Robot-assisted Heller myotomy for achalasia

Achalasia is a rare neuromuscular esophageal disorder in children. There are many surgical options to treatment including botulinum toxin (Botox) injections, oral pharmacologic therapies with nitrates and calcium channel blockers, pneumatic dilation (PD), and surgical myotomy (open surgery, endoscopy, laparoscopy and recently robotic approach). In pediatric age, usually, Heller's myotomy is the main choice. Laparoscopic approach is known and standardized. Few robotic have been published. We decided to report our first case to share our experience with scientific community

Rapid and comprehensive evaluation of (poly)phenolic compounds in pomegranate (punica granatum L.) juice by UHPLC-MSn

The comprehensive identification of phenolic compounds in food and beverages is a crucial starting point for assessing their biological, nutritional, and technological properties. Pomegranate (Punica granatum L.) has been described as a rich source of (poly)phenolic components, with a broad array of different structures (phenolic acids, flavonoids, and hydrolyzable tannins) and a quick, high throughput, and accurate screening of its complete profile is still lacking. In the present work, a method for UHPLC separation and linear ion trap mass spectrometric (MSn) characterization of pomegranate juice phenolic fraction was optimized by comparing several different analytical conditions. The best solutions for phenolic acids, anthocyanins, flavonoids, and ellagitannins have been delineated and more than 70 compounds have been identified and fully characterized in less than one hour total analysis time. Twenty-one compounds were tentatively detected for the first time in pomegranate juice. The proposed fingerprinting approach could be easily translated to other plant derived food extracts and beverages containing a wide array of phytochemical compounds

IL DOLORE ADDOMINALE ACUTO NEL BAMBINO: ASPETTI EZIOPATOLOGICI, CLINICI, CHIRURGICI ED OUTCOME.

Introduzione. Il dolore addominale acuto rappresenta una importante causa di accesso al Pronto Soccorso e una condizione di notevole difficoltà diagnostica. . Obiettivi dello studio. Lo scopo di questa tesi è definire la prevalenza delle patologie che causano dolore addominale neo bambini, con una particolare attenzione all’ impatto della terapia chirurgica e confrontare la prevalenza delle suddette patologie e degli interventi chirurgici eseguiti. Materiali e metodi. Questo è uno studio di coorte retrospettivo dei pazienti con dolore addominale giunti presso il DEA dell’AOUP dal 1 Gennaio 2011 al 31 Dicembre 2016. I dati, entrati a far parte del database, sono stati acquisiti dal sistema informatico del DEA e di tutti i pazienti sono state analizzate le informazioni riguardanti le cartelle cliniche includendo anche gli esami strumentali e laboratoristici eseguiti. Questi pazienti sono stati poi contattati per l’esecuzione di un follow-up telefonico

Pediatric circumcision using n-butyl-cyanoacrylate plus MS monomer. Bacteriostatic and cosmetic advantages over suture.

Purpose: The aim of this study is to compare the use of n-butyl-cyanoacrylate plus MS monomer (NBCA-MS) glue with suture in pediatric circumcision. Materials and Methods: Between January 2013 and January 2017, 160 consecutive pediatric patients (range 18 months–14 years, mean 7.5 years) underwent circumci- sion. Eighty patients were randomly allocated to the glue group and 80 to the suture group. In the glue group wound margins were approximated by n-butyl-cyanoacrylate plus MS monomer (NBCA-MS) glue while in the suture group interrupted 5-0 poly- glycolic acid stitches were used. Each group was randomized into two subgroups: forty patients (subgroup A) received antibiotics (6 days of amoxicillin/clavulanic acid) and 40 (subgroup B) patients did not receive any postoperative drug. Operative time, pain score, postoperative complications and cosmesis were statistically evaluated. Results: The operation time was significantly higher in the suture group; pain severity and duration were not significantly lower in the glue group. In the 80 patients of the glue group no complications occurred; in the suture group 20 (25%) cases of wound edema and 6 (7.5%) infections occurred. Cosmesis evaluation 1 and 6 months postoperatively showed significantly better results in the glue group. Conclusion: Our study demonstrates that NBCA-MS glue wound closure in pediatric circumcision is a safe and effective technique

An unusual plexiform neurofibroma confused with a vascular malformation: a case report

ABSTRACT Introduction: Neurofibromatosis type I, or Von Recklinghausen disease, is a multisystem disorder that primarily involves the skin and nervous system. Plexiform neurofibromas are one of the most pathognomonic and often the most disabling feature of the disease; generally benign, these lesions might degenerate into neurofibrosarcoma. They grow along peripheral nerves, and can be divided, on histological and biological bases, into two different groups: nodular / mass neurofibromas and Plexiform neurofibromas (superficial and deep). Despite the unique appearance of deep plexiform neurofibroma, especially on T2-weghted MRI, cutaneous and subcutaneous forms are more difficult to diagnose. The imaging findings of the superficial forms are different from the imaging characteristics of the deeper lesions and can be confused with a low-flow vascular malformation. Case Report: We report a 2-yearold boy, with diagnosis of neurofibromatosis type I, who came to our attention with a palpable swelling on the left nuchal region exhibiting ultrasonographical characteristics of a venolymphatic malformation

