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Mosso E. Treatment of functional dyspepsia: beyond pharmacological therapy. Minerva Gastroenterol (Torino) 2021; 67:404. [PMID: 35040303 DOI: 10.23736/s2724-5985.20.02761-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Elena Mosso
- Department of Medical Sciences, University of Turin, Turin, Italy -
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Ribaldone DG, Imperatore N, Le Grazie M, Furfaro F, Balestrieri P, De Blasio F, Fagoonee S, Mosso E, Boano V, Reggio D, Sarli E, Castiglione F, Milla M, Vecchi M, Saracco GM, Salizzoni M, Romagnoli R, Fiorino G, Astegiano M. Inflammatory bowel disease course in liver transplant versus non-liver transplant patients for primary sclerosing cholangitis: LIVIBD, an IG-IBD study. Dig Liver Dis 2021; 53:712-716. [PMID: 32972831 DOI: 10.1016/j.dld.2020.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Data regarding the effect of orthotopic liver transplantation (OLT) for primary sclerosing cholangitis (PSC) on inflammatory bowel disease (IBD) course are scarce and conflicting. AIMS To compare the incidence of refractory IBD in two groups (OLT and non-OLT) of patients affected by IBD and PSC. METHODS An observational, multicentre, cohort retrospective study was conducted by the Italian Group for the study of IBD in Italy. The primary outcome was the need for biologic therapy or bowel resection for medically refractory IBD or hospitalization due to IBD relapse during the follow-up. Secondary outcomes were rate of colonic dysplasia, colorectal cancer, other solid tumours, lymphoma. RESULTS Eighty-four patients were included in the study. The primary outcome was not different between OLT and non-OLT groups (11/27, 40.7%, versus 20/57, 35.1%, respectively, p = 0.62). The lymphoma and other tumours (thyroid cancer, kidney cancer, ileal tumour, ovarian cancer, cervical cancer) rates were significantly higher in the OLT group (p = 0.04 and p = 0.005, respectively), at the limit of statistical significance for high-grade colonic dysplasia (p = 0.06). CONCLUSION OLT in patients affected by IBD and PSC is not a risk factor for a more severe IBD course, but it is associated with a higher occurrence of cancer.
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Affiliation(s)
| | - Nicola Imperatore
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy; Gastroenterology and Endoscopy Unit, AORN Antonio Cardarelli, Naples, Italy
| | - Marco Le Grazie
- IBD Referral Center, Gastroenterology Department, Careggi University Hospital, Florence, Italy
| | - Federica Furfaro
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy
| | | | - Federico De Blasio
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | - Sharmila Fagoonee
- Institute of Biostructure and Bioimaging (CNR), Molecular Biotechnology Center, Turin, Italy
| | - Elena Mosso
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | - Valentina Boano
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | - Dario Reggio
- General Surgery 2U, Liver Transplant Center, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Ennio Sarli
- Italian Group for the study of Inflammatory Bowel Disease IG-IBD, Florence, Italy
| | - Fabiana Castiglione
- Gastroenterology Unit, Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Monica Milla
- IBD Referral Center, Gastroenterology Department, Careggi University Hospital, Florence, Italy
| | - Maurizio Vecchi
- Gastroenterology and Endoscopy Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Giorgio Maria Saracco
- Department of Medical Sciences, Division of Gastroenterology, University of Torino, Torino, Italy
| | - Mauro Salizzoni
- General Surgery 2U, Liver Transplant Center, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Renato Romagnoli
- General Surgery 2U, Liver Transplant Center, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Gionata Fiorino
- Humanitas Clinical and Research Center - IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Marco Astegiano
- Department of General and Specialist Medicine, Gastroenterologia-U, Città della Salute e della Scienza di Torino, Turin, Italy
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- Italian Group for the study of Inflammatory Bowel Disease IG-IBD, Florence, Italy
