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Ultrasound unveiling:Decoding venous congestion in heart failure for precision management of fluid status

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World Journal of Cardiology 2024年第6期16卷 306-309页

作者： Davide Ramoni Federico Carbone Fabrizio Montecucco Department of Internal Medicine University of GenoaGenoa 16132Italy Department of Internal Medicine IRCCS Ospedale Policlinico San MartinoGenoa 16132Italy

This editorial discusses the manuscript by Di Maria et al,published in the recent issue of the World Journal of *** here focus on the still elusive pathophysiological mechanisms underlying cardio-renal syndrome(CRS),despite its high prevalence and the substantial worsening of both kidney function and heart *** the measure of right atrial pressure through right cardiac catheterization remains the most accurate albeit invasive and costly procedure,integrating bedside ultrasound into diagnostic protocols may substantially enhance the staging of venous congestion and guide therapeutic *** particular,with the assessment of Doppler patterns across multiple venous districts,the Venous Excess Ultrasound(VExUS)score improves the management of fluid overload and provides insight into the underlying factors contributing to cardio-renal *** specific echocardiographic parameters,particularly those concerning the right heart,may thus improve the VExUS score sensitivity,offering perspective into the nuanced comprehension of cardio-renal dynamics.A multidisciplinary approach that consistently incorporates the use of ultrasound is emerging as a promising advance in the understanding and management of CRS.

关键词： Cardio-renal syndrome Fluid overload Heart failure Ultrasound assessment Venous congestion Venous excess ultrasound score

Facing ethical concerns in the age of precise gene therapy:Outlook on inherited arrhythmias

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World Journal of Cardiology 2024年第2期16卷 64-66页

作者： Federico Carbone Fabrizio Montecucco Department of Internal Medicine University of GenoaGenoa 16132Italy IRCCS ospedale policlinico san martino Genoa Italian Cardiovascular NetworkGenoa 16132Italy

This editorial,comments on the article by Spartalis et al published in the recent issue of the World Journal of *** here provide an outlook on potential ethical concerns related to the future application of gene therapy in the field of inherited *** monogenic diseases with no or few therapeutic options available through standard care,inherited arrhythmias are ideal candidates to gene therapy in their *** with inherited arrhythmias typically have a poor quality of life,especially young people engaged in agonistic *** genome editing for treatment of inherited arrhythmias still has theoretical application,advances in CRISPR/Cas9 technology now allows the generation of knock-in animal models of the ***,clinical translation is somehow expected soon and this make consistent discussing about ethical concerns related to gene editing in inherited *** off-target activity is a known technical issue,but its relationship with ethnical and individual genetical diversity raises concerns about an equitable ***,the costeffectiveness may further limit an equal distribution of gene *** economic burden of gene therapies on healthcare systems is is increasingly recognized as a pressing concern.A growing body of studies are reporting uncertainty in payback periods with intuitive short-term effects for insurance-based healthcare systems,but potential concerns for universal healthcare systems in the long term as ***,those aspects strongly indicate a need of regulatory entities to manage those issues.

关键词： Ethics Inherited arrhythmias CRISPR/Cas9 Gene therapy Equitable accessibility

Effects of positive end-expiratory pressure on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in acute brain injury:Friend or foe?A scoping review

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Journal of Intensive Medicine 2024年第2期4卷 247-260页

作者： Greta Zunino Denise Battaglini Daniel Agustin Godoy IRCCS ospedale policlinico san martino GenovaItaly Dipartimento di Scienze Diagnostiche e Chirurgiche Integrate Universitàdegli Studi di GenovaGenovaItaly Neurointensive Care Unit Sanatorio PasteurCatamarcaArgentina

