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| 1 | Coagulopathy and transfusion therapy in pediatric livertransplantation显示文摘Bleeding and coagulopathy are critical issues complicating pediatric liver transplantation and contributing to morbidity and mortality in the cirrhotic child. The complexity of coagulopathy in the pediatric patient is illustrated by the interaction between three basic models. The first model, 'developmental hemostasis', demonstrates how a different balance between pro- and anticoagulation factors leads to a normal hemostatic capacity in the pediatric patient at various ages. The second, the 'cell based model of coagulation', takes into account the interaction between plasma proteins and cells. In the last, the concept of 'rebalanced coagulation' highlights how the reduction of both pro- and anticoagulation factors leads to a normal, although unstable, coagulation profile. This new concept has led to the development of novel techniques used to analyze the coagulation capacity of whole blood for all patients. For example, viscoelastic methodologies are increasingly used on adult patients to test hemostatic capacity and to guide transfusion protocols. However, results are often confounding or have limited impact on morbidity and mortality. Moreover, data from pediatric patients remain inadequate. In addition, several interventions have been proposed to limit blood loss during transplantation, including the use of antifibrinolytic drugs and surgical techniques, such as the piggyback and lowering the central venous pressure during the hepatic dissection phase. The rationale for the use of these interventions is quite solid and has led to their incorporation into clinical practice; yet few of them have been rigorously tested in adults, let alone in children. Finally, the postoperative period in pediatric cohorts of patients has been characterized by an enhanced risk of hepatic vessel thrombosis. Thrombosis in fact remains the primary cause of early graft failure and re-transplantation within the first 30 d following surgery, and it occurs despite prolongation of standard coagulation assays. Data, however, are currently lacking regarding the use of anti-aggregation/anticoagulation therapies and how to best monitor for thrombosis in the early postoperative period in pediatric patients. Therefore, further studies are necessary to elucidate the interaction between the development of the coagulation system and cirrhosis in children. Moreover, strategies to optimize blood transfusion and anticoagulation must be tested specifically in pediatric patients. In conclusion, data from the adult world can be translated with difficulty into the pediatric field as indication for transplantation, baseline pathologies and levels of pro- and anticoagulation factors are not comparable between the two populations. | Mirco Nacoti Davide Corbella Francesco Fazzi Francesca Rapido Ezio Bonanomi | 2016 | World Journal of Gastroenterology2016，22，6： | 5 |
| 2 | Bone Level Changes Around Axial and Tilted Implants in Full‐Arch Fixed Immediate Restorations. Interim Results of a Prospective Study显示文摘 | Luca Francetti Davide Romeo Stefano Corbella Silvio Taschieri Massimo Del Fabbro | 2010 | Clinical Implant Dentistry and Related Research2010，，5： | 1 |
| 3 | Criticalities in randomized controlled trials on HIPEC for ovarian cancer显示文摘Since the 1990 s, many oncological surgery groups around the world started to apply hyperthermic intraperitoneal chemotherapy(HIPEC) to the different peritoneal spread cancers. The rationale of the application of HIPEC after surgery is to complete the cytoreductive procedure. This combined treatment has now been successfully applied to many different intra-abdominal neoplasms. However, the treatment of peritoneal surface malignancies and the administration of HIPEC still lack high graded evidence data, especially in ovarian cancer. Experimental data exists about every step of the treatment of peritoneal spread ovarian cancer but unfortunately they have not yet been translated into phase Ⅲ clinical randomized trials. Moreover, treatment protocols differ between different centers. A systematic review of published randomized trial protocols was performed. HIPEC techniques are miscellaneous and not yet standardized. Well structured phase Ⅲ randomized trials among specialized centers are needed to investi-gate the effi cacy of this therapeutic approach, as well as technical details that may contribute to the standardization of the procedure and limit morbidity and mortality. In particular, new criteria are mandatory to uniformly stage the disease, to objectively evaluate the extension of cytoreduction and consequently the residual disease, to decide the best method of performing hyperthermia and to perfuse drugs. Moreover, pharmacokinetic and pharmacodynamic studies are urgently needed to assess the best type and dose of anticancer drugs. | Federico Coccolini Luca Ansaloni Davide Corbella Marco Lotti Olivier Glehen | 2013 | World Journal of Obstetrics and Gynecology2013，2，4： | 0 |
| 4 | Anesthetic management of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedures显示文摘Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy procedure are performed with increasing frequency to treat patients with diffused peritoneal carcinomatosis. These procedures have showed to increase life expectancy in what was previously considered a 'terminal condition'. Anyway patients face major and life threatening derangements of their hemodynamic, respiratory and metabolic physiologic balance during the surgery and in the immediate postoperative period. Despite the need of an advanced organ monitoring and support all these derangements seem to be mild and short-lived when timely addressed, at least in the majority of patients. Intensive care physicians are involved in providing surveillance and organ support till the patient is effectively weaned after the operation. Moreover, the anesthesiologist as perioperative physician is involved in pain control, metabolic and nutritional support of this cohort of patients. This task can be challenging considering that part of the patients are already on a long list of pain control medication after previous surgery or chemotherapy. A malnourished state is common too and it is secondary to diffi cult feeding, wasting syndrome from the tumor and massive ascites. The last issue the anesthesiologists need to be aware of is the impact over the quality of life(Qo L) of this procedure. The patient's underlying pathology is unlikely to be defi nitively cured so no treatment is an acceptable choice. The possibility to withhold the treatments must be part of the consultation process like the discussion about the Qo L in the immediate, as well as in the long-term, after the operation. Careful monitoring and treatment of every aspect that can impact the Qo L must be taken and the efforts to be poured into an effective preservation of the Qo L must be doubled when compared with a patient scheduled for major abdominal surgery. | Davide Corbella Emanuele Piraccini Paolo Finazzi Pietro Brambillasca Viviana Prussiani Massimo Ruggero Corso Claudio Germandi Vanni Agnoletti | 2013 | World Journal of Obstetrics and Gynecology2013，2，4： | 0 |
| 5 | Peritoneal carcinomatosis from advanced ovarian cancer: To treat or not to treat ethical issues suggested by a case study显示文摘This article provides a brief description of an epithelial ovarian cancer(EOC) case(stage Ⅳ) treated with the association of complete Cyto Reductive Surgery and hypertermic intra PEritoneal chemotherapy(HIPEC). Theuse of HIPEC in EOC makes theoretic sense in view of the high rates of recurrence following standard treatment, but there are no randomized clinical trial to date and HIPEC for these patients still represents a radical treatment where the choice of no treatment may be acceptable since definitive cure is unlikely. We reviewed the entire decision making process considering the risk/benefit of the procedure in term of mortality/morbidity, the quality of life and the psychological profile of the patient 1 year after surgery. The platform World Health Organization- International Classification of Functioning, Disability and Health that permits evaluation of the person in relation to the psycho-social context is presented. A person-centred approach and assessment of health-related quality-of-life and disability in EOC survivors are of central importance for decision making. | Mirco Nacoti Elena Colombetti Maria Simonetta Spada Marco Ceresoli Luca Ansaloni Gianmariano Marchesi Luca Lorini Davide Corbella Federico Coccolini | 2014 | World Journal of Obstetrics and Gynecology2014，3，1： | 0 |
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