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Gaia S, Ciruolo M, Ribaldone DG, Rolle E, Migliore E, Mosso E, Vola S, Risso A, Fagoonee S, Saracco GM, Carucci P. Higher Efficiency of Percutaneous Microwave (MWA) Than Radiofrequency Ablation (RFA) in Achieving Complete Response in Cirrhotic Patients with Early Hepatocellular Carcinoma. Curr Oncol 2021; 28:1034-1044. [PMID: 33669107 PMCID: PMC8025753 DOI: 10.3390/curroncol28020101] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/27/2021] [Accepted: 02/19/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Contrasting data are available in the literature regarding the superiority of percutaneous microwave ablation (MWA) or radiofrequency ablation (RFA) in very early or early (BCLA 0 or A) hepatocellular carcinoma (HCC). AIMS The primary outcome was to compare the efficacy of RFA and MWA in achieving complete response in cirrhotic patients with early and very early HCC. The secondary outcomes were to evaluate the overall survival and the recurrence rate. METHODS A retrospective, observational, single-center study was performed. Inclusion criteria were liver cirrhosis, new diagnosis of a single node of HCC measuring a maximum of 50 mm or up to three nodules with diameter up to 35 mm, treatment with RFA or MWA. Radiological response was evaluated with multiphasic contrast-enhanced Computed Tomography or Magnetic Resonance Imaging at 5-7 weeks after thermal ablation. Complete response was defined when no vital tissue was detected after treatment. RESULTS Overall, 251 HCC patients were included in this study; 81 patients were treated with MWA and 170 with RFA. The complete response rate was similar in MWA and RFA groups (out of 331 nodules, 87.5% (91/104) were treated with MWA and 84.2% (186/221) were treated with RFA, p = 0.504). Interestingly, a subanalysis demonstrated that for 21-35 mm nodules, the probability to achieve a complete response using MWA was almost 5 times higher than for RFA (OR = 4.88, 95% CI 1.37-17.31, p = 0.014). Moreover, recurrence rate in 21-35 mm nodules was higher with RFA with respect to MWA (31.9% versus 13.5%, p = 0.019). Overall survival was 80.4% (45/56) when treated with MWA and 62.2% (56/90) when treated with RFA (p = 0.027). No significant difference was observed between MWA and RFA treatment in the 15-20 mm nodules group. CONCLUSION This study showed that MWA is more efficient than RFA in achieving complete response in HCC nodules with 21 to 35 mm diameter.
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Affiliation(s)
- Silvia Gaia
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Michela Ciruolo
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | | | - Emanuela Rolle
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Enrica Migliore
- Unit of Cancer Epidemiology, Città della Salute e della Scienza University-Hospital and Center for Cancer Prevention (CPO), 10126 Turin, Italy;
| | - Elena Mosso
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Simone Vola
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Alessandra Risso
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Sharmila Fagoonee
- Institute for Biostructure and Bioimaging (CNR) at Molecular Biotechnology Center, 10126 Turin, Italy;
| | - Giorgio Maria Saracco
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
| | - Patrizia Carucci
- Gastroenterology and Hepatology Unit, Città della Salute e della Scienza University-Hospital, 10126 Turin, Italy; (M.C.); (E.R.); (E.M.); (S.V.); (A.R.); (G.M.S.); (P.C.)
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Mosso E, Bonetto S, Longobardi G, Abenavoli L, Ribaldone DG, Saracco GM, Pellicano R. Management of functional dyspepsia in 2020: a clinical point of view. MINERVA GASTROENTERO 2020; 66:331-342. [PMID: 32623872 DOI: 10.23736/s1121-421x.20.02732-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Dyspepsia is a disorder that refers mainly to central upper abdominal pain or discomfort. When a cause of this symptom is not identified the condition is termed functional dyspepsia (FD), that affects a large part of the general population. The relevance of FD is due to its high prevalence, but also to its chronic or intermittent course. This induces a significant burden for each national healthcare system. The pathogenesis of FD is complex and multifactorial, depending on cultural, environmental, and biological factors. Although considered of main importance in the pathophysiology of several gastroduodenal diseases, in the context of FD Helicobacter pylori (H. pylori) infection plays a limited role. The diagnosis of FD requires the exclusion of organic gastroduodenal diseases as well as H. pylori infection. Thus, the diagnostic workup includes a complete anamnesis, biochemical tests, and endoscopy with biopsy (when requested), and the satisfaction of clinic criteria recommended by the Rome IV consensus. The treatment of FD is also challenging, in fact more and more studies focused on a wide range of different therapies, with a multitude of results. The aim of this literature review is to provide an update of the new evidences useful for diagnosis and management of FD.
