Gastric mucosal lesions after Billroth I resection for benign gastric ulcer

Les lésions histologiques prédominent dans la région périanastomotique: importance de la biopsie en cours de gastroscopi

"Genetically modified" spider-like oligothiophenes : electron properties and electropolymerization

Multithiophene-based semiconductors are a virtually boundless class of molecular functional materials with very promising potential applications in a variety of fields, like electronics, energetics, sensoristics. Starting from our previous exhaustive work on \u201cspider-like\u201d branched oligothiophenes, affording a reliable rationalization of the relationships between structure and electronic properties1,2, we have recently developed many structure modifications with respect to the original all-thiophene systems, aiming to achieve finer and wider modulation of both the HOMO and LUMO levels. In particular, the \u201ccore\u201d of our oligothiophene systems has been modified by inserting appropriate building blocks of different electron richness, asymmetrically affecting both the LUMO and HOMO energy levels and localization along the main conjugated backbone, thus achieving one more freedom degree in tuning the electron properties of the molecule. A wide series of \u201cgenetically-modified\u201d spider-like oligothiophenes and their electrodeposited conducting polymers have been investigated by CV and EIS, focusing on the effect of core modification at constant thiophene side chains, and on the effect of increasing length and/or branching in the thiophene side chains at constant modified core. The core modification appears to be much more effective on the HOMO and LUMO energy levels and positions, while effective conjugation in the thiophene side chains is more determining on the oligomerization ability. The exhaustiveness of our investigation affords interpretative and predictive criteria which could usefully exploited in target-oriented molecular design

"Genetically modified" spider-like oligothiophenes : electron properties and electropolymerization

Multithiophene-based semiconductors are a virtually boundless class of molecular functional materials with very promising potential applications in a variety of fields, like electronics, energetics, sensoristics. Starting from our previous exhaustive work on \u201cspider-like\u201d branched oligothiophenes, affording a reliable rationalization of the relationships between structure and electronic properties1,2, we have recently developed many structure modifications with respect to the original all-thiophene systems, aiming to achieve finer and wider modulation of both the HOMO and LUMO levels. In particular, the \u201ccore\u201d of our oligothiophene systems has been modified by inserting appropriate building blocks of different electron richness, asymmetrically affecting both the LUMO and HOMO energy levels and localization along the main conjugated backbone, thus achieving one more freedom degree in tuning the electron properties of the molecule. A wide series of \u201cgenetically-modified\u201d spider-like oligothiophenes and their electrodeposited conducting polymers have been investigated by CV and EIS, focusing on the effect of core modification at constant thiophene side chains, and on the effect of increasing length and/or branching in the thiophene side chains at constant modified core. The core modification appears to be much more effective on the HOMO and LUMO energy levels and positions, while effective conjugation in the thiophene side chains is more determining on the oligomerization ability. The exhaustiveness of our investigation affords interpretative and predictive criteria which could usefully exploited in target-oriented molecular design

Relapsing bloodstream infections during treatment of acute leukemia

Acute leukemia (AL) patients may experience more than one episode of bloodstream infection (BSI) caused by the same pathogen during the entire chemotherapy program. In order to identify factors influencing BSI recurrence (R-BSI) during subsequent phases of treatment, we analyzed all BSIs occurring to consecutively treated AL patients during a period of active epidemiologic surveillance at our institution between 2004 and 2011. Two hundred and fifty BSIs were observed in 138 patients receiving more than 1 cycle of chemotherapy. BSI due to the same pathogen recurred in 39/138 (28.3 %) patients. Gram-negative rods (GNRs) accounted for 59.6 % and Gram-positive cocci (GPCs) for 34.4 % of BSI. Four pathogens were involved in R-BSI: Escherichia coli, Pseudomonas aeruginosa, coagulase-negative staphylococci, and Streptococcus viridans. GNRs were significantly more frequent among R-BSI compared to non-relapsing BSI (nR-BSI) [69/94 (73.4 %) vs 70/156 (50.6 %), p < 0.0001]; in particular, E. coli accounted for 67 % of R-BSI vs 32.1 % of nR-BSI (p < 0.0001). Receiving more than four chemotherapy courses and having an extended spectrum β-lactamase (ESBL)-producing E. coli BSI at any time of treatment were significantly associated to R-BSI. A trend toward a higher mortality among R-BSI patients in comparison with nR-BSI was observed (17.9 and 7.1 %, respectively, p = 0.12). Among AL patients, R-BSI is a frequent phenomenon, which may contribute to the shift of epidemiology toward GNR and to a higher mortality. This should significantly impact the strategies of antibiotic prophylaxis and treatment in patients with AL

PF688 JAK2 ALLELIC RATIO IMPACTS ON VASCULAR EVENT IN MYELOFIBROSIS BY INCREASING THE RISK OF THROMBOSIS. A SINGLE CENTER EXPERIENCE ON 150 PATIENTS

