Z-scores of fetal bladder distention for the antenatal differential diagnosis of posterior urethral valves and urethral atresia

Objective: To construct reference values for fetal urinary bladder distension in pregnancy and use Z-scores as a diagnostic tool to differentiate posterior urethral valves (PUV) from urethral atresia (UA). Methods: This was a prospective cross-sectional study in healthy singleton pregnancies aimed at constructing nomograms of fetal urinary bladder diameter and volume between 15 and 35 weeks' gestation. Z-scores of longitudinal bladder diameter (LBD) were calculated and validated in a cohort of fetuses with megacystis with ascertained postnatal or postmortem diagnosis, collected from a retrospective, multicenter study. Correlations between anatomopathological findings, based on medical examination of the infant or postmortem examination, and fetal megacystis were established. The accuracy of the Z-scores was evaluated by receiver-operating-characteristics (ROC)-curve analysis. Results: Nomograms of fetal urinary bladder diameter and volume were produced from three-dimensional ultrasound volumes in 225 pregnant women between 15 and 35 weeks of gestation. A total of 1238 urinary bladder measurements were obtained. Z-scores, derived from the fetal nomograms, were calculated in 106 cases with suspected lower urinary tract obstruction (LUTO), including 76 (72%) cases with PUV, 22 (21%) cases with UA, four (4%) cases with urethral stenosis and four (4%) cases with megacystis-microcolon-intestinal hypoperistalsis syndrome. Fetuses with PUV showed a significantly lower LBD Z-score compared to those with UA (3.95 vs 8.83, P < 0.01). On ROC-curve analysis, we identified 5.2 as the optimal Z-score cut-off to differentiate fetuses with PUV from the rest of the study population (area under the curve, 0.84 (95% CI, 0.748–0.936); P < 0.01; sensitivity, 74%; specificity, 86%). Conclusions: Z-scores of LBD can distinguish reliably fetuses with LUTO caused by PUV from those with other subtypes of LUTO, with an optimal cut-off of 5.2. This information should be useful for prenatal counseling and management of LUTO

Stem-like and highly invasive prostate cancer cells expressing CD44v8-10 marker originate from CD44-negative cells

In human prostate cancer (PCa), the neuroendocrine cells, expressing the prostate cancer stem cell (CSC) marker CD44, may be resistant to androgen ablation and promote tumor recurrence. During the study of heterogeneity of the highly aggressive neuroendocrine PCa cell lines PC3 and DU-145, we isolated and expanded in vitro a minor subpopulation of very small cells lacking CD44 (CD44neg). Unexpectedly, these sorted CD44neg cells rapidly and spontaneously converted to a stable CD44high phenotype specifically expressing the CD44v8-10 isoform which the sorted CD44high subpopulation failed to express. Surprisingly and potentially interesting, in these cells expression of CD44v8-10 was found to be induced in stem cell medium. CD44 variant isoforms are known to be more expressed in CSC and metastatic cells than CD44 standard isoform. In agreement, functional analysis of the two sorted and cultured subpopulations has shown that the CD44v8-10pos PC3 cells, resulting from the conversion of the CD44neg subpopulation, were more invasive in vitro and had a higher clonogenic potential than the sorted CD44high cells, in that they produced mainly holoclones, known to be enriched in stem-like cells. Of interest, the CD44v8-10 is more expressed in human PCa biopsies than in normal gland. The discovery of CD44v8-10pos cells with stem-like and invasive features, derived from a minoritarian CD44neg cell population in PCa, alerts on the high plasticity of stem-like markers and urges for prudency on the approaches to targeting the putative CSC

Medicina interna perioperatoria - Il paziente chirurgico complesso: il ruolo dell’internista nell’ospedale snello, a misura del paziente, organizzato per intensità di cure

