Bone mineral density in patients on home parenteral nutrition: a follow-up study.

Home artificial nutrition

Effect of the irrigation method and genotype on the bioaccumulation of toxic and trace elements in rice

The total concentration of three toxic elements (As, Cd and Pb) and five oligoelements (Cu, Mn, Mo, Ni and Se) has been determined using an original and completely validated ICP-MS method. This was applied to rice grains from 26 different genotypes cultivated in the same soil and irrigated with the same water in three different ways: by the traditional continuous flooding (CF) and by two intermittent methods, the sprinkler irrigation (SP) and the periodical saturation of the soil (SA). The adoption of SP hugely minimizes the average amounts of almost all elements in kernels (−98% for As, −90% for Se and Mn, −60% for Mo, −50% for Cd and Pb), with the only exception of Ni, whose concentration increases the average amount found in the CF rice by 7.5 times. Also SA irrigation is able to reduce the amounts of As, Mo and Pb in kernels but it significantly increases the amounts of Mn, Ni and – mainly - Cd. Also the nature of the genotype determined a wide variability of data within each irrigation method. Genotypes belonging to Indica subspecies are the best bioaccumulators of elements in both CF and SP methods and, never, the worst bioaccumulators for any element/irrigation method combination. In the principal component analysis, PC1 can differentiate samples irrigated by SP by those irrigated by CF and SA, whereas PC2 provides differentiation of CF samples by SA samples. When looking at the loading plot Ni is negatively correlated to the majority of the other elements, except Cu and Cd having negative loadings on PC2. These results allow to envisage that a proper combination of the irrigation method and the nature of rice genotype might be a very valuable tool in order to successfully achieve specific objectives of food safety or the attainment of functional properties

Colorectal Cancer Stage at Diagnosis Before vs During the COVID-19 Pandemic in Italy

IMPORTANCE Delays in screening programs and the reluctance of patients to seek medical attention because of the outbreak of SARS-CoV-2 could be associated with the risk of more advanced colorectal cancers at diagnosis. OBJECTIVE To evaluate whether the SARS-CoV-2 pandemic was associated with more advanced oncologic stage and change in clinical presentation for patients with colorectal cancer. DESIGN, SETTING, AND PARTICIPANTS This retrospective, multicenter cohort study included all 17 938 adult patients who underwent surgery for colorectal cancer from March 1, 2020, to December 31, 2021 (pandemic period), and from January 1, 2018, to February 29, 2020 (prepandemic period), in 81 participating centers in Italy, including tertiary centers and community hospitals. Follow-up was 30 days from surgery. EXPOSURES Any type of surgical procedure for colorectal cancer, including explorative surgery, palliative procedures, and atypical or segmental resections. MAIN OUTCOMES AND MEASURES The primary outcome was advanced stage of colorectal cancer at diagnosis. Secondary outcomes were distant metastasis, T4 stage, aggressive biology (defined as cancer with at least 1 of the following characteristics: signet ring cells, mucinous tumor, budding, lymphovascular invasion, perineural invasion, and lymphangitis), stenotic lesion, emergency surgery, and palliative surgery. The independent association between the pandemic period and the outcomes was assessed using multivariate random-effects logistic regression, with hospital as the cluster variable. RESULTS A total of 17 938 patients (10 007 men [55.8%]; mean [SD] age, 70.6 [12.2] years) underwent surgery for colorectal cancer: 7796 (43.5%) during the pandemic period and 10 142 (56.5%) during the prepandemic period. Logistic regression indicated that the pandemic period was significantly associated with an increased rate of advanced-stage colorectal cancer (odds ratio [OR], 1.07; 95%CI, 1.01-1.13; P = .03), aggressive biology (OR, 1.32; 95%CI, 1.15-1.53; P < .001), and stenotic lesions (OR, 1.15; 95%CI, 1.01-1.31; P = .03). CONCLUSIONS AND RELEVANCE This cohort study suggests a significant association between the SARS-CoV-2 pandemic and the risk of a more advanced oncologic stage at diagnosis among patients undergoing surgery for colorectal cancer and might indicate a potential reduction of survival for these patients

Airway bleeding during pulmonary endarterectomy: the "bubbles" technique.