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Affiliation(s)
- Elena Mosso
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Silvia Bonetto
- Department of Medical Sciences, University of Turin, Turin, Italy
| | | | - Ludovico Abenavoli
- Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
| | | | - Giorgio M Saracco
- Department of Medical Sciences, University of Turin, Turin, Italy.,Unit of Gastroenterology, Molinette Hospital, Turin, Italy
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Pugliese D, Daperno M, Fiorino G, Savarino E, Mosso E, Biancone L, Testa A, Sarpi L, Cappello M, Bodini G, Caprioli F, Festa S, Laino G, Maconi G, Mazzuoli S, Mocci G, Sartini A, D'Amore A, Alivernini S, Gremese E, Armuzzi A. Real-life effectiveness of ustekinumab in inflammatory bowel disease patients with concomitant psoriasis or psoriatic arthritis: An IG-IBD study. Dig Liver Dis 2019; 51:972-977. [PMID: 30992173 DOI: 10.1016/j.dld.2019.03.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 02/18/2019] [Accepted: 03/11/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND Few data exist regarding the effectiveness of ustekinumab in inflammatory bowel disease (IBD) patients treated for concomitant psoriasis or psoriatic arthritis. AIMS to describe the outcomes of IBD patients who received subcutaneous ustekinumab through a dermatological or rheumatological prescription. METHODS This multicenter, retrospective study included all IBD patients who were started on ustekinumab for concomitant active psoriasis/ psoriatic arthritis, irrespective of IBD activity. The primary endpoint was overall ustekinumab persistence, defined as the maintenance of therapy because of sustained clinical benefit for IBD. RESULTS Seventy patients (64 Crohn's disease / 6 ulcerative colitis) were enrolled. The median follow-up on ustekinumab therapy was 10.7 months (range, 1.4-67.3). Twelve patients (17.1%) withdrew the treatment after a median of 7.4 months (range, 0.9-23.8). The cumulative probability of maintaining ustekinumab treatment was 97.1% at 6 months and 77.1% at 12 months. Among the 56 patients with baseline active IBD, 34 (60.7%) were in clinical remission at the last follow-up visit. Their cumulative probability of achieving clinical remission was 84.7% and 63.9% at 6 and 12 months, respectively. Two patients stopped ustekinumab for an adverse event. CONCLUSIONS Subcutaneous ustekinumab had a good effectiveness profile for IBD patients treated for concomitant dermatological or rheumatological conditions.
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Affiliation(s)
- Daniela Pugliese
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy
| | - Marco Daperno
- Gastroenterology Unit, A.O. Ordine Mauriziano, Turin, Italy
| | - Gionata Fiorino
- IBD Center, Department of Gastroenterology, Humanitas Research Hospital, Rozzano, Italy
| | - Edoardo Savarino
- Gastroenterology Unit, Department Surgery, Oncology and Gastroenterology, University of Padua, Italy
| | - Elena Mosso
- General and Specialistic Medicine/Gastroenterology, Città della Salute e della Scienza di Torino, Italy
| | - Livia Biancone
- University of Rome Tor Vergata, Department of Systems Medicine, Gastroenterology, Rome, Italy
| | - Anna Testa
- Federico II University, Gastroenterology, Naples, Italy
| | - Lucio Sarpi
- Gastroenterologia ed Endoscopia Digestiva Aziendale USL Umbria1, Perugia, Italy
| | - Maria Cappello
- Gastroenterology and Hepatology Section, DiBiMis, University of Palermo, Palermo, Italy
| | - Giorgia Bodini
- Gastrointestinal Unit, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Flavio Caprioli
- Department of Pathophysiology and Transplantation, University of Milan and Gastroenterology and Endoscopy Unit, IRCCS Cà Granda, IRCCS Policlinico Hospital, Milan, Italy
| | | | - Gabriella Laino
- Department of New Technologies and Translational Research in Medicine and Surgery, University of Pisa, Pisa, Italy
| | - Giovanni Maconi
- Luigi Sacco University Hospital, Gastroenterology and IBD Unit, Milan, Italy
| | - Silvia Mazzuoli
- Gastroenterology Unit, San Nicola Pellegrino Hospital, Trani, Italy
| | - Giammarco Mocci
- Division of Gastroenterology, "Brotzu" Hospital, Cagliari, Italy
| | - Alessandro Sartini
- Department of Internal Medicine, Gastroenterology Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra D'Amore
- Department of Dermatology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Stefano Alivernini
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Elisa Gremese
- Division of Rheumatology, Fondazione Policlinico Universitario A. Gemelli IRCCS Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alessandro Armuzzi
- IBD Unit, Presidio Columbus, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Università Cattolica del Sacro Cuore, Rome, Italy.
