Clinical presentation and management of acromegaly in elderly patients

Background and aim: Acromegaly is a rare disease with a peak of incidence in early adulthood. However, enhanced awareness of this disease, combined with wide availability of magnetic resonance imaging (MRI), has increased the diagnosis of forms with mild presentation, especially in elderly patients. Moreover, due to increased life expectancy and proactive individualized treatment, patients with early-onset acromegaly are today aging. The aim of our study was to describe our cohort of elderly patients with acromegaly. Materials and methods: This is a cross-sectional retrospective study of 96 outpatients. Clinical, endocrine, treatment, and follow-up data were collected using the electronic database of the University Hospital of Padova, Italy. Results: We diagnosed acromegaly in 13 patients, aged 6565\ua0years, presenting with relatively small adenomas and low IGF-1 secretion. Among them, 11 patients were initially treated with medical therapy and half normalized hormonal levels after 6\ua0months without undergoing neurosurgery (TNS). Remission was achieved after TNS in three out of four patients (primary TNS in two); ten patients presented controlled acromegaly at the last visit. Acromegaly-related comorbidities (colon polyps, thyroid cancer, adrenal incidentaloma, hypertension, and bone disease) were more prevalent in patients who had an early diagnosis (31 patients, characterized by a longer follow-up of 24\ua0years) than in those diagnosed aged 6565\ua0years (5\ua0years of follow-up). Conclusions: Elderly acromegalic patients are not uncommon. Primary medical therapy is a reasonable option and is effectively used, while the rate of surgical success is not reduced. A careful cost-benefit balance is suggested. Disease-specific comorbidities are more prevalent in acromegalic patients with a longer follow-up rather than in those diagnosed aged 6565\ua0years

Tele-medicine versus face-to-face consultation in Endocrine Outpatients Clinic during COVID-19 outbreak: a single-center experience during the lockdown period

The COVID-19 outbreak in Italy is the major concern of Public Health in 2020: measures of containment were progressively expanded, limiting Outpatients' visit

Communicating soil carbon science to farmers: incorporating credibility, salience and legitimacy

A key narrative within climate change science is that conserving and improving soil carbon through agricultural practices can contribute to agricultural productivity and is a promising option for mitigating carbon loss through sequestration. This paper examines the potential disconnect between science and practice in the context of communicating information about soil carbon management. It focuses on the information producing process and on stakeholder (adviser, farmer representative, policy maker etc) assessment of the attributes credibility, salience and legitimacy. In doing this it draws on results from consultations with stakeholders in the SmartSOIL project which aimed to provide decision support guidelines about practices that optimise carbon mitigation and crop productivity. An iterative methodology, used to engage stakeholders in developing, testing and validating a range of decision support guidelines in six case study regions across Europe, is described. This process enhanced legitimacy and revealed the importance, and the different dimensions, of stakeholder views on credibility and salience. The results also highlight the complexities and contested nature of managing soil carbon. Some insights are gained into how to achieve more effective communication about soil carbon management, including the need to provide opportunities in projects and research programmes for dialogue to engender better understanding between science and practice

Eradication of chronic myeloid leukemia stem cells: a novel mathematical model predicts no therapeutic benefit of adding G-CSF to imatinib

Imatinib mesylate induces complete cytogenetic responses in patients with chronic myeloid leukemia (CML), yet many patients have detectable BCR-ABL transcripts in peripheral blood even after prolonged therapy. Bone marrow studies have shown that this residual disease resides within the stem cell compartment. Quiescence of leukemic stem cells has been suggested as a mechanism conferring insensitivity to imatinib, and exposure to the Granulocyte-Colony Stimulating Factor (G-CSF), together with imatinib, has led to a significant reduction in leukemic stem cells in vitro. In this paper, we design a novel mathematical model of stem cell quiescence to investigate the treatment response to imatinib and G-CSF. We find that the addition of G-CSF to an imatinib treatment protocol leads to observable effects only if the majority of leukemic stem cells are quiescent; otherwise it does not modulate the leukemic cell burden. The latter scenario is in agreement with clinical findings in a pilot study administering imatinib continuously or intermittently, with or without G-CSF (GIMI trial). Furthermore, our model predicts that the addition of G-CSF leads to a higher risk of resistance since it increases the production of cycling leukemic stem cells. Although the pilot study did not include enough patients to draw any conclusion with statistical significance, there were more cases of progression in the experimental arms as compared to continuous imatinib. Our results suggest that the additional use of G-CSF may be detrimental to patients in the clinic

Impacts of Climate Change on SOC Dynamic and Crop Yield of Italian Rainfed Wheat-Maize Cropping Systems Managed with Conventional or Conservation Tillage Practices