Background Patients with acute brain injury(ABI)are a peculiar population because ABI does not only affect the brain but also other organs such as the lungs,as theorized in brain–lung crosstalk *** patients often require mechanical ventilation(MV)to avoid the complications of impaired respiratory function that can follow ABI;MV should be settled with meticulousness owing to its effects on the intracranial compartment,especially regarding positive end-expiratory pressure(PEEP).This scoping review aimed to(1)describe the physiological basis and mechanisms related to the effects of PEEP in ABI;(2)examine how clinical research is conducted on this topic;(3)identify methods for setting PEEP in ABI;and(4)investigate the impact of the application of PEEP in ABI on the *** The five-stage paradigm devised by Peters et *** expanded by Arksey and O'Malley,Levac et al.,and the Joanna Briggs Institute was used for *** also adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses(PRISMA)extension *** criteria:we compiled all scientific data from peer-reviewed journals and studies that discussed the application of PEEP and its impact on intracranial pressure,cerebral perfusion pressure,and brain oxygenation in adult patients with *** criteria:studies that only examined a pediatric patient group(those under the age of 18),experiments conducted solely on animals;studies without intracranial pressure and/or cerebral perfusion pressure determinations,and studies with incomplete *** authors searched and screened for inclusion in papers published up to July 2023 using the PubMed-indexed online *** were presented in narrative and tubular *** The initial search yielded 330 references on the application of PEEP in ABI,of which 36 met our inclusion *** has recognized beneficial effects on gas exchange,but it produces hemodynamic changes that should be predicted to avoi

关键词： Acute brain injury Mechanical ventilation Positive end-expiratory pressure Intracranial pressure Brain-lung crosstalk Multimodal monitoring

Navigating the autophagic landscape:Epigenetic modulation in gastrointestinal cancer

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World Journal of Gastroenterology 2024年第31期30卷 3628-3634页

作者： Davide Ramoni Federico Carbone Fabrizio Montecucco Department of Internal Medicine University of GenoaGenoa 16132Italy Department of Internal Medicine University of Genoa and IRCSS Policlinico San MartinoGenoa 16132Italy

This editorial comments on the manuscript by Chang et al,focusing on the still elusive interplay between epigenetic regulation and autophagy in gastrointestinal diseases,particularly ***,essential for cellular homeostasis,exhibits diverse functions ranging from cell survival to death,and is particularly implicated in physiological gastrointestinal cell ***,its role in pathological backgrounds remains intricate and *** underscore the dual nature of autophagy in cancer,where its early suppressive effects in early stages are juxtaposed with its later promotion,contributing to *** discrepancy is attributed to the dysregulation of autophagy-related genes and their intricate involvement in cellular *** modifications and regulations of gene expression,including non-coding RNAs(ncRNAs),emerge as critical players in exerting regulatory control over autophagy flux,influencing treatment responses and tumor *** epigenetic mechanisms and improving strategies involving the inhibition or induction of autophagy through pharmacological or genetic means present potential avenues to sensitize tumor cells to ***,nanocarrier-based delivery of ncRNAs offers innovative therapeutic *** the intricate interaction between autophagy and ncRNA regula-tion opens avenues for the development of targeted therapies,thereby improving the prognosis of gastrointestinal malignancies with poor outcomes.

关键词： Epigenetic regulation Autophagy Gastrointestinal cancer Non-coding RNAs Target therapies

Is Takotsubo cardiomyopathy still looking for its own nosological identity?

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World Journal of Cardiology 2022年第10期14卷 557-560页

作者： Riccardo Scagliola Gian Marco Rosa Cardiovascular Disease Unit IRCCS Ospedale Policlinico San MartinoGenoa 16132Italy

Despite several efforts to provide a proper nosological framework for Takotsubo cardiomyopathy(TCM),this remains an unresolved matter in clinical *** clinical,pathophysiologic and histologic findings support the conceivable hypothesis that TCM could be defined as a unique pathologic entity,rather than a distinct subset of myocardial infarction with non-obstructive coronary *** investigations are needed in order to define TCM with the most appropriate disease taxonomy.

关键词： Takotsubo cardiomyopathy Myocardial infarction with non-obstructive coronary arteries Disease classification

Pharmacological methods for ovarian function and fertility preservation in women with cancer:A literature review

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Oncology Research 2024年第8期32卷 1309-1322页

