GERIATRIC CO-MANAGED CARE OF OLDER ADULTS ADMITTED TO A SURGICAL SERVICE FOR GASTROINTESTINAL CANCER. A PROPENSITY SCORE ANALYSIS

Surgery represents the key treatment for the majority of g.i. cancers and the advances in anaesthesia, perioperative medicine, pain medicine and postoperative critical care, as well as surgical techniques, have changed the risk-to-benefit balance of surgery in many high-risk patients. Many more medically complex patients have become eligible for surgical interventions, including those who are older, frail, or have multiple comorbidities, a decline in physiological reserve, impaired nutrition or cognition and are at higher risk for poor outcomes. Geriatric patients require multimodality and multispecialty interventions to improve their care geriatric but geriatric comanagement (GC) in general surgery is rarely implemented. A single-centre observational study was performed within an Italian teaching hospital with a tertiary referral practice for oncological surgery between January 2015 and December 2019. Eligibility criteria were patients aged at least 70 years, with colorectal, gastric, and hepatopancreaticobiliary cancer, admitted to the Oncological Surgery of Policlinico San Martino of Genoa, who underwent elective surgical procedures or palliative treatments and required a hospital stay of at least 1 day. This before and after study aimed to examine the effectiveness of the GC by comparing patient outcomes before and after the implementation of a dedicated geriatric service in November 2018. During the first three years older cancer patients underwent a CGA in order to stratify patients\u2019 frailty and performance status prior to surgery. Starting from November 1st 2018, a GC was implemented in the surgical ward following the appointment of a fulltime consultant geriatrician. This upgraded model of geriatric care consisted of the initiation of daily targeted geriatrician-led ward rounds focusing on older cancer patients. A total of 235 patients were admitted to the oncological surgery ward during the entire study period: 122 (52%) before November 1st 2018 (control group) and 113 (48%) between November 1st 2018 and November 1st 2019 (GC group). Comparison of the two cohorts demonstrated that patients in the control group were older (median age [IQR] 81.50 [78.00, 85.00] years vs 79.00 [76.00, 83.00] years; p\u2009<\u20090.004) and predominantly male (79 [64.8%] vs 59 [52.2%]; p\u2009<\u20090.05). Average Frailty Index scores were 0.12 in the control group and 0.18 in the intervention group (p <0.01), corresponding to a pre-frail phenotype in both cases. Patients from the GC group demonstrated a significant decrease in grade I-V postoperative complications (OR = 0.53 (95%CI 0.32, 0.87), p <. 0.012), which was also confirmed by our adjusted analysis according to the propensity score (weighted OR = OR = 0.37 (95%CI 0.27, 0.50), p < 0.001). Indeed, the GC group exhibited significantly lower CCI scores (\u3b2 coefficient [SE], GC vs control group -10.2 (95%CI -17.3, -3.8), p < 0.009) as compared to the patient from the control group. Specifically, in those patients who received GC, mean CCI score was lower by 12 points, which represents a statistically significant decrease after adjustment (\u3b2 coefficient [SE], intervention vs controls -15.6 (95%CI -23.8, -7.33), p < 0.001). No significant differences between the two groups were observed when considering 90-day and 1-year mortality. Of note, the majority of deaths in the GC group were cancer related (i.e., due to progression of disease). A higher number of patients were deemed eligible to start anticancer treatment in the GC group as compared to the patient from the control group [21 (48%) vs. 35 (69%), p = 0.063]. In conclusion, GC can improve the perioperative management of older cancer patients undergoing elective g.i. surgery by potentially reducing postoperative complications. To our knowledge, amongst the few studies analysing the effectiveness of GC in patient who are candidate to major oncological surgery, this is one of the few ones showing positive results in terms of reduction of postoperative complications

Appropriatezza e opportunità della formazione in tirocinio - Il Progetto "Prevenire e ridurre il dolore nel neonato"

