Tamoxifen in treatment of hepatocellular carcinoma: a randomised controlled trial

Background Results from small randomised trials on tamoxifen in the treatment of hepatocellular carcinoma (HCC) are conflicting, We studied whether the addition of tamoxifen to best supportive care prolongs survival of patients with HCC. Methods Patients with any stage of HCC were eligible, irrespective of locoregional treatment. Randomisation was centralised, with a minimisation procedure accounting for centre, evidence of disease, and time from diagnosis. Patients were randomly allocated best supportive care alone or in addition to tamoxifen, Tamoxifen was given orally, 40 mg per day, from randomisation until death. Results 496 patients from 30 institutions were randomly allocated treatment from January, 1995, to January, 1997. Information was available for 477 patients. By Sept 15, 1997, 119 (50%) of 240 and 130 (55%) of 237 patients had died in the control and tamoxifen arms, respectively. Median survival was 16 months and 15 months (p=0.54), respectively, No differences were found within subgroups defined by prognostic variables. Relative hazard of death for patients receiving tamoxifen was 1.07 (95% CI 0.83-1.39). Interpretation Our findings show that tamoxifen is not effective in prolonging survival of patients with HCC

Prospective validation of the CLIP score: a new prognostic system for patient with cirrhosis and hepatocellular carcinoma

Prognosis of patients with cirrhosis and hepatocellular carcinoma (HCC) depends on both residual liver function and tumor extension. The CLIP score includes Child-Pugh stage, tumor morphology and extension, serum alfa-fetoprotein (AFP) levels, and portal vein thrombosis. We externally validated the CLIP score and compared its discriminatory ability and predictive power with that of the Okuda staging system in 196 patients with cirrhosis and HCC prospectively enrolled in a randomized trial. No significant associations were found between the CLIP score and the age, sex, and pattern of viral infection. There was a strong correlation between the CLIP score and the Okuda stage, As of June 1999, 150 patients (76.5%) had died. Median survival time was 11 months, overall, and it was 36, 22, 9, 7, and 3 months for CLIP categories 0, 1, 2, 3, and 4 to 6, respectively. In multivariate analysis, the CLIP score had additional explanatory power above that of the Okuda stage. This was true for both patients treated with locoregional therapy or not. A quantitative estimation of 2-year survival predictive power showed that the CLIP score explained 37% of survival variability, compared with 21% explained by Okuda stage. In conclusion, the CLIP score, compared with the Okuda staging system, gives more accurate prognostic information, is statistically more efficient, and has a greater survival predictive power. It could be useful in treatment planning by improving baseline prognostic evaluation of patients with RCC, and could be used in prospective therapeutic trials as a stratification variable, reducing the variability of results owing to patient selection

La riabilitazione della disfagia: presupposti valutativi

The aspiration of part of the bolus in the airways is the element to define as subject as dysphagic, but the knowledge of this data does not allow to plan a correct rehabilitation program

Aspetti nutrizionali e prevalenza della sindrome metabolica nei pazienti con colite ulcerosa

La colite ulcerosa (CU) è una malattia infiammatoria cronica intestinale in cui si alternano periodi di attività della malattia a periodi di remissione. La sintomatologia intestinale legata alla flogosi conduce spesso a modifiche dello stile di vita alimentare che frequentemente si protraggono anche in fase di remissione con conseguente rischio di malnutrizione. Lo scopo del nostro studio è valutare nei pazienti affetti da CU la presenza di possibili deficit nutrizionali e la prevalenza della sindrome metabolica (SM), entità clinica sempre più frequente e legata anche ad uno scorretto stile di vita alimentare. Sono stati arruolati 43 pazienti consecutivi (M/F=25/18, età mediana 44 anni) affetti da CU. Sono stati inclusi solo i pazienti in fase di remissione o lieve attività di malattia, in accordo con l’Ulcerative Colitis Disease Activity Index (UCDAI). Tutti i pazienti erano in trattamento con mesalazina. La diagnosi di SM è stata effettuata in accordo con l’ATP III (Adult Treatment Panel III) del 2001, modificato secondo l’ADA 2003. Sono stati valutati vari parametri laboratoristici e antropometrici. E’ stato somministrato a tutti i pazienti un diario alimentare per la registrazione di ogni singolo alimento, quattro giorni su sette. La stima del fabbisogno calorico giornaliero è stata effettuata in base all’attività fisica e al peso corporeo ideale, secondo Broca. L’introito giornaliero dei singoli nutrienti è stato rapportato ai Livelli di Assunzione Giornalieri Raccomandati di Nutrienti (L.A.R.N.) per la popolazione italiana, revisione del 1996. E’ stato usato il programma Winfood Light per la valutazione nutrizionale. 12 pazienti (27.9%) assumevano dieta normocalorica, 17 (39.5%) ipocalorica, 14 (32.6%) ipercalorica. La SM è risultata presente in 13 pazienti (30.2%), età mediana 52 anni. L’apporto di fibre è risultato al di sotto di 30 g/die, mediamente 15.9 g/die. Il rapporto proteine animali/vegetali è risultato al di sopra di quello consigliato, mediamente 2.5. Gli acidi grassi polinsaturi sono risultati al di sotto del valore soglia (4.7%). L’assunzione di vitamina A, calcio e zinco è risultata mediamente più bassa, con una correlazione statisticamente significativa all’analisi multivariata tra SM e bassi livelli di assunzione di zinco