作者： ANA S.CVETANOVIC MATTEO LAMBERTINI KEVIN PUNIE GORANA G.MATOVINA BRKO NIKOLA D.ZIVKOVIC MAJA J.POPOVIC MARIJANA M.MILOVIC KOVACEVIC LAZAR S.POPOVIC Department for Oncology Medical Faculty NisUniversity of NisNis18000Serbia Clinic of Oncology University Clinical Centre NisNis18000Serbia Department of Internal Medicine and Medical Sciences(DiMI) School of MedicineUniversity of GenovaGenova16100Italy Department of Medical Oncology U.O.C Clinica di Oncologia MedicaIRCCS Ospedale Policlinico San MartinoGenova16100Italy Department of General Medical Oncology and Multidisciplinary Breast Centre Leuven Cancer InstituteUniversity Hospitals LeuvenLeuven3001Belgium Department of Medical Oncology Oncology Institute of VojvodinaSremska Kamenica21208Serbia Department for Pathology Medical Faculty NisUniversity of NisNis18000Serbia Center for Pathology University Clinical Centre NisNis18000Serbia Faculty of Medicine University of Novi SadNovi Sad21000Serbia Department of Medical Oncology Institute of Oncology and Radiology SerbiaBelgrade11000Serbia

Oncofertility is an extremely signiﬁcant topic that is increasingly being discussed owing to increased evidence indicating that fertility preservation does not affect the treatment outcomes of patients with cancer but signiﬁcantly contributes to preserving life *** effect of chemotherapy can range from minimal effects to complete ovarian *** data are available on the effects of monoclonal antibodies and targeted therapies on the ovaries and *** ovarian suppression by administering a gonadotropin-releasing hormone agonist(GnRHa)during chemotherapy decreases the gonadotoxic effect of chemotherapy,thereby diminishing the chance of developing premature ovarian insufﬁciency(POI).At present,the concomitant administration of GnRH analogs during chemotherapy is the only accepted pharmacological method for preserving ovarian ***,most randomized studies on the effectiveness of luteinizing hormone-releasing hormone agonists during chemotherapy in preventing POI have been conducted in women with breast cancer,with a considerably small number of studies on patients with hematological ***,most randomized controlled trials on breast cancer have revealed a decrease in treatment-induced POI risk,regardless of the hormone receptor *** addition,studies on hematological malignancies have yielded negative results;nevertheless,theﬁndings must be interpreted with caution owing to numerous *** guidelines from the American Society of Clinical Oncology and ESMO Clinical Practice Guidelines recommend sperm,oocyte,and embryo cryopreservation as a standard practice and only offering GnRHa to patients when proven fertility preservation methods are not *** this manuscript,we present a comprehensive literature overview on the application of ovarian suppression with GnRHa during chemotherapy in patients with cancer by addressing preclinical and clinical data,as well as future perspectives in thisﬁeld

关键词： Gonadotropin-releasing hormone agonists(GnRHa) Fertility preservation Premature ovarian insufficiency(POI) Premenopausal patients

Challenges and advancing strategies of endoscopic submucosal dissection for early gastric cancer:The puzzle of eCura C1

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World Journal of Gastrointestinal Endoscopy 2024年第8期16卷 439-444页

作者： Giulio Calabrese Guido Manfredi Marcello F Maida Francesco V Mandarino Endrit Shahini Francesco Pugliese Paolo Cecinato Liboria Laterza Emanuele Sinagra sandro Sferrazza Department of Gastroenterology and Endoscopy ARNAS Civico–Di Cristina–BenfratelliPalermo 90127SiciliaItaly Department of Gastroenterology and Digestive Endoscopy Ospedale MaggioreCrema 26013Italy Department of Medicine and Surgery University of Enna"Kore"Enna 94100SiciliaItaly Department of Gastroenterology and Digestive Endoscopy IRCCS Ospedale San RaffaeleMilan 20132LombardyItaly Department of Gastroenterology National Institute of Gastroenterology-IRCCS“Saverio de Bellis”Castellana GrotteBari 70013Italy Department of Digestive and Interventional Endoscopy Niguarda HospitalASST NiguardaMilan 20162LombardyItaly Department of Medical and Surgical Sciences IRCCS Azienda Ospedaliero-Universitaria di BolognaPoliclinico Sant’OrsolaBologna 40138Emilia-RomagnaItaly Department of Gastroenterology and Endoscopy Fondazione Instituto San Raffaele GiglioCefalù90015PalermoItaly

In this editorial,we explore the challenges of managing noncurative resections in early gastric cancer after endoscopic submucosal dissection(ESD),starting from the consideration recently made by Zhu et ***,we evaluate the management of eCura C1 lesions,where decisions regarding further interventions are pivotal yet *** among endoscopists,surgeons,and pathologists is underscored to refine risk assessment and personalize therapeutic *** advancements in ESD techniques and interdisciplinary collaboration offer opportunities for outcome optimization in managing eCura C1 ***,despite needing further clinical validation,molecular biomarkers have emerged as promising tools for enhancing *** manuscript highlights the ongoing research attempts to define treatment paradigms effectively and evaluates the potential of emerging options,ultimately aiming to improve patient care and outcomes in this complex clinical scenario.

