A bizarre foreign body in the appendix: A case report

Foreign bodies are rare causes of appendicitis and, in most cases, ingested foreign bodies pass through the alimentary tract asymptomatically. However, ingested foreign bodies may sometimes remain silent within the appendix for many years without an inflammatory response. Despite the fact that cases of foreign-body-induced appendicitis have been documented, sharp and pointed objects are more likely to cause perforations and abscesses, and present more rapidly after ingestion. Various materials, such as needles and drill bits, as well as organic matter, such as seeds, have been implicated as causes of acute appendicitis. Clinical presentation can vary from hours to years. Blunt foreign bodies are more likely to remain dormant for longer periods and cause appendicitis through obstruction of the appendiceal lumen. We herein describe a patient presenting with a foreign body in his appendix which had been swallowed 15 years previously. The contrast between the large size of the foreign body, the long clinical history without symptoms and the total absence of any histological inflammation was notable. We suggest that an elective laparoscopic appendectomy should be offered to such patients as a possible management optio

Benign blockage: gastric outlet obstruction due to a prolapsing gastric pedunculated polyp. Case report and literature review

NO ABSTRACT AVAILABLEAn 89-year-old woman was admitted to the emergency department at “Ospedale Civile Umberto I” in Lugo (Ravenna) for 1 month of vomiting, mild epigastric pain, and postprandial diarrhea without fever. Main comorbidities included chronic atrial fbrillation treated with a direct-acting oral anticoagulant, previous MI, hypertension, diabetes, and hypercholesterolemia, though despite her age the patient was autonomous in her daily activities. On admission, laboratory tests included normal WBC count, Hgb, and CRP. Abdominal X-ray demonstrated a stomach flled by ingested food (Fig. 1a) and difuse air–fuid levels accompanied by abdominal distension (Fig. 1b). A surgical consultation was requested; a CT scan was performed confrming gastric distension by ingested food (Fig. 2). Since gastric outlet obstruction was suspected, the patient was hospitalized in a medical unit, treated with NPO and IV fuids. After 2 weeks, a second surgical consultation was requested due to the recurrence of clinical symptoms with unchanged laboratory tests. An upper GI series reported normal gastric and duodenal transit (Fig. 3) while colonoscopy was negative. The patient underwent EGD that showed a 4-cm pedunculated polyp situated in the gastric antrum; the polyp prolapsed into the duodenal bulb creating a “ball valve”-type intermittent obstruction. Biopsy was consistent with a hyperplastic polyp which was endoscopically resected (Fig. 4a–c). The fnal histological report confrmed a benign lesion; the patient was discharged from the hospital without any further invasive treatment in good general condition

Multicenter Observational/Exploratory Study Addressed to the Evaluation of the Effectiveness and Safety of Pharmacological Therapy in Opioid-Dependent Patients in Maintenance Therapy in Southern Italy

A multicenter-observational study was performed to assess the effectiveness of rac-methadone, levomethadone, and buprenorphine in opioid-dependent patients in polytherapy in Southern Italy. The primary endpoint was the reduction of urinary positivity to the substances and the maintaining doses. Patients (N = 266, age = 44.80 ± 5.65, male = 79.70%, female = 20.30%) have been recruited. At recruitment, 75% of them were on treatment with rac-methadone, levomethadone, and buprenorphine/naloxone. The patients were grouped into three clusters. The levomethadone patients of Cluster A (N patients = 211), after 180 days, showed stability in urinary methadone posi-tivity, with a marked decrease in heroin −53 ± 4%, cannabinol’s −48 ± 2%, and cocaine −37 ± 6% positivity, with no differences between treatments. A lower QTcF value of 426 ± 8.4 ms was recorded in the levomethadone patients (delta = −19 ms) vs. rac-methadone, at significantly lower doses of levomethadone (−34%, −50.2% in males) (p < 0.05). The Cluster B data were collected from 37 patients, with a high prevalence of comorbidity infections (HIV/HCV/HPV), monitored for 21 months during COVID-19. High doses of levomethadone (58.33 ± 31.58 mg/day) were needed to stabilize those that were negative for opioids and cannabinoids, in contrast to the rac-methadone and buprenorphine/naloxone patients that showed positive toxicology. Eighteen patients of the Cluster C in double diagnosis (major depressive 38.90%, bipolar 27.78%, and schizophrenia 16.67%) were stabilized with high doses of racemate 97.5 ± 8 mg/day, 51.8 ± 5 mg/day of levomethadone (−46.8% vs. rac-methadone; −71% in men), and 2.5 ± 1 mg/day of buprenorphine/naloxone. Three patients in remission were treated with tapering doses of levomethadone. Significantly reduced QTcF values were recorded with levomethadone (delta −32 ms vs. rac-methadone) in the bipolar patients, as well as the schizophrenia patients in remission (delta −45.19 ms vs. rac-methadone). Our patients were safely stabilized. Levomethadone, compared to the racemate, contributes to reducing the illicit use, especially of opioids and cannabinoids at significantly lower doses with cardiovascular safety, which, in bipolar patients, is clinically significant