Perché l’internista è necessario nella gestione dei pazienti complessi candidati ad intervento chirurgico F. Gilioli, G. Chesi La medicina interna nell’assistenza del paziente chirurgico complesso M. Fabbri, S. Galli, A. Morettini Il paziente cardiopatico G. Chesi, F. Gilioli Il paziente con broncopneumopatia cronica ostruttiva M. Candela Il paziente diabetico L. Morbidoni La chirurgia nel grande anziano: rischi e opportunità A. Greco, M. Greco, G. D’Onofrio, G. Paroni, D. Sancarlo, M. Lauriola, D. Seripa Il paziente candidato ad intervento chirurgico a rischio trombo-embolico R. Re, M. Campanini Concetto di Ospedale snello, hospitalist e di co-management I. Stefani, A. Mazzone L’internista nel reparto di Ortopedia: il percorso del paziente ricoverato per frattura prossimale di femore R. Nardi, M. Mazzetti, C. Marchetti L’internista nel reparto di neurochirurgia C. Cicognani, S. Zaccaroni L’internista nel reparto di ostetricia A. Maina, V. Donvito, L. Balbi L’internista nel Centro Trapianti di fegato L. Fontanella, M. Imparato La gestione del dolore post-operatorio in ambito internistico M. Bosco, R. Bertè, G. Civardi La sindrome da rialimentazione R. Risicato, G. Scanelli, L. Tramontano, U. Politti Terapia infusionale pre-intra-post-operatoria: solamente un problema dell’anestesista? F. Sgambato, G. Pinna, S. Prozzo, E. Sgambato Il paziente ad elevato rischio emorragico: valutazione e management A.M. Pizzini, I. Iori La gestione perioperatoria o periprocedurale della terapia anticoagulante-antiaggregante in elezione e in urgenza A. Fontanella, R. Re Le complicanze mediche e gli eventi avversi indesiderabili più frequenti nel paziente internistico complesso operato M. Silingardi Pazienti chirurgici ricoverati in Medicina Interna: i pazienti a rischio, selezione delle priorità e delle emergenze urgenze e pianificazione dell’assistenza P. Gnerre, M. Gambacorta, A. Percivale Qualità, indicatori ed audit come strumento di miglioramento nell’assistenza del paziente complesso in chirurgia S. De Carli, A. Montagnani Quali proposte ed evidenze per nuovi modelli organizzativi in cui l’internista può assumere un ruolo fondamentale? A. Fontanella, M. Campanin

Wohnungseinbruch: Tat und Folgen: Ergebnisse einer Betroffenenbefragung in fünf Großstädten

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Effect of Milling and Parboiling Processes on Arsenic Species Distribution in Rice Grains

This study identified the role of milling and parboiling on arsenic (As) content and its species in large numbers of rice samples. Total As contents were 108 \ub1 33 \u3bcg/kg in polished rice grains (PR), 159 \ub1 46 \u3bcg/kg in unpolished rice grains (UR), 145 \ub1 42 \u3bcg/kg in parboiled polished rice grains (PPR) and 145 \ub1 44 \u3bcg/kg in parboiled unpolished rice grains (PUR). The percentages of inorganic As (iAs) were 66% \ub1 8% in PR and from 72% to 77% in other grain categories. The polishing process reduced the As content in the rice grains, removing outer part of the UR with high amount of As, whereas the parboiling technique transferred the semimetal content within the grain. Total As and iAs contents were not significantly different in UR, PPR and PUR, homogenizing its distribution inside the grains. The results allowed to understand how different operations affect As fate and its chemical forms in grains

Pop-off mechanisms in fetal megacystis: extravasation, umbilical cord cyst, ureterocele and mega-ureter

UCC was associated with early-onset megacystis, normal AFI, other congenital anomalies and the highest prevalences of IUFD, while the occurrence of urinary extravasation was associated with an antenatal clinical picture characterised by severe megacystis, abnormal AFI and other congenital anomalies and associated with high rates of pregnancy termination and neonatal death. A mega-ureter/ureterocele mainly occurred in late-onset and isolated megacystis showing a thickened bladder wall, low prevalences of other congenital anomalies and highest survival rates

Phase II study of the safety and efficacy of oral capecitabine in patients with platinum-pretreated advanced or recurrent cervical carcinoma

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Health-related quality of life in breast cancer patients treated with CDK4/6 inhibitors: a systematic review

