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| 1 | Systemic inflammation and immune response after laparotomy vs laparoscopy in patients with acute cholecystitis, complicated by peritonitis显示文摘AIM: To evaluate acute cholecystitis, complicated by peritonitis, acute phase response and immunological status in patients treated by laparoscopic or open approach. METHODS: From January 2002 to May 2012, we conducted a prospective randomized study on 45 consecutive patients (27 women, 18 men; mean age 58 years). These subjects were taken from a total of 681 patients who were hospitalised presenting similar preoperative findings: acute upper abdominal pain with tenderness, involuntary guarding under the right hypochondrium and/or in the flank; fever higher than 38 ℃, leukocytosis greater than 10 × 10 9 /L or both, and ultrasonographic evidence of calculous cholecystitis possibly complicated by peritonitis. These patients had undergone cholecystectomy for acute calculous cholecystitis,complicated by bile peritonitis. Randomly, 23 patients were assigned to laparoscopic cholecystectomy (LC), and 22 patients to open cholecystectomy (OC). Blood samples were collected from all patients before operation and at days 1, 3 and 6 after surgery. Serum bacteraemia, endotoxaemia, white blood cells (WBCs), WBC subpopulations, human leukocyte antigen-DR (HLA-DR), neutrophil elastase, interleukin-1 (IL-1) and IL-6, and C-reactive protein (CRP) were measured at 0, 30, 60, 90, 120 and 180 min, at 4, 6, 12, 24 h, and then daily (8 A.M.) until post-operative day 6.RESULTS: The two groups were comparable in the severity of peritoneal contamination as indicated by the viable bacterial count (open group = 90% of positive cultures vs laparoscopic group = 87%) and endotoxin level (open group = 33.21 ± 6.32 pg/mL vs laparoscopic group = 35.02 ± 7.23 pg/mL). Four subjects in the OC group (18.1%) and 1 subject (4.3%) in the LC group (P < 0.05) developed intra-abdominal abscess. Severe leukocytosis (range 15.8-19.6/mL) was observed only after OC but not after LC, mostly due to an increase in neutrophils (days 1 and 3, P < 0.05). This value returned to the normal range within 3-4 d after LC and 5-7 d after OC. Other WBC types and lymphocyte subpopulations showed no significant variation. On the first day after surgery, a statistically significant difference was observed in HLA-DR expression between LC (13.0 ± 5.2) and OC (6.0 ± 4.2) (P < 0.05). A statistically significant change in plasma elastase concentration was recorded post-operatively at days 1, 3, and 6 in patients from the OC group when compared to the LC group (P < 0.05). In the OC group, the serum levels of IL-1 and IL-6 began to increase considerably from the first to the sixth hour after surgery. In the LC group, the increase of serum IL-1 and IL-6 levels was delayed and the peak values were notably lower than those in the OC group. Significant differences between the groups, for these two cytokines, were observed from the second to the twenty-fourth hour (P < 0.05) after surgery. The mean values of serum CRP in the LC group on post-operative days (1 and 3) were also lower than those in the OC group (P < 0.05). Systemic concentration of endotoxin was higher in the OC group at all intra-operative sampling times, but reached significance only when the gallbladder was removed (OC group = 36.81 ± 6.4 ρg/mLvs LC group = 16.74 ± 4.1 ρg/mL, P < 0.05). One hour after surgery, microbiological analysis of blood cultures detected 7 different bacterial species after laparotomy, and 4 species after laparoscopy (P < 0.05). CONCLUSION: OC increased the incidence of bacteraemia, endotoxaemia and systemic inflammation compared with LC and caused lower transient immunological defense, leading to enhanced sepsis in the patients examined. | Federico Sista Mario Schietroma Giuseppe De Santis Antonella Mattei Emanuela Marina Cecilia Federica Piccione Sergio Leardi Francesco Carlei Gianfranco Amicucci | 2013 | World Journal of Gastrointestinal Surgery2013，5，4： | 23 |
