Cure and survival of sporadic medullary thyroid carcinoma following systematic preoperative calcitonin screening

Background: The improvement in outcome of sporadic medullary thyroid carcinoma (MTC) during the last decades remains controversial, even if a trend toward a better prognosis has been recently proposed. This study was aimed to determine the time trend cure and survival rates in sporadic MTC according to the use of systematic preoperative calcitonin screening. Methods: Retrospective analysis of 178 sporadic MTC patients operated between 1980 and 2017 was performed. The impact of prognostic factors on cure and survival following the introduction of routine preoperative calcitonin screening in 2001 was evaluated according to the year of surgery. Results: Since 2001, a significant decline of node-positive tumors (from 56.1 to 34.7%) and advanced stage at diagnosis (stage III/IV from 56.1 to 34.7%) occurred, with a concomitant significant increase in cure rate (64.5% vs 38.6%; p = 0.0012) and survival (p < 0.05). At univariate analysis, the cure was achieved more frequently in more recently operated patients (64.5% vs 38.6%; p = 0.0012), in disease staging I/II (86.5% vs 13.5%; p < 0.0001), in patients undergoing preoperative calcitonin screening (63.8% vs 23.5%; p < 0.0001) and in the absence of lymph node metastases (86.5% vs 13.5%; p < 0.0001). At multivariate analysis, only preoperative calcitonin screening and stage at diagnosis turned out to be significant independent prognostic factors for cure and survival. Conclusion: The outcome of sporadic MTC improved in the new millennium; diagnosis was achieved earlier, at a less advanced stage. Routine preoperative calcitonin screening may have contributed to improve cure and survival rates

Involve to improve: A participatory approach for a Decision Support System for coastal climate change impacts assessment. The North Adriatic case

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The role of procalcitonin in the follow-up of medullary thyroid cancer

Objective: Calcitonin (Ct) represents the most important biochemical marker of medullary thyroid cancer (MTC), but has certain limits. We analyzed the performance of procalcitonin (ProCt) in follow-up MTC patients. Methods: In this monocentric and retrospective study, we consecutively obtained ProCt and Ct values from all MTC patients that we visited during the period from April 2021 to May 2022. Patients were defined as having structural evidence of disease (29/90, 32.2%) irrespective of Ct values or, in its absence, as not evident disease (NED) if Ct was ≤10 ng/L (47/90, 52.2%), or minimal residual disease if Ct was >10 ng/L (14/90, 15.6%). Results: Ct and ProCt values were highly correlated (r = 0.883, P 0.12 ng/mL (P < 0.01, area under the curve: 0.963), with the following sensitivity, specificity, positive predictive value, and negative predictive value (NPV): 100%, 83.61%, 74.4%, and 100.0%. Conclusions: ProCt and Ct have a high correlation in MTC follow-up. ProCt may be useful as an adjunct to Ct, especially for its NPV concerning the structural disease

Early progression as a predictor of survival in marginal zone lymphomas: An analysis from the FIL-NF10 study

Marginal zone lymphomas (MZLs) are indolent nonfollicular B-cell lymphomas (INFLs) and have heterogeneous clinical behavior. Recently, time to progression of disease at 24 months (POD24) was identified to stratify overall survival (OS) in follicular non-Hodgkin lymphoma and in INFL. Here, we examined the ability of POD24 to predict subsequent OS in a large, international cohort of MZL as part of the NF10 prospective international registry headed by Fondazione Italiana Linfomi (FIL). POD24 was only calculated for MZL patients requiring immediate therapy and was defined as experiencing lymphoma progression within 24 months from diagnosis. Among the 1325 patients enrolled in the NF10 study, we identified 321 patients with MZL for whom immediate therapy was planned right after lymphoma diagnosis. Overall, POD24 was confirmed in 59 patients (18%). Three-year OS for patients with POD24 was 53% with a hazard ratio of 19.5 (95% confidence interval, 8.4-45) compared with patients without POD24 (3-year OS, 95%). Association of POD24 with OS was confirmed for the subgroup of splenic and extranodal MZLs. Assessment of POD24 stratifies subsequent outcome inMZL and identifies a high-risk population