Un caso di colestasi intraepatica benigna ricorrente. una possibile trasmissione autosomica dominante.

La colestasi intraepatica benigna ricorrente (BRIC o Summerskil syndrome) è una rara causa di colestasi con trasmissione ereditaria a carattere autosomico recessivo o sporadico, caratterizzata da episodi ricorrenti di intenso prurito e ittero, che possono presentarsi a qualsiasi età e che si risolvono spontaneamente senza creare grave danno epatico. Presentiamo il caso di un uomo di 46 anni ammesso alla nostra Divisione di Gastroenterologia per episodi autorisolventesi di dolore addominale localizzato in epigastrio associato a febbre e vomito e per la recente comparsa, dopo assunzione di antidolorifici e antibiotici, di ittero ed intenso prurito. Gli esami di laboratorio mostravano ipertransaminasemia, aumento della fosfatasi alcalina (ALP) senza aumento della gammaglutamiltransferasi (GGT), iperbilirubinemia e aumento della colalemia. Tutte le cause virali, tossico-metaboliche, autoimmuni di epatopatia venivano escluse. Venivano praticate una Colangio-Risonanza Magnetica e una ColangioPancreatografia Retrograda Endoscopica (ERCP) che non evidenziavano ostruzioni delle vie biliari. Veniva infine effettuata una biopsia epatica che mostrava solo un quadro di colestasi intraepatica. Veniva dimesso con la diagnosi di BRIC e iniziava terapia con colestiramina e naloxone con rapida riduzione della citolisi e graduale discesa dell’ALP e della bilirubina. Nei quattro mesi successivi si verificava la completa normalizzazione clinico-laboratoristica. Dopo sette anni di completo benessere si aveva un nuovo episodio di ittero colestatico con conseguente ricovero in Divisione Chirurgica, dove veniva praticata una colecistectomia, nonostante la pregressa diagnosi di BRIC. All’esame macroscopico non vi era evidenza di calcoli in colecisti. La biopsia epatica, praticata in corso di intervento, confermava il quadro istologico precedente. Da allora il paziente è rimasto asintomatico, ma all’anamnesi familiare è emerso che anche due fratelli sono stati colecistectomizzati per ittero colestatico, senza evidenza di colelitiasi e che il figlio, all’età di 18 anni, ha presentato un episodio autorisolventesi di ittero e dolore addominale

Mesoporous Titanium Dioxide Thin Films on Quartz via Electrochemical Anodisation Process

Titanium dioxide (TiO2) thin films were prepared by means of electrochemical anodisation or anodic spark deposition (ASD) from thin and flat metallic titanium (Ti) films pre-deposited on high quality quartz substrates by electron beam evaporation. AFM analysis indicates the formation of uniform mesoporous layers and a definite increase about 50% of the film thickness upon anodisation and about 90% upon annealing. Anodised mesoporous TiO2 films have been characterized by Raman spectroscopy, which indicates the presence of well-defined peaks related to anatase structure. Phase transformation from anatase to rutile was observed after annealing at temperatures up to 900\ub0C for 3h

