Efficacy of 12 weeks of proprioceptive training in patients with multiple sclerosis

This pilot study aims to investigate if specific training protocol can improve the quality of life in people with multiple sclerosis through the improvement of some impaired ability like the balance. We enrolled in our project 20 subjects (age: 34,88 ± 4,45; height: 168,25 ± 8,66 cm; weight: 72,31 ± 17,28 kg) but only 5 completed the study. A proprioceptive training was administered for 12 weeks, 2 times a week, an hour for each session. At the beginning (T0) and at the end of the study (T1), static and dynamic balance parameters were tested. Statistical analyzes were performed using IBM SPSS Statistics 22.Changes in balance and strength between T0, T1 were evaluated using t Student test for paired data. Pearson linear correlation coefficient was used to investigate the correlations between all parameters analyzed. As regards static baropodometry, there was a statistic significant different between left forefoot load (T0 54,25 ± 2,5 % and T1 59,5± 1,73%; P<0,05) and left rearfoot load (T0 45,75± 2,5% and T1 40,5± 1,73%; P<0,05). In dynamic baropodometry we gave more attention to three parameters: left length gait line (T0 176±23,58 and T1 215±18,64 (mm); P<0,05), right surface (T0 106,75±14,97 and T1 149±11,58 (cm); P<0,05) and right pressure point (T0 1050± 130,90 and T1 537,25±65,46 (gr/cm); P<0,05). In conclusion, it is possible to hypothesize that the application of proprioceptive treatment in patients with multiple sclerosis can improve gait stability and therefore the walking. However, further studies, with a greater number of subjects, are necessary to confirm this trend

The Changing Landscape for Stroke\ua0Prevention in AF: Findings From the GLORIA-AF Registry Phase 2

Background GLORIA-AF (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients with Atrial Fibrillation) is a prospective, global registry program describing antithrombotic treatment patterns in patients with newly diagnosed nonvalvular atrial fibrillation at risk of stroke. Phase 2 began when dabigatran, the first non\u2013vitamin K antagonist oral anticoagulant (NOAC), became available. Objectives This study sought to describe phase 2 baseline data and compare these with the pre-NOAC era collected during phase&nbsp;1. Methods During phase 2, 15,641 consenting patients were enrolled (November 2011 to December 2014); 15,092 were eligible. This pre-specified cross-sectional analysis describes eligible patients\u2019 baseline characteristics. Atrial fibrillation&nbsp;disease characteristics, medical outcomes, and concomitant diseases and medications were collected. Data were analyzed using descriptive statistics. Results Of the total patients, 45.5% were female; median age was 71 (interquartile range: 64, 78) years. Patients were from Europe (47.1%), North America (22.5%), Asia (20.3%), Latin America (6.0%), and the Middle East/Africa (4.0%). Most had high stroke risk (CHA2DS2-VASc [Congestive heart failure, Hypertension, Age&nbsp; 6575 years, Diabetes mellitus, previous Stroke, Vascular disease, Age 65 to 74 years, Sex category] score&nbsp; 652; 86.1%); 13.9% had moderate risk (CHA2DS2-VASc&nbsp;= 1). Overall, 79.9% received oral anticoagulants, of whom 47.6% received NOAC and 32.3% vitamin K antagonists (VKA); 12.1% received antiplatelet agents; 7.8% received no antithrombotic treatment. For comparison, the proportion of phase 1 patients (of N&nbsp;= 1,063 all eligible) prescribed VKA was 32.8%, acetylsalicylic acid 41.7%, and no therapy 20.2%. In Europe in phase 2, treatment with NOAC was more common than VKA (52.3% and 37.8%, respectively); 6.0% of patients received antiplatelet treatment; and 3.8% received no antithrombotic treatment. In North America, 52.1%, 26.2%, and 14.0% of patients received NOAC, VKA, and antiplatelet drugs, respectively; 7.5% received no antithrombotic treatment. NOAC use was less common in Asia (27.7%), where 27.5% of patients received VKA, 25.0% antiplatelet drugs, and 19.8% no antithrombotic treatment. Conclusions The baseline data from GLORIA-AF phase 2 demonstrate that in newly diagnosed nonvalvular atrial fibrillation patients, NOAC have been highly adopted into practice, becoming more frequently prescribed than VKA in&nbsp;Europe and North America. Worldwide, however, a large proportion of patients remain undertreated, particularly in&nbsp;Asia&nbsp;and North America. (Global Registry on Long-Term Oral Antithrombotic Treatment in Patients With Atrial Fibrillation [GLORIA-AF]; NCT01468701

Pancreatic ductal adenocarcinoma: From biomarkers discovery to personalized treatment

