19.1±8.3, P=0.000; n2 nodes 15.5±7.2 vs. 9.8±5.6, P=0.000）. However, overall survival （Os） and disease-free survival （DFs） were not significantly different either between two groups （5-year Os： Control group, 56.4±4.6% vs. research group, 62.6±4.3%; P=0.271） or between subgroups from stage I to IIIa. TnM stage and histology were significant factors associated with Os and DFs in multivariate analysis; extent of mediastinal lymphadenectomy was not associated with Os or DFs. Conclusions： More radical mediastinal lymphadenectomy may not lead to an improved oncological outcome for lung cancer treated with R0 resection.

关键词： Lung cancer lymphadenectomy outcome quality

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Gastric and duodenal polyps in familial adenomatous polyposis patients: Conventional endoscopy vs virtual chromoendoscopy(fujinon intelligent color enhancement) in dysplasia evaluation

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World Journal of Clinical Oncology 2017年第2期8卷 168-177页

作者： Gabriele Lami Andrea Galli Giuseppe Macrì Emanuele Dabizzi Maria Rosa Biagini Mirko Tarocchi Luca Messerini Rosa Valanzano stefano Milani simone Polvani Gastroenterology research Unit Department of Experimental and Clinical Biomedical Sciences "Mario Serio"University of Florence Clinical Gastroenterology Unit Careggi University Hospital Gastroenterology and Gastrointestinal Endoscopy San Raffaele Hospital Division of Pathological Anatomy Department of Experimental and Clinical MedicineUniversity of Florence surgical Unit Department of Translational Surgery and MedicineUniversity of Florence

AIM To test the fujinon intelligent color enhancement(FICE) in identifying dysplastic or adenomatous polyps in familial adenomatous polyposis(FAP) *** seventy-six consecutive FAP patients, already treated by colectomy and members of sixty-five families, were enrolled. A FICE system for the upper gastro-intestinal tract with an electronic endoscope system and a standard duodenoscope(for side-viewing examination) were used by two expert examiners. Endoscopic resection was performed with diathermic loop for polyps ≥ 6 mm and with forceps for polyps n-fixed biopsy specimens were analyzed by two expert gastrointestinal pathologists blinded to size, location and number of FAPassociated fundic gland *** sixty-nine(90.8%) patients had gastric polyps(34 only in the corpus-fundus, 7 only in the antrum and 28 in the whole stomach) and 52(68.4%) in duodenum(7 in the bulb, 35 in second/third duodenal portion, 10 both in the bulb and the second portion of duodenum). In the stomach fundus after FICE evaluation, 10 more polyps were removed from 10 patients for suspicious features of dysplasia or adenomas, but they were classified as cystic fundic gland after histology. In the antrum FICE identified more polyps than traditional endoscopy, showing a better tendency to identify adenomas and displastic areas. In the duodenum FICE added a significant advantage in identifying adenomas in the bulb and identified more polyps in the Ⅱ/Ⅲ *** FICE significantly increases adenoma detection rate in FAP patients but does not change any spigelman stage and thus does not modify patient's prognosis and treatment strategies.

关键词： Fujinon intelligent color enhancement Familial adenomatous polyposis spigelman Endoscopy Polyp Adenoma stomach Duodenum

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experimental assessment of regenerative properties of platelet rich plasma on the human skin-a review

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Plastic and Aesthetic research 2022年第1期9卷 387-393页

作者： Marco Mario Tresoldi Angela Faga Giovanni nicoletti Unit of Plastic and Reconstructive surgery Department of Clinical SurgicalDiagnostic and Pediatric SciencesUniversity of PaviaPavia 27100Italy Department of surgery Istituti Clinici Scientifici MaugeriPavia 27100Italy Department of Clinical surgical Diagnostic and Pediatric Sciences and Department of Public Health and Experimental and Forensic MedicineAdvanced Technologies for Regenerative Medicine and Inductive Surgery Research CenterUniversity of PaviaPavia 27100Italy Plastic surgery Unit Azienda Socio-Sanitaria Territoriale di PaviaPavia 27100Italy