In questo lavoro, prendendo spunto dal Progetto “Prevenire e ridurre il dolore nel neonato: una sinergia tra infermieri esperti (tutor clinici) e studenti di corso di Laurea in Infermieristica” (Università di Pisa/Azienda USL 2 Lucca), Premio Nottola-Mario Luzi 2013, si vuole sottolineare l’appropriatezza e le opportunità della formazione in tirocinio inserita nel 3° anno della Laurea Triennale in Infermieristica, specialmente se effettuata con la modalità “uno ad uno” tutor/studente in stesso turno, come nel progetto in questione. Nella parte centrale verrà poi approfondito anche il tema della valutazione, prevenzione e trattamento del dolore nel neonato. Dopo aver presentato nei dettagli il Progetto Lucca, si prosegue tracciando un percorso verso la competenza, trattando del termine di apprendimento, delle relative teorie in pedagogia e andragogia, del metodo riflessivo, del concetto di cognizione affettiva e di quello di competenza, in tutte le sue varie declinazioni. Viene poi sottolineata l’importanza della formazione in Sanità in riferimento alle tematiche del Sistema Qualità Aziendale, e come primario strumento nella pratica del Governo Clinico, finalizzato al continuo miglioramento della qualità delle cure;una qualità intesa non solo come efficienza, efficacia ed economicità, ma anche come appropriatezza clinica delle prestazioni. A seguire vengono descritti i vari tipi di formazione infermieristica, di base, continua, sul campo, e in particolare valorizzata l’importanza della formazione in tirocinio, della quale vengono indicate le ricadute positive sia sul tutor che sullo studente, evidenziando in particolar modo la possibilità per lo studente di passare dal sapere al saper fare e saper essere, e gli effetti positivi sull’apprendimento di entrambi prodotti dallo stretto rapporto che si viene a creare tra tutor e studente nel tipo di formazione “uno ad uno” come quella del Progetto Lucca. Vengono poi analizzati i requisiti, le attitudini, le tipologie, le funzioni e le attività specifiche dei tutor, e sottolineata la necessità di formare tutor competenti, indicando i principali argomenti che sono stati oggetto della formazione anche nel Progetto Lucca,finalizzati in particolar modo a creare consapevolezza di essere formatori/educatori e non solo meri valutatori. Viene inoltre valutata l’opportunità di assegnare ai tutor un ruolo dedicato esclusivo, anziché una funzione che va a sommarsi alle numerose attività cliniche quotidiane. La parte centrale del lavoro sottolinea i principi di una buona metodologia nella formazione in tirocinio, e in particolare analizza, come strumento di apprendimento, la Scheda Obiettivi del Progetto Lucca, approfondendo gli obiettivi e le tematiche che ne hanno ispirato la stesura, e le competenze professionali (delle conoscenze, logico-cognitiva/razionale, relazionale-emozionale, tecnico-gestuale) alle quali si è mirato nell’individuazione dei relativi criteri di performances con i quali sono stati poi valutati gli studenti. Vengono inoltre approfonditi in questa parte i principi scientifici del dolore nel neonato, facendo anche riferimento alle procedure invasive che possono creare dolore e/o stress al neonato e alle scale di valutazione di questo tipo di dolore. Il presente lavoro ha compreso anche la somministrazione di un questionario ai tutor interessati nel Progetto Lucca, composto da alcune domande incentrate sull’intensità della presa in carico dello studente da parte del tutor, sull’influenza del rapporto personale/emozionale creatosi con lo studente sull’apprendimento di entrambi,sugli esiti prodotti dalla responsabilità del formare, e sull’opportunità di attribuire ai tutor un ruolo dedicato esclusivo. I questionari hanno avuto un esito che si attesta quasi al valore medio di 3 che corrisponde alla valutazione “molto”, che conferma l’appropriatezza della formazione in tirocinio. Le conclusioni evidenziano l’opportunità di diffondere esperienze di formazione di tirocinio “uno ad uno” come quella realizzata nella Neonatologia di Lucca, specie nei reparti intensivi dove è richiesta una formazione più specifica. Le ricadute saranno positive sia per i tutor, che diventeranno sempre più competenti dovendo essere preparati per insegnare e impareranno anche insegnando, che per gli studenti, che potranno tradurre le conoscenze teoriche in sapere esperto, amplieranno le proprie conoscenze imparando anche il non scritto, e acquisiranno una competenza professionale di qualità sempre migliore. Questi potranno affrontare senza paura, affiancati dai tutor, situazioni inattese, e stimolati nella riflessione cercheranno ogni volta sul campo la soluzione più adatta. Riusciranno così ad integrarsi nella cultura aziendale e a sentirsi parte del gruppo. Inoltre, entrambi, potranno sperimentare un tipo di cognizione affettiva/emozionale che integra quella teorico/razionale e che favorisce l’apprendimento,potranno migliorare l’approccio con la futura formazione, spesso vista solo come un obbligo per certificare crediti formativi, e divenire consapevoli che la loro crescita professionale sarà anche finalizzata al miglioramento della qualità e sicurezza delle cure per i pazienti, anche nell’ottica di una tutela della propria responsabilità professionale. Si conclude infine riflettendo sulla necessità, da parte delle organizzazioni sanitarie che intendono perseguire davvero il miglioramento delle prestazioni al cittadino, di investire sempre più e sempre meglio le proprie risorse per potenziare strumenti e pratiche di formazione e in particolare di formazione sul campo, tra cui appunto quella in tirocinio. In quest’ottica, risulta di grande importanza valutare l’opportunità di attribuire ai tutor un ruolo dedicato, sganciato dalle attività quotidiane di cura, al fine di poter sfruttare le numerose potenzialità di questa figura che spesso, per mancanza di tempo, rimangono inespresse

