Neurotrophin-conjugated nanoparticles prevent retina damage induced by oxidative stress

Glaucoma and other optic neuropathies are characterized by a loss of retinal ganglion cells (RGCs), a cell layer located in the posterior eye segment. Several preclinical studies demonstrate that neurotrophins (NTs) prevent RGC loss. However, NTs are rarely investigated in the clinic due to various issues, such as difficulties in reaching the retina, the very short half-life of NTs, and the need for multiple injections. We demonstrate that NTs can be conjugated to magnetic nanoparticles (MNPs), which act as smart drug carriers. This combines the advantages of the self-localization of the drug in the retina and drug protection from fast degradation. We tested the nerve growth factor and brain-derived neurotrophic factor by comparing the neuroprotection of free versus conjugated proteins in a model of RGC loss induced by oxidative stress. Histological data demonstrated that the conjugated proteins totally prevented RGC loss, in sharp contrast to the equivalent dose of free proteins, which had no effect. The overall data suggest that the nanoscale MNP-protein hybrid is an excellent tool in implementing ocular drug delivery strategies for neuroprotection and therapy

Surgery combined with intra-operative microwaves ablation for the management of colorectal cancer liver metastasis: A case-matched analysis and evaluation of recurrences

Hepatic resection is the only chance of cure for a subgroup of patients with colorectal cancer liver metastasis. As the oncologic outcomes of intra-operative microwaves ablation combined with hepatic resection still remain uncertain in this setting, we aimed to compare this approach with surgery alone in patient's candidate to metastases resection with radical intent

Does cachexia prevention improve outcome of chronic disease and cancer?

3nonenoneBiolo G; Guadagni M; Ciocchi B.Biolo, Gianni; Guadagni, M; Ciocchi, Beniamin

Contraction and nutrition interaction promotes anabolism in cachectic muscle

PURPOSE OF REVIEW: Cachexia is a disease-related multifactorial syndrome characterized by inflammation, massive muscle protein catabolism and carbohydrate and lipid metabolism disorder.Several studies tried to define the impact of either nutrition or physical exercise (single approach strategy) or their combination (multimodal approach strategy) on prevention and/or treatment of muscle wasting in cachectic patients. RECENT FINDINGS: Single approach strategies (i.e. nutrition or physical exercise) have the potential of preventing and improving features of the cachexia syndrome possibly with a differential impact according to the underlying disease. Limited information is available on the beneficial effect of multimodal approach strategies. SUMMARY: Multimodal approaches appear to be more effective than those based on single interventions in physiological condition and in cachectic patients with COPD or chronic kidney disease. Further studies, however, are required in cachexia induced by heart failure, cancer and critical illness

ROBOT-ASSISTED SURGERY FOR COLORECTAL LIVER METASTASIS: A SINGLE CENTER EXPERIENCE

Purpose Although minimally invasive surgery (MIS) of the liver is increasingly widespread, its role in the treatment of colorectal metastasis (CRLM) remain uncertain. Frequent issues regard feasibility and oncological safety of MIS for CRLM are considered: multiple localization, inherent limitations of the intra-operative laparoscopic probes in performing a complete study of the liver, synchronous presence of primary tumor to be resected or previous surgery. In this setting, the role of robot-assisted surgery (RAS) has not been evaluated in literature yet. The aim of this study, is to report our experience with RAS for treatment of CRLM. Materials and methods Surgical and oncological data of all the robot-assisted liver resections for CRLM performed at our center, were retrieved from the prospectively-collected Institutional database, and retrospectively analyzed. All the resections were performed with the da Vinci platform (Si since 2012, and Xi since 2015 for multiple organs resections), through a combined used of monopolar scissors (right hand), and of bipolar Maryland forceps or Gyrus PK SuperPulse Generator (left hand). Intra-operative US scan was obtained with a dedicated robotic probe using the TilePro™ function. Results Sixteen patients underwent robot-assisted resection of CRLM, between May 2012 and July 2017. Four patients (25%) had multiple synchronous CRLM resections (median = 2; range 2 – 3). The tumor size averaged 3.1  1.6 cm. All the lesions were removed following a parenchymal sparing approach, with R0 resection margins. In two cases, with the aid of da Vinci Xi, a synchronous colon resection was performed, whereas in the remaining cases the primary cancer had already been removed (8/14, 57%, with MIS and 6/14, 43%, with traditional approach). There was no conversion to open surgery and no intraoperative complications. Mean hospital stay was 4.5  1.4 days. The mean follow up was 27.3 ± 19 months. During the study period there were no local recurrences; while 7 patients (43%) developed new systemic metastasis. Eight patients (50%) were treated with pre-operative systemic chemotherapy whereas eleven cases (68%) underwent post-operative chemotherapy. All patients are still alive with a 1 and 3 years disease-free survival of 77.5% and 36.3% respectively. Conclusions In our experience, RAS for CRLM surgical treatment was feasible, and played a positive role even in multiple localization and previous or synchronous surgery. The availability of a dedicated US scan intraoperative probe, managed directly with the dominant hand of the surgeon, similarly to the open approach, could improve safety in the management of multiple localization. The da Vinci Xi could improve ability to perform multiquadrant surgery, particularly useful in presence of synchronous primary tumor to be resected. RAS seemed to be oncologically safe in this setting, as no patients experienced local relapse in the treated area

