New insights and evidence on “Food Intolerances”: non-celiac gluten sensitivity and nickel allergic contact mucositis

The clinical examination of patients often comes across the observation of the existence of a close relationship between the ingestion of certain foods and the appearance of various symptoms. Until now, the occurrence of these events has been loosely defined as food intolerance. Today these conditions should more properly be called Adverse Food Reactions (AFRs) which can consist of the presentation of a wide variety of symptoms which are commonly identified as Irritable Bowel Disease (IBS) syndrome. In addition, systemic manifestations such as neurological, dermatological, joint and respiratory disorders may also occur in affected patients. Although the etiology and pathogenesis of some of them are already known, others, such as non-celiac gluten sensitivity and adverse reactions to nickel-containing foods, are not yet fully defined. The study was aimed at evaluating the relationship between the ingestion of some foods and the appearance of some symptoms, clinical improvement and detectable immunohistochemical alterations after a specific exclusion diet. One hundred and six consecutive patients suffering from meteorism, dyspepsia and nausea following the ingestion of foods containing gluten or nickel were subjected to the GSRS questionnaire, modified according to the "Salerno expert criteria". All patients underwent detection of IgA antibodies to tissue transglutaminase, oral mucosal patch test with gluten and nickel (OMPT), and EGDS including biopsies. Our data show that GSRS and OMPT, the use of APERIO CS2 software and the endothelial marker CD34 could be suggested as useful tools in the diagnostic procedure of these new pathologies. Larger, multi-center clinical trials could be helpful in defining these emerging clinical problems

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

Ignition Process in Non-Conventional Combustion System

The main pollutants responsible for the global and local environmental impact are species such as NOx, soot particles, CO2, SOx, polycyclic aromatic hydrocarbons (PAHs) formed during combustion processes. The interest of the scientific community is focused on identifying new technologies that enable more efficient energy production coupled with a simultaneous reduction of pollutants emission. In this background MILD combustion is one of the most promising new technology. It envisages the use of highly diluted and preheated mixtures. The modest temperature gradient due to high mixtures heat capacity implies that system working temperature is not crucial for the formation of pollutant species, while the high inlet temperatures and the uniform conditions in the combustion chamber insures high thermal efficiency. Mild combustion is a technology of interest in many applications, from industrial furnaces for the processing of raw materials to gas turbine combustors, but also in afterburners as a process of pollutants abatement. The high mixture inlet temperatures and dilution levels strongly affect the evolution of the combustion process. The massive employment of such technology in industrial plants is still not developed because of the lack of basic knowledge concerning the phenomenologies that accompanied such non conventional combustion conditions. In this background, it is necessary a study on the basic aspects of the process in consideration of the huge difference with traditional combustion system. In literature there are a lot of works relative to such new process, but they are realized on pilot or industrial facilities where the evolution of the combustion process is strongly affected by the interaction between kinetic and fluid-dynamic aspects. In this thesis the approach to the problem is original since model reactors have been used to characterize the novel technology. They allow to study the mere kinetic evolution of the oxidation process since the fluid-dynamic conditions are extremely simplified and they do not affect the oxidation process. The experimental work was carried out in a tubular flow reactor, at atmospheric pressure and several diagnostic techniques were used. The attention was devoted to the ignition process of methane and its derived fuel mixtures in such highly diluted and preheated conditions. It is worth noting that the thesis represents an important contribute since the lack of experimental data in operative conditions typical of Mild combustion in particular way at atmospheric pressure. A rich experimental database relative to auto-ignition times and reactivity maps at atmospheric pressure in such working conditions are the main results of such work. In parallel with the experimental work, a deepen numerical analysis was carried out by means of commercial software and kinetic detailed mechanisms in order to study the evolution of the oxidation process. It came out that they fail to correctly predict the main features of the combustion process under diluted and pre-heated mixture conditions. Experimental data clearly show that the competition between the oxidation and recombination channels is not properly described by the detailed kinetic schemes. In such context, it is worth noting that experimental database obtained in this work is a valid reference for tuning and updating the detailed kinetic mechanisms

Chapter 8 - New evidence in the diagnostic procedures of celiac disease. Has time come to change the gold standard?

The diagnosis of celiac disease (CD) is based on three parameters: clinical case identification, serological screening and confirmation test. In agreement with the last European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) criteria, if clinical spectrum and screening tests are suggestive of CD, the evidence of villous atrophy is sufficient to confirm the diagnosis. To complete the diagnostic work-up, a favourable response to the treatment with a gluten-free diet (GFD) is mandatory. However, total villous atrophy is the extreme condition of a modifying spectrum of intestinal damage that can be revealed only in the severe forms of CD. Of consequence, if the histological analysis is the only confirmation test performed, it is possible to highlight false negative results especially in case of patchy atrophy or in absence of intestinal damage, a feature easily found in latent CD. The technical difficulties (sufficient size of the biopsy fragments, correct orientation and cut), the subjective evaluation and the occurrence of villous atrophy in other pathological conditions (e.g., intolerance to proteins other than gluten and tropical sprue) add further limitations to the histology-based diagnosis of CD. In this scenario, HLA-DQ2 and -DQ8 haplotypes have a high negative predictive value and, thus, their absence allows to exclude CD. Instead, the presence of circulating IgA or IgG (respectively, in immunocompetent individuals and in patients with selective IgA deficiency) anti-endomysial (EMA) and/or anti-tissue transglutaminase (anti-tTG) and their disappearance after a GFD, supports the diagnosis. The new developed IgA anti-actin and IgA/IgG anti-deamidated gliadin peptides tests could add further information for the diagnosis and monitoring of CD patients. However, if used alone, the screening tests are insufficient to diagnose CD. On the other hand, it has been demonstrated that EMA and anti-tTG can be detected in culture media of intestinal biopsies from untreated CD patients, as well as in culture media of intestinal biopsies from treated CD patients after in vitro exposure to the specific antigenic stimulus. Since the sensitivity of the organ culture seems to be greater than the histological analysis, this system has been recently proposed as confirmation test in the diagnostic work-up of CD, even if some conflictual opinions have limited its widespread use. In this section, the advances recently achieved to simplify the management and/or improve the performance of both screening and confirmation procedures of CD diagnosis are reported, critically evaluated and compared between them and with each older