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Gastric cancer: Current status of lymph node dissection

World Journal of Gastroenterology 2016年第10期22卷 2875-2893页

作者： Maurizio Degiuli Giovanni De Manzoni Alberto Di Leo Domenico D'Ugo Erica Galasso Daniele Marrelli Roberto Petrioli Karol Polom Franco Roviello Francesco Santullo Mario Morino Department of Surgery University of TurinCitta della Salute e della Scienza Department of Surgery University of VeronaOspedale Borgo Trento Division of Surgery Ospedale di Arco Department of Surgery University "Cattolica del Sacro Cuore""A.Gemelli" University Hospital Department of Surgery University of Siena Department of Oncology University of Siena Department of Surgery Wielkopolskie Centrum Onkologii

D2 procedure has been accepted in Far East as the standard treatment for both early(EGC) and advanced gastric cancer(AGC) for many decades. Recently EGC has been successfully treated with endoscopy by endoscopic mucosal resection or endoscopic submucosal dissection, when restricted or extended Gotoda's criteria can be applied and D1+ surgery is offered only to patients not fitted for less invasive treatment. Furthermore, two randomised controlled trials(RCTs) have been demonstrating the non inferiority of minimally invasive technique as compared to standard open surgery for the treatment of early cases and recently the feasibility of adequate D1+ dissection has been demonstrated also for the robot assisted technique. In case of AGC the debate on the extent of nodal dissection has been open for many decades. While D2 gastrectomy was performed as the standard procedure in eastern countries, mostly based on observational and retrospective studies, in the west the Medical Research Council(MRC), Dutch and Italian RCTs have been conducted to show a survival benefit of D2 over D1 with evidence based medicine. Unfortunately both the MRC and the Dutch trials failed to show a survival benefit after the D2 procedure, mostly due to the significant increase of postoperative morbidity and mortality, which was referred to splenopancreatectomy. Only 15 years after the conclusion of its accrual, the Dutch trial could report a significant decrease of recur-rence after D2 procedure. Recently the long term survival analysis of the Italian RCT could demonstrate a benefit for patients with positive nodes treated with D2 gastrectomy without splenopancreatectomy. As nowadays also in western countries D2 procedure can be done safely with pancreas preserving technique and without preventive splenectomy, it has been suggested in several national guidelines as the recommended procedure for patients with AGC.

关键词： Gastric cancer Lymph node dissection Lymphadenectomy D2 gastrectomy D1 gastrectomy D1 plus gastrectomy Robot assisted lymphadenectomy Laparoscopic lymphadenectomy

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Sampling strategies for estimating forest cover from remote sensing-based two-stage inventories

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Forest Ecosystems 2015年第3期2卷 208-219页

作者： Piermaria Corona Lorenzo Fattorini Maria Chiara Pagliarella Consiglio per la ricerca in agricoltura e l’analisi dell’economia agraria-Forestry Research Centre University of siena-Department of Economic and Statistics University of Molise-Department of Biosciences and Territory

Background: Remote sensing-based inventories are essential in estimating forest cover in tropical and subtropical countries, where ground inventories cannot be performed periodically at a large scale owing to high costs and forest inaccessibility(e.g. REDD projects) and are mandatory for constructing historical records that can be used as forest cover baselines. Given the conditions of such inventories, the survey area is partitioned into a grid of imagery segments of pre-fixed size where the proportion of forest cover can be measured within segments using a combination of unsupervised(automated or semi-automated) classification of satellite imagery and manual(i.e. visual on-screen)enhancements. Because visual on-screen operations are time expensive procedures, manual classification can be performed only for a sample of imagery segments selected at a first stage, while forest cover within each selected segment is estimated at a second stage from a sample of pixels selected within the segment. Because forest cover data arising from unsupervised satellite imagery classification may be freely available(e.g. Landsat imagery)over the entire survey area(wall-to-wall data) and are likely to be good proxies of manually classified cover data(sample data), they can be adopted as suitable auxiliary ***: The question is how to choose the sample areas where manual classification is carried out. We have investigated the efficiency of one-per-stratum stratified sampling for selecting segments and pixels, where to carry out manual classification and to determine the efficiency of the difference estimator for exploiting auxiliary information at the estimation level. The performance of this strategy is compared with simple random sampling without ***: Our results were obtained theoretically from three artificial populations constructed from the Landsat classification(forest/non forest) available at pixel level for a study area located in central Italy,

关键词： Spatially balanced sampling Auxiliary information

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Selective uptake of major and trace elements in Erica andevalensis,an endemic species to extreme habitats in the Iberian Pyrite Belt