Marginal zone lymphoma international prognostic index: a unifying prognostic index for marginal zone lymphomas requiring systemic treatment

Background Marginal zone lymphomas (MZL), comprised of three unique but related subtypes, lack a unifying prognostic score applicable to all the patients in need for systemic chemotherapy and/or immunotherapy. Methods Patients from the prospective NF10 study (NCT02904577) with newly diagnosed MZL and receiving frontline systemic therapy at diagnosis or after observation were used to train a prognostic model. The primary endpoint was progression-free survival (PFS) from start of treatment. The model was externally validated in a pooled analysis of two independent cohorts from the University of Iowa and Mayo Clinic Molecular Epidemiology Resource and the University of Miami. Findings We identified 501 eligible patients. After multivariable modeling, lactate dehydrogenase (LDH) above upper normal limit, hemoglobin &lt;12 g/dL, absolute lymphocyte count &lt;1 x 10(9)/L, platelets &lt;100 x 10(9)/L, and MZL subtype (nodal or disseminated) were independently associated with inferior PFS. The proposed MZL International Prognostic index (MZL-IPI) combined these 5 factors, and we defined low (LRG, 0 factors, 27%), intermediate (IRG, 1-2 factors, 57%) and high (HRG, 3+ factors, 16%) risk groups with 5-y PFS of 85%, 66%, and 37%, respectively (c-Harrell = 0.64). Compared to the LRG, the IRG (Hazard Ratio [HR] = 2.30, 95% CI 1.39-3.80) and HRG (HR = 5.41, 95% CI 3.12-9.38) had inferior PFS. Applying the MZL-IPI to the pooled US cohort (N = 353), 94 (27%), 192 (54%), and 67 (19%) patients were classified as LRG, IRG, and HRG, respectively, and the model was validated for PFS (log-rank test p = 0.0018; c-Harrell = 0.578, 95% CI 0.54-0.62). The MZL-IPI was also prognostic for OS in both the training and the external validation sets. Interpretation MZL-IPI is a new prognostic score for use in all patients with MZL considered for systemic treatment. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY license(http://creativecommons.org/licenses/by/4.0/)

Chronic constipation diagnosis and treatment evaluation: The "CHRO.CO.DI.T.E." study

Background: According to Rome criteria, chronic constipation (CC) includes functional constipation (FC) and irritable bowel syndrome with constipation (IBS-C). Some patients do not meet these criteria (No Rome Constipation, NRC). The aim of the study was is to evaluate the various clinical presentation and management of FC, IBS-C and NRC in Italy. Methods: During a 2-month period, 52 Italian gastroenterologists recorded clinical data of FC, IBS-C and NRC patients, using Bristol scale, PAC-SYM and PAC-QoL questionnaires. In addition, gastroenterologists were also asked to record whether the patients were clinically assessed for CC for the first time or were in follow up. Diagnostic tests and prescribed therapies were also recorded. Results: Eight hundred seventy-eight consecutive CC patients (706 F) were enrolled (FC 62.5%, IBS-C 31.3%, NRC 6.2%). PAC-SYM and PAC-QoL scores were higher in IBS-C than in FC and NRC. 49.5% were at their first gastroenterological evaluation for CC. In 48.5% CC duration was longer than 10 years. A specialist consultation was requested in 31.6%, more frequently in IBS-C than in NRC. Digital rectal examination was performed in only 56.4%. Diagnostic tests were prescribed to 80.0%. Faecal calprotectin, thyroid tests, celiac serology, breath tests were more frequently suggested in IBS-C and anorectal manometry in FC. More than 90% had at least one treatment suggested on chronic constipation, most frequently dietary changes, macrogol and fibers. Antispasmodics and psychotherapy were more frequently prescribed in IBS-C, prucalopride and pelvic floor rehabilitation in FC. Conclusions: Patients with IBS-C reported more severe symptoms and worse quality of life than FC and NRC. Digital rectal examination was often not performed but at least one diagnostic test was prescribed to most patients. Colonoscopy and blood tests were the "first line" diagnostic tools. Macrogol was the most prescribed laxative, and prucalopride and pelvic floor rehabilitation represented a "second line" approach. Diagnostic tests and prescribed therapies increased by increasing CC severity

