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diabetic foot syndrome:Immune-inflammatory features as possible cardiovascular markers in diabetes

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World Journal of orthopedics 2015年第1期6卷 62-76页

作者： Antonino Tuttolomondo carlo Maida Antonio Pinto dipartimento Biomedico di medicina interna e Specialistica U.O.C di Medicina Interna e CardioangiologiaUniversità degli Studi di Palermo

diabetic foot ulcerations have been extensively reported as vascular complications of diabetes mellitus associated with a high degree of morbidity and mortality. diabetic foot syndrome(DFS), as defined by the World Health organization, is an "ulceration of the foot(distally from the ankle and including the ankle) associated with neuropathy and different grades of ischemia and infection". Pathogenic events able to cause diabetic foot ulcers are *** the commonest causes of this pathogenic pathway it's possible to consider peripheral neuropathy, foot deformity, abnormal foot pressures, abnormal joint mobility, trauma, peripheral artery disease. Several studies reported how diabetic patients show a higher mortality rate compared to patients without diabetes and in particular these studies under filled how cardiovascular mortality and morbidity is 2-4 times higher among patients affected by type 2 diabetes mellitus. This higher degree of cardiovascular morbidity has been explained as due to the observed higher prevalence of major cardiovascular risk factor, of asymptomatic findings of cardiovascular diseases, and of prevalence and incidence of cardiovascular and cerebrovascular events in diabetic patients with foot complications. In diabetes a fundamental pathogenic pathway of most of vascular complications has been reported as linked to a complex interplay of inflammatory, metabolic and procoagulant variables. These pathogenetic aspects have a direct interplay with an insulin resistance, subsequent obesity, diabetes, hypertension, prothrombotic state and blood lipid disorder. Involvement of inflammatory markers such as IL-6 plasma levels and resistin in diabetic subjects as reported by Tuttolomondo et al confirmed the pathogenetic issue of the a "adipo-vascular" axis that may contribute to cardiovascular risk in patients with type 2 diabetes. This "adipo-vascular axis" in patients with type 2 diabetes has been reported as characterized by lower plasma l

关键词： diabetic foot syndrome Inflammation cytokines cardiovascular risk Marker

Possible association between hepatitis c virus and malignancies different from hepatocellular carcinoma:A systematic review

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World Journal of Gastroenterology 2015年第45期21卷 12896-12953页

作者： Sirio Fiorino Letizia Bacchi-Reggiani Dario de Biase Adele Fornelli Michele Masetti Andrea Tura Fabio Grizzi Matteo Zanello Laura Mastrangelo Raffaele Lombardi Giorgia Acquaviva Luca di Tommaso Arrigo Bondi Michela Visani Sergio Sabbatani Laura Pontoriero carlo Fabbri Andrea cuppini Annalisa Pession elio Jovine unità operativa di medicina interna Ospedale di Budrio dipartimento di medicina Sperimentale Istituto di Cardiologia Policlinico S. Orsola-Malpighi Università degli Studi di Bologna dipartimento di medicina Sperimentale Università di Bologna Unità Operativa Biologia Molecolare Anatomia Patologica Ospedale Bellaria Servizio di Anatomia Patologica Ospedale Maggiore unità operativa di chirurgia A Ospedale Maggiore Institute of Neuroscience National Research Council Humanitas clinical and Research center Rozzano dipartimento di Farmacia e Biotecnologie Università di Bologna Istituto di Malattie Infettive Policlinico S. Orsola-Malpighi Università degli Studi di Bologna unità di cura Materno-Infantile Distretto Lametino u.o. endoscopia Ospedale Maggiore

AIM: To summarize the current knowledge about the potential relationship between hepatitis c virus(HcV) infection and the risk of several extra-liver cancers. MeTHoDS: We performed a systematic review of the literature, according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis(PRISMA) Statement. We extracted the pertinent articles, published in MeDLINe and the cochrane Library, using the following search terms: neoplasm/cancer/malignancy/tumor/carcinoma/adeno-carcinoma and non-Hodgkin lymphomas, kidney/renal-, cholangio-, pancreatic-, thyroid-, breast-,oral-, skin-, prostate-, lung-, colon-, stomach-, haematologic. case series, case-series with control-group, case-control, cohort-studies as well as meta-analyses, written in english were collected. Some of the main characteristics of retrieved trials, which were designed to investigate the prevalence of HcV infection in each type of the above-mentioned human malignancies were summarised. A main table was defined and included a short description in the text for each of these tumours, whether at least five studies about a specific neoplasm, meeting inclusion criteria, were available in literature. According to these criteria, we created the following sections and the corresponding tables and we indicated the number of included or excluded articles, as well as of meta-analyses and reviews:(1) HcV and haematopoietic malignancies;(2) HcV and cholangiocarcinoma;(3) HcV and pancreatic cancer;(4) HcV and breast cancer;(5) HcV and kidney cancer;(6) HcV and skin or oral cancer; and(7) HcV and thyroid cancer. ReSuLTS: According to available data, a clear correlation between regions of HcV prevalence and risk of extra-liver cancers has emerged only for a very small group of types and histological subtypes of malignancies. In particular, HcV infection has been associated with:(1) a higher incidence of some B-cell Non-HodgkinLymphoma types, in countries, where an elevated prevalence of this pathogen is de