Quercetin Reduces Lipid Accumulation in a Cell Model of NAFLD by Inhibiting De Novo Fatty Acid Synthesis through the Acetyl‐CoA Carboxylase 1/AMPK/PP2A Axis

none6noDysregulation of de novo lipogenesis (DNL) has recently gained strong attention as being one of the critical factors that contribute to the assessment of non‐alcoholic fatty liver disease (NAFLD). NAFLD is often diagnosed in patients with dyslipidemias and type 2 diabetes; thus, an interesting correlation can be deduced between high hematic free fatty acids and glucose excess in the DNL dysregulation. In the present study, we report that, in a cellular model of NAFLD, the coexistence of elevated glucose and FFA conditions caused the highest cellular lipid accumulation. Deepening the molecular mechanisms of the DNL dysregulation—RT‐qPCR and immunoblot analysis demonstrated increased expression of mitochondrial citrate carrier (CiC), cytosolic acetyl‐ CoA carboxylase 1 (ACACA), and diacylglycerol acyltransferase 2 (DGAT2) involved in fatty acids and triglycerides synthesis, respectively. XBP‐1, an endoplasmic reticulum stress marker, and SREBP‐1 were the transcription factors connected to the DNL activation. Quercetin (Que), a flavonoid with strong antioxidant properties, and noticeably reduced the lipid accumulation and the expression of SREBP‐1 and XBP‐1, as well as of their lipogenic gene targets in steatotic cells. The anti‐lipogenic action of Que mainly occurs through a strong phosphorylation of ACACA, which catalyzes the committing step in the DNL pathway. The high level of ACACA phosphorylation in Que‐treated cells was explained by the intervention of AMPK together with the reduction of enzymatic activity of PP2A phosphatase. Overall, our findings highlight a direct anti‐lipogenic effect of Que exerted through inhibition of the DNL pathway by acting on ACACA/AMPK/PP2A axis; thus, suggesting this flavonoid as a promising molecule for the NAFLD treatment.openGnoni A.; Di Chiara Stanca B.; Giannotti L.; Gnoni G.V.; Siculella L.; Damiano F.Gnoni, A.; Di Chiara Stanca, B.; Giannotti, L.; Gnoni, G. V.; Siculella, L.; Damiano, F

Predictive values of two frailty screening tools in older patients with solid cancer: a comparison of SAOP2 and G8

Objectives: Comprehensive Geriatric Assessment (CGA), the gold standard for detecting frailty in elderly cancer patients, is time-consuming and hard to apply in routine clinical practice. Here we compared the performance of two screening tools for frailty, G8 and SAOP2 for their accuracy in identifying vulnerable patients. Material and Methods: We tested G8 and SAOP2 in 282 patients aged 65 or older with a diagnosis of solid cancer and candidate to undergo surgical, medical and/or radiotherapy treatment. CGA, including functional and cognitive status, depression, nutrition, comorbidity, social status and quality of life was used as reference. ROC curves were used to compare two screening tools. Results: Mean patient age was 79 years and 54% were female. Colorectal and breast cancer were the most common types cancer (49% and 24%). Impaired CGA, G8, and SAOP2 were found in 62%, 89%, and 94% of the patients, respectively. SAOP2 had a better sensitivity (AUC 0.85, p<0.032) than G8 (AUC 0.79), with higher performance in breast cancer patients (AUC 0.93) and in patients aged 70-80 years (AUC 0.87). Conclusions: G8 and SAOP2 both showed good screening capacity for frailty in the cancer patient population we examined with SAOP2 showing a slightly better performance than G8