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Journal of Environmental Sciences 2011年第3期23卷 444-452页

作者： Fabrizio Monaci Eduardo O.Leidi Maria Dolores Mingorance Benito Valdés Sabina Rossini Oliva Roberto Bargagli Department of Environmental Sciences"G.Sarfatti" University of Siena Via P.A.Mattioli4Siena 53100Italy Department of Plant Biotechnology IRNAS-CSICAvda.Reina Mercedes10Sevilla 41012Spain Andalusian Institute of Earth Science CSIC-UGRProf.Albareda1Granada 18008Spain Deparment of Plant Biology and Ecology University of SevilleAvda.Reina Mercedes s/nApartado de Correo 1095Sevilla 41080Spain

To assess the ecophysiological traits and the phytoremediation potential of the endemic heather Erica andevalensis, we determined the concentrations of major and trace elements in different plant parts and in rizosphere soils from Riotinto mining district （Huelva, Spain）. The results showed that E. andevalensis may grow on substrates with very high As, Cu, Fe and Pb concentrations （up to 4114, 1050, 71900 and 15614μg/g dry weight, respectively）, very low availability of macro- and micronutrients and with pH values ranging from 3.3 to 4.9. In these harsh edaphic conditions E. andevalensis selectively absorbed and translocated essential nutrients and excludes potentially phytotoxic elements, which were accumulated in the root epidermis. The concentrations of major and trace elements in E. andevalensis aerial parts from the Riotinto mining district were in the normal range for plants; likewise other Erica species it accumulated Mn and only in a very polluted site we measured leaf concentrations of As and Pb within the excessive or toxic limits for plants. Differently from previous studies, which emphasized the soil pH and bioavailability of phytotoxic elements as the main stress factors, this study showed that in the Riotinto region, E. andevalensis can tolerate wide range of pH and toxic element concentrations; the harshest environments colonized by monospecific patches of this species were characterized above all by very low availability of nutrients. The extraordinary capability to adapt to these extreme habitats made E. andevalensis a priority species to promote the phytostabilization and the development of a self-sustaining vegetative cover on Riotinto mine tailings.

关键词： mine tailing Riotinto tolerant plants Erica andevalensis rhizosphere soils

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Active Tectonics in Tuscany (Central Italy): Ten Years of Seismicity (2009-2019)

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International Journal of Geosciences 2020年第10期11卷 613-650页

作者： Marcello Viti Dipartimento di Scienze Fisiche della Terra e dell’Ambiente Università degli Studi di Siena Siena Italy

Strong earthquakes (moment magnitude MW ≥ 5.5) are uncommon in Tuscany and surroundings (central Italy). The last strong seismic event occurred a century ago (September 7, 1920 Garfagnana, MW = 6.53). The paucity of seismic instrumental recordings hinders the identification of the tectonic regime active in Tuscany. On the other hand, the geological and geomorphological pieces of evidence collected so far, concerning potential active and capable faults, are scarce, fragmentary and ambiguous. In this work I shed light on the active deformation of Tuscany by using two independent approaches: earthquake source mechanisms and GNSS (GPS) geodetic measurements. I have considered 41 small seismic events (MW ≤ 5.1) that occurred in the study area during the last decade. The related source mechanisms (retrieved by the Time Domain Moment Tensor method) define a relatively clear picture of the active deformation: extension along the northern Apennine watershed and strike-slip regime within inner Tuscany, up to the Tyrrhenian coast. This pattern broadly agrees with the horizontal strain field reconstructed by the geodetic velocity field. The latter has been constrained by a network of 840 GPS stations located in Italy and neighboring countries, operating in the last 20 years.

关键词： Seismotectonics Earthquake Source Active Faulting Satellite Geodesy Northern Apennines Italian Region

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Asymptotic optimality for consensus-type stochastic approximation algorithms using iterate averaging

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控制理论与应用（英文版） 2013年第1期11卷 1-9页

作者： Gang YIN Le Yi WANG Yu SUN David CASBEER Raymond HOLSAPPLE Derek KINGSTON Department of Mathematics Wayne State University Department of Electrical and Computer Engineering Wayne State University Quantitative Business Analysis Department Siena College Control Science Center of Excellence Air Force Research Laboratory

This paper introduces a post-iteration averaging algorithm to achieve asymptotic optimality in convergence rates of stochastic approximation algorithms for consensus control with structural constraints. The algorithm involves two stages. The first stage is a coarse approximation obtained using a sequence of large stepsizes. Then, the second stage provides a refinement by averaging the iterates from the first stage. We show that the new algorithm is asymptotically efficient and gives the optimal convergence rates in the sense of the best scaling factor and ＇smallest＇ possible asymptotic variance.