关键词： Early gastric cancer Endoscopic submucosal dissection eCura Non-curative resection Multidisciplinary approach

Multifaceted relationship between diabetes and kidney diseases:Beyond diabete

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World Journal of Diabetes 2023年第10期14卷 1450-1462页

作者： Pasquale Esposito Daniela Picciotto Francesca Cappadona Francesca Costigliolo Elisa Russo Lucia Macciò Francesca Viazzi Department of Internal Medicine and Medical Specialties(DiMI) University of GenoaGenoa 16132Italy Unit of Nephrology Dialysis and TransplantationIRCCS Ospedale Policlinico San MartinoGenoa 16132Italy

Diabetes mellitus is one of the most common causes of chronic kidney *** involvement in patients with diabetes has a wide spectrum of clinical presentations ranging from asymptomatic to overt proteinuria and kidney *** development of kidney disease in diabetes is associated with structural changes in multiple kidney compartments,such as the vascular system and *** alterations include thickening of the glomerular basement membrane,loss of podocytes,and segmental mesangiolysis,which may lead to microaneurysms and the development of pathognomonic Kimmelstiel-Wilson *** lesions directly related to diabetes,awareness of the possible coexistence of nondiabetic kidney disease in patients with diabetes is *** nondiabetic lesions include focal segmental glomerulosclerosis,IgA nephropathy,and other primary or secondary renal *** diagnosis of these conditions is crucial in guiding clinical management and therapeutic ***,the relationship between diabetes and the kidney is bidirectional;thus,new-onset diabetes may also occur as a complication of the treatment in patients with renal ***,we review the complex and multifaceted correlation between diabetes and kidney diseases and discuss clinical presentation and course,differential diagnosis,and therapeutic opportunities offered by novel drugs.

关键词： Diabetes Diabetic kidney disease Nondiabetic kidney disease Biomarkers Glomerular disease Kidney biopsy Sodium-glucose cotransporter-2 inhibitors

Albumin-bilirubin score in non-malignant liver diseases should be properly validated

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World Journal of Gastroenterology 2023年第46期29卷 6089-6091页

作者： Andrea Pasta Francesco Calabrese Maria Corina Plaz Torres Giorgia Bodini Manuele Furnari EdoardoVincenzo Savarino Vincenzo Savarino Edoardo Giovanni Giannini Elisa Marabotto Gastroenterology Unit Department of Internal MedicineUniversity of GenoaIRCCS‐Ospedale Policlinico San MartinoGenoa 16132Italy Department of Surgery Oncology and GastroenterologyUniversity Hospital of PaduaPadua 35128Italy

The albumin-bilirubin(ALBI)score to assess the risk of decompensation in patients with initially compensated cirrhosis may improve their prognostic *** letter critically evaluates the research,which utilizes the ALBI score to forecast decompensation in cirrhosis patients over a three-year *** score was initially developed to assess liver function in hepatocellular carcinoma,its prognostic utility for non-malignant liver diseases has now been explored,recognizing decompensation as a pivotal event that significantly affects patient’s *** concerns regarding the methodology of this research may be raised,particularly the exclusive use of radiological diagnosis,potentially including patients without definite cirrhosis and thus skewing the decompensation risk *** reported predominance of variceal bleeding as a decompensating event conflicts with established literature,that often reports ascites as the initial decompensation *** letter highlights the absence of details on esophageal varices and their management,which could introduce bias in evaluating the ALBI score's predictive ***,the letter points out the small sample size of patients with high-risk ALBI grades,potentially compromising the score's validity in this *** suggest prospective future research to investigate the dynamic changes in the ALBI score over time to reinforce the validity of the ALBI score as a predictor of decompensation in non-malignant liver disease.

关键词： Albumin-bilirubin score Decompensated cirrhosis Liver disease Nonmalignant liver disease Portal hypertension