several studies demonstrated the favorable effects of platelet rich plasma(PRP)on the skin and promoted its wide use in clinical *** growth factors stored in platelet alfa-granules allow for the tissue regeneration and the main fields of application of PRP in current clinical practice are the cartilage and musculoskeletal defects,osteoarthritis and other bone disorders,chronic and difficult to heal wounds,and aesthetic *** relevant number of different PRP preparation protocols may explain the inconsistency of the different clinical outcomes reported in the *** the technological advances in PRP preparation,the objective assessment of the clinical efficacy of PRP from the literature reports still is difficult due to the low homogeneity of the samples in terms of both inclusion criteria and ***,it might be useful to establish standardized and reproducible experimental models to confirm and objectively measure the effectiveness of the available clinical *** experimental investigations have been carried out to objectively assess the effectiveness of PRP and platelet gel on several *** far as the skin is concerned,the studies carried out to date are limited to fibroblasts in in-vitro culture models or to collagen,vascular supply,epithelium,and hair follicle in in-vivo *** skin,however,is a very complex organ,where different cell lines coexist and feature complex mutual interaction.A model that combines the advantages of both in-vitro and in-vivo cultures is the ex-vivo *** demonstration of the platelet derived growth factors effects through the ex-vivo human full-thickness skin culture model is a keystone to support the evidence of the PRP effectiveness,as it represents an objective,fast,reproducible,and ethical investigational method.

关键词： Platelet rich plasma PRP ex-vivo regeneration culture techniques skin

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Incidence and treatment of mediastinal leakage after esophagectomy:Insights from the multicenter study on mediastinal leaks

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World Journal of Gastroenterology 2019年第3期25卷 356-366页

作者： Uberto Fumagalli Gian Luca Baiocchi AnDrea Celotti Paolo Parise AnDrea Cossu Luigi Bonavina Daniele Bernardi Giovanni de Manzoni Jacopo Weindelmayer Giuseppe Verlato stefano santi Giovanni Pallabazzer nazario Portolani Maurizio Degiuli Rossella Reddavid stefano de Pascale Department of Digestive surgery IEO European Institute of Oncology IRCCS nazario Portolani Department of Clinical and Experimental StudiesSurgical Clinic University of Brescia General surgery 2 ASST Spedali Civili di Brescia Department of Gastrointestinal surgery San Raffaele HospitalVita-Salute San Raffaele University Department of surgery IRCCS Policlinico San DonatoUniversity of Milan General and Upper GI surgery Division University of Verona Department of Diagnostics and Public Health University of Verona Esophageal surgery Unit Tuscany Regional Referral Center for the Diagnosis and Treatment of Esophageal Disease Cisanello Hospital University of Turin Department of Oncology Surgical Oncology and Digestive Surgery San Luigi University Hospital

BACKGROUnD Mediastinal leakage(ML) is one of the most feared complications of esophagectomy. A standard strategy for its diagnosis and treatment has beendifficult to establish because of the great variability in their incidence and mortality rates reported in the existing *** To assess the incidence, predictive factors, treatment, and associated mortality rate of mediastinal leakage using the standardized definition of mediastinal leaks recently proposed by the Esophagectomy Complications Consensus Group(ECCG).METHODs seven Italian surgical centers(five high-volume, two low-volume) affiliated with the Italian society for the study of Esophageal Diseases designed and implemented a retrospective study including all esophagectomies(n = 501) with intrathoracic esophagogastric anastomosis performed from 2014 to *** MLs were defined according to the classification recently proposed by the *** Fifty-nine cases of ML were recorded, yielding an overall incidence of 11.8%(95%CI: 9.1%-14.9%). The surgical approach significantly influenced the occurrence of ML: the proportion of leakage was 10.5% and 9% after open and hybrid esophagectomy(HE), respectively, and doubled(20%) after totally minimally invasive esophagectomy(TMIE)(P = 0.016). no other predictive factors were found. The 30-and 90-d overall mortality rates were 1.4% and 3.2%,respectively; the 30-and 90-d leak-related mortality rates were 5.1% and 10.2%,respectively; the 90-d mortality rates for TMIE and HE were 5.9% and 1.8%,respectively. Endoscopy was the first-line treatment in 49% of ML cases, with the need for retreatment in 17.2% of cases. surgery was needed in 44.1% of ML *** treatment had the lowest mortality rate(6.9%). Removal of the gastric tube with stoma formation was necessary in 8(13.6%) *** The incidence of ML after esophagectomy was high mainly in the TMIE ***, the general and specific(leak-related) mortality rates were low. Early treatme

关键词： Transthoracic esophagectomy Minimally invasive esophagectomy Mediastinal leak Esophagectomy complications

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