关键词： Stochastic approximation algorithm Consensus Iterate averaging Asymptotic optimality

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Quantification of Global Protein Disulfides and Thiol-Protein Mixed Disulfides to Study the Protein Dethiolation Mechanisms

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American Journal of Analytical Chemistry 2013年第10期4卷 9-19页

作者： Lucia Coppo Raffaella Priora Sonia Salzano Pietro Ghezzi Paolo Di Simplicio Brighton and Sussex Medical School Trafford Centre Falmer Brighton UK Department of Neuroscience Pharmacology Unit University of Siena Siena Italy

The redox state of cellular thiols is widely studied because it was recently linked to many different diseases and pathologies. In this work we quantified the concentrations of protein disulfides (PSSP) and thiol-protein mixed disulfides (XSSP) in rat tissues (liver, kidney and heart) and cells (Raw 264.7) by an improved method of XSSP and PSSP determination after oxidative stress induced by diamide. Under native and denaturing conditions, a thiol block by N-ethymaleimide was introduced to avoid thiol exchange reaction activations by protein SH groups (PSH) (PSH + XSSP ←→ PSSP + XSH) and alterations of original XSSP/PSSP levels. Low molecular weight thiols (XSH) and PSH were respectively measured by HPLC on supernatants and on corresponding pellets by DTNB (Ellman’s reagent) after dithiothreitol reduction. PSSP concentrations of liver, heart and kidney were respectively 0.304, 0.605 and 0.785 μmoles/g and after diamide exposure they were significantly augmented of about 65%-70% in liver and heart, but not in the kidney. Normal XSSP, that were -20 times lower than normal PSSP were induced by diamide in liver and heart of about 40 times, but not in kidney. Thermodynamic criteria regarding the pKa values of thiols engaged as PSSP and GSSP were used to interpret dethiolation mechanisms via thiol exchange reactions.

关键词： Protein Disulfides S-Glutathionylation Thiol pKa Diamide Oxidative Stress

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Proximal-distal motor unit number estimationdynamic changes in patients with amyotrophic lateral sclerosis A one-year follow-up

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Neural Regeneration Research 2010年第8期5卷 597-601页

作者： Sartucci Ferdinando Moscato Gianluca Rossi Chiara Caleo Matteo Bocci Tommaso Murri Luigi Giannini Fabio Rossi Alessandro Department of Neuroscience Unit of NeurologyPisa University Medical School Institute of Neuroscience Unit of Neurophysiopathology Pontedera Hospital Pisa Department of Neurological Neurosurgical and Behavioural Sciences Siena University Medical School

BACKGROUND：Amyotrophic lateral sclerosis （ALS） is the most common of all the motor neuron diseases and the absence of a biologic marker has made both diagnosis and tracking evolution of the disease difficult, Electrodiagnostic tests play a fundamental role in quantifying pathological changes in the motor unit ***：We assessed distal-proximal Motor Unit （MU） loss and changes using the method of motor unit number estimation （MUNE）.DESIGN, TIME AND SETTING：A case-control study was performed at the Department of Neuroscience, Pisa University Medical School, Italy from December 1999 to November 2009. PARTICIPANTS：A total of 50 ALS patients were recruited, 30 males：mean age （59.6 ± 13.3） years; 20 females：mean age （63.9 ± 11.7） years; range （30-82） years; all patients had probable or definite ALS. Thirty healthy volunteers were recruited from department staffs, including 20 males and 10 females; mean age （57.7 ± 13.8） years served as ***：MUNE was performed for both the biceps brachii and abductor digiti minimi muscles of the same side. The technique used relayed substantially on manual incremental stimulation of the motor nerve, known as the McComas technique （50 ms sweep duration, a gain of 2 mV/Div for M wave, 0.5 mV/Div for each step; filters 10-20 kHz）.MAIN OUTCOME MEASURES：MUNE results were ***：Functioning MU numbers, measured by MUNE, decreased in the biceps brachii and abductor digiti minimi muscles over the entire one-year follow-up period （one assessment every three months） compared with baseline determination, the rate of MU decrease was similar in both muscles, but steeper ***：MUNE is a feasible method for ALS patients both proximally and distally to track changes over time in muscle MUs during the disease＇s evolution.