There is still uncertainty on the ability of conservation tillage (i.e., reduced- RT and no till - NT) in contributing to the resilience of cropping systems to climate change pressures (Powlson et al 2016). RT or NT can improve soil physical and biological proprieties thus increasing water holding capacity and fertility, stabilizing soil structure and enhancing soil biodiversity and functions. They are also frequently proposed as mitigation practices as they can contribute to increase soil organic carbon (SOC) compared to conventional moldboard ploughing practices (Gonzalez-Sanchezet al., 2012). However, SOC increase occurs mostly in the upper soil layer but not always in the deeper profile (Haddaway et al., 2016) where SOC measurements are less frequently measured. In this study, we used data obtained from long term field experiments(LTE) coupled with three crop simulation models in order to assess the long-term effects of different tillage management practices on crop yield and on changes in SOC stocks in both superficial (0-20cm) and deeper layers (20-50cm) in Mediterranean rainfed cereal cropping systems at current and future climate scenarios

Phenological model intercomparison for estimating grapevine budbreak date (Vitis vinifera L.) in Europe

Budbreak date in grapevine is strictly dependent on temperature, and the correct simulation of its occurrence is of great interest since it may have major consequences on the final yield and quality. In this study, we evaluated the reliability for budbreak simulation of two modeling approaches, the chilling-forcing (CF), which describes the entire dormancy period (endo-and eco-dormancy) and the forcing approach (F), which only describes the eco-dormancy. For this, we selected six phenological models that apply CF and F in dierent ways, which were tested on budbreak simulation of eight grapevine varieties cultivated at dierent latitudes in Europe. Although none of the compared models showed a clear supremacy over the others, models based on CF showed a generally higher estimation accuracy than F where fixed starting dates were adopted. In the latter models, the accurate simulation of budbreak was dependent on the selection of the starting date for forcing accumulation that changes according to the latitude, whereas CF models were independent. Indeed, distinct thermal requirements were found for the grapevine varieties cultivated in Northern and Southern Europe. This implies the need to improve modeling of the dormancy period to avoid under-or over-estimations of budbreak date under dierent environmental conditions. © 2020 by the authors

Phenological Model Intercomparison for Estimating Grapevine Budbreak Date (Vitis vinifera L.) in Europe

Budbreak date in grapevine is strictly dependent on temperature, and the correct simulation of its occurrence is of great interest since it may have major consequences on the final yield and quality. In this study, we evaluated the reliability for budbreak simulation of two modeling approaches, the chilling-forcing (CF), which describes the entire dormancy period (endo- and eco-dormancy) and the forcing approach (F), which only describes the eco-dormancy. For this, we selected six phenological models that apply CF and F in different ways, which were tested on budbreak simulation of eight grapevine varieties cultivated at different latitudes in Europe. Although none of the compared models showed a clear supremacy over the others, models based on CF showed a generally higher estimation accuracy than F where fixed starting dates were adopted. In the latter models, the accurate simulation of budbreak was dependent on the selection of the starting date for forcing accumulation that changes according to the latitude, whereas CF models were independent. Indeed, distinct thermal requirements were found for the grapevine varieties cultivated in Northern and Southern Europe. This implies the need to improve modeling of the dormancy period to avoid under- or over-estimations of budbreak date under different environmental conditions.This research was funded by the European Union’s Horizon 2020 Research and Innovation Programme, under the Clim4Vitis project: “Climate change impact mitigation for European viticulture: knowledge transfer for an integrated approach”, grant agreement no. 810176. It was also supported by FCT-Portuguese Foundation for Science and Technology, under the project UIDB/04033/2020 and the French National Research Agency (ANR) in the frame of the Investments for the Future Program, within the cluster of excellence COTE (ANR-10-LABX-45)

Clinical Implication of Targeting of Cancer Stem Cells

The existence of cancer stem cells (CSCs) is receiving increasing interest particularly due to its potential ability to enter clinical routine. Rapid advances in the CSC field have provided evidence for the development of more reliable anticancer therapies in the future. CSCs typically only constitute a small fraction of the total tumor burden; however, they harbor self-renewal capacity and appear to be relatively resistant to conventional therapies. Recent therapeutic approaches aim to eliminate or differentiate CSCs or to disrupt the niches in which they reside. Better understanding of the biological characteristics of CSCs as well as improved preclinical and clinical trials targeting CSCs may revolutionize the treatment of many cancers. Copyright (c) 2012 S. Karger AG, Base

Neck emergency due to parathyroid adenoma bleeding: a case report

<p>Abstract</p> <p>Introduction</p> <p>The spontaneous rupture of a parathyroid adenoma accompanied by extracapsular hemorrhage is a rare, potentially fatal, condition and is a cervicomediastinal surgical emergency.</p> <p>Case presentation</p> <p>This report describes an atypical two-step spontaneous rupture of an asymptomatic parathyroid adenoma in a 56-year-old Caucasian woman who presented with a painful mass in the right side of her neck.</p> <p>Conclusion</p> <p>Based on this case report and similar cases reported in the medical literature, a diagnosis of extracapsular parathyroid hemorrhage should be considered when a non-traumatic sudden neck swelling coexists with hypercalcemia and regional ecchymosis.</p