En 2016, environ 53 070 patients ont reçu un diagnostic d'adénocarcinome canalaire pancréatique (PDA) aux États-Unis et la plupart d'entre eux mourront de leur maladie dans les 5 ans. Le registre belge du cancer rapporte une incidence estimée à 1200 nouveaux cas par an. La survie globale à 5 ans pour toutes stades confondus a marginalement augmenté au cours des 50 dernières années, passant de 2 à 6%, malgré l'imagerie, les soins périopératoires et l'amélioration des techniques chirurgicales.La chirurgie reste la seule chance de guérison, cependant, seulement 10-15% des patients nouvellement diagnostiqués sont jugés éligibles pour une chirurgie. Même s'il existe peu d'autres modalités de traitement efficaces qui puissent considérablement prolonger la survie globale, la plupart des patients finiront par mourir de métastases au foie, au poumon et / ou au péritoine, les sites de propagation les plus courants. Les patients, les cliniciens et les chercheurs restent frustrés par le manqué d’outils thérapeutiques et des nouvelles stratégies sont nécessaires pour comprendre et mieux prendre en charge cette maladie.Le terme «cancer» engendre un sentiment de peur et colère, en particulier quand on est confronté au diagnostic dévastateur de cancer du pancréas. En plus, une réaction commune est de personnifier le cancer comme une entité maléfique qui doit être combattue pour sauver la vie du patient. Les armes pour cette bataille comprennent le scalpel d'un chirurgien, la chimiothérapie, la radiothérapie, les thérapies ciblées, les immunothérapies, les approches holistiques et la foi religieuse. Mais nous avons trop souvent oublié ou sous-estimé la contribution de la recherche translationnelle pour la médecine de précision, pour mieux adapter les thérapies et éviter les toxicités inutiles.Dans un sens biologique, qu'est-ce qu'un cancer du pancréas ou un cancer? Le cancer est une maladie génétique, soumise à un phénomène évolutif avec ses propres règles, contraintes et caractéristiques prévisibles qui mènent finalement à un phénotype unique.La stratégie "one size fits all" dans la PDA a souvent échoué dans les essais de nouveaux médicaments dans une population non sélectionnée.Cette thèse est une contribution modeste et authentique à une approche plus personnalisée du PDA, de l'acquisition tissulaire, à l'analyse de biomarqueurs tissulaires, à une analyse moléculaire plus profonde afin de mieux comprendre cette maladie mortelle et de proposer l'intégration de biomarqueurs dans le developpement d’etudes cliniques guides par les analyses moléculaires.Doctorat en Sciencesinfo:eu-repo/semantics/nonPublishe

In Deciphering the Future of Adjuvant Treatment in Colon Cancer, the Journey Matters More than the Achievements

The development of adjuvant treatment in colon cancer has followed the same paradigm as in other solid tumors, transposing the drug regimens found to perform the best in the advanced setting into the adjuvant setting. However, despite numerous studies, no progress has been recorded for patients with stage II and III colon cancer since the publication of the MOSAIC trial more than 10 years ago. We performed a comprehensive review of randomized phase III trials both already published and currently recruiting, and revisited the scientific rationale of adjuvant treatment in colon cancer and the philosophical roots of its development in order to challenge the current paradigms and to consider future perspectives. This analysis provides ground for new approaches based on the identification of patients unlikely to benefit from standard therapies with the aim to spare them needless toxicities and to identify a subgroup of patients who would be candidates for advanced research with new therapies.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Gut failure in the ICU

The role of dysfunction of the gastrointestinal tract in the pathogenesis of multiple organ failure (MOF) complicating the course of critically ill patients has been suspected for more than 40 years. However, several hypotheses have been proposed and sometimes refuted to establish a link. This review summarizes the current knowledge on gastrointestinal physiology and recapitulates existing evidence on the link between gastrointestinal dysfunction and MOF. The gastrointestinal tract has various functions apart from digestion. It produces hormones with local and systemic effects, plays a major role in immunological function, and serves as a barrier against antigens within its lumen. Gastrointestinal dysfunction or gut failure is frequently encountered in critical care patients and is associated with bacterial translocation, which can lead to the development of sepsis, initiation of a cytokine-mediated systemic inflammatory response syndrome (SIRS), multiple organ dysfunction syndrome (MODS), and death. The aim of this manuscript is to define gut failure, to review physiopathological mechanisms and clinical implications, and, finally, to suggest preventive measures. Copyright © 2011 by Thieme Medical Publishers, Inc.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Personalized medicine in pancreatic cancer: The revolution has begun

Pancreatic ductal adenocarcinoma carries a dismal prognosis. Both chemotherapy and targeted therapies have been disappointing when administered to unselected populations. Recently, progress has been made in our understanding of the genomic landscape of this cancer which displays remarkable heterogeneity suggesting a reorientation of management and research strategies based on molecular characterization and adapted personalized therapy. Resectable disease offers new opportunities for translational research through functional imaging response evaluation and tumor tissue acquisition before and after neoadjuvant therapy. There is urgent need for clinical trials based on molecular profiling in pancreatic ductal adenocarcinoma. In this review we discuss opportunities and limitations of these new strategies, underlining the importance of tissue acquisition and integration of molecular biomarkers in future molecularly driven clinical trials.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Assessing the learning curve for totally laparoscopic major-complex liver resections: A single hepatobiliary surgeon experience

Background: Encouraging results have been reported in terms of feasibility, safety, and oncologic, outcomes even for major (Z3 segments) or complex for location-specific (right posterior segments) laparoscopic liver resections. Despite this, technically challenging issues and advanced laparoscopic skills required to perform it have limited its use in few highly specialized centers. The aim of this study was to assess the learning curve for major-complex totally laparoscopic liver resections (TLLR) performed by a single HPB surgeon. Materials and Methods: From October 2008 to February 2012, a total of 70 TLLR were performed; 24 (33.3%) were major-complex resections. This series was divided in 2 groups according to time of operation: group A (12 cases early series) and group B (12 cases late series); perioperative outcomes were retrospectively analyzed and compared. Results: Comparing the 2 groups, a statistically significant improvement was found in terms of operative time (P=0.017), blood loss (P=0.004), number of cases requiring a Pringle maneuver (P=0.006), and blood transfusion (P=0.001) from case number ten onward. Conclusions: This study shows that a minimum of 10 cases are required to obtain a significant improvement in perioperative outcome for surgeons with specific training on hepatobiliary surgery and advanced laparoscopic surgical procedures. More studies are required to clarify the minimum standard of training to perform safely this kind of advanced laparoscopic liver surgery on a large scale.SCOPUS: ar.jinfo:eu-repo/semantics/publishe