Background Vascular complications are a recognized cause of morbidity and mortality in Myelofibrosis (MF). However, the mechanism underlying both thrombosis and bleeding as well as which risk factors can predict them remain poorly understood. Aims To evaluate the clinical characteristics, incidence and prognostic factors for vascular events (VE) in a cohort of MF patients (pts). Methods In 150 pts consecutively diagnosed with MF from 2000 to 2018 at the Hematology Unit of ASST Spedali Civili in Brescia major vascular complications (AMI, stroke, TIA, pulmonary embolism (PE) and vascular thromboses, CNS or GI bleeding, haemorrhagic events requiring active treatment) were retrospectively analyzed. Parameters tested as potentially related to VE were: age, sex, mutational status, previous thromboses, cardiovascular risk factors, hematologic parameters at diagnosis, IPSS, cytoreductive therapy and splenectomy. A competing-risk analysis was carried out to identify possible risk factors associated with VE. Results Clinical characteristics of the cohort are detailed in table 1, according to the occurrence of VE. Overall, 68 pts (45%) received antiplatelet agents after MF diagnosis, in 17 cases due to a previous history of thrombosis. After a median follow-up of 45.5 months (5-488) from diagnosis, 34 VE (15 bleedings and 19 thrombosis) were recorded in 30 pts. The cumulative incidence of vascular complications was of 27% at 10 years, accounting for 3.55 vascular events per 100 person-years. Notably, all 4 pts who started an antiplatelet therapy after thrombosis have developed a hemorrhagic event. Thromboses were venous in 11/19 pts (6 splanchnic, 2 deep venous thromboses, 2 PE), whereas arterial in 8 cases (3 AMI, 2 strokes, 1 TIA, 2 peripheral arterial occlusion disease). Bleedings occurred in 40% pts at GI tract, 30% in CNS and 10% in renal district, while in 2 pts after splenectomy. At last follow-up, 51 pts had died, in 5 cases due to VE (2 AMI and 3 hemorrhage). An MF treatment was ongoing in 26/30 pts at the time of VE. Among parameters analysed, a Jak2 allelic ratio higher than 75% was associated with VE in MF (HR2.6; 95%CI 1.1-6.5; p 0.04). Its influence on vascular complications reflects its impact on thrombosis (p 0.005), while a high Jak2 allelic ratio seems not to be related to bleeding (p 0.1). At univariate analysis also no antiplatelet agents treatment correlated with VE (p 0.02). However, only the JAK2 allele burden maintained the statistical significance in predicting vascular complications by multivariable analysis (HR4.3; 95%CI 1.8-9.6,p 0.001). No one of the other parameters investigated impacted on the occurrence of both thromboses and bleeding. By considering thrombotic events only, the risk was significantly higher also for patients with a previous history of thrombosis (p 0.05) but again, by multivariate analysis, only a Jak2 allele burden higher than 75% proved significantly related to thrombosis (HR 6; CI95% 1.9-18.4;p 0.002; Fig1). None of the clinical and molecular parameters analyzed could predict bleeding, except for having less than 100.000 platelets per microliter at diagnosis at univariate analysis (p 0.03). Conclusion In our study, a higher Jak2 allele ratio at diagnosis was the only predictive factor for VE, in particular thrombosis, confirming what described in Essential Thrombocythemia and Polycythemia Vera. Instead, no one of the possible risk factors analyzed could be associated to bleeding events. Studies on a larger population are needed to confirm these data, which would suggest to adopt a more strict anti-thrombotic surveillance in this subset of pts

Validation of the \u201cfitness criteria\u201d for the treatment of older patients with acute myeloid leukemia: A multicenter study on a series of 699 patients by the Network Rete Ematologica Lombarda (REL)

Objectives: Treatment of older patients with acute myeloid leukemia (AML) is still controversial. To facilitate treatment decisions, the \u201cfitness criteria\u201d proposed by Ferrara et al. (Leukemia, 2013), including age > 75 years, performance status and comorbidities, were verified retrospectively in 699 patients with AML (419 de-novo, 280 secondary AML), diagnosed at 8 Hematological Centers (REL). Methods: Patients were categorized in FIT to intensive chemotherapy (i-T) (292, 42.5%), UNFIT to i-T (289, 42.1%), or unfit even to non-intensive therapy (non i-T) (FRAIL) (105, 15.3%). Biological characteristics and treatment actually received by patients [i-T, 274 patients (39.2%); non i-T, 134 (19.2%), best-supportive care (BSC), 291 (41.6%)] were recorded. Results: \u201cFitness criteria\u201d were easily applicable in 98.1% of patients. Overall concordance between \u201cfitness criteria\u201d and treatment actually received by patients was high (79.4%), 76% in FIT, 82.7% in UNFIT and 80% in FRAIL patients. Fitness independently predicted survival (median survival: 10.9, 4.2 and 1.8 months in FIT, UNFIT and FRAIL patients, respectively; p = 0.000), as confirmed also by multivariate analysis. In FRAIL patients, survival with any treatment was no better than with BSC, in UNFIT non i-T was as effective as i-T and better than BSC, and in FIT patients i-T was better than non i-T or BSC. In addition, a non-adverse risk AML, an ECOG PS <2, and receiving any treatment other than BSC had a favorable effect on survival (p < 0.001). Conclusion: These simple \u201cfitness criteria\u201d applied at the time of diagnosis could facilitate, together with AML biologic risk evaluation, the choice of the most appropriate treatment intensity in older AML patients