Goodbye Hartmann trial: a prospective, international, multicenter, observational study on the current use of a surgical procedure developed a century ago

Background: Literature suggests colonic resection and primary anastomosis (RPA) instead of Hartmann's procedure (HP) for the treatment of left-sided colonic emergencies. We aim to evaluate the surgical options globally used to treat patients with acute left-sided colonic emergencies and the factors that leading to the choice of treatment, comparing HP and RPA. Methods: This is a prospective, international, multicenter, observational study registered on ClinicalTrials.gov. A total 1215 patients with left-sided colonic emergencies who required surgery were included from 204 centers during the period of March 1, 2020, to May 31, 2020. with a 1-year follow-up. Results: 564 patients (43.1%) were females. The mean age was 65.9 ± 15.6 years. HP was performed in 697 (57.3%) patients and RPA in 384 (31.6%) cases. Complicated acute diverticulitis was the most common cause of left-sided colonic emergencies (40.2%), followed by colorectal malignancy (36.6%). Severe complications (Clavien-Dindo ≥ 3b) were higher in the HP group (P < 0.001). 30-day mortality was higher in HP patients (13.7%), especially in case of bowel perforation and diffused peritonitis. 1-year follow-up showed no differences on ostomy reversal rate between HP and RPA. (P = 0.127). A backward likelihood logistic regression model showed that RPA was preferred in younger patients, having low ASA score (≤ 3), in case of large bowel obstruction, absence of colonic ischemia, longer time from admission to surgery, operating early at the day working hours, by a surgeon who performed more than 50 colorectal resections. Conclusions: After 100 years since the first Hartmann's procedure, HP remains the most common treatment for left-sided colorectal emergencies. Treatment's choice depends on patient characteristics, the time of surgery and the experience of the surgeon. RPA should be considered as the gold standard for surgery, with HP being an exception

Complicated intra-abdominal infections in Europe: preliminary data from the first three months of the CIAO Study

Peer reviewe

Complicated intra-abdominal infections in Europe: a comprehensive review of the CIAO study

Peer reviewe

TAPSE: An old but useful tool in different diseases

5noreservedRV function is an important component of overall heart function with prognostic value in predicting symptomatic limitation and outcome in different cardiovascular pathologies. RV longitudinal contraction accounts for the majority of total RV function, up to 80%, as compared to transverse shortening. Calculation of RV volume and RV ejection fraction (RVEF) remains hampered by the complex RV geometry and we lack a good geometric model allowing the calculation of right ventricular ejection fraction; secondly, the large apical trabeculations of the right ventricle make the endocardial delineation more difficult to obtain than for the left ventricle. To notice, the gold standard method for the assessment of the chamber (MRI) is resource intensive and cannot be employed in many settings. Considering these problems, multiple parameters have been developed for the evaluation of RV systolic function: tricuspid annular plane systolic excursion (TAPSE), systolic excursion velocity (S′), and longitudinal strain by speckle tracking.mixedAloia, Elio; Cameli, Matteo; D'Ascenzi, Flavio; Sciaccaluga, Carlotta; Mondillo, SergioAloia, Elio; Cameli, Matteo; D'Ascenzi, Flavio; Sciaccaluga, Carlotta; Mondillo, Sergi

Additional value of Galectin-3 to BNP in acute heart failure patients with preserved ejection fraction

Background: Almost half of patients with acute heart failure have preserved ejection fraction (HFpEF). HFpEF is a diagnostic challenge using traditional investigation tools; Galectin-3 (Gal-3) is an emerging biomarker useful in individuals at risk for HF. The aim of our study is to analyse the relation and prognostic value of Gal-3, BNP and renal dysfunction in patients with HFpEF compared to patients with reduced ejection fraction (HFrEF). Methods: We enrolled 98 patients with acute heart failure (AHF) and measured Gal-3, BNP, and estimated glomerular filtration rate (eGFR) within 12 h of hospital admission. On the basis of echocardiographic findings we divided our sample into two groups: patients with HFrHF (ejection fraction 50%). Patients were followed up at 6 months. Results: No differences in Gal-3 levels were found in the two subgroups (HFrEF: 19.5 ± 5.1 ng/mL; HFpEF: 20.5 ± 8.7, p = 0.56). Gal-3 was inversely related to renal dysfunction (LogGal-3 vs eGFR: r = -. 0.30, p = 0.01) but did not correlate with LogBNP levels (r = 0.07, p = 0.55). Gal-3 was associated with more advanced diastolic dysfunction in HFpEF (p = 0.009). In addition LogGal-3 was related to diastolic LV stiffness (all patients: r = 0.45, p 1.30 was related to poor outcome independently from renal dysfunction and other risk factors only in HFpEF (univariate HR 23.98 [3.03-89.45]; p < 0.001). Adjusted for renal dysfunction (HR 16.32 [1.98-34.09]; p = 0.009). Conclusions: Gal-3 is not able to distinguish between HFrEF and HFpEF patients. However it is related to diastolic dysfunction severity and LV stiffness in HFpEF. Gal-3 demonstrates a prognostic role independently from renal dysfunction in subjects with HFpEF

Prediagnostic circulating parathyroid hormone concentration and colorectal cancer in the European prospective investigation into cancer and nutrition cohort

BACKGROUND: Parathyroid hormone (PTH) has been proposed to play a promoting role in carcinogenesis. However, no epidemiologic studies have yet directly investigated its role in colorectal cancer (CRC). METHODS: A case-control study nested within the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort was conducted with 1,214 incident, sporadic CRC cases matched to 1,214 controls. Circulating pre-diagnostic PTH and 25-hydroxy vitamin D [25(OH)D] concentrations were measured by enzyme-linked immunosorbent assays. Detailed dietary and lifestyle questionnaire data were collected at baseline. Multivariable conditional logistic regression was used to estimate the incidence rate ratio (RR) with 95% confidence intervals (95%CI) for the association between circulating PTH and CRC risk. RESULTS: In multivariate analyses (including adjustment for 25(OH)D concentration) with a priori defined cut-points, high levels of serum PTH (≥65ng/L) compared to medium PTH levels of 30–65 ng/L were associated with increased CRC risk (RR=1.41, 95%CI: 1.03-1.93). In analyses by sex, the CRC risk was 1.77 (95%CI: 1.14-2.75) and 1.15 (95%CI: 0.73-1.84) in men and women, respectively (P(heterogeneity)=0.01). In sub-group analyses by anatomical sub-site, the risk for colon cancer was RR=1.56, 95%CI:1.03-2.34, and for rectal cancer RR=1.20, 95%CI:0.72-2.01 (P(heterogeneity)=0.21). Effect modification by various risk factors was examined. CONCLUSIONS: The results of this study suggest that high serum PTH levels may be associated with incident, sporadic CRC in Western European populations, and in particular among men. IMPACT: To our knowledge, this is the first study on PTH and CRC. The role of PTH in carcinogenesis needs to be further investigated