Mesoporous Titanium Dioxide Thin Layers for Gas Sensor Applications: Vacuum Deposition and Electrochemical Anodization

Titanium dioxide (TiO2) thin films were prepared by means of Anodic Spark Deposition (ASD) from thin and flat metallic titanium (Ti) films pre-deposited on high quality quartz slides by electron beam evaporation. AFM analysis indicates the formation of uniform mesoporous layers and a definite increase (about 50%) of the film thickness upon anodisation. The oxide mesoporous films have been characterized by XPS and Raman spectroscopy. Raman spectra of mesoporous TiO2 films were characterized by well-defined peaks related to anatase structure. An incomplete phase transition from anatase to rutile was observed upon annealing at temperatures up to 900 \ub0C for 3h

Circulating microRNAs in Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a pathology characterized by chronic inflammation and skin lesions. The molecular basis of the inflammatory network remains unclear; however, since microRNAs (miRNAs) are involved in the modulation of inflammation, the composition of a micro-transcriptome RNA library using the blood of HS patients was analysed here. The total miRNA expression profiles of miRNAs from HS patients was assayed by real-time qPCR. Here, compared to healthy controls, miR-24-1-5p, miR-146a-5p, miR26a-5p, miR-206, miR338-3p, and miR-338-5p expression was found significantly different in HS. Knowing the significance of the miRNA mechanism in inflammatory and immune progression, we suggest that miRNA profiles found in HS patients can be significant in understanding the pathogenesis modality and establishing efficient biomarkers for HS early diagnosis. In particular, miR-338-5p was closely related to HS invasiveness and production of cytokines and was atypically overexpressed. miR-338-5p may represent a good promise as a non-invasive clinical biomarker for HS

Early Treatments of Fragile Children with COVID-19—Results of CLEVER (Children COVID Early Treatment), a Retrospective, Observational Study

(1) Background: SARS-CoV-2 infection is notably mild in children, though comorbidities may increase the risk of hospitalization and may represent a risk for increased disease severity. There is an urgent need for targeted therapies with an acceptable efficacy and safety profile. To date, most of the medicines for COVID-19-specific treatment are prescribed off-label for children due to a lack of clinical trials and consequent evidence in this population. (2) Methods: This was a retrospective, observational study investigating the safety of treatments for the prevention of severe COVID-19 in fragile pediatric patients who received monoclonal antibodies and antivirals for mild-to-moderate symptoms between December 2021 and July 2022. (3) Results: Thirty-two patients were included. Monoclonal antibodies were prescribed to 62%, intravenous antivirals to 22%, and oral antivirals to 16% of children. Sotrovimab was the most frequently prescribed drug among monoclonal antibodies and overall (59%). The second most prescribed drug was remdesivir (22%). No severe adverse drug reaction was reported. There was no progression to severe disease and no death cases due to COVID-19 or drug administration. At drug-type stratification, resolution of symptoms and swab positivity time showed no difference between the two groups at 7 and 28 days. Off-label prescriptions were 84% overall, and in similar proportions between the two groups. (4) Conclusions: in this small sample, antivirals seemed safe and showed no differences in efficacy as compared to MAbs for the early treatment of COVID-19 in fragile children, thus representing a valuable choice, even when administered off-label

Circulating microRNAs in Hidradenitis Suppurativa

Hidradenitis suppurativa (HS) is a pathology characterized by chronic inflammation and skin lesions. The molecular basis of the inflammatory network remains unclear; however, since microRNAs (miRNAs) are involved in the modulation of inflammation, the composition of a micro-transcriptome RNA library using the blood of HS patients was analysed here. The total miRNA expression profiles of miRNAs from HS patients was assayed by real-time qPCR. Here, compared to healthy controls, miR-24-1-5p, miR-146a-5p, miR26a-5p, miR-206, miR338-3p, and miR-338-5p expression was found significantly different in HS. Knowing the significance of the miRNA mechanism in inflammatory and immune progression, we suggest that miRNA profiles found in HS patients can be significant in understanding the pathogenesis modality and establishing efficient biomarkers for HS early diagnosis. In particular, miR-338-5p was closely related to HS invasiveness and production of cytokines and was atypically overexpressed. miR-338-5p may represent a good promise as a non-invasive clinical biomarker for HS