Pulmonary endarterectomy (PEA) is a technically demanding operation, currently performed in few centers worldwide. 1 A bloodless surgical field is mandatory to identify the correct arterial dissection plane, which has to be extended toward subsegmental branches with limited visibility. Vessel perforation is a rare but potentially fatal complication, leading to uncontrollable airway bleeding. A general algorithm for the approach to pulmonary hemorrhage has been proposed by the group from the University of California at San Diego,2 whereas alternative managements are only briefly mentioned in the literature.3 Extracorporeal life support unloads pulmonary circulation but invariably requires anticoagulation, which is detrimental in pulmonary hemorrhage. We describe a novel technique for the treatment of intraoperative airway bleeding during PEA

Potential Role of Probiotics for Inflammaging: A Narrative Review

BACKGROUND AND AIMS: Inflammaging, a chronic, low-grade inflammation (LGI), is one of the mechanisms of adaptation of an organism to aging. Alterations in the composition of gut microbiota and gut permeability are among the main sources of LGI. They may be modulated by supplementation with live microorganisms, i.e. probiotics. This narrative review was performed with the aim to critically examine the current evidence from randomized clinical trials (RCTs) on the effects of probiotics on pro-inflammatory and anti-inflammatory cytokines and C-reactive protein (CRP) in healthy older subjects. METHODOLOGY: RCTs on the effects of probiotics on inflammatory parameters in subjects older than 65 years published in English and Italian from 1990 to October 2020 were searched in PubMed. Studies that were not RCTs, those using probiotics together with prebiotics (synbiotics), and studies performed in subjects with acute or chronic diseases were excluded. The findings of RCTs were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS: A total of nine RCTs met the eligibility criteria and were included in this narrative review. Four articles reported that probiotic supplementation significantly affected inflammatory parameters, respectively, by reducing TGF-β1 concentrations, IL-8, increasing IL-5 and Il-10, and IFN-γ and IL-12. CONCLUSIONS: Based on this narrative review, probiotic supplementation showed a limited effect on inflammatory markers in healthy individuals older than 65 years. Besides being few, the studies analyzed have methodological limitations, are heterogeneous, and provide results which are incomparable

Lung cancer resection: the prediction of postsurgical outcomes should include long-term functional results.

STUDY OBJECTIVES: To assess (1) the possibility of predicting long-term postoperative lung function, and (2) the usefulness of maximal oxygen consumption (O(2)max) as a criterion for operability and as a predictor of long-term disability. DESIGN: Prospective study. SETTING: Outpatients and inpatients of a university hospital. PARTICIPANTS: Sixty-two consecutive patients (mean +/- SD age, 62 +/- 8 years; 51 male and 11 female patients) were preoperatively evaluated for lung cancer resection (pneumonectomy or bilobectomy [n = 14] and lobectomy [n = 48]). MEASUREMENTS: Clinical examination and recorded respiratory symptoms and spirometry results before surgery and 6 months after surgery. If predicted postoperative FEV(1) (ppoFEV(1)) was < 40%, patients underwent exercise testing; if O(2)max was between 10 mL/kg/min and 20 mL/kg/min, patients underwent a split-function study. RESULTS: All the patients with ppoFEV(1) > or = 40%-even those patients (26%) with FEV(1) < 80%-underwent thoracotomy without further tests. Seven patients with ppoFEV(1) < 40% underwent exercise testing, and three of them underwent a split-function study. Nine patients (15%; including six patients with COPD and one patient with asthma) had immediate postoperative complications (pneumonia [n = 5] and respiratory failure [n = 4]); seven of these patients had ppoFEV(1) > or = 40%. ppoFEV(1) significantly underestimated the actual postoperative FEV(1) (poFEV(1); p < 0.001) 6 months after pneumonectomy or bilobectomy but was reliable for actual poFEV(1) after lobectomy. Two patients with predicted postoperative O(2)max > 10 mL/kg/min became oxygen dependent and had marked limitation of daily living. CONCLUSIONS: ppoFEV(1) > or = 40% reliably identifies patients not requiring further tests and not at long-term risk of respiratory disability. O(2)max, effective for defining the immediate surgical risk, is not useful in predicting long-term disability