关键词： Neoplasm cancer Hepatitis c virus Risk factors ext

Anti-tumor necrosis factor α therapy associates to type 17 helper T lymphocytes immunological shift and significant microbial changes in dextran sodium sulphate colitis

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World Journal of Gastroenterology 2019年第12期25卷 1465-1477页

作者： Valentina Petito cristina Graziani Loris R Lopetuso Marco Fossati Alessandra Battaglia Vincenzo Arena Domenico Scannone Gianluca Quaranta Andrea Quagliariello Federica Del chierico Lorenza Putignani Luca Masucci Maurizio Sanguinetti Alessandro Sgambato Antonio Gasbarrini Franco Scaldaferri Istituto di Patologia Speciale Medica Università Cattolica del Sacro Cuore uoc di medicina interna e Gastroenterologia Area di Gastroenterologia e Oncologia Medica Dipartimento di Scienze Gastroenterologiche Endocrino-Metaboliche e Nefro-Urologiche Fondazione Policlinico Universitario "A. Gemelli" IRCCS dipartimento delle Scienze della Salute della Donna e del Bambino Fondazione Policlinico Universitario "A. Gemelli" IRCCS Istituto di clinica ostetrica e Ginecologica Università Cattolica del Sacro Cuore u.o.S.A. Gineco-Patologia e Patologia Mammaria Fondazione Policlinico Universitario "A. Gemelli" IRCCS Istituto di Anatomia Patologica Università Cattolica del Sacro Cuore dipartimento di Anatomia Patologica e Istologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS dipartimento di Microbiologia Fondazione Policlinico Universitario "A. Gemelli" IRCCS Istituto di Microbiologia Università Cattolica del Sacro Cuore unità di Microbioma umano Ospedale Pediatrico Bambino Gesù IRCCS unità di Parassitologia Ospedale Pediatrico Bambino Gesù IRCCS Istituto di Patologia Generale Università Cattolica del Sacro Cuore

BAcKGRouND Anti-tumor necrosis factor α(TNFα) represents the best therapeutic option to induce mucosal healing and clinical remission in patients with moderate-severe ulcerative colitis. on the other side gut microbiota plays a crucial role in pathogenesis of ulcerative colitis but few information exists on how microbiota changes following anti-TNFα therapy and on microbiota role in mucosal *** To elucidate whether gut microbiota and immune system changes appear following anti TNFα therapy during dextran sulfate sodium(DSS) *** eighty c57 BL/6 mice were divided into four groups: "No DSS", "No DSS + antiTNFα", "DSS" and "DSS + anti-TNFα". "DSS" and "DSS + anti-TNFα" were treated for 5 d with 3% DSS. At day 3, mice whithin "No DSS+anti-TNFα" and"DSS+anti-TNFα" group received 5 mg/kg of an anti-TNFα agent. Forty mice were sacrificed at day 5, forty at day 12, after one week of recovery post DSS. The severity of colitis was assessed by a clinical score(disease Activity Index), colon length and histology. Bacteria such as Bacteroides, clostridiaceae, enterococcaceae and Fecalibacterium prausnitzii(F. prausnitzii) were evaluated by quantitative *** 1 helper T lymphocytes(Th1), type 17 helper T lymphocytes(Th17) and cD4+ regulatory T lymphocytes(Treg) distributions in the mesenteric lymph node(MLN) were studied by flow *** Bacteria associated with a healthy state(i.e., such as Bacteroides, clostridiaceae and F. prausnitzii) decreased during colitis and increased in course of anti-TNFαtreatment. conversely, microorganisms belonging to enterococcaceae genera,which are linked to inflammatory processes, showed an opposite ***, in colitic mice treated with anti-TNFα microbial changes were associated with an initial increase(day 5 of the colitis) in Treg cells and a consequent decrease(day 12 post DSS) in Th1 and Th17 frequency cells. Healthy mice treated with anti-TNFα showed the same histological, microbial and immune featur

关键词： Gut microbiota Dextran sodium sulphate colitis Immune system T cells Mesenchymal lymphnode Tumor necrosis factor α

Serum SccA-IgM as a predictor of hepatocellular carcinoma in patients with liver cirrhosis

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open Journal of Gastroenterology 2012年第2期2卷 56-61页