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Abstract
Microscopic colitis (MC) is diagnosed in presence of microscopic alterations of colonic mucosa, in patients without macroscopic lesions who referred for chronic diarrhea. The two types of MC are lymphocytic colitis (LC) and collagenous colitis (CC), but it is unclear whether these are the different expression of one unique disease or if they are distinct conditions. Today, although MC represents a consistent health problem, being responsible for a large part of gastroenterological consultations for diarrhea, it remains often underestimated. The detailed pathogenesis of MC has not been determined yet. Probably, it is the result of an interaction between individual, environmental and genetic factors. The most relevant risk factor for the development of MC is the use of certain drugs (such as non-steroidal anti-inflammatory drugs [NSAIDs], proton pump inhibitors [PPIs], selective serotonin reuptake inhibitors, beta-blockers, statins). Smoking is another relevant factor reported as associated with the development of MC. Diagnosis needs the execution of a colonoscopy in patients complaining about chronic diarrhea and abdominal pain. The crucial role is played by histology: MC is characterized by the presence of colonic mucosal lymphocytic infiltrate, with intraepithelial lymphocytes ≥20 per 100 enteric surface cells, in CC there is a typical subepithelial collagen layer, whose thickness is ≥10 μm. We carried out a review of the current literature to rule out what is new on epidemiology, diagnosis and therapy of MC.
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Affiliation(s)
- Elena Mosso
- Department of Gastroenterology, University of Turin, Turin, Italy
| | - Valentina Boano
- Department of Gastroenterology, University of Turin, Turin, Italy
| | - Mario Grassini
- Section of Physiopathology and Manometry, Unit of Gastroenterology and Endoscopy, Cardinal Massaja Hospital, Asti, Italy
| | - Edda Battaglia
- Section of Physiopathology and Manometry, Unit of Gastroenterology and Endoscopy, Cardinal Massaja Hospital, Asti, Italy
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Di Stefano C, Vanni E, Mirabella S, Younes R, Boano V, Mosso E, Nada E, Milazzo V, Maule S, Romagnoli R, Salizzoni M, Veglio F, Milan A. Risk factors for arterial hypertension after liver transplantation. J Am Soc Hypertens 2018; 12:220-229. [PMID: 29366595 DOI: 10.1016/j.jash.2018.01.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 12/29/2017] [Accepted: 01/01/2018] [Indexed: 12/11/2022]
Abstract
Arterial hypertension represents a common complication of immunosuppressive therapy after liver transplantation (LT). The aim of the study is to evaluate the prevalence and risk factors associated with hypertension after LT. From a cohort of 323 cirrhotic patients who underwent LT from 2008 to 2012, 270 patients were retrospectively evaluated, whereas 53 (16.4%) patients deceased. Hypertension was defined as blood pressure ≥140/90 mm Hg in at least two visits and/or the need for antihypertensive therapy. The prevalence of hypertension was 15% before LT and significantly increased up to 53% after LT (P < .001). Mean follow-up was 43 ± 19 months. In normotensive (NT) subjects at baseline, 35.9% developed sustained hypertension after LT, whereas 15.2% developed transient hypertension within the first month after LT, and then returned NT. The development of sustained hypertension after LT was related to the mammalian target of rapamycin inhibitor treatment (odds ratio [OR], 4.02; 95% confidence interval [CI], 1.26-13.48; P = .02), alcoholic cirrhosis before LT (OR, 3.38; 95% CI, 1.44-8.09; P = .005), and new-onset hepatic steatosis after LT (OR, 2.13; 95% CI, 1.10-4.11; P = .02). Tacrolimus, the etiology and severity of liver disease, and other immunosuppressive regimens were not related to the development of hypertension after LT. In our cohort, the prevalence of arterial hypertension has increased up to 53% after LT, and metabolic comorbidities and immunosuppressive treatment with mammalian target of rapamycin inhibitors are the risk factors for the development of hypertension after LT.
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Affiliation(s)
- Cristina Di Stefano
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy.
| | - Ester Vanni
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Stefano Mirabella
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Ramy Younes
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Valentina Boano
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Elena Mosso
- Division of Gastroenterology, Department of Medical Sciences, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Elisabetta Nada
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Valeria Milazzo
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Simona Maule
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Renato Romagnoli
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Mauro Salizzoni
- Liver Transplant Center, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Franco Veglio
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
| | - Alberto Milan
- Department of Medical Sciences, Hypertension Unit, Città della Salute e della Scienza, University of Torino, Torino, Italy
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