Premature birth and risk of developing cognitive impairments : Newborn follow-up and early interventions

reservedI progressi nelle cure perinatali negli ultimi decenni hanno permesso la sopravvivenza di neonati al limite delle condizioni compatibili con la vita. Ogni anno in Italia nascono oltre 25 mila neonati pretermine, ossia prima della trentasettesima settimana di gestazione. L’elaborato affronta la tematica della nascita prematura e delle conseguenze che tale condizione comporta a livello cognitivo nel bambino durante il suo percorso di sviluppo. La nascita pretermine, le cure che sono necessarie per mantenere il neonato in vita e la prolungata separazione fisica del prematuro dai genitori nei primi giorni di vita provocano conseguenti effetti psicologici e fisiologici sul bambino e sui genitori. La nascita prematura porta con sé numerose sfide da affrontare sia per i professionisti sanitari che per il nucleo familiare. Lo scopo della ricerca è quello di comprendere l’importanza di attuare un intervento precoce nella presa in carico e stimolazione del neonato prematuro e del suo nucleo familiare per prevenire lo sviluppo di deficit intellettivi. I primi mille giorni di vita del neonato sono fondamentali per intervenire positivamente nel suo sviluppo neuro cognitivo grazie all’elevato livello di neuroplasticità presente. L’ambiente di vita e le esperienze proposte al bambino sono fattori protettivi importanti per una sua crescita ottimale. Nella prima parte dell’elaborato si esporranno le cause e le conseguenze della nascita prematura, facendo particolare riferimento al significato che assume questa esperienza per i genitori. Si espone il percorso di presa in carico del nato prematuro nelle Unità di Terapia Intensiva Neonatale e successivamente nel Follow Up. Dall’analisi dei fattori di rischio e dei fattori protettivi per lo sviluppo neuro cognitivo del nato pretermine emerge la necessità di crescita in un contesto stimolante. I genitori, in quanto caregivers principali, svolgono un ruolo fondamentale nel processo di crescita del figlio e necessitano di sviluppare le conoscenze e le competenze adeguate. Ogni nucleo familiare ha caratteristiche diverse e peculiari e necessita quindi di un progetto individualizzato in base ai bisogni rilevati per la sua specifica situazione. A conclusione dell’elaborato si esporranno le possibili implicazioni che la figura dell’Educatore Professionale potrebbe avere nel settore delle cure neonatali e nel contatto con la ‘famiglia pretermine’

Excess aldosterone as a mechanism of resistant salt-sensitive arterial hypertension

Albeit vastly underdiagnosed, primary aldosteronism is the most common cause of arterial hypertension and particularly of drug-resistant arterial hypertension, a high-risk condition with a poor prognosis. A timely diagnosis followed by targeted treatment is pivotal to prevent the cardiovascular morbidity and mortality related to the detrimental consequences of aldosterone excess. This doctoral thesis highlights the importance of the screening for primary aldosteronism in patients with resistant hypertension, even if they are on multiple drugs potentially confounding the diagnosis. These patients can benefit from surgical treatment, resolve their resistance to treatment and improve their quality of life. Moreover, for the first time, the sodium accumulation in the skin of these patients was evaluated, which was found to be reversible after surgery, suggesting the presence of tissue-specific regulatory mechanisms that act in the pathophysiology of hypertension. In this regard, it has been speculated that tissue sodium storage might represent an independent cardiovascular risk factor and that it might be responsible of the target organ damage in patients with primary aldosteronism

Postoperative Hypoparathyroidism

Hypoparathyroidism is a pathological clinical condition characterized by low serum calcium levels in the presence of absent or inappropriately low parathyroid hormone (PTH) levels. It is usually caused by reduced parathyroid gland (PG) function due to secondary (and often iatrogenic) causes (>75%); less frequently, it occurs as a primary disorder caused by intrinsic genetic defects (Di George syndrome) or an autoimmune diseas