Background: Evaluation of health-related quality of life (HR-QoL) among cancer patients has gained an increasing importance and is now a key determinant of anticancer treatments’ value. HR-QoL has been assessed in trials testing cyclin-dependent kinase 4/6 inhibitors (CDK4/6i) in breast cancer (BC), using various questionnaires at different timepoints. HR-QoL reports from BC patients treated with CDK4/6i in the real-world setting are also available. Methods: We systematically reviewed the literature, searching for full-length articles, and selected conference abstracts reporting data on HR-QoL in BC patients at any stage and of any molecular subtype treated with abemaciclib, palbociclib or ribociclib. Results: A total of 533 full-length articles and 143 abstracts were retrieved. After screening for eligibility, 38 records were included (31 clinical trials; 7 real-world reports). Assessment methods were heterogeneous across studies in terms of questionnaires, evaluation timepoints and endpoints. Overall, adding CDK4/6i to endocrine therapy did not worsen patients’ HR-QoL, with a positive trend towards pain improvement. Gastrointestinal scores (diarrhea, nausea and appetite loss) statistically favored the control arm among metastatic BC patients receiving abemaciclib, whereas they were superimposable in the early setting. The combination of palbociclib and endocrine therapy showed similar HR-QoL outcomes compared with endocrine therapy alone, but determined better scores compared with chemotherapy. HR-QoL was specifically assessed in premenopausal patients treated with ribociclib, showing similar scores compared with postmenopausal patients. Conclusions: Despite methodological heterogeneity does not allow a proper comparison, HR-QoL was generally maintained with CDK4/6i. However, differences between abemaciclib, palbociclib and ribociclib exist and mainly rely on the distinct safety profiles of the compounds. These differences should be acknowledged and taken into account in the clinical practice

In vitro evaluation of the inhibitory activity of different selenium chemical forms on the growth of a fusarium proliferatum strain isolated from rice seedlings

In this study, the in vitro effects of different Se concentrations (5, 10, 15, 20, and 100 mg kg−1) from different Se forms (sodium selenite, sodium selenate, selenomethionine, and selenocystine) on the development of a Fusarium proliferatum strain isolated from rice were investigated. A concentration‐dependent effect was detected. Se reduced fungal growth starting from 10 mg kg−1 and increasing the concentration (15, 20, and 100 mg kg−1 ) enhanced the inhibitory effect. Se bioactivity was also chemical form dependent. Selenocystine was found to be the most effective at the lowest concentration (5 mg kg−1 ). Complete growth inhibition was observed at 20 mg kg−1 of Se from selenite, selenomethionine, and selenocystine. Se speciation analysis revealed that fungus was able to change the Se speciation when the lowest Se concentration was applied. Scanning Electron Microscopy showed an alteration of the fungal morphology induced by Se. Considering that the inorganic forms have a higher solubility in water and are cheaper than organic forms, 20 mg kg−1 of Se from selenite can be suggested as the best combination suitable to inhibit F. proliferatum strain. The addition of low concentrations of Se from selenite to conventional fungicides may be a promising alternative approach for the control of Fusarium species

Predicting candidemia in internal medicine departments: are we chasing the Holy Grail?

Candidemia is a challenging clinical condition with high rates of morbidity and mortality.1 Key requirements for its prompt management include early identification and timely initiation of appropriate systemic antifungal therapy, consistently reported as a major determinant of survival. However, the diagnosis of candidemia can be challenging and is often delayed as there are no specific clinical signs, blood cultures have low sensitivity, and detection of fungal blood cultures takes a long time. In addition, there is evidence that a significant percentage of such infections occurs in patients admitted to internal medicine departments. This is not particularly surprising given the advanced age of many inpatients at internal medicine departments and multiple complex comorbidities. Moreover, related therapies and healthcare system contacts often involve the use of central venous catheters and other indwelling devices, potentially entailing high risk of candidemia.2 Therefore, optimization of the diagnostic and therapeutic approach is an important and still unfulfilled need for the management of candidemia in internal medicine department