Small bowel carcinomas in celiac or Crohn's disease: Distinctive histophenotypic, molecular and histogenetic patterns

Non-familial small bowel carcinomas are relatively rare and have a poor prognosis. Two small bowel carcinoma subsets may arise in distinct immune-inflammatory diseases (celiac disease and Crohn's disease) and have been recently suggested to differ in prognosis, celiac disease-associated carcinoma cases showing a better outcome, possibly due to their higher DNA microsatellite instability and tumor-infiltrating T lymphocytes. In this study, we investigated the histological structure (glandular vs diffuse/poorly cohesive, mixed or solid), cell phenotype (intestinal vs gastric/pancreatobiliary duct type) and Wnt signaling activation (β-catenin and/or SOX-9 nuclear expression) in a series of 26 celiac disease-associated small bowel carcinoma, 25 Crohn's disease-associated small bowel carcinoma and 25 sporadic small bowel carcinoma cases, searching for new prognostic parameters. In addition, non-tumor mucosa of celiac and Crohn's disease patients was investigated for epithelial precursor changes (hyperplastic, metaplastic or dysplastic) to help clarify carcinoma histogenesis. When compared with non-glandular structure and non-intestinal phenotype, both glandular structure and intestinal phenotype were associated with a more favorable outcome at univariable or stage- and microsatellite instability/tumor-infiltrating lymphocyte-inclusive multivariable analysis. The prognostic power of histological structure was independent of the clinical groups while the non-intestinal phenotype, associated with poor outcome, was dominant among Crohn's disease-associated carcinoma. Both nuclear β-catenin and SOX-9 were preferably expressed among celiac disease-associated carcinomas; however, they were devoid, per se, of prognostic value. We obtained findings supporting an origin of celiac disease-associated carcinoma in SOX-9-positive immature hyperplastic crypts, partly through flat β-catenin-positive dysplasia, and of Crohn's disease-associated carcinoma in a metaplastic (gastric and/or pancreatobiliary-type) mucosa, often through dysplastic polypoid growths of metaplastic phenotype. In conclusion, despite their common origin in a chronically inflamed mucosa, celiac disease-associated and Crohn's disease-associated small bowel carcinomas differ substantially in histological structure, phenotype, microsatellite instability/tumor-infiltrating lymphocyte status, Wnt pathway activation, mucosal precursor lesions and prognosis

Anti-SARS-CoV-2 Vaccination Campaign: Risk Perception, Emotional States, and Vaccine Hesitancy in a Sample of Adolescents’ Vaccinated Parents in Southern Italy.

Background: The international strategic plan for COVID-19 vaccines remains the practical option for the protection of health. However, vaccine hesitancy remains an obstacle to full population vaccination, with rapid developments in COVID-19 vaccines and concerns about efficacy acting as influencing factors. Aim: The present study investigated the perception of vaccine hesitancy among parents of adolescents in order to explore the reasons and related emotional states. Methods: In January–March 2022, an online questionnaire was administered to a sample of parents who brought their children to the vaccine center of a local health unit, ASL Salerno (Campania, Italy). Results: The participants were 1105 parents (F = 64.6%; mean age = 47.37 years, SD = 7.52) of adolescents (F = 47.6%; mean age = 14.83 years, SD = 1.72). All parents had received the COVID-19 vaccine. Regarding the vaccination schedule, 46.8% believed that children receive more vaccinations than they should; 25.1% believed that it is better to develop immunity rather than get vaccinated; 41.2% believed that their child could have side effects; 29.6% were very concerned that vaccines were unsafe, while 35.3% believed vaccines do not prevent disease; 21.5% were very reluctant about pediatric vaccines; and 23.8% did not trust the information received. Conclusions: In order to increase vaccination and reduce the prevalence of vaccine hesitancy, it is essential to support the value of vaccination among all parents and make information more accessible and usable through competent pediatricians

Individual and Contextual Determinants of Flu Vaccination Adherence: A University Nudge Intervention

Introduction: The University of Salerno has implemented a nudge intervention with the aim of promoting vaccine adherence among employees of academia and identifying individual and contextual determinants that influence adherence. Method: A purpose-built questionnaire was used during the reference period of October–December 2022 in order to assess levels of state anxiety (STAIY1), perceived stress (PSS-10), and public sentiments, which influence vaccination behavior, with consequences for the whole population (VCI). Results: Analysis of the results revealed a difference in mean scores on the PSS: those who have always adhered to the vaccination campaign compared to those who have never been vaccinated perceived higher levels of stress (12.01 vs. 11.33; F = 4.744, p = 0.031); furthermore, there was a relationship between the presence/absence of pathologies and VCI (F = 3,93; df = 1; p = 0.04). Conclusions: The University of Salerno’s nudge intervention made its employees more responsible for protecting the health of the academic community and encouraged good adherence to the flu vaccination campaign. University employees, equipped with high cultural tools, sought information primarily from institutional sources indicated by the university during the free vaccination campaign at the university’s vaccine cente