Short-term abstinence from cocaine self-administration, but not passive cocaine infusion, elevates αCaMKII autophosphorylation in the rat nucleus accumbens and medial prefrontal cortex

Increases in alpha calcium/calmodulin-dependent protein kinase type II ( α CaMKII) activity in the nucleus accumbens shell has been proposed as a core component in the motivation to self-administer cocaine and in priming-induced drug-seeking. Since cocaine withdrawal promotes drug-seeking, we hypothesized that abstinence from cocaine self-administration should enhance α CaMKII as well. We found that short-term abstinence from contingent, but not non-contingent, cocaine i.v. self-administration (2 h/d for 14 d; 0.25 mg/0.1 ml, 6s infusion) elevates α CaMKII autophosphorylation, but not the kinase expression, in a dynamic, time- and brain region-dependent manner. Increased α CaMKII autophosphorylation in the nucleus accumbens (NAc) and medial prefrontal cortex (mPFC), but not dorsolateral striatum (dlS), was found 24 h, but not immediately, after the last cocaine self-administration session. Notably, in the mPFC, but not NAc and dlS, α CaMKII autophosphorylation was still enhanced 7 d later. The persistent enhancement in the mPFC of abstinent rats may represent a previously unappreciated contribution to initial incubation of cocaine-seeking

Formyl Peptide Receptor (FPR)1 Modulation by Resveratrol in an LPS-Induced Neuroinflammatory Animal Model

Among therapeutic approaches that have been investigated, targeting of receptors implicated in managing neuroinflammation has been described. One such family of receptors comprises the formyl peptide receptors (FPRs) whose ligands could play a role in host defense. The murine FPR gene family includes at least six members while in humans there are only three. The two most important members are the Fpr1 and Fpr2. Fpr1encodes murine FPR1, which is considered the murine orthologue of human FPR. Resveratrol, a non-flavonoid polyphenol rich in red wine and grapes, apart from its beneficial health effects and anti-inflammatory properties, has been reported to reduce neuroinflammation in different neurodegenerative disease models. Resveratrol anti-inflammatory responses involve the activation of the protein deacetylase sirtuin 1 (SIRT1) gene. In this work we have investigated in an LPS-based murine model of neuroinflammation the role of FPR1, examining not only if this receptor undergoes a reduction of its expression during neuroinflammation, but also whether treatment with resveratrol was able to modulate its expression leading to an amelioration of neuroinflammatory picture in a murine model of neuroinflammation. Results of this work showed that FPR1 together with SIRT1 resulted upregulated by resveratrol treatment and that this increase is associated with an amelioration of the neuroinflammatory picture, as demonstrated by the induction of IL-10 and IL1-RA expression and the downregulation of proinflammatory mediators, such as TNF-α and IL-1β. The expression and the modulation of FPR1 by resveratrol may be evaluated in order to propose a novel anti-inflammatory and pro-resolving therapeutic approach for the reduction of the detrimental effects associated with neuro-inflammation based neurodegenerative diseases and also as a promising strategy to promote human health by a diet rich in antioxidative bioactive compounds

Hydroxyapatite–Silicon Scaffold Promotes Osteogenic Differentiation of CGF Primary Cells s

Simple Summary: The aim of this study was to identify new and innovative strategies to improve the tissue-regeneration process. Concentrated growth factor (CGF) is an autologous biomaterial rich in growth factors and multipotent stem cells. The purpose of our study was to evaluate the osteogenic differentiation of CGF primary cells in the presence of a hydroxyapatite–silicon scaffold, which represents a very interesting material in the field of bone reconstructive surgery. Our findings showed that the hydroxyapatite–silicon scaffold provided support to primary CGF cells by enhancing osteogenic differentiation. These data suggest interesting perspectives in the use of CGF together with scaffolds in the field of regenerative medicine. Abstract: The application of scaffolding materials together with stem cell technologies plays a key role in tissue regeneration. Therefore, in this study, CGF (concentrated growth factor), which represents an autologous and biocompatible blood-derived product rich in growth factors and multipotent stem cells, was used together with a hydroxyapatite and silicon (HA-Si) scaffold, which represents a very interesting material in the field of bone reconstructive surgery. The aim of this work was to evaluate the potential osteogenic differentiation of CGF primary cells induced by HASi scaffolds. The cellular viability of CGF primary cells cultured on HA-Si scaffolds and their structural characterization were performed by MTT assay and SEM analysis, respectively. Moreover, the matrix mineralization of CGF primary cells on the HA-Si scaffold was evaluated through Alizarin red staining. The expression of osteogenic differentiation markers was investigated through mRNA quantification by real-time PCR. We found that the HA-Si scaffold was not cytotoxic for CGF primary cells, allowing their growth and proliferation. Furthermore, the HASi scaffold was able to induce increased levels of osteogenic markers, decreased levels of stemness markers in these cells, and the formation of a mineralized matrix. In conclusion, our results suggest that HA-Si scaffolds can be used as a biomaterial support for CGF application in the field of tissue regeneration