Solid state lactic acid fermentation: A strategy to improve wheat bran functionality

Wheat bran, a by-product produced in huge amount during cereal milling, is today largely unexploited because of its poor suitability as food ingredient. Solid-state fermentation (SSF) using a Lactobacillus rhamnosus strain was applied to wheat bran and its influence on bioactive compounds (free and bound phenolic acids) and antioxidant activity were evaluated. Moreover, the phytic acid (PAc) degradation and arabinoxylans (WEAX) solubilization properties were studied: the SSF treatment resulted in an almost 37% decrement and a three times increment of PAc and WEAX, respectively. Finally, in order to get the bigger picture, microbial metabolites and the volatile profile of fermented wheat bran were characterized, showing amino acids and lipids metabolites and a complex aroma profile. Overall, lactic acid fermentation can be considered a valuable pre-treatment for the valorisation of cereal by-products

Hydrolysed fumonisin B1 and N-(deoxy-D-fructos-1-yl)-fumonisin B1: stability and catabolic fate under simulated human gastrointestinal conditions

Food processing may induce thermal degradation of fumonisins in corn via Maillard-type reactions, or alkaline hydrolysis via loss of the two tricarballylic acid moieties. In the former case, N-(1-deoxy-D-fructos-1-yl)-fumonisin B1 (NDF) can be formed, while the latter derivative is called hydrolysed fumonisin B1 (HFB1). The aim of this study was to deepen the knowledge about the gastrointestinal stability of HFB1 and NDF in humans. Due to the lack of standard, NDF was chemically synthesised and cleaned up in high purity to be used for further experiments. While NDF is already partially cleaved (about 41%) during simulated digestion, it remained rather stable towards human colon microflora. In contrast to this, HFB1 is partially metabolised by the colon microflora to unknown compounds after 24 h of fermentation, as seen by a loss of about 22%. Concluding, the cleavage of NDF during digestion as well as the likely metabolisation of HFB1 emphasise the need for animal trials to ascertain their toxicity in vivo

Melanoma in children, adolescents and young adults: anatomo-clinical features and prognostic study on 426 cases

Purpose: This study was conducted to determine the difference in anatomo-pathological and prognostic features of cutaneous melanoma in children, adolescents and young adults. Methods: This is a retrospective review on 383 young patients ≤ 39 years of age with cutaneous melanoma, in a period from 2006 to 2016 in Area Vasta Nord Ovest, Tuscany, Italy. We subdivided patients in three groups (children ≤ 14 years, adolescents 15–21 years, young adults 22–39 years). We correlated all the anatomo-pathological parameters with age groups. Results: We identified a total of 426 cases of cutaneous melanoma on an overall total of 383 patients. Mean age at diagnosis for all the patients ≤ 39 years of age was 31.2 years: in group A was 11.2 years, in group B 19.2 years and in group C 32.5 years. Incidence, in the subjects between 0 and 14 years, is 14 cases per million inhabitants, between 15 and 21 years of 145, and between 22 and 39 years of 394. Global incidence was 1.6 case per million for group A, 8.9 cases per million for group B, 105 cases per million for group C. No statistically significative correlation could be described for clinical parameters and age groups. Conclusions: Incidence of melanoma in our casuistry results as the highest in the world. These data open new study for this kind of cancer

Ultra-HPLC–MSn(Poly)phenolic Profiling and Chemometric Analysis of Juices from Ancient Punica granatum L. Cultivars: A Nontargeted Approach

This study deals with the qualitative characterization of the phenolic profile of pomegranate juices obtained from ancient accessions. Composition data, together with genetic, morphological, and agronomical parameters, may lead to a full characterization of such germplasm, with the aim of its retrieval and biodiversity valorization. Environmental adaptation, indeed, may contribute to an enrichment of the phenolic content in pomegranate, with important effects on its nutritional properties. More than 65 punicalagins, ellagic acid derivatives, flavonoids, anthocyanins, and phenylpropanoids were simultaneously detected from four centuries old Punica granatum L. ecotypes from northern Italy and compared with those of P. granatum cv. Dente di Cavallo, a widely cultivated Italian cultivar, using a simple ultra-HPLC (uHPLC) separation and MS(n) linear ion trap mass spectrometric characterization. Fingerprinting phytochemical discrimination of the accessions was obtained by chemometric analysis despite their limited geographical distribution, confirming the great intraspecific variability in pomegranate secondary metabolism. The combined recourse to uHPLC-MS(n) qualitative fingerprinting and multivariate analysis may represent a useful tool for the discrimination and selection of pomegranate germplasm with specific properties related to polyphenolic content