Antibiotic use and surgical site infections: A single-center retrospective study

Background and Objective: Healthcare associated infections (HAI) pose a serious threat to public health. The HAI are closely related to antimicrobial resistance (AMR). In 2018 a prevalence study by Suetens et al. coordinated at European level by the ECDC, estimated that 3.8 million patients acquire a HAI each year in Europe, confirming that such infections represent a significant health problem. The consequences that HAI and AMR have on public health can and must be contained with prevention and control actions. In the context of HAI the Surgical Site Infections (SSI) represent one of the most common adverse events occurring in surgical patients. The aim of study is to evaluate the main species involved in SSI and the postoperative antibiotics therapy. Methods: This is a retrospective study conducted in a.o.u. San giovanni e ruggi d’aragona hospitals in salerno, from january 2017 to december 2019. All patients who developed wound infection were included in the study. Incidence and common microorganisms of infection were identified. The identification and antibiotic sensitivity tests were performed with vitek 2. The ibm statistical package for social sciences version 22.00 (spss inc., chicago, il, usa) was used for data analysis. Results: A total of 82 patients were included in study group. The most common microorganisms isolated were gram-positive (53%) followed by gram-negative (39%) and fungi (8%). enterococcus spp (30.6%) and staphylococcus spp (23.5%) were the main isolated among gram-positive. staphyolococcus methicillin-resistant were 45%, and only 1% of enterococcus spp were vancomicyn resistance.ff escherichia coli (13%) and klebsiella pneumoniae (9%) were the most isolated among gram-negative, of these only 35% of isolates were multidrug resistant. Conclusion: These results may help to the choice of empiric therapy and the antimicrobial prophylaxis strategies in SSI

Alert Microorganisms Procedure: Surveillance, Monitoring And Prevention Of Health Care Associated Infections

Health care-associated infections (HCAIs) are infections developed in a hospital or other health care facility, that first appear 48 hours or more after hospital admission, or within 30 days after having received health care. It’s estimated that among all hospitalized patients, about 7% for highincome countries and about 15% for low-middle income countries contract a HCAI. Among the main causes of HCAIs there are the so-called Alert Microorganisms, intended as different species with a high probability of diffusion in hospital settings, often combined with a problematic therapeutic approach or antibiotic resistance. The objective of our study was to describe the protocol applied in the setting of AOU “San Giovanni di Dio e Ruggi D’Aragona” of Salerno in order to evaluate its efficiency in reducing cases of infections. Methods: Protocol “Alert Microorganisms Procedure: Surveillance, Monitoring And Prevention Of Health Care Associated Infections”, applied in AOU “San Giovanni di Dio e Ruggi D’Aaragona” of Salerno; Alert Microorganisms detection form, filled by the doctor and/or the head nurse of the interested Department; HCAI Surveillance evaluation form, filled by the HCAI-supervising doctor, in order to evaluate the progression and/or new cases of contamination/infection. Results: Gram-negative and fungi were the most common identified pathogens. Patiens have been isolated in a single room and treated with personal-use devices and specific therapy. When single room was not avaiable, patients’ bed were placed 1,5m away from other patients, even with screens or dividers Conclusion: The Surveillance of Alert Microorganisms allowed us to define protocols to manage and monitor HCAIs and identify areas that need to be improved. The continuous and correct application of the protocol may lead in the future to a significant reduction of the risk for patients to contract HCAI

Small bowel carcinomas in celiac or Crohn's disease: Distinctive histophenotypic, molecular and histogenetic patterns