Copy Number Variation Analysis in Single-Suture Craniosynostosis: Multiple Rare Variants Including RUNX2 Duplication in Two Cousins With Metopic Craniosynostosis

Little is known about genes that underlie isolated single-suture craniosynostosis. In this study, we hypothesize that rare copy number variants (CNV) in patients with isolated single-suture craniosynostosis contain genes important for cranial development. Using whole genome array comparative genomic hybridization (CGH), we evaluated DNA from 186 individuals with single-suture craniosynostosis for submicroscopic deletions and duplications. We identified a 1.1 Mb duplication encompassing RUNX2 in two affected cousins with metopic synostosis and hypodontia. Given that RUNX2 is required as a master switch for osteoblast differentiation and interacts with TWIST I, mutations in which also cause craniosynostosis, we conclude that the duplication in this family is pathogenic, albeit with reduced penetrance. In addition, we find that a total of 7.5% of individuals with single-suture synostosis in our series have at least one rare deletion or duplication that contains genes and that has not been previously reported in unaffected individuals. The genes within and disrupted by CNVs in this cohort are potential novel candidate genes for craniosynostosis. (C) 2010 Wiley-Liss, Inc

Grape seed extracts modify the outcome of oxaliplatin in colon cancer cells by interfering with cellular mechanisms of drug cytotoxicity

Grape seed extracts are commonly utilized as dietary supplements for their antioxidant properties, even from cancer patients. However, whether these natural extracts interfere with chemotherapeutics utilized in colon cancer treatment is still poorly investigated. The cytotoxicity of extracts from Italia and Palieri cultivars either alone or in combination with oxaliplatin was evaluated in colon cancer cells. Grape seed extracts displayed anti-proliferative activity depending on the concentration utilized through apoptosis induction. In combination, they affected the activation of Erk1/2 and counteracted the intrinsic and the extrinsic pathway of apoptosis, the DNA damage and the generation of ROS induced by oxaliplatin. Noteworthy grape seed extracts strongly enhanced the uptake of oxaliplatin into all cells, by affecting the cell transport system of platinum. The addition of these natural extracts to oxaliplatin strongly reduced the cellular response to oxaliplatin and allowed a huge accumulation of platinum into cells. Here, we shed light on the chemical biology underlying the combination of grape seed extracts and oxaliplatin, demonstrating that they might be detrimental to oxaliplatin effectiveness in colon cancer therap

MRI analysis for Hippocampus segmentation on a distributed infrastructure

Medical image computing raises new challenges due to the scale and the complexity of the required analyses. Medical image databases are currently available to supply clinical diagnosis. For instance, it is possible to provide diagnostic information based on an imaging biomarker comparing a single case to the reference group (controls or patients with disease). At the same time many sophisticated and computationally intensive algorithms have been implemented to extract useful information from medical images. Many applications would take great advantage by using scientific workflow technology due to its design, rapid implementation and reuse. However this technology requires a distributed computing infrastructure (such as Grid or Cloud) to be executed efficiently. One of the most used workflow manager for medical image processing is the LONI pipeline (LP), a graphical workbench developed by the Laboratory of Neuro Imaging (http://pipeline.loni.usc.edu). In this article we present a general approach to submit and monitor workflows on distributed infrastructures using LONI Pipeline, including European Grid Infrastructure (EGI) and Torque-based batch farm. In this paper we implemented a complete segmentation pipeline in brain magnetic resonance imaging (MRI). It requires time-consuming and data-intensive processing and for which reducing the computing time is crucial to meet clinical practice constraints. The developed approach is based on web services and can be used for any medical imaging application

From karyotypes to precision genomics in 9p deletion and duplication syndromes

While 9p deletion and duplication syndromes have been studied for several years, small sample sizes and minimal high-resolution data have limited a comprehensive delineation of genotypic and phenotypic characteristics. In this study, we examined genetic data from 719 individuals in the worldwide 9p Network Cohort: a cohort seven to nine times larger than any previous study of 9p. Most breakpoints occur in bands 9p22 and 9p24, accounting for 35% and 38% of all breakpoints, respectively. Bands 9p11 and 9p12 have the fewest breakpoints, with each accounting for 0.6% of all breakpoints. The most common phenotype in 9p deletion and duplication syndromes is developmental delay, and we identified eight known neurodevelopmental disorder genes in 9p22 and 9p24. Since it has been previously reported that some individuals have a secondary structural variant related to the 9p variant, we examined our cohort for these variants and found 97 events. The top secondary variant involved 9q in 14 individuals (1.9%), including ring chromosomes and inversions. We identified a gender bias with significant enrichment for females (p = 0.0006) that may arise from a sex reversal in some individuals with 9p deletions. Genes on 9p were characterized regarding function, constraint metrics, and protein-protein interactions, resulting in a prioritized set of genes for further study. Finally, we achieved precision genomics in one child with a complex 9p structural variation using modern genomic technologies, demonstrating that long-read sequencing will be integral for some cases. Our study is the largest ever on 9p-related syndromes and provides key insights into genetic factors involved in these syndromes

