MESENCHIMAL STEM CELLS IN INFLAMMATORY BOWEL DISEASES: CLINICAL EVIDENCES AND POTENTIAL INSIGHTS FOR THE CLINICIANS

Mesenchimal stem cells (MSCs) have been used experimentally and clinically in the treatment of a wide variety of pathologies MSCs can be safely transplanted in autologous and allogenic ways as they are non-immunogenic, and consequently represent a therapeutic option for refractory connective tissue diseases, fibrosing diseases like scleroderma and fistulizing colitis like in Crohn's disease (CD). The immunomodulatory properties of MSCs have already shown promise when used as therapy for otherwise medically refractory CD. Accumulating evidence suggests that the properties may also be exploited of several other conditions. The currently available experimental and clinical data indicate that, similar to previously obtained data in the setting of HSCT, MSC treatment for IBD is feasible and safe. aim of this review is to analyze the pathophysiological insights for the use of MSCs in inflammatory bowel diseases, and to summarize the clinical evidences about the efficacy and safety of stem cell therapy in such disorders

ADVANCED ENDOSCOPIC IMAGING FOR SURVEILLANCE FOR DYSPLASIA AND COLORECTAL CANCER IN INFLAMMATORY BOWEL DISEASE: COULD THE PATHOLOGIST BE FURTHER HELPED?

Patients with inflammatory bowel disease (IBD) have an increased risk of developing intestinal cancer. The magnitude of that increased risk as well as how best to mitigate it remain a topic of ongoing investigation in the field. It is important to quantify the risk of colorectal cancer in association with IBD. The reported risk varies widely between studies. This is partly due to the different methodologies used in the studies. Because of the limitations of surveillance strategies based on the detection of dysplasia, advanced endoscopic imaging and techniques involving the detection of alterations in mucosal antigens and genetic abnormalities are being investigated. Development of new biomarkers, predicting future occurrence of colonic neoplasia may lead to more biomarker-based surveillance. There are promising results that may lead to more efficient surveillance in IBD patients and more general acceptance of its use. A multidisciplinary approach, involving in particular endoscopists and pathologists, together with a centralized patient management, could help to optimize treatments and follow-up measures, both of which could help to reduce the IBD-associated cancer risk

USEFULNESS OF CT COLONOGRAPHY IN PATIENTS WITH OCCLUSIVE COLORECTAL CANCER BEFORE METALLIC STENT PLACEMENT: A SINGLE ENTER EXPERIENCE

Up to 15% of patients with colorectal cancer (CRC) present with large bowel obstruction. Currently, computed tomography colonography (CTC) is regarded as a promising technique for complete evaluation of the proximal colon and simultaneous assessment of extraluminal status. Aim of this retrospective, observational study is to evaluate the feasibility of using CTC for preoperative examination of the proximal colon before metallic stgent placement in patients with colon obstruction caused by CRC. Sixteen patients who demonstrated colonic obstruction caused by CRC, underwent CTC immediately after incomplete colonoscopy. Per-patient sensitivity of CTC for lesion 5 mm larger in diameter in the colon proximal to the stent was 100% (95% CI: 0,4385-1). Per-patients specificity for lesions 5 mm and larger in the proximal colon was 92,3% (95% CI: 6669-0,9863). CTC did not generate any false diagnosis of synchronous cancer. false positive findings at CTC did not result in a change in surgical plan for asny patients. Although the small number of patient of our study, our data show that CTC is a safe and useful method for preoperative examination of the proximal colon before metallic stent placement in patients with acute colon obstruction caused by CRC

NUTRITION, MALNUTRITION AND DIETARY INTERVENTIONS IN INFLAMMATORY BOWEL DISEASE

Inflammatory Bowel Disease (IBD), which includes both Crohn's disease (CD) and Ulcerative Colitis (UC), is a chronic idiopathic inflammatory disorder affecting the gastrointestinal tract. Diet, as a source of luminal antigens, is thought to be an important factor in the pathogenesis of IBD. often the nutritional status of patients is significantly compromised, particularly in CD. several factors, including drug-nutrient interactions, disease location, symptoms, and dietary restriction can lead to protein energy malnutrition and specific nutritional deficiencies. solid evidence regarding the accountability of certain dietary components in the etiology of IBD are lacking. With regard to malnutrition, its consequence are growth failure, weight loss, bone disease, and/or micronutrient deficiencies, although micronutrient deficiency in IBD in most cases does not tend to have any evident clinical manifestation, except with regardo of iron, folic acid, and vitamin B. Nutritional supplemantation is essential for patients with evidence of malnutrition to increase calorie, and protein intake. Nutritional supplementation can also have efficacy in the induction and maintenance of remission in adults with CD, however it does not replace other treatments. Aim of this review is to discuss the role of nutrition and nutrients' deficiencies in the clinical setting of IBD, and to analyze efficacy and safety of the dietary interventions in patients with IBD

CLINICAL OUTCOMES OF SELF-EXPAMDABLE METALLIC STENTS IN PALLIATION OF MALIGNANT ANASTOMOTIC STRICTURES: A SINGLE CENTER EXPERIENCE