Non-familial small bowel carcinomas are relatively rare and have a poor prognosis. Two small bowel carcinoma subsets may arise in distinct immune-inflammatory diseases (celiac disease and Crohn's disease) and have been recently suggested to differ in prognosis, celiac disease-associated carcinoma cases showing a better outcome, possibly due to their higher DNA microsatellite instability and tumor-infiltrating T lymphocytes. In this study, we investigated the histological structure (glandular vs diffuse/poorly cohesive, mixed or solid), cell phenotype (intestinal vs gastric/pancreatobiliary duct type) and Wnt signaling activation (β-catenin and/or SOX-9 nuclear expression) in a series of 26 celiac disease-associated small bowel carcinoma, 25 Crohn's disease-associated small bowel carcinoma and 25 sporadic small bowel carcinoma cases, searching for new prognostic parameters. In addition, non-tumor mucosa of celiac and Crohn's disease patients was investigated for epithelial precursor changes (hyperplastic, metaplastic or dysplastic) to help clarify carcinoma histogenesis. When compared with non-glandular structure and non-intestinal phenotype, both glandular structure and intestinal phenotype were associated with a more favorable outcome at univariable or stage- and microsatellite instability/tumor-infiltrating lymphocyte-inclusive multivariable analysis. The prognostic power of histological structure was independent of the clinical groups while the non-intestinal phenotype, associated with poor outcome, was dominant among Crohn's disease-associated carcinoma. Both nuclear β-catenin and SOX-9 were preferably expressed among celiac disease-associated carcinomas; however, they were devoid, per se, of prognostic value. We obtained findings supporting an origin of celiac disease-associated carcinoma in SOX-9-positive immature hyperplastic crypts, partly through flat β-catenin-positive dysplasia, and of Crohn's disease-associated carcinoma in a metaplastic (gastric and/or pancreatobiliary-type) mucosa, often through dysplastic polypoid growths of metaplastic phenotype. In conclusion, despite their common origin in a chronically inflamed mucosa, celiac disease-associated and Crohn's disease-associated small bowel carcinomas differ substantially in histological structure, phenotype, microsatellite instability/tumor-infiltrating lymphocyte status, Wnt pathway activation, mucosal precursor lesions and prognosis

Infrarenal Aortic Treatment With AFX2 Endograft: Results From a Multicentric, International, Non-Randomized, Prospective Registry—the AFX2-LIVE Study

Introduction: To confirm real-world clinical practice results reported with anatomically fixed bifurcated endograft, a physician-initiated study was designed-AFX2-LIVE registry. Materials and Methods: From November 2019 to August 2021, investigators enrolled all consecutive patients treated with AFX2 (Endologix Inc., Irvine, CA, USA) endograft. Patients with abdominal aortic aneurysms (AAAs), penetrating aortic ulcers (PAU), and isolated infrarenal aortic dissections were included. Clinical and anatomical data, including baseline, intraoperative, and in-hospital details, as well as follow-up data, were collected in an anonymized prospectively compiled database. The primary endpoint of this study was to evaluate the technical and clinical success of endovascular aortic repair (EVAR) using AFX2 endograft. Results: A total of 535 patients were enrolled from 43 Italian and Spanish centers and analyzed according to the protocol. Four hundred eighty-nine patients were male (91.4%), with a mean age of 75 +/- 8.92 years (range 52-94). Four hundred sixty-six patients (87.1%) were treated for AAA, 49 (9.3%) for PAU, and 20 (3.6%) for isolated abdominal aortic dissection. A proximal extension was needed in 48% of the cases. Assisted technical success was achieved in all but one patient (99.8%). At 30 days follow-up, no AAA-related deaths were recorded, and nine patients (1.6%) required reintervention. At a mean follow-up period of 15.22 +/- 13.65 (range 1-53) months, data were available for 479 patients (89.5%). Clinical success was achieved in 98.2% (95% confidence interval [CI]: 96.4-99.1) at 3 months, 93.9% (95% CI: 90.1-96.1) at 1 year, and 74.1% (95% CI: 62.8-82.4) at 4 years follow-up. The estimated freedom from all-cause mortality was 97.7%, 93.4%, 81.6%, 77.5%, and 70.9%, and freedom from AAA-related mortality was 100%, 99.6%, 99.6%, 99.6%, and 97.3% at 3, 12, 24, 36, and 48 months, respectively. Twenty reinterventions (3.7%) were required in 19 patients, of which 3 late open conversions (0.6%) were performed, and 2 AAA-related deaths were observed. Conclusion: This study demonstrated excellent clinical and technical success rates of EVAR with anatomically fixed endografts, providing valuable insights into real-world clinical outcomes. Clinical Impact The AFX2-LIVE study could have a significant impact by providing robust evidence supporting the effectiveness and safety of EVAR using bifurcated endografts with anatomical fixation in real-world clinical practice, ultimately leading to improved outcomes and enhanced patient care in the management of abdominal aortic pathologies