| 2 | 第三十二指肠的部分的腺癌: 案例报告和文学的评论显示文摘We focus on the diagnostic and therapeutic problemsof duodenal adenocarcinoma,reporting a case and reviewing the literature.A 65-year old man with adenocarcinoma in the third duodenal portion was successfully treated with a segmental resection of the third part of the duodenum,avoiding a duodeno-cephalo-pancreatectomy.This tumor is very rare and frequently affects the Ⅲ and Ⅳduodenal portion.A precocious diagnosis and the exact localization of this neoplasia are crucial factors in order to decide the surgical strategy.Given a non-specificity of symptoms,endoscopy with biopsy is the diagnostic gold standard.Duodeno-ceph-alo-pancreatectomy(DCP) and segmental resection of the duodenum(SRD) are the two surgical options,with overlapping morbidity(27% vs 18%) and post operative mortality(3% vs 1%).The average incidence of postoperative long-term survival is 100%,73.3% and31.6% of cases after 1,3 and 5 years from surgery,respectively.Long-term survival is made worse by two factors:the presence of metastatic lymph nodes and tumor localization in the proximal duodenum.The two surgical options are radical:DCP should be used only for proximal localizations while SRD should be chosen for distal | Federico Sista Giuseppe De Santis Antonio Giuliani Emanuela Marina Cecilia Federica Piccione Laura Lancione Sergio Leardi Gianfranco Amicucci | 2012 | World Journal of Gastrointestinal Surgery2012，4，1： | 2 |
| 3 | Genetic algorithms as a strategy for feature seleetion显示文摘 | Leardi R Boggia R Terrile M | 1992 | JournalofChemometrics1992，6，5： | 1 |
| 4 | Polycyclic aromatic hydrocarbons assessment in the sediments of the Porto Torres Harbor (Northern Sardinia, Italy)显示文摘 | Giuseppe De Luca Antonio Furesi Riccardo Leardi Giovanni Micera Angelo Panzanelli Paola Costantina Piu Gavino Sanna | 2004 | Marine Chemistry2004，，1： | 1 |
| 5 | Genetic algorithms applied to feature selection in PLS regression:how and when to use them显示文摘 | Leardi R Lupiancz Gonzalez A | 1998 | Chemometrics and intelligent laboratory systems1998，41，2： | 1 |
| 6 | Sequential Application of Backward Interval PLS and Genetic Algorithms for the Selection of Relevant Spectral Regions显示文摘 | Leardi R Norgaard L | | 0，，11： | 1 |
| 7 | Genetic algorithms as a tool for wavelength selection in multivariate calibration显示文摘 | Delphine Jouan-Rimbaud Riccardo Leardi | 1995 | Analytical Chemistry1995，67，23： | 1 |
| 8 | Diagnosis and treatment of haemorrhoids in the elderly: results from 291 patients显示文摘 | L. Navarra R. Pietroletti G. Maggi S. Leardi M. Simi | 1999 | Techniques in Coloproctology1999，，3： | 1 |
| 9 | Randomized clinical trial examining the effect of music on therapy in stress response to day surgery显示文摘 | Leardi S Pietroletti R Angeloni G | 2007 | Br J Surg2007，94，8： | 1 |
| 10 | Multivariate calibration of mango firmness using vis/NIR speetroscopy and acoustic impulse method显示文摘 | Mare Valente Riceardo Leardi | 2009 | Journal of Food Engineering2009，，4： | 1 |
| 11 | Determination and speciation of trace and uhratrace selenium ions by energy-dispersive X-ray fluorescence spectrometry using graphene as solid adsorbent in dispersive micro-solid phase extraction显示文摘 | Kocot K Leardi R Walczak B | 2015 | Talanta2015，134，： | 1 |
| 12 | Variable selection for multivariate calibration using a genetic algorithm : prediction of additive concentrations in polymer films from Fourier transform-infrared spectral data显示文摘 | Leardi R Seasholtz M B PeU R J | 2002 | Analytica Chimiea Aeta2002，，2： | 1 |
| 13 | Multivariate calibration of mango firmness using vis/NIR spectroscopy and acoustic impulse method显示文摘 | Marc Valente Riccardo Leardi Guy Self | 2009 | Journal of Food Engineering2009，94，1： | 1 |
| 14 | Polycyclic aromatic hydrocarbons assessment in the sediments of the Porto Torres Harbor (Northern Sardinia,Italy)显示文摘 | Luca G D Furesi A Leardi R | | 0，，1： | 1 |
| 15 | Randomized clinical trial examining the effect of music therapy in stress response to day surgery显示文摘 | Pietroletti R Angeloni G | 2007 | Br J Surg2007，94，8： | 1 |
| 16 | Genetic algorithms applied to feature selection in PLS regression:how and when to use them显示文摘 | R Leardi A Lupiáez González | 1998 | Chemometrics and Intelligent Laboratory Systems1998，41，2： | 1 |
| 17 | Randomized clinical trial exam-ining the effect of music therapy in stress response to day surgery显示文摘 | Leardi S Pietroletti R Angeloni G | 2007 | BrJ Surg2007，94，8： | 1 |
| 18 | Three-way principal component analysis applied to noodles sensor3 data analysis显示文摘 | Cordella C B Y Leardi R Rutledge D N | | 0，，01： | 1 |
| 19 | Application of genetic algorithm-PLS for feature selection in spectral data sets显示文摘 | R Leardi | 2000 | J Chemometrics and Intelligent Laboratory Systems2000，14，5： | 1 |
| 20 | Sequartid application of backuard interval partial least squares and genetic algorithms for the selection of relection of relevant spectral legions 显示文摘 | Leardi R Norgaard L | 2004 | Journal of Chemometrics2004，28，11： | 1 |
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