Alexithymia, Metacognition, and Theory of Mind in Children and Preadolescents With Migraine Without Aura (MWoA): A Case-Control Study

Background: Some studies have demonstrated the high impact of headache and migraine in several areas of children and adolescents’ life. In recent years, there has been an increase in scientific interest in the relationship between migraine and emotional regulation, investigating the possible consequences of emotional dysregulation on physical and mental health. While some studies have been carried out on the relationship between alexithymia and headache or migraine (especially in adults), no data exist on relationship between Theory of Mind (TOM), metacognition, and alexithymia in children and adolescents with migraine. Methods: Children with diagnosis of migraine without aura (MWoA) (36 males and 34 females) were compared to a healthy control group (31 males and 39 females). The age range was from 8 to 13 years in both groups. All children completed the Alexithymia Questionnaire for Children (AQC) for the assessment of alexithymia levels and the Domain of Social Perception included in the NEPSY-II to evaluate levels of TOM. Metacognitive development was evaluated with Io e La Mia Mente for children aged between 8 and 10 years and with Metacognitions Questionnaire for Children (MCQ-C) for children from 11 to 13. Results: There were no differences between children with MWoA and the control group in metacognitive abilities; only in the subscale “Negative Meta Worrying” of MCQ-C girls scored higher than boys, regardless of the group they were part of. Also, in the NEPSY-II subscale there were no statistically significant differences between the two groups. Children with MWoA scored higher in the AQC subscales “Difficulty Identifying Feelings” and “Difficulty Describing Feelings” than controls. Moreover, children between 8 and 10 years statistically differed from older children in “Difficulty Identifying Feelings” and in Total Score. Conclusion: Our data suggest that children with MWoA have no metacognitive and TOM problems compared to a healthy group. The experimental group showed higher traits of alexithymia, confirming what suggested by other studies in the literature. Future research will have to focus on migraine with aura and tension-type headache to evaluate any differences with children with MWoA

Correction to: Human migration: the big data perspective

n/

Give more data, awareness and control to individual citizens, and they will help COVID-19 containment.

The rapid dynamics of COVID-19 calls for quick and effective tracking of virus transmission chains and early detection of outbreaks, especially in the "phase 2" of the pandemic, when lockdown and other restriction measures are progressively withdrawn, in order to avoid or minimize contagion resurgence. For this purpose, contact-tracing apps are being proposed for large scale adoption by many countries. A centralized approach, where data sensed by the app are all sent to a nation-wide server, raises concerns about citizens' privacy and needlessly strong digital surveillance, thus alerting us to the need to minimize personal data collection and avoiding location tracking. We advocate the conceptual advantage of a decentralized approach, where both contact and location data are collected exclusively in individual citizens' "personal data stores", to be shared separately and selectively (e.g., with a backend system, but possibly also with other citizens), voluntarily, only when the citizen has tested positive for COVID-19, and with a privacy preserving level of granularity. This approach better protects the personal sphere of citizens and affords multiple benefits: it allows for detailed information gathering for infected people in a privacy-preserving fashion; and, in turn this enables both contact tracing, and, the early detection of outbreak hotspots on more finely-granulated geographic scale. The decentralized approach is also scalable to large populations, in that only the data of positive patients need be handled at a central level. Our recommendation is two-fold. First to extend existing decentralized architectures with a light touch, in order to manage the collection of location data locally on the device, and allow the user to share spatio-temporal aggregates-if and when they want and for specific aims-with health authorities, for instance. Second, we favour a longer-term pursuit of realizing a Personal Data Store vision, giving users the opportunity to contribute to collective good in the measure they want, enhancing self-awareness, and cultivating collective efforts for rebuilding society