关键词： motor unit number estimation amyotrophic lateral sclerosis motor neuron disease time changes denervation reinnervation

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Fetal programming and early identification of newborns at high risk of free radical-mediated diseases

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World Journal of Clinical Pediatrics 2016年第2期5卷 172-181页

作者： Serafina Perrone Antonino Santacroce Anna Picardi Giuseppe Buonocore Department of Molecular and Deve-lopmental Medicine University of Siena

Nowadays metabolic syndrome represents a real outbreak affecting society. Paradoxically, pediatricians must feel involved in fighting this condition because of the latest evidences of developmental origins of adult diseases. Fetal programming occurs when the normal fetal development is disrupted by an abnormal insult applied to a critical point in intrauterine life. Placenta assumes a pivotal role in programming the fetal experience in utero due to the adaptive changes in structure and function. Pregnancy complications such as diabetes, intrauterine growth restriction, preeclampsia, and hypoxia are associated with placental dysfunction and programming. Many experimental studies have been conducted to explain the phenotypic consequences of fetal-placental perturbations that predispose to the genesis of metabolic syndrome, obesity, diabetes, hyperinsulinemia, hypertension, and cardiovascular disease in adulthood. In recent years, elucidating the mechanisms involved in such kind of process has become the challenge of scientific research. Oxidative stress may be the general underlying mechanism that links altered placental function to fetal programming. Maternal diabetes, prenatal hypoxic/ischaemic events, inflammatory/infective insults are specific triggers for an acute increase in free radicals generation. Early identification of fetuses and newborns at high risk of oxidative damage may be crucial to decrease infant and adult morbidity.

关键词： Fetal programming Oxidative stress High-risk newborn Biomarkers Perinatal medicine Metabolic syndrome

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Understanding fatigue in primary biliary cholangitis:From pathophysiology to treatment perspectives

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World Journal of Hepatology 2022年第6期14卷 1111-1119页

作者： Erica Nicola Lynch Claudia Campani Tommaso Innocenti Gabriele Dragoni Maria Rosa Biagini Paolo Forte Andrea Galli Gastroenterology Research Unit Department of Experimental and Clinical Biomedical Sciences“Mario Serio”University of FlorenceFlorence 50134Italy Department of Experimental and Clinical Medicine University of FlorenceFlorence 50134Italy Department of Medical Biotechnologies University of SienaSiena 53100Italy Division of Gastroenterology University Hospital“Careggi”Florence 50134Italy

Fatigue is considered one of the most frequent and debilitating symptoms in primary biliary cholangitis(PBC),affecting over 50%of PBC *** in five patients with PBC suffer from severe fatigue,which significantly impairs quality of *** is made up of a central and a peripheral component,whose pathophysiology is still greatly *** fatigue is characterised by a lack of self-motivation and can manifest both in physical and mental activities(lack of intention).Peripheral fatigue includes neuromuscular dysfunction and muscle weakness(lack of ability).Peripheral fatigue could be explained by an excessive deviation from aerobic to anaerobic metabolism leading to excessive lactic acid accumulation and therefore accelerated decline in muscle function and prolonged recovery *** opposed to itching,and with the exception of endstage liver disease,fatigue is not related to disease *** objective of this review is to outline current understanding regarding the pathophysiology of fatigue,the role of comorbidities and contributing factors,the main tools for fatigue assessment,the failed therapeutic options,and future treatment perspectives for this disabling *** fatigue is an extremely common and debilitating symptom and there is still no licensed therapy for fatigue in PBC patients,further research is warranted to understand its causative mechanisms and to find an effective treatment.

关键词： Fatigue Primary biliary cholangitis Treatment Pathophysiology Central fatigue Peripheral fatigue

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The undisclosed role of anoxia/hypoxia and disturbed sleep on glucose metabolism

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Journal of Diabetes Mellitus 2012年第2期2卷 186-190页

作者： Patrizio Tatti Desiderio Passali Luisa Passali Diabetes and Endocrinology Unit Azienda Sanitaria Locale Roma “H” Roma Italy ENT Department University of Siena Siena Italy

Up to recently the respiratory disturbances were considered a risk factor for hypertension, but there was no trace of a role in metabolic disorders. Only recently the existence of a connection among the respiratory disturbance caused by the obstruction of the upper airways and a wide array of metabolic disturbances has been demonstrated. The respective roles of anoxia/ hypoxia and the attendant disturbed sleep remain, however, to be clarified.

关键词： Diabetes Mellitus OSAS Sleep Disturbance

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