作者： Daniela Buccione Gianluca Fatti Andrea Gallotta elisabetta Loggi Roberto di Donato Lilia Testa carlo Saitta Valentina Santi Antonio di Micoli Virginia erroi Marta Frigerio Valentina Fazio Antonino Picciotto Alessandra Biasiolo Francoise Degos Patrizia Pontisso Giovanni Raimondo Franco Trevisani APHP Hopital Beaujon INSERM U 773 Clichy France dipartimento di medicina clinica e Sperimentale “G. Patrassi” Università di Padova Padova Italia dipartimento di medicina clinica Alma Mater Studiorum-Università di Bologna Bologna Italia dipartimento di medicina interna Policlinico Universitario di Messina Messina Italia dipartimento di medicina interna Università di Genova Genova Italia Xeptagen S.p.A. Venezia Italia

Aberrant Squamous cell carcinoma Antigen (SccA) expression is an early hepatocarcinogenetic event and circulating SccA-IgM complexes are elevated in most Hcc patients. We evaluated whether serum SccA-IgM levels can identify HcV +ve cirrhotic patients at low Hcc risk. In this retrospective study we enrolled 29 cirrhotic patients in whom serum SccA-IgM was measured 8 - 69 months (median 31) before Hcc diagnosis, and 28 cirrhotic patients who remained Hcc- free, with SccA-IgM measured 15 - 68 months (median 48) before the study end. The best discriminating value of SccA-IgM was calculated and tested in predicting Hcc diagnosis within 12, 24 and 36 months. Sensitivity analysis, considering different Hcc incidence, was conducted to identify the patient subgroup with an annual cancer risk below the threshold of a cost-effective semiannual surveillance with ultrasound. cumulative Hcc incidence at 12, 24 and 36 months was 7.0%, 15.7% and 26.3%, respectively. SccA-IgM levels were higher in Hcc than in cirrhotic patients [median: 381 (95% c.I.: 50 - 5289) vs. 100 (70 - 493) Au/mL, P = 0.005]. The SccA-IgM value ≤ 200 Au/mL accurately identified patients at low risk of Hcc development in the subsequent year (sensitivity 75%, specificity 62%, positive predictive value 13% and negative predictive value 97%). considering an annual Hcc incidence ≤ 3%, patients with SccA-IgM ≤ 200 Au/mL (60% of the whole patients) had an Hcc risk below the accepted threshold of a cost-effective surveillance (1.5%). In conclusion, provided that our provocative results are confirmed in larger studies, SccA-IgM serum measurement could permit implementation of a two step (with different costs) surveillance: an initial serological surveillance, based on the annual monitoring of this biomarker, and the conventional surveillance by semiannual uS when SccA-IgM becomes >200 Au/mL. This could improve the cost/effectiveness of surveillance of HcV infected patients at risk of Hcc.

关键词： SccA-IgM Hcc Risk Assessment Surveillance cost/effectiveness

Management of antiplatelet or anticoagulant therapy in endoscopy: A review of literature

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World Journal of Gastrointestinal endoscopy 2020年第6期12卷 172-192页

作者： Marcello Maida Sandro Sferrazza carlo Maida Gaetano cristian Morreale Alessandro Vitello Giovanni Longo Vincenzo Garofalo emanuele Sinagra Gastroenterology and endoscopy unit S.Elia-Raimondi HospitalCaltanissetta 93100Italy Gastroenterology and endoscopy unit Santa Chiara HospitalTrento 38123Italy u.o.c.di medicina interna con Stroke care Dipartimento di Promozione della SaluteMaterno-Infantiledi Medicina Interna e Specialistica di Eccellenza“G.D’Alessandro”University of PalermoPalermo 93100Italy cardiology unit S.Elia-Raimondi HospitalCaltanissetta 93100Italy Gastroenterology and endoscopy unit Istituto San Raffaele GiglioCefalu 90015Italy

endoscopic procedures hold a basal risk of bleeding that depends on the type of procedure and patients’***,they are often performed in patients taking antiplatelet and anticoagulants agents,increasing the potential risk of intraprocedural and delayed *** if the interruption of antithrombotic therapies is undoubtful effective in reducing the risk of bleeding,the thromboembolic risk that follows their suspension should not be ***,it is fundamental for each endoscopist to be aware of the bleeding risk for every procedure,in order to measure the risk-benefit ratio for each ***,knowledge of the proper management of antithrombotic agents before endoscopy,as well as the adequate timing for their resumption is *** review aims to analyze current evidence from literature assessing,for each procedure,the basal risk of bleeding and the risk of bleeding in patients taking antithrombotic therapy,as well as to review the recommendation of American society for gastrointestinal endoscopy,european society of gastrointestinal endoscopy,British society of gastroenterology,Asian pacific association of gastroenterology and Asian pacific society for digestive endoscopy guidelines for the management of antithrombotic agents in urgent and elective endoscopic procedures.

关键词： Antiplatelet Anticoagulant endoscopy Management Bleeding Risk