Background: self-expandable metallic stents (SEMS) are employed as the preferred non surgical palliative treatment for gastric outlet obstruction due to malignancies. Metallic stents are often employed to treat malignant anastomotic obstructions after surgicsl interventions as esophagojejunostomy, gastrojejunostomy and esophagogastrojejunostomy. Methods: this case series reports prospectively the clinical outcomes of SEMS in the palliative care of malignant anastomotic strictures caused by the recurrence gastric cancer follwing gastric surgery as oncological curative treatment, in a series of nine consecutive patients, treated between January 2009 and december 2012 in our center. Results: Nine patients (M:F=8:1) were enrolled in the study. The operation was a total gastrectomy with esophagogastrojejunostomy (n=4), subtotal gastrectomy with Bilroth-II reconstruction (n=4), subtotal gastrectomy with Billroth-II reconstruction (n=3), and subtotal gastrectomy with esophagogastrostomy (n=2). The technical success rate was 88,9%, and the clinical success rate was 88.9%. The reostruction of the stent, due to the ingrowth of the tumor, occurred in 1 patient (11,1%) within 1 month after stent placement. the migration of the stent occurred after the placement of a covered stent in 1 patient who underwent a subtotal gastrectomy (with Billroth-II reconstruction). A case o partial stent dislodgement was treated with the placement of a second stent. The median survival period was 180 days (range, 30-240 days) and the median stent patency was 45 days 8range, 30-90 days). Conclusions: Although the number of the patients treated with SEMS results, in this series, almost small to certainly judge the safety and feasibility of SEMS, we believe that the endoscopic insertion of SEMS seems to be a safe, easily feasible, and effective treatment in the palliative care of malignant anastomotic strictures caused by the recurrence of gastric cancer following gastric surgery. The technical and clinical success, and the onset of complications of this procedure are influenced by several factors, such as the type of anastomosis, the technical features of the stent, and the extent of the underlying tumor

Diurnal and Circadian Rhythms in the Tomato Transcriptome and Their Modulation by Cryptochrome Photoreceptors

BACKGROUND: Circadian clocks are internal molecular time-keeping mechanisms that provide living organisms with the ability to adjust their growth and physiology and to anticipate diurnal environmental changes. Circadian clocks, without exception, respond to light and, in plants, light is the most potent and best characterized entraining stimulus. The capacity of plants to respond to light is achieved through a number of photo-perceptive proteins including cryptochromes and phytochromes. There is considerable experimental evidence demonstrating the roles of photoreceptors in providing light input to the clock. METHODOLOGY: In order to identify genes regulated by diurnal and circadian rhythms, and to establish possible functional relations between photoreceptors and the circadian clock in tomato, we monitored the temporal transcription pattern in plants entrained to long-day conditions, either by large scale comparative profiling, or using a focused approach over a number of photosensory and clock-related genes by QRT-PCR. In parallel, focused transcription analyses were performed in cry1a- and in CRY2-OX tomato genotypes. CONCLUSIONS: We report a large series of transcript oscillations that shed light on the complex network of interactions among tomato photoreceptors and clock-related genes. Alteration of cryptochrome gene expression induced major changes in the rhythmic oscillations of several other gene transcripts. In particular, over-expression of CRY2 had an impact not only on day/night fluctuations but also on rhythmicity under constant light conditions. Evidence was found for widespread diurnal oscillations of transcripts encoding specific enzyme classes (e.g. carotenoid biosynthesis enzymes) as well as for post-transcriptional diurnal and circadian regulation of the CRY2 transcript

Conserved Daily Transcriptional Programs in Carica papaya

Most organisms have internal circadian clocks that mediate responses to daily environmental changes in order to synchronize biological functions to the correct times of the day. Previous studies have focused on plants found in temperate and sub-tropical climates, and little is known about the circadian transcriptional networks of plants that typically grow under conditions with relatively constant day lengths and temperatures over the year. In this study we conducted a genomic and computational analysis of the circadian biology of Carica papaya, a tropical tree. We found that predicted papaya circadian clock genes cycle with the same phase as Arabidopsis genes. The patterns of time-of-day overrepresentation of circadian-associated promoter elements were nearly identical across papaya, Arabidopsis, rice, and poplar. Evolution of promoter structure predicts the observed morning- and evening-specific expression profiles of the papaya PRR5 paralogs. The strong conservation of previously identified circadian transcriptional networks in papaya, despite its tropical habitat and distinct life-style, suggest that circadian timing has played a major role in the evolution of plant genomes, consistent with the selective pressure of anticipating daily environmental changes. Further studies could exploit this conservation to elucidate general design principles that will facilitate engineering plant growth pathways for specific environments

Toracentesi e pleurodesi nel trattamento dei versamenti pleurici. Esperienza personale

Scopo. Il versamento pleurico è segno di una patologia polmonare, pleurica o extrapolmonare, benigna o maligna. Scopo del nostro lavoro è riportare la nostra esperienza sul trattamento del versamento pleurico neoplastico mediante toracentesi e successiva pleurodesi. Pazienti e metodi. Nel periodo gennaio 2000-gennaio 2007 sono state eseguite 217 toracentesi, di cui 123 (57%) in soggetti affetti da versamento pleurico neoplastico. In 92 di questi ultimi soggetti (75%)si è direttamente posizionato un tubo da toracostomia di piccolo calibro per potere poi eseguire la pleurodesi con talco deasbestato sterile. Risultati. Non si sono registrate complicanze gravi legate alla toracentesi e alla pleurodesi e la mortalità correlata alla procedura è stata nulla. La pleurodesi è stata eseguita prevalentemente con tecnica ‘talc slurry’. Il tasso di recidiva dopo il primo trattamento è stato del 12.2%. Conclusioni. Il versamento pleurico è una condizione patologica che solitamente richiede procedure interventistiche evacuative ripetute,con notevole disagio per il paziente, e di regola senza risultati definitivi. Sulla base della nostra esperienza e valutate le caratteristiche degli agenti sclerosanti in commercio in Italia, possiamo affermare che l’agente più sicuro, efficace ed economico per la pleurodesi è il talco deasbestato