Comparative antioxidant activity of cultivated and wild Vaccinium species investigated by EPR, human neutrophil burst and COMET assay

objectives: The Vaccinium (V.) spp. berries are considered a source of antioxidants, mainly belonging to polyphenols, specifically flavonoids and anthocyanins. Wild genotypes generally contain more antioxidants than cultivated counterparts. So, seven different antioxidants assays on extracts from cultivated and wild Vaccinium berries were performed, to evaluate their difference in terms of bioactivity on oxidative protection and minimum dosage to have a significant action. Materials and Methods: Four cell-free antioxidant assays (ABTS radical scavenging and electronic paramagnetic resonance using Fremy's salt, superoxide anion and hydroxyl radical), and three assays on human cells (two luminol amplified chemiluminescence, LACL, one on DNA damage, COMET) were used to measure the effects of cultivated blueberry (V. corymbosum) and wild bilberry (V. myrtillus) on the differently induced oxidative stress. Concentrations vs activity patterns were obtained by successive dilutions of extracts in order to identify both EC50 and minimum significant activity (MSA). Results: All the assays (except for the hydroxyl radical scavenging) showed a good relationship mainly with anthocyanin and polyphenol content and the significant greater activity of wild Vaccinium extracts. In fact, LACL data gave an EC50 of 11.8 and an MSA of 5.2 g were calculated as fresh weight dosage in cultivated berries, compared with lower doses in wild berries, EC50 of 5.7 g and MSA of 3.4 g. Conclusions: Wild Vaccinium extracts averaged 3.04 and 2.40 fold more activity than cultivated extracts by EC50 and MSA, respectively. COMET assay confirmed the stronger action on DNA protection in wild samples

The Interreg Project AdSWiM: Managed Use of Treated Wastewater for the Quality of the Adriatic Sea

The Italy-Croatia Cross Border Cooperation (CBC) Programme is the financial instrument supporting the cooperation between the two European Member States overlooking the Adriatic Sea. The first call for proposals was launched in 2017, identifying four priority axes of intervention. Subsequently, in 2019, the kick-off of the AdSWiM project “Managed use of treated urban wastewater for the quality of the Adriatic Sea” took place in Udine (IT). Adriatic marine waters are generally classified as good to excellent based on the Bathing Water Directive (2006/7/EC). Nevertheless, issues of low productivity or the lack of nutrients have been often suggested, especially on the Italian side. The project addresses the question of whether wastewater treatment plants (WWTPs) discharging to the sea, after applying appropriate pollution control and management technologies, can modulate the nutrient content of their effluents to support localized depleted areas. This idea is borrowed from one of the motivations that support the reuse of treated wastewater for irrigation, thus leading to the return of nutrients (nitrogen, phosphorus, potassium, etc.) to natural biogeochemical cycles. However, the hypothesis of modulating the nutrient composition of wastewater opens up to several critical aspects, including legislative and technological ones. Being aware of the delicate environmental implications, we have undertaken the project involving WWTPs, research centers, municipalities, and legal experts with the aim of investigating in detail the problems related to wastewater reuse, especially with regard to the content of nutrients. Our experimental approach aimed to evaluate appropriate and possibly new treatment technologies to reduce the microbial load and to implement chemical and microbiological tests on the treated wastewater. Results have shown that it can be tricky to draw decisive conclusions because (i) the wastewater management systems differ between the two sides of the Adriatic sea due to the different levels of technological development of WWTPs; (ii) the Italian and Croatian coasts deeply differ in geographic characteristics (i.e., topography, orography, current circuits, presence of rivers) and anthropogenic pressure (i.e., exploitation levels, population density); (iii) the new treatment technologies to lower bacterial contamination need further efforts to raise their technological level of readiness (TRL) and make them implementable in the existing WWTPs. However, in terms of chemical control methodologies, the proposed sensors and biosensors gave positive results, managing to decrease the detection limits for the measured parameters, and the tested technologies for microbiological monitoring were also effective. In particular, the latter was carried out by using recent molecular biology techniques, capable of resolving the microbiota in treated wastewater, which emerged to be strictly related to the features of the WWTPs