A Single Institution Experience of Colorectal Liver Metastasis Treatment with the da Vinci Robotic System

Aim: In the treatment of colorectal metastasis (CRLM), minimally invasive surgery (MIS) has gained increasing importance. However the widespread of standard laparoscopy for this indication is still limited, due to the drawbacks of the ultrasound (US) laparoscopic probe in performing a complete study of the liver (frequent multiple localizations), the synchronous presence of primary tumor to be resected or presence of previous surgery. The role of robot-assisted surgery (RAS) in this setting has not been evaluated in literature yet. The aim of this study, is to report our experience with RAS for treatment of CRLM. Methods: We retrospectively analyzed surgical and oncological data of all the robot-assisted liver resections for CRLM performed at our center from a prospectively-collected Institutional database. All the resections were performed with the da Vinci platform (Si since 2012, and Xi since 2015 for multiple organs resections). Intra-operative US scan was obtained with a dedicated robotic probe using the TilePro™ function. Result: Sixteen patients underwent robot-assisted resection of CRLM, between May 2012 and July 2017. Four patients (25%) had multiple synchronous CRLM resections (median = 2; range 2 – 3). The tumor size averaged 3.1±1.6 cm. All the lesions were removed following a parenchymal sparing approach, with R0 resection margins. In two cases, with the aid of da Vinci Xi, a synchronous colon resection was performed, whereas in the remaining cases the primary cancer had already been removed (8/14, 57%, with MIS and 6/14, 43%, with traditional approach). Mean hospital stay was 4.5±1.4 days. The mean follow up was 27.3±19 months and there were no local recurrences; while 7 patients (43%) developed new systemic metastasis. All patients are still alive with a 1 and 3 years disease-free survival of 77.5% and 36.3% respectively. Conclusions: In our experience, RAS for the surgical treatment of CRLM surgical treatment was feasible, and seemed to be oncologically safe as no patients experienced local relapse in the treated area. In this setting a dedicated US robotic probe and the availbility of Da Vinci Xi could improve the MIS approach especially in multiple localization and previous or synchronous surgery

Robotic-assisted surgery for colorectal liver metastasis: A single-centre experience

Background: Although minimally invasive surgery (MIS) of the liver is increasingly widespread, its role in the treatment of colorectal liver metastasis (CRLM) remains uncertain. In this setting, the role of robotic-assisted surgery (RAS) has not been significantly evaluated yet. The aim of this study was to report our experience with RAS for treatment of CRLM. Subjects and Methods: Prospectively collected surgical and oncologic data on all of the robotic-assisted liver resections for CRLM performed at our centre were retrieved from the institutional database and retrospectively analysed. Intra-operative ultrasound (US) was obtained with a dedicated robotic probe using the TilePro™ function.\ud Results: Twenty patients underwent robotic-assisted resection of CRLM between May 2012 and April 2018. Six patients (30%) had multiple synchronous CRLM resections (median = 2; range 2-4). The tumour size averaged 3.0 ± 1.8 cm. All of the lesions were removed using a parenchymal-sparing approach, with R0 resection margins. Mean hospital stay was 4.7 ± 1.8 days. The mean follow-up was 22.5 ± 19.5 months. During the study period, there were no local recurrences, while 9 patients (45%) developed new systemic metastasis. All patients are still alive as of September 2018 with 1- and 3-year disease-free survival of 89.5% and 35.8%, respectively. Conclusions: In our experience, RAS for CRLM surgical treatment was feasible and played a positive role even in patients with multiple metastases and previous or synchronous surgery. RAS seemed to be oncologically effective in this setting, as no patients experienced local relapse in the treated area

Perioperative Nutritional Aspects in Total Pancreatectomy: A Comprehensive Review of the Literature

Total pancreatectomy (TP) is a highly invasive procedure often performed in patients affected by anorexia, malabsorption, cachexia, and malnutrition, which are risk factors for bad surgical outcome and even may cause enhanced toxicity to chemo-radiotherapy. The role of nutritional therapies and the association between nutritional aspects and the outcome of patients who have undergone TP is described in some studies. The aim of this comprehensive review is to summarize the available recent evidence about the influence of nutritional factors in TP. Preoperative nutritional and metabolic assessment, but also intra-operative and post-operative nutritional therapies and their consequences, are analyzed in order to identify the aspects that can influence the outcome of patients undergoing TP. The results of this review show that preoperative nutritional status, sarcopenia, BMI and serum albumin are prognostic factors both in TP for pancreatic cancer to support chemotherapy, prevent recurrence and prolong survival, and in TP with islet auto-transplantation for chronic pancreatitis to improve postoperative glycemic control and obtain better outcomes. When it is possible, enteral nutrition is always preferable to parenteral nutrition, with the aim to prevent or reduce cachexia. Nowadays, the nutritional consequences of TP, including diabetes control, are improved and become more manageable

Rapid versus slow withdrawal of antiepileptic monotherapy in two-year seizure-free adults patients with epilepsy (RASLOW) study: A pragmatic multicentre, prospective, randomized, controlled study

To establish whether a slow or a rapid withdrawal of antiepileptic monotherapy influences relapse rate in seizure-free adults with epilepsy and calculates compliance and differences in the severity of relapses, based on the occurrence of status epilepticus, seizure-related injuries, and death